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This study aimed to compare the nasofrontal region in metopic and non-metopic cranial series and to assess whether the persistent metopic suture is related to a specific morphology of this part of the cranium. For the purpose of the study, a total of 159 dry crania (control series n = 90 and metopic one n = 69) of contemporary adult males were scanned with a laser scanner. Digital morphometry was accomplished by recording the three-dimensional coordinates of eleven landmarks, 3 bilateral and 5 in the mid-sagittal plane, characterizing the nasofrontal region. Between these landmarks, 43 linear measurements were calculated as Euclidian distances and 25 triangles were constructed. The angles, areas and heights of these triangles were also computed. The results show that the metopic crania have a distinctive nasofrontal morphology as the significant differences are not in the forehead height, but mainly in its configuration and in the nasal bones dimensions. The metopic crania have significantly flattened glabella, broad interorbital distance and wider, shorter and less prominent nasal bones compared to the non-metopic ones.

Introduction: Sepsis is a significant cause of morbidity and mortality worldwide. Current clinical practice, however, lacks reliable diagnostic indicators for it and its prognosis. Aim: The present study aimed to investigate the efficacy of delta neutrophil index (DNI), which reflects the proportion of circulating immature granulocytes, in predicting infections and sepsis. Materials and methods: A prospective non-interventional single-center clinical follow-up study was performed in a Bulgarian ICU between January 1, 2017 and May 31, 2018. We analyzed adult patients: 45 patients met the sepsis criteria, as defined in SEPSIS-3, whereas 37 were infected patients fulfilling no criteria of sepsis. Logistic regression and Roc-curve analysis were used to evaluate the severity and prognostic value of DNI as a prediction marker in critically ill septic patients. Results: The results have shown that at DNI values of 1.4 there is 73% sensitivity and 87% specificity (AUC 0.764, 95% CI 0.650–0.878, p=0.0001) to assume the presence of sepsis. Additionally, DNI was significantly associated with the severity of the condition of patients, the organ dysfunction and the IL-8 marker. Conclusions: DNI may serve as a useful marker for early diagnosis of sepsis and could support decision making process regarding its treatment at an early stage of a disease development.

The persistent metopic suture is an anatomic variation related to a specific skull configuration. Data on the proportionality of the neurocranium and the occurrence of additional variations when the metopic suture persists are still insufficient. This study presents a comparison between a metopic and a non-metopic homogenous cranial series. The most distinctive quantitative and qualitative characteristics of the skull configuration when the metopic suture persists were identified using data mining techniques. A total of 175 contemporary adult male skulls were investigated. The skulls were divided in two groups: a control series (n = 100) and a metopic series (n = 75). All skulls were scanned with a hand-held laser scanner CreaformVIUscan and polygonal models were created. For 150 of the skulls, industrial µCT scanning was performed using Nikon XT H 225 and volumetric images were generated. A total of 92 attributes, both quantitative (dimensions) and qualitative (anatomical variations of the skull), were recorded from the 3D models. The major distinctive peculiarities observed in the neurocranial configuration when the metopic suture persists concerned the dimensions of the frontal bone which was considerably shorter, wider and more convex compared to the control. The metopic skulls manifested wormian bones in the sphenoidal fontanelle, around the temporal squama and along the lambdoid suture. These supernumerary bones were considerably more common in the metopic series in comparison with the control. The most reliable model resulting from the data mining summarizes a total of five classification rules entirely based on quantitative characteristics of the frontal bone.

Mastoid Triangle (MT) is a triangle constructed between the landmarks porion, mastoidale and asterion. The aim of the study is to evaluate the sex differences in the MT size in Bulgarian adults and to develop discriminant functions for sex estimation based on the MT sides and area. The study was carried out on 148 head CT scans. A sample of 53 males and 53 females was used for development of discriminant functions, and a test sample of 21 males and 21 females was applied for their validation. Using the software InVesalius©, 3D models of the skulls were segmented and exported in STL format. The 3D coordinates of the landmarks porion, asterion and mastoidale were collected using the software MeshLab©. The MT sides, area and angles were calculated. The sex differences were assessed by the independent t-test. Bilateral differences were evaluated using the paired t-test. Univariate and multivariate discriminant function analyses were applied. The results showed that the MT sides and area differed significantly between both sexes. Sex differences were also established for the angle at mastoidale. Bilateral differences were found in males for the distance porion-mastoidale, which was significantly greater on the right side. The MT dimensions showed sufficient discriminating power for sex estimation among Bulgarians (up to 89%), and the total MT area proved to be the best single sex discriminating trait. The test sample corroborated the usefulness of the MT in sex estimation demonstrating similar or higher overall accuracy rates.

