L16(45), which consisted of five factors, each with four levels. Base on the fluidity and compressive strength of the tested matrix, three groups of suitable matrixes mix proportions were selected to serve as the matrix type for pervious concrete mix proportion design. Then, an orthogonal array L9(34), which consisted of four controllable three-level factors, was adopted in the pervious concrete. The parameters investigated included the coarse aggregate size, fine aggregate content, matrix type, and aggregate-to-binder ratio. The test results demonstrate that the key factors affecting the compressive strength of the matrix and the pervious concrete were closely related to the cementitious material. In the matrix, the proportion of the cementitious material was the most important factor, while in the pervious concrete, the type of matrix was the most important factor.The mechanical properties of traditional pervious concrete are insufficient, which limits its application. In view of the imperfections of traditional permeable concrete in mechanics, this paper aimed to find a suitable material composition that can be used as a feasible mix design of high-performance pervious concrete, to essentially improve its mechanical properties. Based on the view that concrete is a two-phase material, in order to understand the rheological properties of the matrix, it was subjected to a rheological test, and then the filler aggregate was uniformly incorporated into the aforementioned matrix to further explore the composition and properties of the resulting pervious concrete. For the matrix, the orthogonal array employed was  Most urban areas of the world are covered by reinforced concrete buildings and impervious roads, mainly due to the continuous development of contemporary urbanization . ComparePervious concrete is a porous, lightweight concrete made from aggregates, hydraulic cement, and water, containing a large number of connected pores ,5. In pe3, which is already close to the upper limit of lightweight concrete [The proportion of pervious concrete varies from region to region. The standard pervious concrete used in the United States is a mixture of single-sized coarse aggregates and cement combined at a low water-to-cement ratio . Howeverconcrete . In ordeconcrete . In geneconcrete . Accordiconcrete ,22,25,37concrete ,38,39,40concrete ,43,44,45Pervious concrete has been proven to have the potential to protect the environment and improve road safety. It has gradually become an important material for constructing parking lots and roads ,12,13,252/g was used. The silica fume was locally manufactured with a specific gravity of 2.75. Ultra-fine silica powder was purchased from abroad, and its specific gravity was 2.73. The fine aggregate was natural river sand with a specific gravity of 2.57, a water absorption of 1.45%, and a fineness modulus of 2.7. The coarse aggregate was gravel with a specific gravity of 2.59 and a water absorption of 1.30%. Superplasticizers and the viscous agent were local products . The fibers were polypropylene fibers with a water absorption of 0% and a density of 0.9 g/cm3.The materials used in the test included cement, silica fume, ultra-fine silica powder, coarse aggregates, fine aggregates, superplasticizers, a viscous agent, and polypropylene fiber. A locally produced Type I Portland cement with a specific gravity of 3.15 and a fineness of 3400 cmaL(cb), which represents a total of c factors that can accommodate a maximum of b levels in a groups of experiments; that is, an experimental array has a rows and c columns. As shown in L16(45) was adopted for the matrix, which consisted of five controllable four-level factors. Moreover, an orthogonal array L9(34) was adopted for pervious concrete, which consisted of four controllable three-level factors :Silica fume (SF):Ultra-fine silica powder (SFP)), the superplasticizer content, the viscous agent content, and the fiber content. As for pervious concrete, the test parameters included the coarse aggregate size, the fine aggregate content , the matrix type, and the aggregate-to-binder ratio (A/B).  factors . Based oL16(45) and L9(34), the mix proportions of the matrix and the pervious concrete are listed in According to the aforementioned orthogonal arrays, namely The rheology of the matrix was tested using a viscometer  with a viscosity measurement accuracy of ±1% of the measurement range and a type spindle (#HB04) was selected. The fluidity test of the matrix was in accordance with ASTM C230 , and theS/N) ratio (η) [MSD is the mean squared deviation around the target value; n is the number of repetitions or observations; iy is the observed data; and y0 is the desired nominal value.In the Taguchi experimental design method, the deviation between the experimental value and the expected value is usually calculated by a so-called loss function. Traditionally, the value of the loss function is usually converted to the signal-to-noise ratio (atio (η) . In geneatio (η) :(1)The-sS/N ratios into the contributions of each of the process parameters and the errors [In this study, the observed flow values of the matrixes were set to a nominal level, while the observed values of the mechanical properties of the matrixes and pervious concretes were set to maximum levels. In addition, optimization of the observations was further detected by variance analysis. This was mainly achieved by separating the total variability of the e errors .Fresh matrix can be regarded as a thick suspension that is obtained by uniformly adding cement to water. Basically, the rheological behavior of this suspension structure is closely related to the water–binder ratio, the size and distribution of the binder particles, the interactions between the binder particles, and the ability of the binder particle surfaces to adsorb water molecules. The initial stage of matrix formation , usually the cement particles, will show an agglutination phenomenon called flocculation, and then the flocculation tends to link into a continuous aggregate, this time called the flocculent state. When stirring the fresh matrix, the shear force generated by the stirring will break or destroy the original flocculation structure so that the previously aggregated particles can be uniformly dispersed in water, and this behavior is the cause of thixotropy. If the shear rate of the spindle is kept at a certain value, the matrix maintains an equilibrium structure and exhibits a distinct and invariable viscosity. When the shearing force ceases, the exact opposite of the above process occurs, i.e., the flocculation structure is formed again. Therefore, depending on the shear conditions applied, both opposing conditions may occur. In other words, when the shear force acts, the cement slurry exhibits a fluid behavior, and on standing, the flocculation structure makes the matrix comparable to a weak solid and has significant yield stress. In view of this, the deformation behavior of the matrix under stress should be essentially interpreted by the viscosity test results.As is clear from In addition to the above, the hysteresis loop phenomenon also showed an effect on the rheological test results of the matrix, which was caused by the difference in the rotational speed of the spindle from high to low or from low to high. According to the test results, there were hysteresis loops in different matrixes, as shown in The results of the rheological tests on the matrixes are shown in In addition, The rheological analysis results confirmed that the water–binder ratio is an important factor affecting the rheological properties of the cement paste. For example, in the case of a cement paste having a relatively high water–binder ratio, the water molecules can disperse the attraction between the cementitious particles and thus exhibit a low viscosity. With low water–binder ratios, where the number of bonds between the cementitious particles, the bonding strength, and the friction between the particles are relatively increased, an additional dispersant such as superplasticizers must be considered to obtain plasticity and flow. Therefore, this study used silica fume and ultra-fine silica powders to replace part of the cement. Each matrix was subjected to a rheological test under conditions in which the amounts of superplasticizer, viscous agent, and polypropylene fiber were changed. S/N ratios using Equation (2). As shown in S/N ratio of the first level was calculated by averaging the S/N ratios of experiments M1–M4. The influence of each selected factor on the performance characteristic investigated is described in detail below.Due to the characteristics of the selected orthogonal array, the effects of each test parameter at different levels can be evaluated separately. Taking the water–binder ratio as an example, the mean S/N ratio at each parameter level for flow value, while S/N response graph for flow value. The delta column in S/N ratio from Level 1 to Level 4. In theory, the importance can be evaluated by the delta value of each factor—the larger the delta value is, the greater the influence of the level of change of the factor on the performance parameter and the more important the factor is. As shown in Equation (3), the larger the S/N ratio is, the smaller the variance in flow value around the desired value is . From F values were obtained with a 95% level of confidence, and the percentage contribution of each parameter was also calculated. The superplasticizer content was the most significant factor that contributed to the target value of the flow of the matrix. The percentage contributions of these factors were as follows: superplasticizer content (53.37%), proportion of cementitious materials (18.78%), water–binder ratio (18.19%), and viscous agent content (9.65%). Thus, based on the results of the S/N ratio and variance analysis, the optimal combination of the experimental control factors for achieving nominal flow value is A3B3C1D1E3, i.e., water–binder ratio at level 3, proportion of cementitious materials at level 3, superplasticizer content at level 1, viscous agent content at level 1, and fiber content at level 3.S/N ratio and variance analysis, the optimal combination of the experimental control factors for achieving maximum compressive strength is A1B1C4D2E1.From S/N ratios are shown in 3, the void content of the pervious concrete was between 20.6% and 25.7%, and the hydraulic conductivity was between 21.6 and 24.2 mm/s. It can be seen from the composition of the pervious concrete that as the amount of fine aggregate increased, the void content tended to decrease. In addition, the unit weight was inversely proportional to the void content, while the hydraulic conductivity increased as the void content increased. Overall, the mechanical properties of the C3 mix are superior. The 28-day test results of the pervious concretes and the corresponding It can be seen from S/N ratio at each level for the compressive strength parameters, whereas S/N response graph for compressive strength. From the analysis results of 2B3C3D3.Moreover, In terms of the elastic modulus, the test results showed values between 9479.2 and 29001.5 MPa. The C1 mix had the lowest elastic modulus (9479.2 MPa), and the C3 mix had the highest elastic modulus (29001.5 MPa). The maximum value was three times the minimum value, indicating a very significant difference between the elastic moduli of the various mixtures. In the case where the coarse aggregate had the same particle size, the elastic modulus generally decreased as the void content increased. In other words, the elastic modulus of the pervious concrete is closely related to its material composition. Taking the C1–C3 mixtures as an example, the elastic modulus was inversely proportional to the void content, as shown in S/N ratio of the elastic modulus parameters of S/N response diagram of 2B3C3D3.According to the average As for the bending strength of the pervious concrete, the test results showed values between 1.88 and 2.99 MPa. The C4 mix had the lowest value (1.88 MPa), and the C3 mix had the highest value (2.99 MPa). There was a significant difference between the flexural strength of the various mixtures. In the case where the coarse aggregate had the same particle size, the flexural strength generally decreased as the void content increased. This shows that the flexural strength of the pervious concrete is closely related to its material composition. Taking the C1–C3 mixtures as an example, the flexural strength was inversely proportional to the void content, as shown in 1B3C3D3.On the other hand, as can be seen from Regarding the splitting strength of pervious concrete, the test results showed values between 1.43 and 2.69 MPa. The C4 mix had the lowest value (1.43 MPa), and the C3 had the highest value (2.69 MPa). The maximum value was 1.88 times the minimum value, indicating a very significant difference between the splitting strength of the various mixtures. In the case where the coarse aggregate had the same particle size, the splitting strength generally as the void content increased. In other words, the splitting strength of the pervious concrete is closely related to its material composition. Taking the C1–C3 mixtures as an example, the splitting strength was inversely proportional to the void content, as shown in 3B3C3D2.On the other hand, the analysis results of To verify the optimal combination of the experimental control factors obtained using the Taguchi method, confirmation tests were carried out. The results show that the key factors affecting the compressive strength of the matrix and the pervious concrete are closely related to the cementitious material. For the matrix, the superplasticizer content was shown to be the most important factor affecting the target value of flow, while the proportion of cementitious material was the most important factor affecting the compressive strength. Based on the fluidity and compressive strength of the tested matrix, three matrixes with suitable mix proportions were selected to serve as the matrix types for the mix proportion design of pervious concrete. The test results confirmed that the matrix type was the most significant factor affecting the compressive strength of the pervious concrete. The percentage contributions of each factor were as follows: matrix type (43.54%), aggregate-to-binder ratio (39.99%), and fine aggregate content (16.47%). Further, the matrix type was also the most significant factor affecting the flexural strength of the pervious concrete. On the other hand, the fine aggregate content was the most significant factor that contributed to the elastic modulus of the pervious concrete. Moreover, the fine aggregate content was also the most significant factor affecting the splitting strength of the pervious concrete. The percentage contributions of each factor were as follows: Fine aggregate content (55.24%) and matrix type (42.71%).


