Replicating File Segments between Multi-Cloud Nodes in a Smart City: A Machine Learning Approach.

The design and management of smart cities and the IoT is a multidimensional problem. One of those dimensions is cloud and edge computing management. Due to the complexity of the problem, resource sharing is one of the vital and major components that when enhanced, the performance of the whole system is enhanced. Research in data access and storage in multi-clouds and edge servers can broadly be classified to data centers and computational centers. The main aim of data centers is to provide services for accessing, sharing and modifying large databases. On the other hand, the aim of computational centers is to provide services for sharing resources. Present and future distributed applications need to deal with very large multi-petabyte datasets and increasing numbers of associated users and resources. The emergence of IoT-based, multi-cloud systems as a potential solution for large computational and data management problems has initiated significant research activity in the area. Due to the considerable increase in data production and data sharing within scientific communities, the need for improvements in data access and data availability cannot be overlooked. It can be argued that the current approaches of large dataset management do not solve all problems associated with big data and large datasets. The heterogeneity and veracity of big data require careful management. One of the issues for managing big data in a multi-cloud system is the scalability and expendability of the system under consideration. Data replication ensures server load balancing, data availability and improved data access time. The proposed model minimises the cost of data services through minimising a cost function that takes storage cost, host access cost and communication cost into consideration. The relative weights between different components is learned through history and it is different from a cloud to another. The model ensures that data are replicated in a way that increases availability while at the same time decreasing the overall cost of data storage and access time. Using the proposed model avoids the overheads of the traditional full replication techniques. The proposed model is mathematically proven to be sound and valid.

The impact of informality and institutional quality on environmental footprint: The case of emerging economies in a comparative approach.

The endeavor to implement the 2030 Agenda of national and international stakeholders became increasingly impetuous, considering the wide range of uncertainties and risks. The new humans-centered development model built on the prominence of environmental and social values seeks to reinforce communities' resilience and mitigate environmental risks, leaving no one behind. For this to happen, solid and effective institutions, the right environmental policies, and a safe statutory labor framework are the sine qua non. In this study, we evaluated the effects of informality, institutional quality, and renewable energy consumption on ecological footprint of two groups of emerging countries from Europe and Asia from 2002 to 2018. Our results by PMG-ARDL approach highlight dissimilarities between the two groups, showing greater heterogeneity. In this sense, informality is found to have positive and significant effects on ecological footprint in the long run in emerging European countries. In contrast, the effect is negative for emerging Asian countries. In the short run, the effects are less critical in the studied countries between the two groups. Institutional quality variables impacted environmental quality differently. In this sense, it is detrimental for policymakers to consider concerted measures to decrease institutional vulnerabilities and reduce the level of the informal economy. The outcome of this study concurs with a complete awareness of the importance of informality and institutional quality to mitigate social and environmental risks conjunctively.

Aniline blue test for sperm protamination-a valuable add-on to the bull breeding soundness evaluation.

Bull breeding soundness evaluation (BBSE) is the most common procedure used to predict bull potential fertility. However, the use of traditional methods for semen evaluation can affect its reliability. The inclusion of additional advanced test in BBSE may increase its accuracy. This study aimed to investigate the correlation between the degree of sperm protamination and BBSE main parameters of scrotal circumference (SC), progressive motility (PM), morphologically normal sperm (NS), and different categories of morphological defects. In addition, to determine the correlation between the three methods used for protamine assessment, five Brangus bulls were subjected to the BBSE. Semen samples were collected via electro-ejaculation and evaluated using traditional methods. Three different methods were used to determine the degree of sperm protamination: aniline blue (AB) staining, chromomycin A3 staining with fluorescent microscope (CMA3-FLM), and CMA3 with flow cytometry (CMA3-FCM). Sperm protamine deficiency assessed using the three methods exhibited significant differences among bulls according to their classification by BBSE, and showed significant negative correlation with semen quality parameters of NS and PM. A significant positive correlation was found between AB positivity and morphological abnormalities. The three methods used for protamine assessment also revealed significant positive correlations. Among the three tests, AB staining was the cheapest and easiest test that offers an objective assessment method for sperm protamination. Hence, it can be concluded that the assessment of protamination using AB staining test might serve as an additional valuable parameter or a replacement whenever detail sperm motility and morphology analyses in conducting BBSE to predict bull fertility are not possible.