Objectives The sagittal suture (SS) is assumed to be an initial site for the commencement of cranial suture closure as well as the most frequent spot of isolated craniosynostosis. The present study aimed to inspect the reorganization of the SS at the microlevel to assess the relation between its closure and aging and to establish whether it could be used as a reliable indicator in age-at-death prediction. Materials and methods The SS was investigated in 68 dry contemporary adult male skulls of known age-at-death. An additional series of 20 skulls was used for verification. The skulls were scanned using a micro-computed tomography system. The SS closure degree was assessed along the three bone layers on cross-sectional tomograms by using a scoring scale. Results In the entirely open SS, the bone edges consist of compact bone and are widely separated. With SS maturation, the bone edges come into contact, and the remodeling process leads to a decrease in the sutural area and bone homogenization across all three layers. SS closure is an irregular process roughly related to aging, beginning in the early 20s, reaching its peak at about 30 years of age and abating in the late 40s. Discussion Although related to aging, SS closure is not a simple function of it. Rather, the underlying factors inducing and managing this process are multifaceted and complex. Although the etiology of SS maturation remains unclear, it is reasonable to use SS closure cautiously and only as a supportive method for age prediction.

The aim of the present study is to apply support vector machines (SVM) and artificial neural network (ANN) as sex classifiers and to generate useful classification models for sex estimation based on cranial measurements. Besides, the performance of the generated sub-symbolic machine learning models is compared with models developed through logistic regression (LR). The study was carried out on computed tomography images of 393 Bulgarian adults (169 males and 224 females). The three-dimensional coordinates of 47 landmarks were acquired and used for calculation of the cranial measurements. A total of 64 measurements (linear distances, angles, triangle areas and heights) and 22 indices were calculated. Two datasets were assembled including the linear measurements only and all measurements and index, respectively. An additional third dataset comprising all possible interlandmark distances between the landmarks was constructed. Two machine learning algorithms—SVM and ANN and a traditional statistical analysis LR—were applied to generate models for sex estimation. In addition, two advanced attribute selection techniques (Weka BestFirst and Weka GeneticSearch) were used. The classification accuracy of the models was evaluated by means of 10 × 10-fold cross-validation procedure. All three methods achieved accuracy results higher than 95%. The best accuracy (96.1 ± 0.5%) was obtained by SVM and it was statistically significantly higher than the best results achieved by ANN and LR. SVM and ANN reached higher accuracy by training on the full datasets than the selection datasets, except for the sample described by the interlandmark distances, where the reduction of attributes by the GeneticSearch algorithm improved the accuracy.

Purpose To evaluate the ocular surface at the microstructural level of adults who habitually undertake indoor-suntanning utilising in vivo confocal microscopy. Methods Participants were prospectively recruited and enrolled into either а study group (n = 75) with a history UV indoor tanning, or a control group (n = 75) with no prior history of artificial tanning. The study group participated in voluntary tanning sessions performed with standard equipment and maintained their usual routine for eye protection. Slit lamp biomicroscopy and in vivo confocal microscopy were performed at baseline before undertaking a series of suntanning sessions (10 sessions of 10 min duration over a 15 day period), within three days after the last session, and four weeks after the last session. Control group participants were examined at baseline and 8 weeks later and did not participate in tanning sessions. Results All participants were female with a mean age of 25 ± 4 years and 24 ± 4 years in the study and control groups, respectively. No clinically significant changes were observed in either group over time using slit lamp biomicroscopy (all p ≥ 0.05), however, statistically significant differences were observed between the study and the control group for all corneal layers imaged using confocal microscopy (all p ≤ 0.03). Characteristic cystic conjunctival lesions with dark centres and bright borders were observed in 95% of the study group before and in 100% after the suntanning sessions. Conclusion Indoor suntanning resulted in statistically significant microstructural changes in the cornea and the bulbar conjunctiva that are undetectable with slit lamp biomicroscopy.

