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Patients with the dual burden of chronic kidney disease (CKD) and cardiovascular disease (CVD) experience unacceptably high rates of morbidity and mortality, which also entail unfavorable effects on healthcare systems. Currently, concerted efforts to identify, prevent and treat CVD in CKD patients are lacking at the institutional level, with emphasis still being placed on individual specialty views on this topic. The authors of this position paper endorse the need for a dedicated interdisciplinary team of subspecialists in cardio-nephrology that manages appropriate clinical interventions across the inpatient and outpatient settings. There is a critical need for training programs, guidelines and best clinical practice models, and research funding from nephrology, cardiology and other professional societies, to support the development of the subspecialty of cardio-nephrology. This position paper from the coordinating committee from the Working Group for Cardiorenal Medicine of the Spanish Society of Nephrology (S.E.N.) is intended to be the starting point to develop the subspecialty of cardio-nephrology within the S.E.N.. The implementation of the subspecialty in day-to-day nephrological practice will help to diagnose, treat, and prevent CVD in CKD patients in a precise, clinically effective, and health cost-favorable manner. Resumen: Los pacientes con enfermedad renal crónica (ERC) que presentan enfermedad cardiovascular (ECV) tienen índices de morbilidad y mortalidad inaceptablemente elevados, que impactan desfavorablemente sobre los sistemas de salud. En la actualidad, se requieren actuaciones multidisciplinares para identificar, prevenir y tratar la ECV en los pacientes con ERC, debiendo pues superarse la época de las actuaciones de las especialidades individuales. Los autores de este artículo respaldan la necesidad de un equipo interdisciplinar de subespecialistas en cardionefrología que gestione las intervenciones clínicas adecuadas en el entorno hospitalario y en el ambulatorio. Existe una gran necesidad de programas de formación, de guías y modelos de práctica clínica, y de fondos para la investigación en las sociedades de nefrología, cardiología y otras, para apoyar el desarrollo de la subespecialidad de cardio-nefrología. Este documento de opinión del comité coordinador del Grupo de Trabajo de Medicina Cardiorenal de la Sociedad Española de Nefrología (S.E.N.) pretende ser el inicio del desarrollo de la subespecialidad de Cardionefrología en el marco de la S.E.N. La implementación de la subespecialidad en la práctica nefrológica diaria contribuirá a diagnosticar, tratar y prevenir la ECV en los pacientes con ERC de una manera precisa, clínicamente efectiva y sanitariamente rentable.

Although considered one of the major energy-intensive industries (EIIs), the pulp and paper industry has also the potential for energy production from an industrial waste, black liquor. This study proposes black liquor gasification (BLG) coupled with calcium looping (CaL) as a CO2 capture route for the pulp and paper industry. BLG with H2 production (BLG-CaL-H2), BLG with gas turbine combined cycle (BLG-CaL-GT) or with solid oxide fuel cell (BLG-CaL-SOFC) were considered. The dependence of carbon capture and storage (CCS) cost on the natural gas, limestone, electricity imported and H2 sale prices aside the expenditures related with BLG-CaL were evaluated. The CCS route, based on CaL retrofitted to the pulp and paper plant, was found to have a lower cost of CO2 avoided (39.0 €/tCO2) when compared with BLG-CaL (48.8–57.1 €/tCO2). Between the BLG-CaL scenarios, BLG-CaL-H2 presented the lowest cost of CO2 avoided (48.8 €/tCO2) but the highest energy penalty. Based on the thermodynamic performance, it was shown that CaL retrofit and BLG-CaL-SOFC presented the best overall performance, turning the electricity importer reference plant into electricity exporter. The economic sensitivity showed that the capital requirement of BLG-CaL has a strong effect on the cost of CO2 avoided for all alternatives. The H2 production is also strongly affected by the H2 sale price while BLG-CaL-SOFC and BLG-CaL-GT are strongly dependent on natural gas price.

This article aims to list environmental practices used by Latin American companies in the pulp and paper industry, to create a list, through a scientific method, that can direct other researchers and managers interested in the subject. The research strategies used were bibliographic research and content analysis. The content analysis used 36 sustainability reports published by Latin American companies in the industry between 2018 and 2019. Although 264 companies were mapped, only 36 of them presented sustainability report possible to be accessed. Through the sample of 36 sustainability reports, 36 sustainable environmental practices were identified that could be grouped into five groups, namely: (1) Reuse of waste, efficiency in the production process and effluents treatment; (2) Preservation and area recovery; (3) Energy efficiency; (4) Initiatives with stakeholders; (5) Control of gas emission. Despite the exploratory nature, the information presented here can be used by managers in the area and researchers interested in improving environmental practices of the pulp and paper industry.