Satisfactory breeding potential is transiently eliminated in beef bulls with clinical anaplasmosis.

BACKGROUND: Natural service breeding is common in U.S. cow-calf operations. Diseases impacting bull reproductive performance have significant economic consequences for producers. Anaplasmosis may be an underappreciated cause of poor reproductive performance in bulls. The primary systemic effects of bovine anaplasmosis including anemia, fever, and weight loss, can all result in unsatisfactory reproductive performance. The objective of this pilot study was to evaluate breeding soundness examination (BSE) outcomes and clinical changes in bulls during and upon resolution of clinical anaplasmosis. Anaplasma marginale-challenged bulls were observed for clinical disease and infection progression and changes in breeding soundness compared to uninfected control bulls for 16 weeks. RESULTS: All Anaplasma marginale-challenged bulls were PCR-positive, seropositive, and showed clinical signs by 3-, 17-, and 24-days post-challenge, respectively. Clinical signs of anaplasmosis included pallor, icterus, fever (≥ 40.2 °C), and weight loss. Acute anemia was observed in all challenged bulls with PCV nadirs ≤ 18% and peak percent parasitized erythrocyte ≥ 50%. Decreased scrotal circumference and poor semen quality (e.g., increased percentage of abnormal spermatozoa, decreased progressively motile sperm), were initially observed within days after onset of clinical anaplasmosis signs and continued weeks beyond disease resolution. Control bulls remained negative for A. marginale. CONCLUSION: This pilot study demonstrates that clinical anaplasmosis reduces breeding soundness in beef bulls. Anaplasmosis should be considered as a differential for bulls with decreased semen quality, especially within endemic areas. A 90 day or greater retest window is recommended for bulls of unsatisfactory breeding potential recently recovered from clinical anaplasmosis.

Ageing affects plasma steroid concentrations and testicular volume, echotexture and haemodynamics in rams.

The objective was to determine the effect of ageing on plasma steroid concentrations and testicular volume, echotexture and haemodynamics in Ossimi rams. Twenty-four rams were allocated, by age, into three groups: young (1 year; 32.00 ± 0.78 kg, n = 6); mature (2.5 years; 48.00 ± 1.02 kg, n = 9) and aged (7.5 years; 65.00 ± 1.10 kg, n = 9). Aged rams had the highest (p Ë‚ 0.05) plasma testosterone concentrations 3.90 ± 0.75 ng/ml (three-fold the other groups), whereas in young rams, plasma estradiol-17ß concentrations (5.85 ± 0.34 pg/ml) were approximately one-quarter (p Ë‚ 0.05) of other groups. Regarding pulsed-wave Doppler indices values of the (resistive index RI; and pulsatility index PI) were lower (p Ë‚ 0.05) in the mature (0.32 ± 0.04 and 0.36 ± 0.03, respectively) and aged (0.51 ± 0.03 and 0.77 ± 0.06) rams compared to young rams (0.62 ± 0.03 and 0.98 ± 0.07). In the young group, testicular pixel intensity was highest (p Ë‚ 0.05) but values of coloured area/pixels were lowest (p Ë‚ 0.05) compared to the other groups. In conclusion, these parameters indicate that aged rams (7.5 years) are likely to be suitable for breeding ahead of the younger aged groups (1 and 2.5 years) examined, but a final decision would need to be tempered by consideration of other parameters in the breeding soundness examination (BSE), such as physical soundness and semen characteristics. Of the parameters studied, testicular pixel intensity could be most readily incorporated in a BSE for deciding a ram's breeding efficiency.

Breeding soundness examination (BSE): a decision-making tool that requires a particular guideline for male goats.

Breeding soundness examination (BSE) is a common evaluation to predict the reproductive ability of male livestock. The generated guideline for BSE is specified for each animal species to enhance the performance of BSE. However, there is no particular BSE guideline for bucks yet; then, the BSE guidelines for ram and bull are commonly used for bucks. This investigation was conducted to determine the main BSE characteristics and the appropriate age range for assessment in Boer goats. For this purpose, semen was collected using electro-ejaculation, and seminogram variables (semen-BSE traits) were evaluated using conventional methods. The association between common testicular biometric variables (TBVs) and semen-BSE traits were assessed using Pearson's correlation coefficients and multiple linear regression. Logistic regression was used to test the validity of TBVs for the BSE of Boer goats. In this study, a strange appearance of the head of sperm, known as "rod-in-head" (RIH), was observed. The results showed that the appropriate age range for performing BSE in bucks is 12-30 months. Moreover, scrotal length in the range of 10-15.9 cm was the eligible TBV to be used as a predictor for semen-BSE traits. It was suggested that developing a BSE guideline for bucks is necessary for unbiased selection in performing BSE.