Speckle noise can reduce the image quality of synthetic aperture radar (SAR) and complicate image interpretation. This study proposes a novel three-step approach based on the conventional probabilistic patch-based (PPB) algorithm to minimize the impact of bright structures on speckle suppression. The first step improves the calculation accuracy of the weight by pre-processing speckle noise with a linear minimum mean-square error filter and reassessing similarity between pixels. In the second step, an iterative method is developed to avoid interfering with bright structures and acquires a more accurate homogeneous factor by adaptively changing the size of the search window. In the final step, the spreading and blurring of bright structures is corrected using a modified bias-reduction technique. Experimental results demonstrate the proposed algorithm has improved performance for both speckle suppression and preservation of edges and textures, evaluated by indicators including the equivalent number of looks, the edge preservation index, the mean, and standard deviation of ratio images. Synthetic aperture radar (SAR) is a coherent imaging system . Each piThe simplest speckle removal approach is spatial multi-looking , which eThe first is a local spatial filtering method proposed by Lee ,5,6,7,8.The second approach involves transform-domain filtering methods, such as linear minimum mean-square error (LMMSE) estimation in the wavelet domain . These mThe third approach is adaptive filtering, which includes methods based on partial differential equations (PDEs)  and non-Compared with the conventional PPB, the proposed algorithm achieves a more accurate weighting and homogeneous factor to improve the performance of speckle suppression, with a modified bias-reduction method to further balance speckle suppression with the correction of bright structure spreading.This paper is structured as follows. The conventional PPB algorithm is introduced and analyzed in s represents a pixel to be processed in the SAR image. A search window (centered on Ps) is defined to estimate the intensity of Ps, as represented by the pink rectangle in the figure. The conventional PPB algorithm calculates the weight s and the pixel (Pi) in the search window and replaces the intensity of Ps with [sD represents a set composed of pixels in the search window and i.As illustrated in  Ps with :(1)I^Ps=Aks, and iAk, are the amplitudes of the kth pixels in the two patches centered on Ps and Pi, respectively. The greater the weight, the more similar Ps and Pi. The term L is the equivalent number of looks and h is defined as [q is given by:s was modified as follows [s in the raw SAR image. The homogeneous factor wh=q−E follows :(5)I^PsR1, P2, and P3) with intensities of 2 is much more similar to P1, whereas the product terms satisfy 3) is higher when estimating the intensity of P1 in Equation (1). This improves the filtering result, which degrades speckle suppression performance. This effect is evident near bright structures, and widens edges and increases the size of strong scattering targets. This effect is referred to as the spreading of bright structures and can be seen in The comparison between Equation (5) was used to correct for the spreading of bright structures by moderately restoring the original intensities of pixels according to the factor 1, P4, and P5 in 4 decreased from 17 to 15, the homogeneous factor decreased from 0.9032 to 0.1942. This occurred because bright structures were excluded from the search window, as shown in The first approach involved calculation of a homogeneous factor The primary objective of speckle pre-processing is to suppress speckle noise in homogeneous areas without losing edge and texture details, which reduces the influence of speckle noise on weight calculation. This study adopts the linear minimum mean-square error (LMMSE) filter for pre-processing . AlthougThen, a threshold was set, which was 25 dB higher than the average intensity of the search window . Any pixs and Pi do not contain any strong scattering points, which indicates that an influence of strong scattering points on weight calculation does not exist. In this case, the weight Case 1: Patches centered on Ps and Pi are strong scattering points. It was assumed that these two points are likely similar. The weight was then calculated using Equation (2).Case 2: Both Ps or Pi was a strong scattering point (not both). In this instance, the two patches centered on Ps and Pi were thought to be completely different and the weight was accordingly set to 0.Case 3: Either Ps or Pi contained strong scattering points, none of which were Ps or Pi. In order to reduce the impact of the strong scattering points, the weight was then determined from Equation (2), in which all intensities for strong scattering points were replaced by the average intensity of the patch.Case 4: The patches centered on PAs illustrated in s is set to s is less than 0.5, which is an empirical threshold. In this case, (1) The initial side length of the search window centered on Pi = 1, 2, …), and the corresponding homogeneous factor (2) Let (3) The ratio i equals 1, or step (4) when i is greater than 1.The value of (4) The ratio The iteration terminates if As aforementioned, the minimum size of the search window was set to 3 × 3. Therefore, homogeneous factors were updated by applying the methods proposed in A new ratio (1) When Equations (9) and (10) demonstrate that n is a parameter to balance speckle suppression with the correction of bright structure spreading. In the conventional PPB algorithm, (2) When n on the speckle suppression and correction for the spreading of bright structures. From left to right, the values of n for these images are 1, 5, 10, 20, and 50. When n = 1, the speckle noise in the corresponding image was the most serious. As n increased, the speckle noise was more effectively suppressed, while the spreading of bright structures worsened. When the value of n was between 5 and 10, a more balanced performance was obtained. In this study, the value of n was set to 5.In the filtering process described by Equation (9), the bright structures are also suppressed and blurred. A matrix denoted by Four TerraSAR-X images were used to validate the proposed algorithm, as illustrated in the first column of 1 and ENL2 were calculated using the areas enclosed by the red frames, labeled 1 and 2, respectively.Several quantitative metrics were used to evaluate io image ,21. The Processing and evaluation results indicated that all three algorithms significantly suppress speckle noise. The fast non-local and conventional PPB algorithms have basically the same ability in speckle suppression, which is indicated by the ENL value. The fast non-local algorithm performed the worst in edge preservation. The proposed algorithm produced the highest ENL and EPI values, indicating that it was most successful in both preserving edges and suppressing speckle.L-look raw image [A point-to-point comparison of the texture preservation results is shown in aw image . As all In this study, we developed a novel three-step technique based on the conventional PPB algorithm. The proposed algorithm improved the calculation accuracy of the weighting by pre-processing speckle noise with the LMMSE filter and reducing the influence of bright structures. The algorithm also improves upon the accuracy of the homogeneous factor by adaptively changing the size of the search window, and then corrects for the spreading and blurring of bright structures. TerraSAR-X images with clear edges, uniform backgrounds, and complicated internal structures were used to validate this technique. This algorithm has the advantages of the conventional PPB and has better performance for both speckle suppression and the preservation of edges and textures. In a future study, deep neural networks, such as generative adversarial networks, which have adaptive and strong filtering abilities, will be used to further improve the performances. In particular, we expect that suppressing bright structure spreading can be achieved without weakening the denoising effect.