The aim of the present study is to develop effective and understandable classification models for sex estimation and to identify the most dimorphic linear measurements in adult crania by means of data mining techniques. Furthermore, machine learning models and models developed through logistic regression analysis are compared in terms of performance. Computed tomography scans of 393 adult individuals were used in the study. A landmark-based approach was applied to collect the metric data. The three-dimensional coordinates of 47 landmarks were acquired and used for calculation of linear measurements. Two datasets of cranial measurements were assembled, including 37 standard measurements and 1081 interlandmark distances, respectively. Three data mining algorithms were applied: the rule induction algorithms JRIP and Ridor, and the decision tree algorithm J48. Two advanced attribute selection methods (Weka BestFirst and Weka GeneticSearch) were also used. The best accuracy result (91.9 %) was achieved by a set of rules learnt by the JRIP algorithm from the dataset constructed by application of the GeneticSearch selection algorithm to the dataset of standard cranial measurements. The set consisted of five rules including seven cranial measurements. Its accuracy was even better than the classification rates achieved by the logistic regression models. Concerning the second dataset of nonstandard measurements, the best accuracy (88.3 %) was obtained by using classification models learnt by two algorithms – JRIP with a dataset preprocessed by the BestFirst selection algorithm and Ridor with preprocessing by the GeneticSearch selection algorithm. Our experiments show that for the two datasets mentioned above the rule-based models contain smaller sets of rules with shorter lists of measurements and achieve better classification accuracy results in comparison with decision tree-based models.

Introduction: Female genital mutilation or cutting (FGM/C) is a public health problem. Approximately three million women and girls undergo FGM/C every year, worldwide. The purpose of the study was to assess the influence of education on hegemonic masculinity attitudes between male and female students and whether parental education differentiated the groups. Method: A cross-section design was used. Data were collected through a survey response from 338 students in May 2017. The data were analyzed using chi-square and correlational tests. Results: Education did not change the attitudes of students toward FGM/C (χ2= 3.64, p = .16); however, parental education had an influence on both male and female students’ attitudes toward FGM/C. Discussion: The study suggests that education alone may not be sufficient to end FGM/C practice. A comprehensive community-led strategy incorporating culturally congruent health care to involve multiple parties of health professionals, religious leaders, government, and policy makers may be needed to address the problem.

This study aimed to investigate the frequency of squamous suture (SqS) obliteration, to estimate the involvement of the major calvarial sutures and those surrounding the temporal squama, and to inspect the neuro- and basicranium for deformities. A series of 211 dry skulls of contemporary adult males were macroscopically observed. The skulls with closed SqS were scanned using an industrial µCT system. Digital morphometry of the skulls with obliterated SqS was performed by recording the 3D coordinates of anatomic landmarks and calculation of linear distances, angles and indices. Obliteration of SqS was observed in 3 (1.42%) skulls. One skull showed bilateral SqS obliteration. The other two cases were unilateral, one right-sided and one left-sided. SqS obliteration seems to be co-ordinated with the closure of the parietomastoid suture, partially related to the closure of the occipitomastoid, sphenoparietal and sphenofrontal sutures, and independent from the closure of the sphenosquamosal suture and the major calvarial sutures. No severe disproportions in the skull configuration were observed in the three investigated cases. The major differences in the complimentary hemicrania concern the parietal and occipital parts of the skull vault. Dorsum sellae erosion, an indicator for raised intracranial pressure, was observed in all three cases.

Background: The aim of the study is to measure the facial soft tissue thicknesses (STTs) in Bulgarians, to evaluate the relation of the STTs to the nutritional status, sex and bilateral asymmetry, and to examine the correlations between the separate STTs as well as between the STTs and body weight, height, and body mass index (BMI). In the present study, the facial STTs were measured on computed tomography scans of the head of Bulgarian adults. Materials and methods: The STTs were measured at 7 midline and 9 bilateral landmarks. The measurements were performed in the free software InVesalius in the axial and sagittal planes. The mean, standard deviation, minimum and maximum values, median and coefficient of variation were reported for the STT at each landmark according to the sex and BMI category. The BMI, sex and bilateral differences were assessed for statistical significance. Pearson correlation analysis was applied to assess the strength and direction of the relationships between the STTs and body height, weight and BMI, as well as between separate STTs. Results and Conclusions: The facial soft tissues in Bulgarian adults changed in accordance with the nutritional status of the individual and in both sexes all STTs augmented with the increasing BMI. For both normal and overweight BMI categories, males had more soft tissue at the majority of facial points than females, as the only exceptions were observed in the cheek zone, where STTs were thicker in females. Significant bilateral differences were observed in either sex and BMI category. Stronger correlations were established for the STTs in the jaw region and between the cheek and jaw soft tissues. Besides, the correlations between the homologous bilateral landmarks were among the strongest ones.