Topological graph description of multicellular dynamics based on vertex model.

Vertex models are generally powerful tools for exploring biological insights into multicellular dynamics. In these models, a multicellular structure is represented by a network, which is dynamically rearranged using topological operations. Remarkably, the topological dynamics of the network are important in guaranteeing the results from the models and their biological implications. However, it remains unclear whether the entire pattern of multicellular topological dynamics can be accurately expressed by a set of operators in the models. Surprisingly, vertex models have been empirically used for several decades without any mathematical verification. In this study, we propose a rigorous two-/three-dimensional (2D/3D) vertex model to describe multicellular topological dynamics. To do this, we classify several types of vertex models from a graph-theoretic perspective. Based on the classification, mathematical analyses reveal several conditions that enable us to apply the operators accurately without topological errors. Under these conditions, the operators can completely express the entire pattern of multicellular topological dynamics. From these results, we newly propose rigorous 2D/3D vertex models that can be applied to general multicellular dynamics, and we clarify several points to verify the results obtained from previous models.

The use of ultrasonography in the reproductive evaluation of boars.

The objective was to study the use of ultrasound as a complementary test in the breeding soundness evaluation in male pigs and study the pattern of echogenicity of the testicular parenchyma in boars of different racial groups. Twenty-six adult boars from four different racial groups were used, 10 from the Piau breed (group 1), four from the commercial and finishing group (group 2), six Pietrain breed (group 3) and six from the Duroc breed (group 4). All animals were evaluated for breeding soundness evaluation and the ultrasound examination of the testicles. The groups of animals that were evaluated showed no difference in the main semen parameters that were evaluated, except for the sperm volume, concentration of the ejaculated sperm and the supravital staining; the lowest figures were for the animals from the Piau breed (group 1). In relation to the testicular biometrics, Duroc animals (group 4) had a greater scrotal width compared to the other groups. But when we assessed the intensity of pixels of the testicles, there was a difference between groups. The groups 2 (finishing animals), 3 (Pietrain) and 4 had no difference between themselves. Group 3 had greater pixel intensity in relation to group 1. Of the 26 animals studied, five showed an abnormality during ultrasound evaluation, like hydrocele, hyperechoic mass in the testicular parenchyma, cyst in the head of the epididymis and the presence of fluid in the head and tail of the epididymis. The various animal groups studied did not differ in the principal reproductive parameters evaluated, showing that despite the great variability of reproductive traits between breeds and within the same breed, the breeding soundness evaluation, the more complete it is, is essential for the selection of breeders and the ultrasonography of the reproductive system becomes an important addition in this examination.

An Edge Computing Based Smart Healthcare Framework for Resource Management.

The revolution in information technologies, and the spread of the Internet of Things (IoT) and smart city industrial systems, have fostered widespread use of smart systems. As a complex, 24/7 service, healthcare requires efficient and reliable follow-up on daily operations, service and resources. Cloud and edge computing are essential for smart and efficient healthcare systems in smart cities. Emergency departments (ED) are real-time systems with complex dynamic behavior, and they require tailored techniques to model, simulate and optimize system resources and service flow. ED issues are mainly due to resource shortage and resource assignment efficiency. In this paper, we propose a resource preservation net (RPN) framework using Petri net, integrated with custom cloud and edge computing suitable for ED systems. The proposed framework is designed to model non-consumable resources and is theoretically described and validated. RPN is applicable to a real-life scenario where key performance indicators such as patient length of stay (LoS), resource utilization rate and average patient waiting time are modeled and optimized. As the system must be reliable, efficient and secure, the use of cloud and edge computing is critical. The proposed framework is simulated, which highlights significant improvements in LoS, resource utilization and patient waiting time.

An assessment of dairy herd bulls in southern Australia: 2. Analysis of bull- and herd-level risk factors and their associations with pre- and postmating breeding soundness results.