The theoretical knowledge of 101 professionals was measuredusing a validated questionnaire before and after the educationalintervention; the quality of blood pressure records was evaluated using avalidated form which was applied to 354 records in the pre-interventionperiod and 288 in the post-intervention period. The educational program wasbased on active teaching-learning methodologies and consisted of twostrategies: expository/dialogue class and a board game. The Wilcoxon,Mann-Whitney, Fisher and Chi-Square tests were used for comparisons,adopting a level of significance of α=0.05. the median of the professionals’ scores increased from 19 to 22 points inthe post-intervention period (p<0.001). There was an improvement in thequality of the blood pressure recordings regarding the variables: cuff size(p<0.001), arm used in the procedure (p<0.001) and patient position(p<0.001). the educational program showed positive results in the promotion ofknowledge among nursing professionals and in the improvement of the qualityof blood pressure recording. In general, these records may enable the exchange of information between themembers of the multi-professional team, the contact with the patient’s healthhistory and the evaluation of the quality of care provided3.Blood pressure (BP) recording is one of the steps of the indirect BP measurement. Itprovides important information for care and supports the clinical evaluation, thediagnosis and the therapeutic procedures used with patients affected by the mostdiverse health conditions2.National and international guidelines on hypertension (HTN) recommend that BPrecording includes the position of the patient’s body, the arm used for cuffplacement and the systolic blood pressure (SBP) and diastolic blood pressure (DBP)obtained immediately after performing the procedure5. In addition, the theoretical and practical knowledge about indirect BPmeasurement is below the expected for compliance with the technique7.Despite the importance of BP recording for patient care, especially regardingdiagnostic definition and planning of treatment and interventions, studies haveshown that the conduct of nursing professionals regarding the BP documentation isstill outdated and does not adequately portray the care received by the client9. However, the use of these strategies has been questioned due to the lack oftheoretical foundation of the pedagogical method and the consequent impairment ofthe quality of evidences produced on professional training in health10.Educational interventions based on active teaching methodologies have been applied tonursing students and demonstrated positive results regarding the technique ofindirect BP measurement11. The use of educational games in this context aims to facilitate the learningof concepts and techniques and to promote critical thinking, professionalencouragement, social interaction, creativity, imagination, cognition and emotion12.In the organizational environment, ludic activities have been recognized forfacilitating the construction of knowledge, improving the performance of healthprofessionals in their daily activities and promoting adherence to the guidelinesand protocols established in clinical practiceBP recording has been recognized as part of the indirect BP measurement for more thanthirty years; however, its importance for the quality of care has been littlediscussed in the scientific and academic circles. In this sense, the development ofresearch and the implementation of educational strategies regarding thisdocumentation can support evidence-based practices and improve quality of care andpatient safety in different levels of health care.Given the above, the objective of the present study was to evaluate the effect of aneducational program on BP recording for nursing professionals in relation totheoretical knowledge and the quality of these records. A secondary objective was tocompare two educational approaches: expository/dialogue classes andexpository/dialogue classes allied with the use of a board game.13.This is a quasi-experimental study, conducted between December 2015 and June 2016, ina large emergency hospital in the city of Sao Paulo. Quasi-experimental studies areconsidered intervention studies and are different from true experiments because theydo not include a randomization process or define a control group14 was used to evaluate the quality of BP recordings in the pre- andpost-intervention periods. The before-and-after model with one group14 compared the theoretical knowledge of nursing professionals before and afterthe application of the educational program.The quasi-experimental before-and-after model with independent samples15. The sample of medical records consisted of the total number of visits in theemergency unit, between the months of December 2015 and June 2016. Records frompatients with emotional upheavals and/or psychomotor agitation, which could make itdifficult to measure and periodically record BP were excluded. The physical andpsychic conditions of these patients were identified through the records made by themedical and nursing staff during the period of care in this health service.In order to detect the significant mean differences in the quality of BP recordingsin the two periods, at least 88 observations would be necessary in each case,considering proportional comparison, effect sizes of 0.3, a significance level of 5%and 80% power15. Considering that the intention of the researchers was to make theeducational program available to all care staff, the sample consisted of the totalnumber of eligible workers, which resulted in a larger number than planned.To compare the theoretical knowledge before and after the implementation of theeducational program, all nursing professionals were invited to participate in theintervention, which was carried out between January and May 2016. The calculation ofthe sample size revealed that a minimum of 90 participants would be necessary toconduct a paired t-test to compare the scores obtained in the questionnaire appliedto each professional, before and after the intervention period, considering asignificance level of 5%, effect size of 0.3 and 80% powerProfessionals who were away from work, those who refused to participate in the study,and those who did not complete all stages of the study were excluded. These stageswere the signing of consent terms, completion of questionnaires and participation ineducational interventions.The quality of BP recordings was evaluated with a form called “Quality of BloodPressure Recordings” (QBPR). The theoretical knowledge of nursing professionals wasevaluated by a questionnaire called “Theoretical Knowledge on Blood PressureRecording in Emergency Hospital Service” (TKBPR-EHS). Both instruments weredeveloped in 2015 by the researcher of this study and validated in design andcontent by a group of six experts, who were chosen based on the following criteria:being a nurse, having a master or doctorate degree, having professional experiencein the area of care, having methodological knowledge on the construction ofquestionnaires and scales and working in teaching or research with cardiovascularhealth, blood pressure measurement, hypertension, patient safety, educationalinnovation or related issues.2. Its final version consisted of five items regarding records, namely: themeasurement of the arm circumference (AC), the cuff size, the arm in which the ACwas measured, the patient’s position and the BP values measured in millimeters ofmercury (mmHg).The QBPR was constructed based on literature documents on the measurement andrecording of BP18. It consists of six items related to the identification of the participant and 23 items distributed in eightmultiple-choice questions with four options of answer and three true or falsequestions composed of five sub-items. Overall, the TKBPR-EHS was composed of 11questions that addressed the following themes: importance of BP recording fornursing care; BP recording in cases of hemodynamic instability; record of changed BPvalues; BP recording with automatic devices and its advantages; recording of patientposition; recording of heart rate; recording of cuff size; BP recording according tohospital routine; frequency of BP recordings according to the patient’s clinicalcondition; frequency of BP recordings according to the nursing prescription;recording of the steps of the BP measurement procedure.The TKBPR-EHS was developed based on a thorough review of the literature on nursingrecords and BP measurement® method19 in order to verify if all items of the data collection instrument werecomprehensible to all members of the population to which it is intended. Aconvenience sample composed of three nursing professionals with different levels ofeducation was chosen for this test, aiming to encompass all the different strata ofthe study population and to guarantee the reliability of the answers during thevalidation process.The TKBPR-EHS questionnaire was submitted to semantic validation by theDISABKIDS20was used to systematize the opinions of experts regarding the judgment of theitems of the QBPR form and the TKBPR-EHS questionnaire. The Content Validity Index (CVI)21 was applied to verify the degree of agreement between the specialists in eachitem of the instruments. The items that obtained CVI greater than or equal to 80%were considered valid.The Delphi method23. The expository/dialogue class and the board game were the teachingstrategies used during the intervention period. Both were based on the concept ofactive teaching-learning methodologies and on the perspective of autonomous education25.The intervention was based on an educational program called “Pressure and Action”,developed by one of the authors of this study and based on documents prepared by thespecialists in HTNFor the expository/dialogue class, posters and illustrated badges with guidelines onthe recording of the indirect BP measurement in a specific institutional form, withfields destined to the cuff size, the arm used in the procedure, the patient’sposition, heart rate and BP values in mmHg were elaborated.The board game consisted of 50 question-and-answer cards, five colored game pawns, adice, an instruction manual and a board divided into five thematic axes: HTNphysiopathology, BP concepts, BP oscillometric devices, BP cuffs, BP measurementprocedure and BP recordings. For each thematic axis there were ten questions withtheir respective answers, each one illustrated in colored cards numbered from 1 to10.All phases of the data collection procedure were performed by one of the authors andconducted as follows:Phase I (preliminary): the medical records cataloged in the Service of Medical andStatistical Archive were investigated in December 2015, before the implementation ofthe educational program, using the QBPR form.15.Phase II (implementation): from January to May 2016, nursing professionals wererecruited and invited to participate in the educational intervention, through aninvitation letter that contained the Informed Consent Form (TCLE) and detailedinformation on the research, its objectives and its importance for theirprofessional development. In a private room, the TKBPR-EHS questionnaire wasdelivered to each participant, immediately before and immediately after theintervention. A total of 38 professionals attended the expository/dialogue class andplayed the board game, and the remaining 63 only attended the expository/dialogueclass, due to their workload and their unavailability to participate in theintervention. Groups of 38 and 63 professionals are sufficient to achieve an effectsize of 0.6 when comparing the differences in performance between the participantsPhase III (exploratory): the medical records cataloged in the Service of Medical andStatistical Archive were investigated in June 2016, after the implementation of theeducational program, using the QBPR form.26 in the learning and behavioral levels. The learning level was used toevaluate the theoretical knowledge of nursing professionals; the behavioral levelevaluated the quality of BP recordings in the pre- and post-interventionperiods.The effect of the educational program was evaluated by the Kirkpatrick Model15The data collected were stored and typed twice in the program Microsoft Excel 2010.Then, they were processed in the program Statistical Package for the Social Sciencesversion 20.0 for Windows. The analyzes were conducted with the computer program Rversion 3.2.2. The pwr package was used for sample size estimatesDescriptive analyzes were performed for all variables, which were described inabsolute and relative frequencies, medians and quartiles. The Wilcoxon test forpaired data was used to compare the performance of nursing professionals in theCTRPA-SHE. To compare the quality of BP recordings before and after the educationalprogram, the Fisher’s exact test and the Chi-square tests were used for categoricalmeasures and the Mann-Whitney test was used for numerical or ordinal measurements inindependent samples. The Wilcoxon test for paired data and the Mann-Whitney testwere used to compare the professionals who participated in the two strategies(classroom and game) and those who participated only in the expository/dialogueclass. The significance level adopted for the tests was α = 0.05.The study was submitted to the Research Ethics Committee of the mentioned hospitalinstitution and was approved under protocol no. 31962014.1.0000.0071/2015.A total of 664 