This study's focus was to develop a potential pathway for recycling of the paper mill sludge compost (PMSC) in brick making. Composting reduces the paper mill sludge (PMS) moisture content considerably and shredding becomes easier. The addition of PMSC leads to an increase of porosities in bricks and makes them lighter, besides delivering energy to the firing process from burning organics. Lighter construction materials help minimize construction outlay by reducing labour and transportation costs and lesser expense on foundation construction. The variability in the experimental data and the brick properties were investigated for two types of soils, typical in the brick industry of India (alluvial and laterite soil), blended with PMSC in five mix ratios (0%, 5%, 10%, 15% and 20%). The samples of oven-dried bricks were fired at two different temperatures (850 and 900 °C) in an electrically operated muffle furnace representing typical conditions of a brick kiln. Various properties of bricks were analyzed which included linear shrinkage, bulk density, water absorption and compressive strength. Conclusions were drawn based on these properties. It was found that the addition of PMSC to the alluvial and laterite soil by up to 10% weight yield mechanical properties of fired bricks compliant with the relevant Indian and ASTM codes. Toxicity characteristic leaching procedure (TCLP) tests showed that PMSC incorporated fired bricks are safe to use in regular applications as non-load-bearing and infill walls. This study is timely in light of the European Green Deal putting focus on circular economy. Besides, it fulfills the objective of UN sustainable development goals (SDG). © 2021 Elsevier Ltd

Background: Proteins in the urine of women with preeclampsia (PE) bind Congo Red dye (urine congophilia). We sought to determine the diagnostic performance of a paper-based point-of-care test detecting urine congophilia for rapid triage and diagnosis of PE. Methods: Prospective cohort study conducted in 346 consecutive pregnant women evaluated for PE in the Labour and Delivery triage unit at our institution. The Congo Red Dot (CRD) Paper Test (index test) was performed on fresh urine samples. The CRD Paper Test results were compared to an expert adjudicated diagnosis in each case. The accuracy of the CRD Paper Test was also compared to urine and serum analytes (placental growth factor and soluble fms-like tyrosine kinase-1) previously proposed as diagnostic aids for PE. Findings: During the first triage visit, 32% (112/346) of women received a clinical diagnosis of PE. Yet, 63% (217/346) were admitted for in-patient diagnostic work-up or delivery. The CRD Paper Test was positive in 25% (86/346) of the cases. Adjudication confirmed PE in 28% (96/346) of all cases. The CRD Paper Test outperformed measured serum and urine markers (80·2% sensitivity, 89·2% specificity, 92·1% negative predictive value, 86·7% accuracy). The pre-test, positive and negative post-test probabilities were 27·7%, 74·0%, and 8·0%, respectively. Of women who were discharged undelivered, 38% (133/346) had at least one additional triage visit and the interval between the last negative and first positive CRD Paper Test was 12 (interquartile range, [5–34]) days. Interpretation: The CRD Paper Test is a simple, non-invasive, “sample-in/answer-out” point-of-care clinical tool for rapid identification of PE. Funding: Saving Lives at Birth Program and NICHD. Keywords: Preeclampsia, Cohort study, Congophilia, Misfolded proteins, Point-of-care

This work was supported by the research group "Ciencia y Cultura del Patrimonio"(HUM-1057) and the Ministerio de Economia y Competitividad in the framework of the I + D research project "Nuevas alternativas al conocimiento de los materiales y los procesos de conservacion y restauracion de obra grafica y patrimonio documental"(REF.MAT2014-58659-P). Funding for open access charge: Universidad de Granada/CBUA., This study offers a new tool to restorers to bleach paper documents: artificial light radiation (ALR). It is a controlled method that is an alternative to other highly aggressive procedures that have been applied to cellulose based media. Its main novelty is its intrinsic lighting characteristics which guarantee uniformity and avoid heating the paper. The results of testing this new tool were compared to those of bleaching with hydrogen peroxide (H2O2). Each of the two methods was applied to five different types of widely used paper: Arches and Somerset (brands serving for engraving and digital printing), Ingres (drawing), press-type (magazines and newspapers) and Bible-type (historical documents). Once characterised by physico-mechanical, chemical and optical parameters (grammage, thickness, specular gloss, optical properties, air permeance, tensile properties, determining the pH of both surface and aqueous extracts), the different papers were bleached by the two methods according to pre-established criteria. Finally, to determine the evolution and effects of the two treatments, the papers were subjected to accelerated ageing., Research group "Ciencia y Cultura del Patrimonio" HUM-1057, Spanish Government MAT2014-58659-P, Universidad de Granada/CBUA

The handling of cultural heritage objects has become a highly debated topic in the last decade. The work and outcomes described in this paper are aimed to provide objective data to assist in making appropriate decisions as to whether or not wearing gloves is appropriate in a given situation. The forensic fingermark development techniques of 1,2-indandione and single metal deposition II were used to investigate the efficacy of handwashing and glove use to improve the information available when deciding whether to use gloves when handling paper objects. It was found that fingermarks did not permeate through polymer glove types but could through cotton gloves. It was also shown that the amounts of observable fingermark residues were greater 5 min after handwashing than if handwashing had not occurred, undermining previous arguments for not wearing gloves if hands could be washed before object handling., Graphical abstract Image 1, Highlights • Fingermarks can be transferred onto paper even after washing hand. • Developed fingermark residues initially increase after handwashing. • Handwashing is not sufficient to prevent fingermark contamination of artifacts. • Fingermark residues can be transferred from surfaces to gloves to paper. • Some antibacterial gels can increase the amount of fingermark residue deposited.