BACKGROUND A bifid mandibular condyle (BMC) is a rare anatomical variation with an etiology not fully understood. Although there are numerous case reports regarding it, purposeful epidemiological investigations on the BMC frequency among different groups are scarce. This study aims to investigate the incidence and laterality of BMC among series of adult males from Bulgaria and perform a morphometric analysis of it. MATERIALS AND METHODS A series of 500 dry intact mandibles from adult males was investigated. The condyles were macroscopically observed and when skulls were available, the corresponding mandibular fossae were also inspected. In the cases when bifid condyles were found, 27 measurements were taken. RESULTS Bifid mandibular condyle was observed in 4 (0.8%) mandibles. All of the cases were unilateral, 2 on the right side (0.4%) and 2 on the left (0.4%). The condyles were divided into medial and lateral heads by a sagittal fissure or a notch. CONCLUSION The established frequency of BMC was comparable with those reported in Turkish and Korean populations. The lack of injury marks and traces implies a developmental etiology of this condition.

Gender is a critical component of HIV and sexual risk interventions. Examining the range, effectiveness and methodological rigor of studies that include a gender based component can inform current interventions and future directions for intervention research. This review investigated gender informed intervention studies conducted in sub-Saharan Africa that measured an outcome related to HIV. We reviewed 311 articles, 41 of which met our inclusion criteria, resulting in 11 articles that described eight different studies used in the analyses. The findings demonstrated wide variations in the types of interventions from low intensity educational content to multi-component interventions. Study outcomes were categorized into biological outcomes, HIV risk, behavioral, violence and risk reduction. Most interventions showed positive effects, and although research methodologies varied considerably, longer interventions appeared to be more effective. More research, however, is needed to build the evidence base for effectiveness of gender-based programs in reducing HIV infections in sub-Saharan Africa.

In comparative and evolutionary aspects in humans, the middle meningeal artery enters the cranium through the foramen spinosum, whereas in great apes the middle meningeal artery can enter the cranium through foramen spinosum, through foramen ovale or through petrosphenoid fissure. Generally, in nonhuman primates the anterior meningeal system is associated with the ophthalmic branch of the internal carotid artery. The vessels joining the two systems pass through the additional channels: the superior orbital fissure or through the cranio-orbital foramen. In anatomically modern humans, the absence of foramen spinosum involves abnormal development and course of the middle meningeal artery and it is usually accompanied with replacement of the conventional middle meningeal artery with such, arising from the ophthalmic artery system. In these cases the middle meningeal artery most often enters the middle cranial fossa through the superior orbital fissure and rarely through the meningo-orbital foramen. All skulls, investigated in the present study, belonged to adult individuals of both sexes, conditionally grouped into three cranial series--contemporary male, medieval male, and medieval female series. The absence of foramen spinosum was established only among the medieval male and female series--in 1 (0.70%) male and in 1 (0.72%) female skull on the right side and in 3 (2.13%) female skulls on the left side. In 1 (0.72%) female skull, a small atypically located foramen spinosum was established on the right side. In all of the described cases, the intracranial meningeal grooves started from the lateral edge of the superior orbital fissure and probably reflect the ophthalmic origin of the middle meningeal artery.

The mylohyoid bridging is a hyperostotic variation representing formation of bony bridges over the mylohyoid groove. The goals of this study were to establish the frequency of mylohyoid bridging in contemporary and medieval series from Bulgaria and to examine the changes in the prevalence through time, to assess and compare the different types of mylohyoid bridging, to establish the patterns of distribution with respect to laterality, sex and age and to accomplish a morphometric analysis. Materials and methods: The study was performed on a total of 448 intact dry mandibles of adult individuals from both sexes, grouped into contemporary male, medieval male and medieval female series from Bulgaria. The individuals in the series were distributed into two age cohorts: between 20-40 years old and above 40 years. Мacroscopic, metric and statistical analyses were performed. Results and Conclusions: The frequency of the mylohyoid bridging was 10.99% (21 out of 191 mandibles) for the contemporary male series, 9.45% (12 out of 127) for the male series and 7.69% (10 out of 130) for the medieval female series. The comparison between both male series indicated slightly increasing of the mylohyoid bridging with time. No significant bilateral and sex differences in the frequency and pattern of distribution of the mylohyoid bridging were established. The most common type of bridging was the distal one. The dependence of the mylohyoid bridging on the aging is controversial since in the female series its frequency was significantly higher in the individuals over 40 years, while in both male series it did not differ considerably between the age groups. The metric analysis did not show significant differences between the male series. However, the sexual differences were noteworthy with respect to the whole length of the mylohyoid groove and the distance between the bridge and the distal point of the mylohyoid groove. Furthermore, the considerable differences between the metric characteristics of lingular and distal type showed that this approach is useful and could be applied for precise differentiation of the mylohyoid bridging types. During the investigation, we also observed several cases of an accessory groove in the region of the mylohyoid groove. This additional groove most probably reflects variations in the branching patterns of the inferior alveolar nerve and/or mylohyoid nerve and could be of importance in oral surgery and dental practice.