medical records were eligible, of which 363 were analyzed in thepre-intervention period and 301 in the post-intervention period. In the two periods,three medical records were excluded due to emotional upheavals and 19 due topsychomotor agitation .The sample of professionals was composed of 135 participants, of whom 27 wereexcluded due to work leaves, three due to refusal to participate in the study andfour because they did not complete all stages of the study. At the end, 642 medicalrecords and 101 nursing professionals composed the respective samples .The quality of BP recordings was analyzed in 354 records filled in thepre-intervention period (55.1%) and 288 in the post-intervention period (44.9%). Inthe pre-intervention period, two records (0.6%) contained AC measurement and anothertwo (0.6%) had the record of the member in which AC was measured. In the sameperiod, no records were found on the cuff size or on the patient’s position duringthe BP measurement procedure.The analysis of the data on the post-intervention period showed an increase in thefrequency of records with the variables “cuff size” (24.7%), “arm in which AC wasmeasured” (29.2%) and “patient’s position” (69.1%). After the implementation of the educational program, there was a significant increasein the proportion of records containing the cuff size, the arm in which the AC wasmeasured and the patient’s position (p<0.001).The variable “BP recording with measurement in mmHg” showed compliance in 99.0% ofthe cases and did not show significant differences in the pre- and post-interventionperiods (p= 0.900).The sample of nursing workers was composed of 42 nurses, 58 nursing technicians andone nursing assistant. The characteristics of the professionals who participated inthe study and were evaluated on their theoretical knowledge about BP recordingbefore and after the educational program are presented in The frequency of correct answers in each CTRPA-SHE question was analyzed and isdemonstrated in There was a significant improvement in the proportion of correct answers to questionnumber 1 on “the importance of blood pressure recordings for nursing care”(p=0.006), question number 2 on “blood pressure values that may be a sign ofhemodynamic severity” (p=0.001), alternatives a and b of question number 4 on the“accuracy of BP values obtained with the use of automatic devices” (p=0.001) and“possibility of storing BP values” (p=0.027), question number 6 on “heart raterecording” (p<0.001), number 7 on “cuff selection” (p<0.001), alternatives a,b and c of question number 10 on “frequency of BP recordings”  and question number 11 on “recording of BP measurement steps”(p<0.001).Regarding the total score obtained in the CTRPA-SHE, 80 nursing professionals (79.2%)had a higher final score after the implementation of the educational program, 17(16.8%) maintained the same score and four (4.0%) had lower scores. The median ofthe scores obtained in the pre-intervention period was 19 right answers (1stquartile 18 and 3rd quartile 21), while in the post-intervention period it was 22(1st quartile 20 and 3rd quartile 23), out of a total of 23 items (p<0.001).The comparison between the professional categories regarding the number of rightanswers showed no significant differences in the performance of nursing assistants,technicians or nurses in the pre-intervention (p=0.759) and post-intervention(p=0.828) periods. The median score for all professional categories was 19 rightanswers in the pre-intervention period (1st quartile 18 and 3rd quartile 21) and 22in the post-intervention period (1st quartile 20 and 3rd quartile 23).A total of 63 nursing professionals (62.4%) participated in the expository/dialogueclass, while 38 professionals (37.6%) participated in the class and in the boardgame. The median age of the participants in the board game was 31 years, and 84.2%were female. As for the professional category, 11 workers were nurses (28.9%), 26were nursing technicians (68.4%) and 1 was a nursing assistant (2.6%).The median of the scores obtained by the professionals who participated only in theexpository/dialogue class was 19 right answers in the pre-intervention period (1stquartile 17 and 3rd quartile 21) and 22 in the postintervention period (1st quartile20 and 3rd quartile 23). On the other hand, the median of the scores obtained by theprofessionals who participated in the expository/dialogue class and in the boardgame was 19 right answers in the pre-intervention period (1st quartile 18 and 3rdquartile 21) and 22 in the postintervention period (1st quartile 21 and 3rd quartile22). The scores of these two groups did not show significant differences in thepre-intervention (p=0.412) and post-intervention (p=0.273) periods.This study aimed to evaluate the effect of an educational program on BP recording fornursing professionals in relation to the theoretical knowledge and the quality ofthese records. Until the present moment, only few studies exploring this theme andits importance in the clinical and care context have been identified.2. The nursing record referring to the steps of this procedure is alreadyclarified in the literature and consists of documentation of AC measurement, cuffsize, arm used, patient position, time of measurement, values obtained withoutrounding, and heart rate2. The registration of all these steps is justified by the need to obtainreliable values that portray the clinical condition of the patient and contribute tothe definition of a diagnosis and assertive treatment, monitoring and follow-up ofhealth conditions.The indirect BP measurement comprises a series of steps that support the performanceof the procedure in a correct and standardized manner, as specified by national andinternational guidelines on HTN8.The results showed a significant improvement in the quality of BP recordings whenconsidering the variables documentation of the patient’s position, cuff size and armselected for the measurement of pressure values, in the pre- and post-interventionperiods. These results are in agreement with other studies in the literature, whichused similar research methods and proved the effectiveness of educational strategiesin promoting knowledge about the procedure of indirect BP measurement and itsapplicability in care practice28. The cuff should correspond to 80% of the length and 40% of the width of theAC, in a length/width ratio of 2:12. Cuffs of varying sizes are required to meet a range of arm circumferences;however, health professionals have been using a standard size for BP measurement,sometimes as an inadequate choice and sometimes due to unavailability of other cuffsor lack of standardization of measures by manufacturers29.The choice of an appropriate cuff, based on the patient’s AC measurement, isnecessary to obtain reliable BP values2. Based on this new practice, this study demonstrated a significantimprovement in the quality of the records referring to the size of the cuffselected. Guidance on the use of illustrated cuffs, as a substitute for ACmeasurement, can make the procedure more practical and contribute to the reductionof errors related to improper use of the equipment.In recent years, alternatives to reduce misuse of the cuff have been studied anddiscussed by the societies of HTN specialists, with emphasis on the Canadianorientation which recommends the use of cuffs that delimit the AC interval andindicate the appropriate size through illustrated marks on the fabric surroundingthe rubber bag2. The results regarding the record of the arm in which BP was measured werepositive; however, less than 30% of the professionals who participated in theeducational intervention performed the registration in practice, a fact that issimilar to evidence found in previous studies7.The choice of the patient’s arm is considered essential for individualized care,considering the need to identify the one with the highest blood pressure and make ita reference for the definition of the diagnosis27. In addition, studies have demonstrated the existence of differences in SBPand DBP values in the different arms of older people and in patients with HTN,diabetes mellitus, hypercholesterolemia and peripheral vascular disease31.The registration of the arm used in the procedure indicates to other professionalspossible situations that are contraindications for measurement in the contralaterallimb, such as lymphedemas, thrombosis, grafting, ischemia, fistulas and the use ofcentral or peripheral devices32.The position of the patient during BP measurement is an essential information for theinterpretation of the values obtained, definition of the diagnosis and decision ofclinical procedures and nursing care. The SBP and DBP values present significantalterations when comparing sitting, lying and standing positions, due to the stronginfluence of hydrostatic and isometric factors on systemic vascular regulation33. A study showed that the rounding of BP values can reach 70% in a givensample and it is directly related to the poor quality of care and lack oftheoretical-practical knowledge to perform the procedure7.One of the most common error factors in the steps of indirect BP measurement isrelated to the rounding of BP values and the observer’s preference to registercertain terminal digits, such as zero, two and fourThe results of the present study showed that, even before the educational program,nursing professionals performed 99% of BP recordings with units of measurementcompatible with the determination of the device, in mmHg. This may be associatedwith the use of digital oscillometric devices, which record BP values with up tothree digits and minimize the observer’s preference to certain terminal digits.Regarding the theoretical knowledge, the results showed higher scores in theCTRPA-SHE after the educational program, mostly on the questions on BP recordings inpatients with hemodynamic instability, advantages of the use of oscillometricdevices on BP recordings, the frequency of BP recordings according to the patient’sclinical condition and the recording of the steps of the indirect measurement of BP.These evidences demonstrate the positive effect of the intervention implemented inthis study and the applicability of active teaching-learning methodologies in thecontext of nursing care.35. As teaching strategies based on this methodology, we emphasizeexpository/dialogue classes, group discussions, individual instruction, games,simulation and role playing, which promote the active participation of the student,the use of cognitive, affective and psychomotor skills and the development oftheoretical-practical knowledge, critical thinking, clinical reasoning and problemsolving skills37.The active methodologies use questioning as a facilitator of the teaching-learningprocess, since they lead the student to relate discoveries of phenomena of interestwith their previous knowledge and with real-world experiences9. However, there are several evidences on the lack of quality of healthrecords and on the existence of significant gaps in the knowledge of nursingprofessionals regarding documentation of patient care and practical application ofnursing process steps39.The use of innovative strategies has demonstrated effective results in improvingtheoretical and practical knowledge about the indirect BP measurement40. The same logic can be applied for technical courses for workers in thatprofession.Nursing records and the indirect BP measurement are themes that are constantlyaddressed in nursing undergraduate courses, since they are part of the daily life ofthe health team and can help care planning. Despite this, the skills acquired inuniversity education have not been sufficient to develop the knowledge and skillsrequired by the labor market, which makes the educational role of healthorganizations a key part of professional trainingBP recording is considered a simple and easy task; however, the promotion ofknowledge through the update of programs and continuing health education contributesto the technical and scientific training of professionals and to patient safety andquality of nursing care.This study collaborated with the development of an innovative educational program,which was evaluated through the application of validated data collection instrumentscapable of measuring the theoretical knowledge of nursing professionals about BPrecordings and investigating the quality of these records in medical charts ofpatients admitted to an emergency hospital service. The strategies demonstrated herecan be adapted and applied in other health services for the promotion of healtheducation.There are some limitations in relation to the internal and external validity of theresults presented in this study, such as the choice of non-probabilistic samples andthe peculiarities of the site and the population selected. Experimental studies withmore representative samples and with the implementation of active teaching-learningmethodologies in other care contexts and in health care services with differentlevels of technological and financial investment should be carried out.The implementation of an educational program on BP recordings for nursingprofessionals showed positive results regarding the promotion of theoreticalknowledge and the quality of BP recordings in a hospital service. The implementationof active teaching-learning methodologies contributes to the development oftechnical skills, the establishment of safe practices and the promotion ofprofessional knowledge.