Tissue paper is defined by its physical and mechanical properties, namely: high softness, low grammage, high bulk and high liquid absorption capacity. It is expected that the production of tissue paper will continue to grow, which increases the importance of better understanding the processes involved in its production as well as its optimization [1] . The experimental data presented in this article, are the physical-mechanical characterization of a group of 13 industrial base tissue papers, which were collected at the end of the tissue paper machine on Portuguese factories. These samples vary in grammage, composition and creping [2] , enabling a later evaluation of the crepe type [3] and its relationship with the final properties of the tissue paper.

The progress in the fabrication of carbon-nanotube-based structures has made it possible to use Raman spectroscopy to measure the deformation states of carbon nanotubes and abutting materials. In this work, we investigate the effects of laser power and surrounding materials on the Raman shift of carbon-nanotube (CNT) papers for the laser intensity in a range of 0.071 to 1.415 kW/mm2 without action of mechanical loading. Two different configurations of the CNT papers are used in the Raman measurement; one uses a suspended CNT paper, and the other places a CNT paper on a glass or aluminum substrate. The experimental results reveal that there exist combinational effects of the laser power and abutting materials on the changes of the wavenumbers of the D, G and G′ bands of the CNT papers. We derive an analytical relation between the strain components, temperature and the change of the wavenumber of the Raman peak, which yields a proportional relationship between the change of the wavenumber of the Raman peak and the laser power. Such a relationship is supported by the experimental results.

During the early stages of the COVID-19 pandemic, EASL and ESCMID published a position paper to provide guidance for physicians involved in the care of patients with chronic liver disease. In the meantime, many countries and healthcare systems have been, or are still overwhelmed by the pandemic, significantly impacting on the care of this group of patients, whilst others have started to return towards their usual routine. In addition, many studies have been published focusing on how COVID-19 may affect the liver and how pre-existing liver diseases might influence the clinical course of COVID-19. While many aspects remain poorly understood, it has become increasingly evident that pre-existing liver diseases and liver injury during the course of the disease have to be kept in mind when caring for patients with COVID-19. Thus, this review should serve as an update on the previous position paper summarizing the evidence for liver disease involvement during COVID-19 and also provid, PNN was supported by the National Institute of Health Research (NIHR) Birmingham Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Highlights • UASB was proposed for RPMW anaerobic treatement under mesophilic conditions. • Start-up up of the UASB reactor was completed in the 24 days. • 80,76 % COD and 90 % TS were removed at an OLR of 7,27 g COD/L d. • At optimal OLR of 8.31 g COD/L d was required to produce 62.51 L/d biogas. • For HRT 15.14 h, after reactor start-up 80.63 % of COD was removed. • The average biogas composition was 72.98 % CH4, 19.76 % CO2, 0.9 % O2., The anaerobic digestion (AD) has become an alternative source and an attractive treatment method. Up-flow Anaerobic Sludge Blanket (UASB) digester has been designed to treat the Recycled paper mill wastewater (RPMW) in Morocco. This paper provides a research on anaerobic digestion of RPMW using UASB technology. The UASB digester was designed following the characterization of wastewater and the feed rate, with the volume of 70 liters. The UASB reactor treating the RPMW was operated for 130 days with minimal overload problems. The experiments were carried out in the mesophilic temperature (37 °C) at different organic loading rates (OLR). A daily analysis was performed to ensure the efficiency of the digester. In this study, the AD experiment was performed in continuous mode with an effluent inlet flow rate equal to 1 L/h. Using the optimal OLR value 5.18 g COD/Ld and with an effluent 5,7 g COD/L, a biogas yield of 92 N mL/g COD removed (at normal temperature and pressure) was obtained during the RPMW anaerobic treatment. The reactor was operated at an optimal hydraulic retention time (HRT) of 15.14 h with a biogas production volume of the optimal value 62.5 L/d. These results indicate that RPMW can be effectively treated in a UASB reactor with the advantage of producing biogas. We tested our system with RPMW, to see the production capacity of the UASB system, which the objective is to develop the system for the industrial scale.

According to a recent World Health Organization estimate, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which originated in China in 2019, has spread globally, infecting nearly 100 million people worldwide by January 2021. Patients with chronic liver diseases (CLD), particularly cirrhosis, hepatobiliary malignancies, candidates for liver transplantation, and immunosuppressed individuals after liver transplantation appear to be at increased risk of infections in general, which in turn translates into increased mortality. This is also the case for SARS-CoV-2 infection, where patients with cirrhosis, in particular, are at high risk of a severe COVID-19 course. Therefore, vaccination against various pathogens including SARS-CoV-2, administered as early as possible in patients with CLD, is an important protective measure. However, due to impaired immune responses in these patients, the immediate and long-term protective response through immunisation may be incomplete. The current SARS-CoV-2 pandemic has led to the exceptionally fast development of several vaccine candidates. A small number of these SARS-CoV-2 vaccine candidates have already undergone phase III, placebo-controlled, clinical trials in healthy individuals with proof of short-term safety, immunogenicity and efficacy. However, although regulatory agencies in the US and Europe have already approved some of these vaccines for clinical use, information on immunogenicity, duration of protection and long-term safety in patients with CLD, cirrhosis, hepatobiliary cancer and liver transplant recipients has yet to be generated. This review summarises the data on vaccine safety, immunogenicity, and efficacy in this patient population in general and discusses the implications of this knowledge on the introduction of the new SARS-CoV-2 vaccines.