In pasture-based, seasonally calving dairy herds of southern Australia, the mating period usually consists of an initial artificial insemination period followed by a period of natural service using herd bulls. The primary objective of this study was to identify associations between individual bull- and herd-level management factors and bull fertility as measured by a pre- and postmating bull breeding soundness evaluation (BBSE). Multivariable mixed effects logistic regression models were used to identify factors associated with bulls being classified as high risk of reduced fertility at the premating and postmating BBSE. Bulls older than 4 yr of age at the premating BBSE were more likely to be classified high risk compared with bulls less than 4 yr of age. Bulls that were in herds in which concentrates were fed before mating were more likely to be classified as high risk at the postmating BBSE compared with bulls that were in herds where concentrates were not fed. Univariable analyses also identified areas in need of further research, including breed differences between dairy bulls, leg conformation and joint abnormalities, preventative hoof blocking for bulls, and mating ratios.

An assessment of dairy herd bulls in southern Australia: 1. Management practices and bull breeding soundness evaluations.

In the pasture-based, seasonally calving dairy herds of southern Australia, the mating period usually consists of an initial artificial insemination period followed by a period of natural service using herd bulls. Bull breeding soundness evaluations (BBSE) were performed on 256 bulls from 32 dairy herds in southwest Victoria, using guidelines produced by the Australian Cattle Veterinarians, before and immediately after a single natural mating period. At the same time, herd managers were questioned regarding the management of the bulls. The objectives of this study were to describe the management practices of dairy herd bulls; to describe the causes of increased risk of reduced fertility in dairy herd bulls, as measured by a standard BBSE; and to describe the reasons for bull removal by herd managers during mating. At the premating BBSE, 19.5% of bulls were classified as high risk of reduced fertility, mostly due to physical abnormalities and reduced semen quality. At the postmating BBSE, 36.5% of bulls were classified as high risk of reduced fertility, mostly due to physical abnormalities, primarily lameness. Of the bulls used, 15.9% were removed from normal mating use by the herd manager, predominantly due to lameness and injuries. A premating BBSE is recommended in dairy herd bulls to identify bulls at risk of reduced fertility. Lameness is the most common problem in dairy herd bulls during the natural mating period, and risk factors associated with lameness in these bulls should be identified to better manage herd bulls.

Physical Evaluation of Beef Bulls.

Physical evaluation of beef bulls is important in determining their ability to be long-lived useful breeding animals. A basic examination should include an assessment of the bull's conformation, gait, and overall appearance. Skeletal soundness can be easily evaluated with well-formed feet and legs. Muscularity and reproductive soundness can be verified visually as should the head and mouth. Finally, attention should be paid to breed characteristics if it is a purebred bull. A bull must be able to walk, eat, and see to effectively function as a natural service sire in pasture, pens, or especially extensive range environments.

A Review on the Carbonation of Steel Slag: Properties, Mechanism, and Application.

Steel slag is a by-product of the steel industry and usually contains a high amount of f-CaO and f-MgO, which will result in serious soundness problems once used as a binding material and/or aggregates. To relieve this negative effect, carbonation treatment was believed to be one of the available and reliable methods. By carbonation treatment of steel slag, the phases of f-CaO and f-MgO can be effectively transformed into CaCO3 and MgCO3, respectively. This will not only reduce the expansive risk of steel slag to improve the utilization of steel slag further but also capture and store CO2 due to the mineralization process to reduce carbon emissions. In this study, based on the physical and chemical properties of steel slag, the carbonation mechanism, factors affecting the carbonation process, and the application of carbonated steel slag were reviewed. Eventually, the research challenge was also discussed.

The Bull Breeding Soundness Examination and Its Application in the Production Setting.

breeding soundness for several reasons and at several times during their life span. These include before sale for the reason of affirming their sale ability or before a breeding season to determine their readiness for breeding. Bulls may also be evaluated for diagnostic purposes. The breeding soundness examination (BSE) is universally promoted as an important management tool, but there continues to be a level of inconsistency in its performance. A complete bull BSE consists of a thorough physical examination including internal and external reproductive tract, measurement of the circumference of the scrotum and evaluation of individual sperm motility and morphology.

Theileria orientalis Ikeda infection does not negatively impact growth performance or breeding soundness exam results in young beef bulls at bull test stations.