The aim of the study was to evaluate the content, occurrence, and leachability of arsenic (As), lead (Pb), and thallium (Tl) in wastes from coal cleaning processes with respect to the safe management of this waste. The study focused on wastes resulting from the wet gravitation and flotation processes employed for the purposes of coking coal cleaning in four coal mines situated in the Upper Silesian Coal Basin (Poland). The scope of the study included (i) determination of the content of these elements in the investigated wastes using atomic absorption spectrometry, (ii) evaluation of their mode of occurrence using electron microprobe analysis, and (iii) preliminary assessment of their leachability in deionized water. The content of the analyzed elements in the examined samples of coal waste was twice as high as the average content of these elements in the Earth’s crust. The contents of As and Pb, however, did not exceed their permissible contents in inert waste in accordance with Polish legal regulations based on EU directives. The limit on the content of Tl is not specified by these regulations, but its amount in the examined samples was similar to that occurring in the soils. Moreover, leaching tests have shown that these elements are hardly eluted from the analyzed material. Their content in the water leachates was generally lower than the detection limit of the analytical method, complying with the standards for good and very good water quality. Low leachability of these elements most probably results from their mode of occurrence in the investigated wastes. The chemical analysis using an electron microprobe and the analysis of the correlation between these elements, e.g., total and pyritic sulfur, have shown that Pb, As, and Tl are mainly found in sulfide minerals which are characterized by negligible solubility. In conclusion, the investigated hard coal processing waste does not constitute a threat to the environment and can be commercially used or safely neutralized, e.g., by landfilling. The last of the aforementioned operations, used in order to remove gangue from raw coal, is commonly applied in the case of coking coal production to ensure coke quality parameters  required by coke consumers. Coals used in Poland for combustion are not enriched to the same extent as coking coals; therefore, the content of mineral matter and sulfur is often higher  and its environmental impact have recently been the subject of numerous papers  were performed by means of atomic absorption spectrometry using a Hitachi Z-2000 Spectrometer. The determinations of As and Tl contents in the samples were performed using electrothermal atomization in a graphite furnace, whereas Pb and Fe contents were determined through flame atomization. For the determinations of Tl and Pb contents, the analytical samples of the wastes were subjected to slow combustion at 600 °C and then digested in a microwave system SpeedWave 4 Berghof using concentrated nitric acid (V) . Determinations of As and Fe contents were performed for the analytical samples also by digestion in a microwave system but in a mixture of concentrated nitric acid (V)  and hydrofluoric acid , using a supersaturated solution of boric acid  as a complexing reagent.In order to pre-assess the mode of occurrence of the analyzed elements, a statistical analysis of the correlation between their content and the content of ash, total sulfur, pyritic sulfur, and the organic matter (as C element content) was carried out. For these purposes, the regression analysis by means of F-Snedecor test was used with the application of the Statistica software.A JEOL JXA-8230 Electron Probe Microanalyzer (EPMA) was used to determine the modes of occurrence of As, Pb, and Tl . The analysis of the chemical composition allowed for the identification of the mineral components and their accompanying trace elements. Samples for the analysis were prepared in the form of cuts with a diameter of 1 in. For this purpose, representative sample grains were embedded in an epoxy resin and polished using diamond abrasives. In order to ensure proper conductivity, the samples prepared in such a way required additionally coating their surface with the graphite layer before making the measurements. The measurements were carried out under the following operating conditions: acceleration voltage of 20 kV (for sulfides) and 15 kV , probe current of 20 nA, and the spot size 1–5 μm. The analyzed elements  were determined with the use of the L-type X-ray spectrometer equipped with pentaerythritol crystal (PETL), the H-type X-ray spectrometer equipped also with pentaerythritol crystal (PETH) or thallium acid phthalate crystal (TAPH), and J-type X-ray spectrometer with pentaerythritol crystal (PETJ). For the measurements of these elements in sulfide minerals, the following analytical lines, crystals, and standards were used: As ; Pb ; Tl . While for the measurements of these elements in aluminosilicate minerals, oxides, and carbonate minerals, the following parameters were used: As ; Pb ; Tl .A preliminary leaching test was carried out for samples from one mine, involving the preparation of water leachates in accordance with EN 12457-4:2006, by shaking the wastes in deionized water at a mass ratio of 1:10 at ambient temperature for 24 h (basic test). The contents of the analyzed elements in the leachates were determined by means of atomic absorption spectrometry with atomization in a graphite furnace based on the standard PN-EN ISO 15586:2005. The application of this leachability test results from the European legal regulations  and the geo-accumulation index (Igeo) were used in order to evaluate the enrichment rate of As, Pb, and Tl in the examined wastes. The EF factor was estimated according to formula  in the tested material; Bn, geochemical background of the analyzed element; BFe, geochemical background of the normalizing element (Fe).Indicators such as the enrichment factor , and its average content was 11.5 mg/kg db. The average crustal content of As is about 1.8 mg/kg . Based on Fig. The amount of Tl in the examined wastes was similar (0.7–1.7 mg/kg db) for all samples. The average content of Tl in the upper parts of the Earth’s crust is about 0.55 mg/kg   Table . TherefoThe microscopic analysis in combination with the point analysis of the chemical composition of the wastes from C and D mines was carried out by means of EPMA in order to accurately determine the modes of occurrence of Pb, As, and Tl. Examples of micrographs of the observed mineral phases are shown in Fig. 2), marcasite (FeS2), and chalcopyrite (CuFeS2). Also, a small amount of it was recorded in carbonates. In the case of both As and Tl, their presence in the form of their minerals , realgar (AsS), auripigment (As2S3), lorandite (TlAsS2), or hutchinsonite 2As5S9)) in the investigated sample cuts was not observed, while both of them were found in sulfide minerals (Table 2), galena (PbS), chalcopyrite (CuFeS2), and pyrite (FeS2), while As in marcasite (FeS2) and pyrite (FeS2).This analysis confirmed the association of Pb with sulfides Table . Lead ocThe results of the leaching experiments for As, Pb, and Tl from three selected samples are shown in Table 3 for both As and Pb in accordance with the EU law    WHO .3 of elution liquid) which is equal to 0.5 mg Pb/kg db  but also on environmental conditions and on the time of material contact with the liquid. Therefore, it is necessary to conduct a broader study taking into account, for example, the scenario of co-deposition of these wastes with municipal wastes (application of the TCLP test), in order to obtain a full picture of the possible impact of the investigated wastes on the environment.