Background: The cell-based quadrivalent influenza vaccine (QIVc) is now offered as an alternative to egg-based quadrivalent (QIVe) and adjuvanted trivalent (aTIV) influenza vaccines in the UK. While post-licensure studies show non-inferiority of cell-based vaccines, it is not known how its safety profile compares to other types of vaccines in real-world use. Methods: We conducted a retrospective cohort study using computerised medical records from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network database. We used a self-controlled case series design and calculated the relative incidence (RI) of adverse events of interest (AEIs) over different risk periods. We then compared the RIs of AEIs within seven days of vaccination overall and between QIVc and QIVe in the 18-64 years age group, and between QIVc and aTIV in the ≥65 years age group. Findings: The majority of AEIs occurred within seven days of vaccination, and a seasonal effect was observed. Using QIVc as the reference group, QIVe showed similar incidence of AEIs whereas live attenuated influenza vaccine (LAIV) and aTIV had lower incidence of AEIs. In the stratified analyses, QIVe and aTIV were associated with a 16% lower incidence of AEIs in the seven days post-vaccination in both the 18-64 years and ≥65 years age groups. Interpretation: Routine sentinel network data allow comparisons of safety profiles of equally suitable seasonal influenza vaccines. The higher incidence of AEIs associated with QIVc suggest monitoring of several seasons would allow robust comparisons to be made.

© 2021 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/), Heart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients' functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members' clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks., A insuficiência cardíaca (IC) com fração de ejeção reduzida (ICFEr) está associada a níveis elevados de hospitalização e mortalidade. A ICFEr também tem um impacto negativo na capacidade funcional e na qualidade de vida dos doentes, bem como na despesa em saúde. Nos últimos anos, surgiram novos medicamentos modificadores do prognóstico da ICFEr, originando um intenso debate na comunidade científica internacional em relação a uma mudança de paradigma para o tratamento da ICFEr. Neste artigo, relatamos a contribuição de um painel de especialistas portugueses em IC para o debate em curso. Com base na evidência clínica publicada mais recentemente e no julgamento clínico dos membros do painel, três princípios-chave são destacados: (i) sacubitril/valsartan deve ser preferido como terapia de primeira linha para a ICFEr, em vez de um inibidor da enzima de conversão da angiotensina ou um bloqueador do recetor da angiotensina; (ii) os quatro medicamentos básicos para a ICFEr são o inibidor do recetor da angiotensina e da neprilisina, os agentes bloqueadores beta-adrenérgicos, os antagonistas do recetor mineralocorticoide e os inibidores do cotransportador sódio-glucose 2, independentemente da presença de diabetes mellitus tipo 2; (iii) essas quatro classes de medicamentos para a ICFEr devem ser rapidamente introduzidas num período curto de 4-6 semanas, seguindo um protocolo de segurança, e depois tituladas durante as oito semanas seguintes.

The performance of an amine-based post-combustion CO2 capture and storage (CCS) process in an existing Kraft pulp mill and an existing pulp and board mill was assessed. The pulp and paper industry is an energy-intensive industry, with significant amounts of CO2 emitted onsite. The majority of this CO2 originates from the combustion of biomass, which renders it carbon neutral if the biomass used by the industry is grown and harvested in a sustainable manner. If the CO2 emissions from the pulp and paper industry were to be captured and permanently stored, then this could make the industry a potential carbon sink. In this evaluation, different configurations of capturing CO2 from the flue gases of the recovery boiler, the multi-fuel boiler and the lime kiln were assessed. For a stand-alone Kraft pulp mill, the excess steam available is sufficient to cover the demand from the CO2 capture plant. For an integrated pulp and board mill, there is less excess steam available for the CO2 capture plant and an auxiliary boiler may be required. The retrofit of a post-combustion CO2 capture plant into an existing pulp mill increases the steam demand by 1-8 GJ/air dried tonne (adt) pulp, depending on the volume of the flue gas treated. This translates to a reduction in the amount of electricity exported to the grid by 0.1-1.0 MWh/adt pulp for a stand-alone Kraft pulp mill, and by 0.1-0.5 MWh/adt pulp for an integrated pulp and board mill. The total potential for negative CO2 emissions amounts to just under 2.0 Mt CO2/a both for the market pulp mill and for the integrated pulp and board mill.

In the present manuscript, novel effluent treatment processes for pulp and paper mill effluents are divided into two categories: a) those involving the use of chemical additives and b) those which are free of such chemicals. It is especially of high importance for pulp and paper industry to adopt the most efficient and cost-effective treatment methods. This paper critically reviews the recent studies on the treatment of pulp and paper mill effluents while providing suggestions for further studies on the application of various physic-chemical and biological methods for the treatment of such complex effluents containing a number of recalcitrant pollutants. Keywords: Pulp and paper industry, Industrial effluents, Chemical additives, Non-additive treatment processes