Introduction: Theileria orientalis Ikeda genotype is an emerging cattle disease in the US. Since 2017, when T. orientalis Ikeda was discovered in beef cattle in two counties in Virginia, cattle infections have risen to include ~67% of Virginia counties and 14 states. Consistent with New Zealand studies, many infected herds in Virginia were >90% positive upon initial testing without overt evidence of infection. Central bull tests present a unique opportunity to study the effects of T. orientalis Ikeda infections, as bulls from multiple source herds are consolidated. The objective of this study was to determine if infection with T. orientalis Ikeda affected the average daily gain (ADG), adjusted yearling weight (AYW) and breeding soundness of bulls at two test stations in Virginia over a period of years. Materials and methods: The bulls were fed and housed similarly to compare their growth performance and breeding soundness. For T. orientalis Ikeda testing, DNA was extracted from whole blood for quantitative polymerase chain reaction. Results: The number of bulls infected with T. orientalis Ikeda at initial delivery to the stations increased significantly over the years studied. Multivariable linear regression models, using Angus bulls from Virginia test stations, indicated no significant effect on ADG or AYW in bulls that became test positive during the test or were positive for the duration, compared to Angus bulls that were negative for the duration. At LOC A, the odds of passing a breeding soundness exam (BSE) were not significantly different for bulls that turned positive during the test or were positive for the duration, compared to bulls that were negative for the duration of the test. At LOC B, bulls that became positive during the test were 2.4 times more likely (95% CI: 1.165-4.995, p = 0.016) to pass their BSE compared to bulls that remained negative throughout the test. Discussion: We do not suppose that an obscured infection of T. orientalis Ikeda is protective for bulls to pass a BSE. However, this study demonstrates an obscured infection of T. orientalis Ikeda does not negatively affect weight gain or achievement of a satisfactory BSE rating at the central bull test stations in Virginia.

Short Communication: changes in gait after 12 wk of shoeing in previously barefoot horses.

Farriery can impact gait symmetry and lameness outcomes, but there is limited scientific data documenting these effects. We hypothesized that shoeing previously barefoot horses with plain stamp shoes on the hind hooves would increase gait symmetry, alter hock angles and increase range of motion, and improve lameness scores more than shoeing with traditional fullered shoes. At the start of the study, gait symmetry via wireless inertial motion sensors (IMS), kinematic gait analysis (hock angle and range of motion), and American Association for Equine Practitioner's (AAEP) lameness scoring were completed for 14 barefoot horses. Horses were then trimmed and hind hooves were shod (wk 0) in three-quarter fullered shoes or plain stamp style shoes. Horses were trimmed and re-shod at week 6. At the end of 12 wk, the IMS analysis, kinematic gait analysis, and lameness scoring were repeated. Differences between shod and barefoot values were calculated for each horse, and impact of shoe type was analyzed via t-test. Significance was determined at P ≤ 0.05. No differences were observed in the IMS scores, hock angles or range of motion, or AAEP lameness scores between horses shod in fullered or plain stamp shoes (P ≥ 0.08). As no variables were determined to be significantly different between the two shoe types, data from all horses were combined to analyze the differences between the barefoot and shod state. Shoeing increased the maximum angle of the right and left hocks (P ≤ 0.03) and the minimum angle of the left (P = 0.02) but not right hock (P = 0.23) relative to barefoot conditions. No differences in hock range of motion were observed in either hock. Lower AAEP lameness scores were observed in horses when shod compared with barefoot (P = 0.001). In conclusion, shoeing previously barefoot horses improved AAEP lameness scores and increased hock angles, regardless of the type of shoe.

Horses are athletic animals whose quality of movement affects their ability to perform. Management of hooves can influence gait symmetry. Shoeing horses is an accepted standard of care for athletic animals. Here, we show that shoeing previously barefoot horses using industry accepted farriery protocols increased maximum hock angles at the trot and reduced lameness scores.

Semen Quality of the First and Second Ejaculates Collected from Breeding Inactive Stallions after Cooling and Freezing.