The level and distribution of patient waiting times for elective treatment are a major concern in publicly funded health care systems. Strict targets, which have specified maximum waiting times, have been introduced in the NHS over the last decade and have been criticised for distorting existing clinical priorities in scheduling hospital treatment. We demonstrate the usefulness of conditional density estimation (CDE) in the evaluation of the reform using data for Scotland for 2002 and 2007. We develop a modified goodness of fit test to discriminate between models with different numbers of bins. We document a change in prioritisation between different patient groups with longer waiting patients benefiting at the expense of those who previously waited less. Our results contribute to understanding the response of publicly funded health systems to enforced targets for maximum waiting times.

Wormian bones, also known as intrasutural bones, are present as an anatomical variation in healthy individuals. However, a higher than the usual incidence can be an important feature of some congenital pathological conditions. In this study we describe a case of an adult cranium with multiple Wormian bones. The cranium was a single sample obtained from an archaeological excavation in Vinitsa, Northeastern Bulgaria, and probably dated in the Chalcolithic. The Chalcolithic is a period of human history connected with discovering and using of copper. Actually, it is a transitional phase between the Neolithic and the Bronze Age. In this case the Wormian bones are mostly large in size and arranged in a mosaic pattern in several cranial regions. The cranium also shows features such as dolichocrany, a moderate platybasia, a notch in the posterior margin of the foramen magnum, hypoplastic and asymmetrical frontal sinuses, underdeveloped mastoid air cells, hyperostosis cranii interna, moderate frontal bossing, a complete metopic suture, a delayed sutural closure, relatively small facial bones, an early loss of teeth, dental caries and hypoplastic enamel defects on two preserved molars. Differential diagnosis indicates that the combination of all these features shows a link with pathological conditions involving dysplasias with prominent membranous bone involvement and an increased bone density such as cleidocranial dysplasia and pyknodysostosis.

Background In low and high income countries alike, disability exacerbates social, economic, and health disparities, in spite of their differences. Objective This study seeks to identify factors that predict the circumstances people with disabilities face, including poverty. Methods A cross-sectional study design was employed using census track level data for the cities of Monterrey, Nuevo Leon, and Dallas, Texas, from Mexico 2010 and USA 2000 census data collections. Two methods, spatial autocorrelation and geographically weighted regression were used to identify spatial patterns of disability and to explore the relation between disability and context-specific socio-demographic factors. Results Results indicated that people with disabilities living below the poverty line experience high segregation levels in the semi-central zones of Dallas. In Monterrey, people with disabilities clustered in central areas of the city. A Geographically Weighted Regression (GWR) from both data analyses reported high goodness of fit (R ≥ 0.8 for Dallas data and R ≥ 0.7 for Monterrey data, respectively) and predictability of disability prevalence when social disadvantage factors such as unemployment, housing insecurity, household living conditions, and lack of education were present. Conclusions The divergent and sometimes conflicting trends in practices and policies addressing disability in low and high income environments renders a reexamination of the framework of disability. An understanding of local characteristics joins a grounded socio-cultural understanding of the various contexts that shape location-based social networks and political decisions in providing such an analysis.

>> Summary Background: Gender is a critical concept of human immunodeficiency virus (HIV) sexual risk; yet, few studies have examined the intersection between risk and protective factors associated with incidence of HIV among couples. The paper examines gender-specific constructs of resiliency among couples in Kenya. Methods: Using data from the Demographic and Health Surveys, Kenya (2008/2009), we apply logistic regression techniques to analyse three resilience-related outcomes (condom use, HIV test and knowing an HIV test place) in estimating the gender differences and barriers to HIV/AIDS sexual risk. Results: Men outcomes were significantly associated with previous HIV testing, urban residence, being insured and higher levels of education. Predictors for women indicators included previous experience of sexual violence, previous HIV test, urban residence, number of children and willingness to care for a relative with AIDS. Conclusions: Practical implications are discussed to include providing protective factors to women and formulating policies that minimise the challenges faced by women.