In this work, a granular activated carbon (GAC) was produced using primary paper mill sludge (PS) as raw material and ammonium lignosulfonate (AL) as binder agent. PS is a residue from the pulp and paper industry and AL is a by-product of the cellulose pulp manufacture and the proposed production scheme contributes for their valorisation together with important savings in GAC precursors. The produced GAC (named PSA-PA) and a commercially available GAC (GACN), used as reference material, were physically and chemically characterized. Then, these materials were tested in batch experiments for the adsorption of carbamazepine (CBZ), sulfamethoxazole (SMX), and paroxetine (PAR) from ultra-pure water and wastewater. Even though GACN and PSA-PA possess very similar specific surface areas (S) (629 and 671 m g, respectively), PSA-PA displayed lower maximum adsorption capacities (q) than GACN for the pharmaceuticals here studied (6 ± 1–44 ± 5 mg g and 49 ± 6–106 ± 40 mg g, respectively). This may be related to the comparatively higher incidence of mesopores in GACN, which might have positively influenced its adsorptive performance. Moreover, the highest hydrophobic character and degree of aromaticity of GACN could also have contributed to its adsorption capacity. On the other hand, the performance of both GACs was significantly affected by the matrix in the case of CBZ and SMX, with lower q in wastewater than in ultra-pure water. However, the adsorption of PAR was not affected by the matrix. Electrostatic interactions and pH effects might also have influenced the adsorption of the pharmaceutical compounds in wastewater., This work was funded by FEDER through Compete 2020 and by national funds through FCT by the research project PTDC/AAG-TEC/1762/2014. Vânia Calisto and Marta Otero also thank FCT for a postdoctoral grant (SFRH/BPD/78645/2011) and support by the FCT Investigator Program (IF/00314/2015), respectively. Thanks are also due for the financial support to CESAM (UID/AMB/50017-POCI-01-0145-FEDER-007638), to FCT/MEC through national funds, and the co-funding by the FEDER, within the PT2020 Partnership Agreement and Compete 2020

Purpose To analyze the 50 most-cited articles pertaining to “Bankart lesions,” also known as anteroinferior labral tears, by means of citation analysis as well as to provide analysis and summary of the origins and trends of research on Bankart lesions. Methods Scopus was used to query the literature on Bankart lesions. Included articles were related to Bankart lesions and the indications, risk factors, techniques, and outcomes of arthroscopic and open Bankart repair. The 50 most-cited articles were analyzed in the following areas: year of publication, citations in the most recent year, total citation count, contributing authors, institutions, countries, and journals, article classifications, and level of evidence. Results Years of publication ranged from 1938 to 2013. There were 608 total citations in the most recent year. Total citation count was 12,441. Regarding country, journal, and authorship, United States, R. A. Arciero, and Arthroscopy were the highest respective contributors. Rush University had the greatest number of publications. The most common article classification was clinical outcomes. Of 49 clinical articles, the most frequent Level of Evidence was IV. The majority of the top 50 Bankart literature consisted of case series and retrospective studies performed in the United States. Conclusions Our findings are consistent with the hypothesis that the 50 most-cited articles about Bankart lesions are predominantly U.S.-based, produced by academic orthopaedic groups, clinical outcomes articles, and of Level IV and V evidence. This list of articles should serve as a reference tool for any orthopaedist looking to review Bankart literature.

The process of bioconversion of solid organic wastes through vermicomposting justifies the environmental message for sustainability such as reduce, recycle and reuse of wastes. In the present study, wastes derived from two different types of paper mill sludge (primary and secondary), was used for their bioconversion through the vermicomposting process using an indigenous species of earthworm (Perionyx excavatus). The maturity and stability stage of vermicompost production was assessed using FT-IR, GC-MS and TG analyses. During vermicomposting, different biochemical functional groups present in the wastes have shown differential chemical alteration and turnover as revealed by FT-IR spectroscopy. This study has also confirmed the trend of biodegradation of complex substances like lignin, cellulose, proteins etc. and thereby demonstrates the extent of mineralization. TG spectral analysis had revealed a mass loss of 80% and 71% in vermicompost produced from primary and secondary sludge respectively. GC-MS studies have also shown the presence of several humic acids like octadecanoic acid, heptadecanoic acid etc. in the decomposing substances demonstrating as an indicator of the maturity of products. This was further confirmed by the decrease of humification index which focuses the combined action of both earthworms and microbes in the degradation of organic wastes. The present study has highlighted the role of an indigenous earthworm in converting specific industrial wastes especially by recording the point of maturation using humic acids an indicator of the quality of decomposing of wastes following several instrumental applications.

Paper mills yield large volumes of sludge materials which pose an environmental and economic challenge for disposal, despite the fact that they could be a valuable source for cellulose nanofibres (CNF) production. The aim of the study was to evaluate the production process and properties of CNF prepared by mechanical fibrillation of never-dried and dried paper mill sludge (PMS). Atomic force microscopy (AFM) showed that average diameters for both never-dried and dried paper sludge nanofibres (PSNF) were less than 50 nm. The never-dried and dried sludge nanofibres showed no statistical significant difference (p>0.05) in strength ∼92 MPa, and ∼85 MPa and modulus ∼11 GPa and ∼10 GPa. The study concludes that paper mill sludge can be used in a dried state for CNF production to reduce transportation and storage challenges posed on industrial scale.