Stereophotogrammetry can be used to study facial morphology in both healthy individuals as well as subjects with orofacial clefts because it shows good reliability, ability to capture images rapidly, archival capabilities, and high resolution, and does not require ionizing radiation. This study aimed to compare the three-dimensional (3D) facial morphology of infants born with unilateral cleft lip and palate (UCLP) with an age-matched normative 3D average face before and after primary closure of the lip and soft palate.Thirty infants with a non-syndromic complete unilateral cleft lip, alveolus, and palate participated in the study. Three-dimensional images were acquired at 3, 6, 9, and 12 months of age. All subjects were treated according to the primary surgical protocol consisting of surgical closure of the lip and the soft palate at 6 months of age. Three-dimensional images of UCLP patients at 3, 6 (pre-treatment), 9, and 12 months of age were superimposed on normative datasets of average facial morphology using the children’s reference frame. Distance maps of the complete 3D facial surface and the nose, upper lip, chin, forehead, and cheek regions were developed.Assessments of the facial morphology of UCLP and control subjects by using color-distance maps showed large differences in the upper lip region at the location of the cleft defect and an asymmetry at the nostrils at 3 and 6 months of age. At 9 months of age, the labial symmetry was completely restored although the tip of the nose towards the unaffected side showed some remnant asymmetry. At 12 months of age, the symmetry of the nose improved, with only some remnant asymmetry noted on both sides of the nasal tip. At all ages, the mandibular and chin regions of the UCLP patients were 2.5–5 mm posterior to those in the average controls.In patients with UCLP deviations from the normative average 3D facial morphology of age-matched control subjects existed for the upper lip, nose, and even the forehead before lip and soft palate closure was performed. Compared to the controls symmetry in the upper lip was restored, and the shape of the upper lip showed less variation after primary lip and soft palate closure. At this early age, retrusion of the soft-tissue mandible and chin, however, seems to be developing already. Orofacial clefts (OFCs) are one of the most frequently diagnosed congenital craniofacial malformations . OrofaciTreatment of OFCs starts within the first months after birth. Primary treatment of a complete unilateral or bilateral cleft may include presurgical infant orthopedics  and primary surgical correction of the cleft lip and palate. Different techniques and timelines have been described for infant orthopedics and cleft lip closure. The use of numerous different protocols for primary treatment of OFCs across different treatment centers indicates the lack of clear scientific evidence favoring one method over the others .Facial morphology is an important outcome variable of cleft treatment, and various methods for assessment of facial morphology have been described in the literature, including direct physical measurements , rating Comparison of the facial morphology of individuals with craniofacial malformations and normal controls can be achieved by registration of average faces of each group . ConstruThe medical ethics commission of the institution in which the study was conducted approved the study protocol (Commissie Mensgebonden Onderzoek regio Arnhem-Nijmegen #2007/163). The study was performed in accordance with the 1964 Declaration of Helsinki and its subsequent amendments. Written informed consent from the subjects’ parents was obtained prior to their inclusion in the study.The patients in this study were children with non-syndromic complete UCLP. The subjects in this study are part of a prospective longitudinal 3D study on facial growth from the age of 3 months to 6 years . Data foThe control group was recruited before the age of 3 months at the Maternity Clinic of the Radboud University Medical Centre and Regional Health Services (GGD Gelderland-Zuid) between April 2007 and September 2010. Inclusion criteria for the controls were born at term (38+ weeks) and both parents Caucasian. Exclusion criteria for the controls were occurrence of oral clefts in the first-, second-, or third-degree relatives. Fifty controls were enrolled in the study. In a previous study, normative average faces at 3, 6, 9, and 12 months of age were developed .Since 2008, the primary surgery protocol at the Nijmegen Cleft Palate Craniofacial Unit consists of surgical closure of the lip and the soft palate at 6 months of age. The lip is closed by a modified Millard technique, and closure of the soft palate is done according to a modified von Langenbeck technique. The hard palate is closed at 3 years of age, and alveolar bone grafting is performed at 9–11 years of age before eruption of the permanent canine.Acquisition of 3D images was done within a period of −21 and +21 days around the age of 3, 6, 9, and 12 months. Image acquisition was performed in a designated 3D imaging room with no windows and a consistent amount of ambient lighting. The 3dMDfacial System  with a 2-pod configuration was used for frontal facial image acquisition including both ears. The distance between the infants and cameras was one meter. The camera was calibrated on a daily basis. The 3D images consisted of approximately 20,000 points and the texture map was eight megapixel. Three-dimensional images of the subjects’ faces were acquired at 3, 6 (pre-treatment), 9, and 12 months of age at the 3D Lab  by trained photographers. The duration of the image capture was 1.5 milliseconds. On each occasion, approximately three images were obtained within 10 minutes. Image quality was visually assessed immediately after acquisition by the photographer for completeness of 3D image data and a neutral facial expression using 3dMDpatient V4.0 software.High-quality 3D images of the face at rest from the entire sample at 3, 6, 9, and 12 months of age were selected. Inclusion criteria were (1) a neutral facial expression with the eyes open and the lips lightly opposed without straining, (2) orientation of the face in the natural head position, (3) no data holes in the facial region medial to the ears, caudal to the hairline, and cranial to the menton, (4) correct 3D image construction, and (5) no presence of lip tape or a nasal feeding tube. The reliability of the selection procedure was very good, as shown by a kappa value of 0.90 .The selected 3D images were exported from the 3dMDpatient 4.0 software as wavefront object (.obj) files with texture. Next, the 3D images were imported into Maxilim version 2.3.0.3 . The children’s reference frame described previously was used to align all 3D images in the correct position and orientation . Third, In the next step, the 3D images were cropped in order to remove excess data of the subjects’ head and select only the face. A general face template was scaled to every individual 3D image by a Procrustes transformation based on the landmarks of the left and right pupil, the pronasale, and the left and right exostomion. After the template was scaled to the individual subjects, the outer boundary of the scaled template was used to crop the 3D images and to remove excess data such as hair, ears, and the neck. Then, the Coherent Point Drift algorithm was used for non-rigid deformation of the general face template to the mesh of the 3D images . After tT-tests were applied to assess the differences in the mean distances and mean standard deviations of the distances at intervals of 3–6 months, 6–9 months, and 9–12 months of age for the full face and selected facial regions, with significance set at p < 0.05. A 95% confidence interval was applied when interpreting the reliability of the results.Color-distance maps are presented for visual assessment of the variations in facial morphology of UCLP patients vs. control subjects. Distance maps of UCLP subjects superimposed on the corresponding normative average age-matched faces were quantified in terms of the mean distance and standard deviation for the face and its regions . In total, 239 3D images of 30 UCLP subjects at four different time-points were available. After the selection process, 131 images were excluded because they did not meet the inclusion criteria. From the remaining 108 3D images, 34 3D images were excluded since they were duplicate images of the same patient, and 14 3D images were excluded because the corresponding image before or after primary lip closure was missing. Finally, 60 single 3D images of 20 individual patients at 3, 6, 9, and 12 months of age were included .The average faces of UCLP subjects at 3, 6, 9, and 12 months of age are presented in p-values, and 95% CI) between UCLP subjects’ faces relative to the average face of the age-matched control subjects for three age intervals . In general, the mean increments were negative from 6 to 9 months of age, indicating that during that time period, facial growth in UCLP subjects was smaller than that in the averaged control faces.p = 0.01), nose (p = 0.02), and cheeks (p = 0.03), indicating significantly greater growth in these regions in the UCLP subjects. The mean increment of the standard deviation of the upper lip became significantly smaller (p = 0.01) from 6 to 9 months of age, indicating that the shape of the upper lip shows less variation between UCLP subjects and controls at 9 months of age compared to 6 months. Moreover, a significant difference was found from 9 to 12 months of age for the mean increment of the forehead (p = 0.04), indicating significantly more growth of the forehead in the UCLP subjects. Finally, the mean increment of the standard deviation of the nose became significantly smaller (p = 0.02) from 9 to 12 months of age, indicating that the shape of the nose shows less variation between UCLP subjects and controls.Significant differences were found from 3 to 6 months of age for increments in the full face  is used in non-growing individuals and cross-sectional studies but this method is not appropriate for longitudinal analysis. Iterative closest point has the effect of regression to the mean which is likely to mask any regional differences in individual growth patterns. In the present study, the children’s reference frame was used to superimpose 3D images on the average  0.51 mm  and thisThe reproducibility of the manual identification of the facial regions was not evaluated because this was performed only once on the general face template. In turn, after mapping of the general face template to the individual 3D facial images, the manual selected facial regions were automatically transferred from the general face template to every individual 3D facial image. We used the same general face template for both the controls and the UCLP patients. Therefore, intra- and inter-study reproducibility of the selection of facial regions is 100% in our case. Manual selection of facial regions is likely to introduce a reproducibility error if another general face template is developed with another manual selection of facial regions. However, the boundaries of the facial regions have little influence on the interpretation of the color-distance maps.The use of a generic mesh is a recent advancement in technical analysis of 3D facial images and allows greater utilization of the potential of complex longitudinal 3D information compared to simple linear and angular measurements, removes the need for localization of landmarks and reduces operator