Aim: To compare the effectiveness of conventional and rotary NiTi files for Gutta-Percha (GP) removal in straight roots during retreatment root canal treatment (RCT), using manual Hedstrom files and ProTaper Universal System, respectively. Methods: It was an in-vitro experimental study using non-probability consecutive sampling. Sixty extracted single rooted maxillary and mandibular permanent teeth with straight canals were selected for this study. Following preparation, the root canals were filled with GP along with a sealer and kept for two weeks in a moist environment at room temperature. Thirty teeth were randomly allocated to the study and control groups each. GP removal was accomplished with Hedstrom files and Pro Taper retreatment files in group 1 and group 2, respectively. Digital radiographs were obtained using Kodak RVG digital radiography system software version VER.6.10.8.3-A and analyzed for the difference of opacities indicating residual GP. AutoCAD 2006 software was used to outline the root canal and the residual root filling. Independent sample t test was used to compare the total residual GP in both groups. Results: No significant difference in the residual root filling was observed following removal with conventional Hedstrom files versus ProTaper universal retreatment files. In both groups, the residual GP was confined to the apical third of the roots. Conclusion: ProTaper Universal Retreatment files and manual Hedstrom files are equally effective in the removal of GP in straight canals.

One of the most important subjects of hydraulic engineering is the reliable estimation of the transverse distribution in rectangular channel of bed and wall shear stresses. This study makes use of the Tsallis entropy, Genetic Programming (GP) and (ANFIS) methods to assess the shear stress distribution (SSD) in rectangular channel. To evaluate the results of the Tsallis entropy, GP and ANFIS models, laboratory observations were used in which shear stress was measured using an optimized Preston tube. This is then used to measure the SSD in various aspect ratios in the rectangular channel. To investigate the shear stress percentage, 10 data series with a total of 112 different data for were used. The results of the sensitivity analysis show that the most influential parameter for the SSD in smooth rectangular channel is the dimensionless parameter B/H, Where the transverse co-ordinate is B, and the flow depth is H. With the parameters (b/B), (B/H) for the bed and (z/H), (B/H) for the wall as inputs, the modeling of the GP was better than the other one. Based on the analysis, it can be concluded that the use of GP and ANFIS algorithms is more effective in estimating shear stress in smooth rectangular channels than the Tsallis entropy-based equations.

Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is central to implement antimicrobial stewardship (AMS) programs in primary care. This study aimed to design a GP-pharmacist antimicrobial stewardship (GPPAS) model in Australian primary care. A seven-component exploratory study was conducted since 2017 to 2021 to inform a GPPAS model. We generated both secondary and primary evidence through a systematic review, a scoping review, a rapid review, nationwide surveys of Australian GPs and CPs including qualitative components and a pilot study of a GPPAS model. All study evidence was synthesised, reviewed, merged and triangulated to design a prototype GPPAS model using a Systems Engineering Initiative for Patient Safety theoretical framework. Secondary evidence informed effective GPPAS interventions, and primary evidence captured interprofessional issues, challenges and future needs to implement GPPAS interventions by GPs and CPs. A GPPAS model framework involving GP-pharmacist team-based five GPPAS sub-models were successfully designed to foster AMS education, antimicrobial audits, diagnostic stewardship, delayed prescribing, and routine review of antimicrobial prescription by improved GP-CP collaboration. A GPPAS model could be used as a guide to collaboratively optimise antimicrobial use by GPs and CPs. Implementation studies on GPPAS model and sub-models are required to integrate GPPAS model into GP-pharmacist interprofessional care models in Australia.

Background: dementia is a significant health issue worldwide. Mild cognitive impairment (MCI) can transform into dementia over time. General practitioners may be the first to notice the cognitive deficit, so they may need a screening test in the event of suspicion, which they must be able to use under great time pressure. We examined the usability of the Hungarian Test Your Memory (TYM-Hun) self-administered dementia test in general practice, and with the results of the received tests, we tried to draw conclusions regarding the population. Methods: In the four Hungarian cities with medical universities, general practitioners filled out 368 questionnaires with their clients over 50 years of age. Results: the total scores of the test showed a significant correlation with education and the type of occupation, while a significant negative correlation with age. We found the clock drawing test and recall indicates cognitive decline the earliest. Based on the TYM-Hun results, the prevalence levels for MCI and dementia are slightly higher in Hungary than globally. Conclusion: the test can sensitively indicate MCI and early-stage dementia as a screening test, and two of its subtests can raise the possibility of cognitive impairment at an earlier age than the others.

Background and Objectives The socioeconomics working group of the European ME/CFS Research Network (EUROMENE) has conducted a review of the literature pertaining to GPs’ knowledge and understanding of ME/CFS. Materials and Methods A MEDLINE search was carried out. The papers identified were reviewed following the Synthesis Without Meta-analysis (SWiM) methodology, and were classified according to the focus of the enquiry (patients, GPs, database and medical record studies, evaluation of a training programme, and overview papers), and whether they were quantitative or qualitative in nature. Results 33 papers were identified in the MEDLINE search. The quantitative surveys of GPs demonstrated that a third to a half of all GPs did not accept ME/CFS as a genuine clinical entity and, even when they did, they lacked confidence in diagnosing or managing it. Patient surveys indicated that a similar proportion of patients was dissatisfied with the primary medical care they had received. These findings were consistent with the findings of the qualitative studies that were examined, and have changed little over several decades. Conclusions Lack of knowledge and understanding of ME/CFS among GPs is widespread, and the resultant diagnostic delays constitute a risk factor for severe and prolonged disease. Failure to diagnose ME/CFS renders problematic attempts to determine its prevalence, and hence its economic impact.