The use of fibre-based materials as substrates in printed electronics has been increasing, mainly due to its attractive characteristics, such as low-cost or wide availability. Additionally, paper enables recycling and it shows attractive features, such as high thermal stability, when compared to traditional polymer-based substrates (Tobjörk and Österbacka, 2011 [1]). Nevertheless, one of the drawbacks of using paper substrates is that the surface usually is very rough, typically, showing roughness values above 10 μm2. In most cases, printing structures that need to be highly uniform, without disruptions, require additional coating. Inkjet printing provides sharp detail reproduction and strict lines on printed structures. Sintering is required for drying the ink. Thermal sintering is the traditionally used method, but requires long periods of time and promotes the ageing of the paper due to a long exposure at high temperature. When printing conductive structures on paper alternative photonic sintering methods such as IR-sintering show some attractive characteristics. IR-sintering is compatible with roll-to-roll fabrication, providing low-cost, fast and localized sintering, which makes it suitable for fibre-based substrates (Tobjörk et al., 2012 [3]). This work has been carried out to study and compare the efficiency of thermal and IR sintering of conductive structures on different paper and polymer substrates. All substrates were printed using silver based ink, which was applied on the substrate surface by inkjet. Resistivity values of the printed structures were used to compare the performance on the substrates. IR-sintering showed the best results in terms of achieved conductivity of the printed lines when using short sintering time of no more than 10 min. The conductivity values of the inkjet-printed silver lines on Lumi silk substrate reached about 40% of the bulk silver value after IR-sintering, whereas with thermal-sintering this value only reached about 20% of the bulk silver value. IR-sintering improves the sintering process, increasing the conductivity of the printed structures and at the same time reducing significantly the sintering time. In the case of Lumi silk substrate, high conductivity was observed after only two minutes of sintering time when IR-oven was used. Both techniques can be used in a roll-to-roll mass manufacturing process, enabling the fabrication in large scale of flexible electronic devices, on paper substrates, without the need for extra steps, such as coatings.

Background Citation analysis is a commonly used method for appraising the impact of academic publications within a particular field of study. A gap exists in the citation analysis literature with regard to the topic of direct anterior approach (DAA) hip arthroplasty. The purpose of this study is to identify the 50 most frequently cited publications related to this topic. Methods The Clarivate Analytics Web of Knowledge database was utilized to search for publications relating to DAA hip arthroplasty. The top 50 most cited articles that met inclusion criteria were recorded and reviewed for various metrics. Results The top 50 publications were cited a total of 3521 times, with an average of 86.3 total citations per year between 1980 and 2019. 47 of the 50 articles identified had been published since the year 2000. Cohort designs were the most common study type. Conclusions This analysis provides insight into factors that characterize highly cited articles on the specific topic of DAA hip arthroplasty. These factors include higher levels of evidence, recent publication, and origin in the United States. Citations of DAA hip arthroplasty papers appear to be on the rise. The curation and analysis of this set of 50 articles will provide orthopaedic surgery clinicians, researchers, and residency program directors a guide for quickly isolating influential articles on the topic of DAA hip arthroplasty. This may serve as a quick reference for clinical decision-making, foundation for further research, and curriculum on DAA hip arthroplasty.

Zeolite nanostructures were used as hosts for dyes normally used in some bioassays (pH and protein), and applied on microfluidic paper-based analytical devices (PADs). The obtained dye nanomaterials were characterized by several techniques (structural (FTIR and XRD), surface (SEM/EDX), textural (N2 adsorption) analyses and dye loading determination by TGA analysis), to confirm the stability of both host and guest. After their deposition on the papers surface, the color change was studied by analyzing the RGB values, taking into account the lifetime and the results stability of the PADs. These results confirmed that both the lifetime and the color change of the modified devices were stable over one week. It was also demonstrated that the choice of the paper for the PAD as well as the zeolite nanostructures properties influences the colorimetric response. This strategy by encapsulating dyes into zeolites solve current challenges in colorimetric sensors in where long-term stability of the colorimetric results is an issue. The results obtained were promising for the studied assays, and the strategy could also be extended to other bioassays., A.R.B. thanks for the ERASMUS+ program to her grant. This work has been developed under the scope of the projects: BioTecNorte (NORTE-01-0145-FEDER-000004), AIProcMat@N2020 (NORTE-01-0145-FEDER-000006), projects supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (ERDF). This work also has been funded by ERDF through COMPETE2020–Programa Operacional Competitividade e Internacionalização (POCI), Project POCI-01-0145-FEDER-006984, Associate Laboratory LSRE-LCM and by national funds through FCT, Fundacão para a Ciência e a Tecnologia for project PTDC/AAGTEC/5269/2014 and Centre of Chemistry (UID/QUI/00686/2013 and UID/QUI/0686/2016). The support from the Oslofjordfondet project, «Touchsensor for enklere og raskere urinprøvetaking og analyse (no. 234972)» and NSFC project no. 61650410655 is also acknowledged., info:eu-repo/semantics/publishedVersion