error, and finally allows automatic identification of corresponding facial regions.Facial morphology is influenced by variations in facial expressions, even when stereophotogrammetric images with a neutral facial expression are selected. The influence of involuntary facial expressions has shown to range from 0.38 to 0.88 mm in the full facial surface, but the influence is higher in the nasolabial area, especially in UCLP subjects, with mean distances ranging from 0.72 to 0.93 mm at 3–12 months of age . This vaWe were able to quantify deviations from the normal facial anatomy in the regions of the upper lip, nose, and even the forehead at 3 and 6 months of age before lip and soft palate closure was performed. The results confirm the presence of intrinsic as well as functional/adaptive differences from birth on between individuals with and without UCLP as already proposed by earlier researchers . Markus,Stereophotogrammetry has the potential to serve as a method for early detection of facial growth disturbances related to certain surgical treatments as well as soft-tissue changes related to presurgical nasoalveolar molding (PNAM). It would be interesting to compare the effect of the latter therapy on the nasolabial area, as the assumed effect of PNAM especially concerns the shape of the nose. Stereophotogrammetry is a non-invasive and rapid imaging technique, although acquisition of high-quality images is dependent on a highly experienced operator. A stereophotogrammetric setup is expensive, but it provides greater value than conventional two-dimensional photography by allowing quantification and localization of deviations from normal facial development at an early age, as shown in this study. This enables early identification of treatment protocols that are potentially detrimental for the development of normal facial morphology and can be subsequently abandoned earlier. The routine use of stereophotogrammetry in cleft centers is recommended in order to increase the sample size in multi-center studies and for comparison of the outcomes of various cleft treatment protocols. The recent development of handheld 3D cameras will stimulate the use of stereophotogrammetry in the clinic due to its reduced costs and increased mobility .With stereophotogrammetry, it is possible to detect the static morphology of the face and quantify differences between multiple 3D faces in detail. However, the normal morphology can only partially fulfill the desired goal of a normal facial appearance and esthetics. Normal facial dynamics is another crucial factor for perception of normal facial appearance and esthetics. Therefore, future research should also focus on other standardized facial expressions besides a relaxed neutral expression, like maximal smile and pouting of the lips.There are limitations to our study. From our longitudinal prospective 3D facial imaging database of 30 non-syndromic Caucasian UCLP subjects, 11–20 high-quality 3D images were included per age. Initial sample size was lower than expected due to difficulty for the parents to attend at every desired 3D imaging window of time. Second, despite capturing multiple 3D images per occasion many 3D images had to be excluded due to not meeting the inclusion criteria. This is inherent with 3D facial imaging in infants as these subjects are unable to cooperate with the ideal image capture procedure. We did not differentiate between boys and girls in order to obtain a sufficient sample size. This seems to be acceptable since sexual dimorphism in the soft tissue of the face in babies has not been demonstrated in literature, while on the other hand sexual dimorphism in adolescents and adults has been demonstrated . One stuA limitation of this study is the relatively large time window in which 3D images were acquired, namely +/− 3 weeks around the exact age of 3, 6, 9, and 12 months. The relatively large time window was necessary to obtain a sufficient sample size. A difference of six weeks at most at these young ages will certainly influence the study outcome. It is recommended that future studies aim to limit the time window in which 3D images are made. Furthermore, future studies may need to acquire 3D images every month, or even every week, to develop accurate growth models for faces. The results of this study are not applicable to other cleft subtypes. Future studies should focus on comparison of normative and UCLP average faces with the developing facial morphology of other cleft subtypes such as unilateral cleft lip and alveolus and bilateral cleft lip, alveolus, and palate.Another limitation of the study is the inability to distinguish between the effect of intrinsic growth and the effect of treatment in UCLP subjects. To differentiate between these two factors we would need an additional control group in our study of untreated UCLP subjects. However, for obvious ethical reasons it will never be possible to withhold surgical treatment from a group of newborns with clefts.In patients with UCLP deviations from the normative average 3D facial morphology of age-matched control subjects existed for the upper lip, nose, and even the forehead before lip and soft palate closure was performed. Compared to the controls symmetry in the upper lip was restored, and the shape of the upper lip showed less variation after primary lip and soft palate closure. At this early age, retrusion of the soft-tissue mandible and chin, however, seems to be developing already.10.7717/peerj.7302/supp-1Supplemental Information 1Click here for additional data file.


In this paper, we aim to use odor fingerprint analysis to identify and detect various odors. We obtained the olfactory sensory evaluation of eight different brands of Chinese liquor by a lab-developed intelligent nose. From the respective combination of the time domain and frequency domain, we extract features to reflect the samples comprehensively. However, the extracted feature combined time domain and frequency domain will bring redundant information that affects performance. Therefore, we proposed data by Principal Component Analysis (PCA) and Variable Importance Projection (VIP) to delete redundant information to construct a more precise odor fingerprint. Then, Random Forest (RF) and Probabilistic Neural Network (PNN) were built based on the above. Results showed that the VIP-based models achieved better classification performance than PCA-based models. In addition, the peak performance (92.5%) of the VIP-RF model had a higher classification rate than the VIP-PNN model (90%). In conclusion, odor fingerprint analysis using a feature mining method based on the olfactory sensory evaluation can be applied to monitor product quality in the actual process of industrialization. Due to its particularity and generality, fingerprint can provide the basis to distinguish between samples due to its uniqueness and reliability . Odor fiChinese liquors belong to the distilled liquor which is loved by people for its strong aromatic odor. As a traditional fermented beverage, the saccharifying ferment of Chinese liquor is daqu, xiaoqu, bran koji and yeast wine, which is produced with cereal grains as the main raw materials and is processed by distilling, saccharifying and fermenting . The micCurrently, there are multiple studies on liquors by traditional sensory evaluation and physical or chemical methods ,9. With Along with the rapid development of artificial intelligence, intelligent nose, also known as artificial nose, intelligent olfaction system, as a new bionic detection instrument, could make up the deficiency of the traditional olfactory sensory evaluation . IntelliAs is known to all, drift is an inevitable question in measurement. Sensor drift refers to the output of sensor changes from time to time when the input remains unchanged. Currently, it is believed that sensor drift is caused by two causes, on the one hand is the chemical process which occurs between the sensor material and the environment, on the other hand is the system noise . In pracIn this paper, taking Chinese liquors as an example, we followed the offline sensor drift compensation approach for the intelligent nose system while the majority of past studies have focused on the simulation of human olfaction to detect and identify odor fingerprint information.The appropriate multivariate statistical and pattern recognition methods can effectively increase the differentiation of odor fingerprints based on the intelligent nose and can check the accuracy of models. Previous research primarily focused on the feature extraction of time domain features such as peak, mean, maximum variance, root mean square and standard deviation ,32. HoweTaking eight different brands of Chinese liquors as an example, this paper aims to use the odor fingerprint analysis, simulate human olfaction through experiments with the lab-developed intelligent nose and adopt the feature mining method to detect and identify various odors. According to the raw experimental data from 16 sensors of the lab-developed intelligent nose, we extracted the time domain and frequency domain characteristics to construct the odor fingerprint. In addition, odor fingerprints were analyzed by PCA and VIP scores for selecting characteristic features. Next, we selected Random Forest (RF) and Probabilistic Neural Network (PNN) to dynamically characterize the interactions among the feature variables, and then obtained the best variable characteristics and the highest classification accuracy. This is a significant study for the detection and identification of Chinese liquors through odor fingerprint analysis based on the olfactory sensory evaluation. In this paper, eight different brands of Chinese liquors purchased at a local liquor store were selected as samples. These samples differed in brand, alcohol content, flavor, raw materials, and origin. Details were listed in 3. The chamber is made of cardboard which is covered by Polytetrafluoroethylene (PTFE). PTFE has weak adsorption and strong leakproofness so that there is no other interfering research to affect the test results in the air chamber. Sensor arrays contain a temperature sensor, humidity sensor and 16 independent sensors. LM35CZ type temperature sensor by National Semiconductor, Santa Clara, CA, USA and HIH-4000-003 type humidity sensor by Yi Jiajie Electronic Technology CO., LTD, ShenZhen, China, in the air chamber are used to monitor the internal temperature and humidity. Sixteen independent sensors are sensitive to different substances. These sensors can detect odor fingerprint data and consist of two systems: TGS-8 system by FIGARO, Japan and MQ/MP system by ZhengZhou Winsen Electronics Techbology CO., LTD, ZhengZhou, China. Details of these sensors used in the experiment are listed in As shown in The static head-space sampling method was adopted in this experiment. The lab environment is best to control the temperature at 23 ± 2 °C and the relative humidity at 60 ± 5%. The experimental procedure was performed as following:(1) Open the air pump 2 and valve 1, put a clean and empty Erlenmeyer flask in the defined location. Then observe the zero value of each sensor and compare with the standard value.(2) Twenty milliliters of the sample was put in a 100 mL Erlenmeyer flask, sealed and left to sit for 5 min.(3) Close air pump 2 and adjust air pump 1 so that the gas flowmeters 1 and 2  display 2 L/min to clean windpipes for 10 s. Then open air pump 2 to clean the entire device. This process lasted 5 min to eliminate the influence by other gases.