This study aimed to assess the semen quality after the cooling and freezing of the first and second ejaculates of the season, which were collected 1 h apart. After collection (n = 40 ejaculates), the gel-free semen volume, concentration, total number of sperm, and sperm morphology were determined. An aliquot of each ejaculate was extended and cooled for 48 h; a second aliquot was cushion-centrifuged and cooled for 48 h; and a third aliquot was processed and then frozen. The total motility (TM) and progressive motility (PM), plasma membrane integrity (PMI), and high mitochondrial membrane potential (HMMP) were assessed pre-(0 h), 24 h, and 48 h post-cooling and before and after freezing. The second ejaculate had a lower gel-free semen volume (p = 0.026). The sperm concentration was greater in the first than in the second ejaculate (p < 0.001). The sperm morphology was similar between the ejaculates (p > 0.05). Cushion-centrifugation prevented a reduction in the TM, PM, and PMI over time (p < 0.05). The TM, PM, and PMI decreased after freezing but not between the ejaculates (p > 0.05). The first and second ejaculates of the season, which were collected 1 h apart, varied in quantity but not in quality after cooling and freezing.

Characterizing Foot and Leg Scores for Montana's Registered Angus Cattle.

The objective of this study was to characterize foot angle and claw set scores of Montana's (USA) registered Angus cattle using a total of 4723 cattle scored: 1475 yearling bulls, 992 yearling heifers, 1044 2- and 3-year-old cows, and 1212 cows ≥ 4 years old. Yearling bulls had a 0.12 and 0.20 greater mean foot angle and claw set score, respectively, compared to yearling heifers (p < 0.01). Foot angle and claw set scores increased (p < 0.01) with advancing cow age. The combined worst foot changed quadratically with age (p < 0.01) with the majority of problem feet in cows aged 2 to 3 years and older being hind feet issues. The proportion of foot angle and claw set scores not equal to 5 increased quadratically with age (p < 0.01), with heifers having the lowest proportion of scores not equal to 5 (15.8 and 31.7%, respectively) compared to cows aged 4 years and older. Sire lines had an effect on progeny claw set (p < 0.05) and foot angle scores (p < 0.05), as well as variation of progeny foot scores. These data could potentially be used to refine expected progeny difference models.

Does Size Matter? Testicular Volume and Its Predictive Ability of Sperm Production in Rams.

Over the years, testicular volume has been used to evaluate the reproductive capacity of rams and the effects of different factors related to reproductive performance. The aim of this study was to determine the most suitable tool and formula to calculate testicular volume under field conditions to guarantee a more accurate determination of sperm production. First, testicles from 25 rams (n = 50) were measured in vivo and postmortem using calipers and ultrasonography during the breeding season (BS). The accurate testicular volume (ATV) was calculated through water displacement. In addition, the sexual status of donor rams was evaluated during a period of four years in a reproduction center, and the three most crucial groups in terms of genetic value and seminal collections were studied in the second part of this experiment: ER-NBS (Elite rams during the non-breeding season), ER-BS-S (Elite rams with a standard frequency of seminal collection), and ER-BS-O (Elite rams with a high frequency of seminal collection). The total testicular volume (TTV), testosterone (T), and total spermatozoa obtained from two consecutive ejaculates in the same day (SPERM) were measured, and the relationship between SPERM and TTV and T was analyzed to predict SPERM. Although all published formulas revealed statistically significant differences (p ≤ 0.05) from the ATV, our proposed formula (ItraULE) (Testicular volume = L × W × D × 0.61) did not show significant differences. In the second part of the study, in the ER as a model donor ram for its high genetic value and high demand from farmers, TTV and T showed strong positive correlations with SPERM (r = 0.587, p = 0.007 NBS; r = 0.684, p = 0.001 BS-S; r = 0.773, p < 0.0001 BS-O). Moreover, formulas were established to predict SPERM in these practical scenarios. In conclusion, the use of ultrasonography and a new formula adapted to rams could improve the prediction of SPERM considering crucial factors such as season and semen collection frequency.

Diagnostic tests in canine andrology - What do they really tell us about fertility?

Dog breeders often require breeding soundness evaluations which include andrological examinations of the genital organs, hormone measurements, and semen analyses. During the past decades, a considerable number of research results have been published, allowing diagnoses of specific andrological conditions and fertility assessment. For specific examinations, however, no standard procedures have been defined and for some parameters different reference ranges have been published. Therefore, examination results from different facilities are difficult to compare and profound conclusions regarding health and fertility of a male dog are not always possible. Conventional semen examination, however, is still useful in identifying deviations or no deviations from normality, especially if confounding factors are taken into account and if the exam is repeated in case of inconclusive findings. A standardization of examination procedures and reference ranges would help to harmonize the exchange of examination results and interpretation of the findings.