Background One of the most important part of tissue engineering (TE) is a matrix called scaffold. A good scaffold integrates with the host tissue and support the growth and differentiation of the cells. Collagen is the most abundant protein in the ECM and has been considered to be a group of proteins with a characteristic molecular structure—fibrillar structure, which contributes to the extracellular scaffolding. Objective In this research we study the biocompatibility and attachment of collagen scaffold by measuring the level of availability of mesenchymal stem cell (MSC) cluster from stromal vascular fraction (SVF). Method This study was experimental invitro on MSC culture derived from SVF, with post-test control group design. Biocompatibility was measured by viability of MSC from SVF with marker Propidium Iodine through flowcytometry and electron microscope was used to assess the population density of MSC from SVF by measuring the number of cluster cells seen. Result Oxidize cellulose has the greatest value of MSC cluster with average number of 2003 cell cluster. This result was significant with p, Highlights • Biocompatibility and attachment of collagen scaffold. • Measuring the level of availability of mesenchymal stem cell (MSC) cluster from stromal vascular fraction (SVF). • Experimental in vitro study on MSC culture derived from SVF. • Biocompatibility was measured by viability of MSC from SVF with marker Propidium Iodine through flowcytometry. • Electron microscope was used to assess the population density of MSC from SVF.

Paper and board recycling is now a central issue in papermaking. Understanding of material flows, as a part of the total production chain, as well as, fibrous and non-fibrous component flows needs further clarification. These flows are studied at a European level, with special focus on Germany and Sweden. Non-fibrous components are discussed in terms of a material which hampers the processing of paper and board. Resource-efficiency improvements, in conjunction with economic benefits, are sought and recycling has been able to fulfil both of these. The main drivers to maximize the use of recovered paper in paper and board manufacturing, have been improved over the last decades. These drivers are cost, environmental image and good technical properties to be used as raw material. The increased recycling rate has reduced the quality of the collected paper, produced recycled paper, and replaced virgin pulp. Also, recycling as a process, like deinking, produces large amounts of waste material that has challenges to find proper utilization. These problem areas are addressed in this paper, too. One focus area in the analysis of statistical information is an estimation of the share of non-fibrous components and fibre volumes of paper in Europe (EU) for the year 2010.

Academic reading, a form of active reading, often involves interaction with the text. Highlighting and annotating are some of the most common strategies of interacting with academic texts, yet we have limited understanding of exactly how such interactions affect reading comprehension in digital versus analog reading environments. In this paper, we present an exploratory study, comparing how university students (n = 50) interact with a digital and a physical text, focusing on highlights and annotations. We compare reading time, interaction with, and subsequent memory of the texts. We make nine observations about reading time, highlighting and annotation frequency and memory scores between paper and laptop. We find that students annotate significantly less on laptop than on paper, but that neither highlighting nor annotations influence subsequent memory of the text in either condition. Our broader contribution is to augment understanding of how different interaction features aid academic reading in a natural environment.

When academics’ opinions, which are published in academic journals as letters to the editor or commentaries, are retracted based on sensitivities and objections that are raised for example on social media, there needs to be a reflection on what this might represent. On one hand, an opinion is precisely that, i.e., a subjective and biased view about an issue. Those views might even be radical, unpopular, or insensitive, but ultimately approved by editors for publication nonetheless. To maintain a truly sustainable scholarly discourse, the best academic way to counter such opinions is by allowing disagreeing voices to express themselves, also as letters to the editor or commentaries. Pressure-induced retractions of opinions not only stifle academic debate, they send the message that opinions need to be moderated and standardized to meet a publishing market that is being increasingly driven by legal parameters, political correctness, as well as business and commercial values rather than academic ones. In an environment of restrictive academic freedom, what emerges is an academia in which the way things are said, tone, and the sensitivity of those that might be affected are given greater weight than the message itself. By cherry-picking parts of the message that detractors or critics might disagree with, the original message may be drowned out by the noise of the objectors. The struggle of academics to liberally voice their opinions in the scholarly publishing realm, and to preserve those opinions, has never been more acute in this age of misinformation and radicalism fueled by polarized social and mass media. Is the politicization and/or commercialization of academia, alongside the retraction of opinions, stifling open and healthy academic debate, or expressing itself as the retraction of opinions, and does this represent a distinct form of “cancel culture” in academia and academic publishing?

IMPORTANCE: Exercise therapies are advocated in osteoarthritis (OA) clinical guidelines. However, challenges to accessing exercise may be limiting widespread uptake. OBJECTIVE: To evaluate the effects of a self-directed web-based strengthening exercise and physical activity program supported by automated behavior-change text messages on knee pain and function for people with knee OA. DESIGN, SETTING, AND PARTICIPANTS: The participant-blinded and assessor-blinded randomized clinical trial enrolled 206 people who met clinical criteria for knee OA in communities across Australia from July 2018 to August 2019, with follow-up taking place at 24 weeks. INTERVENTIONS: The control group was given access to a custom-built website with information on OA and the importance of exercise and physical activity. The intervention group was given access to the same information plus a prescription for a 24-week self-directed strengthening regimen and guidance to increase physical activity, supported by automated behavior-change text messages encouraging exercise adherence. MAIN OUTCOMES AND MEASURES: Primary outcomes were change in overall knee pain (numeric rating scale, 0-10) and difficulty with physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 0-68) over 24 weeks. Secondary outcomes were another knee pain measure, sport and recreation function, quality of life, physical activity, self-efficacy, overall improvement, and treatment satisfaction. RESULTS: Of 206 participants, 180 (87%; mean [SD] age, 60 [8.4] years; 109 [61%] women) completed both 24-week primary outcomes. The intervention group showed greater improvements in overall knee pain (mean difference, 1.6 units; 95% CI, 0.9-2.2 units; P