Background: Although, negative repercussions of inadequate health service use on the health outcomes has been presumably exacerbated by COVID-19, the impact of the pandemic measures has been not evaluated properly yet. Objective: Our study aimed to quantify the COVID-19 pandemic measures’ effect on the general practitioner (GP) visit, specialist care, hospitalization and cost-related prescription nonredemption (CRPNR) among adults in Hungary, and to identify the social strata susceptible to the pandemic effect. Methods: This community-based cross-sectional study based on nationally representative data of 6,611 (Nprepandemic=5,603 and Npandemic=1,008) subjects aged 18 years and above. Data were obtained from the European Health Interview Survey 2019 (EHIS) and International Social Survey Program 2021 (ISSP) for prepandemic and pandemic, respectively. Multivariable logistic regression models were applied to determine the sociodemographic and clinical factors influencing the health care use by odds ratios (OR) along with the corresponding 95% confidence intervals (CI). To identify the social strata susceptible to pandemic effect, the interaction of the time of data collection with level of education, marital status, and ethnicity, was also tested. Results: While, the CRPNR did not changed, the frequency of GP visit, specialist care and hospitalization rate were remarkably reduced by 22.2%, 26.4%, and 6.7%, respectively, during the pandemic in Hungary. Roma proved to be not specifically affected by the pandemic in any studied respect. The pandemic restructuring of health care impacted the social subgroups evenly with respect to hospital care. However, the pandemic effect was weaker among primary educated adults (ORhigh-school vs primary-education =0.434; 95% CI 0.243-0.776, ORhigh-school vs primary-education =0.598; 95% CI 0.364-0.985), and among widows (ORwidowed vs married =2.284; 95% CI 1.043-4.998, ORwidowed vs married=1.915; 95% CI 1.157-3.168) on the frequency of GP visit and specialist visit; and the prepandemic CRPNR inequality by level of education was increased (ORhigh-school vs primary-education =0.236; 95% CI 0.075-0.743). Conclusion: Primary educated and widowed did not follow the general trend, and their prepandemic limited health care use was not reduced further during pandemic, resulting in an inequality reduction. The vulnerability of primary educated to CRPNR was the only gap widened in the pandemic period. This shows that although the management of pandemic health care use restrictions was implemented by increasing the social inequality in Hungary, the prevention of inequity in drug availability for primary educated individuals could require more support.

Building electric energy is characterized by a significant increase of its uses (e.g. vehicle charging), a rapidly declining cost of all related data collection and a proliferation of smart grid concepts, including diverse and flexible electricity pricing schemes. Not surprisingly, an increased number of approaches have been proposed for its modeling and forecasting. In this work, we place our emphasis on three forecasting related issues. First, on the forecasting explainability, i.e. the ability to understand and explain to the user what shapes the forecast. To this extent we rely on concepts and approaches that are inherently explainable, such as the evolutionary approach of genetic programming (GP) and its associated symbolic expressions, as well as the so-called SHAP (SHapley Additive eXplanations) values, which is a well established model agnostic approach for explainability, especially in terms of feature importance. Second, we investigate the impact of the training timeframe on the forecasting accuracy; this is driven by the realization that a fast training would allow for faster deployment of forecasting in real life solutions. And third, we explore the concept of counterfactual analysis on actionable features, i.e. features that the user can really act upon and which therefore present an inherent advantage when it comes to decision support. We have found that SHAP values can provide important insights into the model explainability. As for GP models, we have found comparable and in some cases superior accuracy when compared to its neural-network and time-series counterparts but a rather questionable potential to produce crisp and insightful symbolic expressions, allowing a better insight into the model performance. We have also found, and report here on an important potential especially for practical, decision support, solutions of counterfactuals built on actionable features and short training timeframes.

In CNS drug discovery, estimation of brain exposure of lead compounds is critical for their optimization. Compounds need to cross the blood-brain barrier (BBB) to reach the pharmacological targets in the CNS. The BBB is a complex system involving passive and active mechanisms of transport and efflux transporters such as P-glycoproteins (P-gp) and breast cancer resistance protein (BCRP), which play an essential role in CNS penetration of small molecules. Several in vivo, in vitro and in silico methods are available to estimate human brain penetration. Preclinical species are used as in vivo models to understand the unbound brain exposure by deriving the Kp,uu parameter, the brain/plasma ratio of exposure corrected with the plasma and brain free fraction. MDCK-mdr1 (Madin Darby canine kidney cells transfected with the MDR1 gene encoding for the human P-gp) assay is the most commonly used in vitro assay to estimate compound permeability and human efflux. The in silico methods to predict brain exposure, such as CNS MPO, CNS BBB scores and various Machine Learning models, help save costs and speed up compound discovery and optimization at all stages. These methods enable the screening of virtual compounds and building of a CNS penetrable compounds library as well as optimization of lead molecules for CNS penetration. Therefore, it is crucial to understand these methods' reliability and ability to predict CNS penetration. We review the in silico, in vitro and in vivo data and their correlation with each other and assess published in silico approaches to predict the BBB penetrability of compounds.