(4) Place the test samples in the defined location and adjust air pumps 1 and 2 so that the gas flowmeters 1 and 2 display 0.5 L/min to let the gas enters the chamber. Ten seconds later, close air pump 2 and keep the gas coming into the chamber sequentially. At the same time, observe the signals and record test data.(5) Without loss of generality, repeat the experiment 10 times for each sample by repeating Steps (2)–(4). Note that the relative humidity will not change in the course of the experiment. At last, a total of 80 sets of data is obtained.In this paper, we extracted time domain and frequency domain features to construct an odor fingerprint map. The time-domain feature is the average value (AV) of intelligent nose response signals of sensors. The frequency domain feature is the mean of variance (MV) of the eight wavelet packet coefficients obtained by three layers of wavelet packet decomposition with db6 wavelet .ith sensor of TGS-8 system were defined as:Tix1, Tix2, …, Tix5940 are response value of the ith sensor of TGS-8 system intelligent nose.The time domain features of the ith sensor of the MQ/MP system were defined as:Mix1, Mix2, …, and Mix5940 are response values of the ith sensor of the MQ/MP system electronic nose.The time domain features of the ith sensor of the TGS-8 system were defined as:TiS1, TiS2, …, TiS8 are the variance yields extracted from the coefficients of the wavelet packet of the ith sensor of the TGS intelligent nose; the response value measured from the intelligent nose was decomposed into wavelet packet components based on the db6 wavelet, and then extracting the coefficients of the wavelet packet.The time domain features of the ith sensor of the MQ/MP system were defined as:MiS1, MiS2, …, MiS8 in the formula are the variance yields extracted from coefficients of wavelet packet of the ith sensor of the MQ/MP intelligent nose; the response value measured from the intelligent nose was decomposed into wavelet packet components based on the db6 wavelet, and then extracting the coefficients of the wavelet packet.The frequency domain features of the As is known to all, sensor sensitivity has a great influence on the intelligent nose system performance. The sensitivity of the sensor should be considered to achieve the best performance.pR is the resistance value of the sensor. lR is the resistance value of the load resistance and the output voltage of sensor is the voltage across the load resistance. The relationship between the output voltage and reference voltage is as follows:As shown in lR is equal to pR, the sensor has the greatest response sensitivity to improve the performance of the intelligent nose system.All these show that when lR values. Other sensors have the same characteristics.As shown in lR is about one-fifteenth of the value of pR, the output response of sensors is obvious.As shown in sx(0) is the zero response value of the sensor.Signal processing, as an important step of improving the performance of the intelligent nose, refers to preprocess signals of sensor array responses. The standardized processing is the most popular method that translates raw data into a dimensionless index. Therefore, this step can avoid pattern recognition failure because of the large magnitude of some sensors. We choose the relative difference method to suppress sensor drift. Then, in order to expedite the convergence rate of the model, the odor fingerprint information obtained by different sensors should be converted to the same dimension and the same order of magnitudes. We normalized the fusion feature sets and the normalized interval is . After the series of the above-mentioned processing , additive drift and response drift of the sensor will be suppressed.Principal Component Analysis (PCA) is a meaningful multivariate statistical method. It can convert multiple variables to a few comprehensive variables through linear transforming. These comprehensive variables that are principal components can reflect most of the information of the original variables at the greatest extent. These principal components are not only linearly independent of each other but also mutually orthogonal. In this paper, PCA was used to process the original features that fused the time domain and frequency domain. From this, principal components can express characteristic features of Chinese liquors’ olfactory information.1, k2, …, km] variable subsets were generated based on the best VIP scores. Which ki means the subset has top ith variables and m is the number of all variables. In this paper, we analyzed the original features and generated 32 subsets based on the VIP scores to express the interaction between different variables.In the Partial Least Square (PLS), the Variable Importance of Projection (VIP) scores were used to create a new data space in a lower dimensional system . The VIPIn this paper, altogether 80 sets of data were divided into two parts based on the Kennard-stone algorithm, 1/2 as the training set and the rest as the testing set. The former was used to construct the classification model and the latter was used to test the classification performance of models established by the former.The KS algorithm is commonly used as an effective method to select a training set. In the KS algorithm, all samples were considered as candidates for training sets that were selected in order. The KS algorithm can be summarized as follows: (1) Calculating the distance between every two samples and selecting the two samples with the largest distance. (2) Calculating the distance between the remaining sample and the selected two samples, respectively. (3) Repeating this step until the number of selected samples is equal to the predetermined number .Random Forest (RF) is an ensemble of classification and regression tree (CART). It was first proposed by Kam in 1995  and BreiS1, S2, …, TS were generated. (2) The corresponding decision trees C1, C2, …, CT were generated by each training set. Before the property was selected on each internal node, m properties that were randomly selected from M properties should be seen as the split attribute set of the current node. (3) Each tree has complete growth without pruning. (4) For the testing set sample X, every decision tree was tested to obtain the corresponding categories C1(X), C2(X), …, CT(X). (5) By taking the vote, the most output category in the T decision trees was taken as the category of the testing set.With its fast training rate and simple realization, it is widely used in biological information , ecologyProbabilistic Neural Networks (PNN) is the supervised classifier which was first put forward by D. F. Speeht in 1990 . It is aThe odor fingerprint information obtained in the experiment was analyzed by the PCA algorithm. The first three principal components account for 42.59%, 34.16%, and 11.95% respectively. Observing the scree plot from M5, AVM4, AVM7, MVM5, MVM4, MVM7, AVM8, MVM2, AVT6, AVM2, MVM8, MVT6, MVM1 and AVM1 are greater than 1, indicating that these variables have significant meaning in the odor fingerprint of Chinese liquors. While the VIP scores of the rest are less than 1, which means that these variables have less effect on the classification of Chinese liquors, VIP scores cannot give a verdict for the classification performance of models. Therefore, we found a series of fusion matrix as an input of the model based on VIP scores. Each subset includes the top several variables, in other words, subset #1 includes AVM5, subset #2 contains AVM5 and AVM4, the last subset #32 contains all variables. We can select the prime variable combination by dynamically observing the classification performance of RF networks and PNN network. Results showed that it provides a reliable method to construct a much more concise odor fingerprint map by selecting the best combination of variables.In RF networks, the value of mtry and the number of decision trees are the main parameters of generalization performance. The default mtry value is the square root of the total number of variables, so the value of mtry in the experiment was four. We selected the number of decision trees from 2 to 100 at two trees intervals. The training accuracy rate and predicting accuracy rate were regarded as the evaluation criterion. From this, we can focus on the influence of decision trees on the classification performance in RF networks.The three feature sets  combined with the RF model achieved the classification for olfactory information of Chinese liquors. To reduce the impact of randomness, 100 prediction models were established, and their accuracy rates were averaged as the classification accuracy rate of the current model. As shown form The three feature sets  combined with the PNN model work well in classifying the olfactory information of Chinese liquors. As shown in The PNN models based on PCA-optimized and VIP-optimized are superior to the model based on the original features, which means that there is a lot of redundant information in the original features. Compared with the PNN model based on PCA-optimized, the model of VIP-optimized performed well, which means that the feature mining method based on VIP-optimized can improve the accuracy rate and extract effective features.(1) By comparison, the classification accuracy of the RF network was better than the PNN network based on the different feature methods. Thus, it can be seen that the RF network has stronger processing power in this experiment.(2) Compared with the original features, classification performance did not significantly improve based on the PCA-optimized both in the RF network and PNN network. The data processing method based on PCA cannot obtain the best combination of variables to identify various odors more accurately.M5, AVM4, AVM7, MVM5, MVM4, MVM7, AVM8, MVM2, AVT6, AVM2, MVM8, MVT6, MVM1, AVM1, and AVM6 were considered as the characteristic features.(3) Compared with the original feature and PCA-optimized, selected features based on the best VIP scores obtained the obvious promotion of the classification performance. The classification accuracy of the RF network in subset #15 and the PNN network in subset #16 was 92.5% and 87.5%, respectively. Finally, the RF network showed the best classification performance of 92.5% in subset #15. Combined with VIP scores, AVIn conclusion, taking eight different brands of Chinese liquors as an example, our work adopted the odor fingerprint analysis based on olfactory sensory evaluation and the feature mining method which combined the time domain and frequency domain to simulate human olfaction and to identify various odors. Variable selection using VIP scores is especially suitable for extracting features from a mass of data. In addition, the VIP-based models achieved better prediction accuracies than the PCA’s. The results demonstrated that VIP coupled with the RF or PNN network is effective in extracting and analyzing features of odor fingerprint. Compared with the PNN model, the RF model achieved the slightly higher accuracy. Meanwhile, compared with the traditional statistical methods and simple extraction, this feature mining method used the least characteristic variables and the best fusion method and can capture hidden patterns and variables inside the odor fingerprint. The odor fingerprint analysis using the feature mining method based on olfactory sensory evaluation can be applied to the food and drinks industry for product discrimination, classification, quality and control. Besides, the lab-developed intelligent nose can be used in the actual process of industrialization to monitor product quality.