Objective Clinicians may use implicit or explicit motor learning approaches to facilitate motor learning of patients with stroke. Implicit motor learning approaches have shown promising results in healthy populations. The purpose of this study was to assess whether an implicit motor learning walking intervention is more effective compared with an explicit motor learning walking intervention delivered at home regarding walking speed in people after stroke in the chronic phase of recovery. Methods This randomized, controlled, single-blind trial was conducted in the home environment. The 79 participants, who were in the chronic phase after stroke (age = 66.4 [SD = 11.0] years; time poststroke = 70.1 [SD = 64.3] months; walking speed = 0.7 [SD = 0.3] m/s; Berg Balance Scale score = 44.5 [SD = 9.5]), were randomly assigned to an implicit (n = 38) or explicit (n = 41) group. Analogy learning was used as the implicit motor learning walking intervention, whereas the explicit motor learning walking intervention consisted of detailed verbal instructions. Both groups received 9 training sessions (30 minutes each), for a period of 3 weeks, targeted at improving quality of walking. The primary outcome was walking speed measured by the 10-Meter Walk Test at a comfortable walking pace. Outcomes were assessed at baseline, immediately after intervention, and 1 month postintervention. Results No statistically or clinically relevant differences between groups were obtained postintervention (between-group difference was estimated at 0.02 m/s [95% CI = −0.04 to 0.08] and at follow-up (between-group difference estimated at −0.02 m/s [95% CI = −0.09 to 0.05]). Conclusion Implicit motor learning was not superior to explicit motor learning to improve walking speed in people after stroke in the chronic phase of recovery. Impact To our knowledge, this is the first study to examine the effects of implicit compared with explicit motor learning on a functional task in people after stroke. Results indicate that physical therapists can use (tailored) implicit and explicit motor learning strategies to improve walking speed in people after stroke who are in the chronic phase of recovery.

This study focused on preparation of microfibers from bamboo culms using steam explosion with and without chemical treatments, and utilization of the isolated fibers in formation of bamboo paper fabricated with nanofibrillated cellulose (NFC). Compared with those obtained from the steam explosion alone (S), the bamboo microfibers isolated using the steam explosion followed by bleaching process (S/A) exhibited a significantly reduced fiber width of 7.5 μm and a markedly increased cellulose content of 97.85%. The S/A fiber showed an increased decomposition temperature, corresponding with lower contents of hemicellulose and lignin than those of the S fiber. The S/A microfibers were subsequently proceeded to paper formation. Physical and mechanical properties of the paper with an introduction of different NFC concentrations (0–50 wt%) were investigated. The linear relationship between the density, porosity and mechanical properties of the paper and NFC contents was observed. The more the NFC content, the greater the density and the lower the porosity the paper exhibited. At 50 wt% NFC, the paper density increased to 0.64 g cm−3, and the paper porosity decreased to 57.0% whereas the paper without NFC showed a density of 0.39 g cm−3 and porosity of 73.6%. Tensile strength and strain of the paper composed with 50 wt% NFC were 10-fold and 3-fold, respectively, greater than those of the paper without NFC. The addition of NFC could manifest paper mechanical properties and porosity within the paper structure, which would be useful for scaffold and membrane applications. Keywords: Bamboo, Mechanical properties, Paper, Nanofibrillated cellulose, Steam explosion, Microfibers, Nanofibers

This discussion paper addresses the safety of HIV cure studies, particularly those involving stopping antiretroviral therapy, known as an analytic treatment interruption (ATI) in the context of the SARS-CoV-2 pandemic. More than 30 studies listed on ClinicalTrials.gov include an ATI and many others were planned to begin over the next 12 months but most were halted due to the COVID-19 pandemic. We consider the ethics, risks and practical considerations to be taken into account before re-opening HIV cure clinical trials, noting the specific risks of ATI in the context of circulating SARS-CoV-2.

BACKGROUND: Digital models are considered the new standard in the clinical practice of orthodontics. However, they are difficult to use in the absence of a true scale for chairside use during clinical appointments. Therefore, an easy standardized method with true-scale paper print images would be of great utility. The aim of this study was to correlate and compare measurements obtained manually in true-scale paper printed images of digital models with those obtained digitally in the computer. METHODS: Sixty desktop scanned digital models (30 upper and 30 lower) were analyzed. Ortho Insight 3D software was used for generating the printed images on paper and for measuring the digital models. Intercanine width, interpremolar width (first and second), intermolar width (first), and arch length measures were performed with both methods and were correlated and compared. RESULTS: There was a high correlation between measurements performed with both methods. Values obtained from paper print images were lower and showed statistically significant differences (

Pulp and paper industry produces massive amounts of sludge from wastewater treatment, which constitute an enormous environmental challenge. A possible management option is the conversion of sludge into carbon-based adsorbents to be applied in water remediation. For such utilization it is important to investigate if sludge is a consistent raw material originating reproducible final materials (either over time or from different manufacturing processes), which is the main goal of this work. For that purpose, different primary (PS) and biological sludge (BS) batches from two factories with different operation modes were sampled and subjected to pyrolysis (P materials) and to pyrolysis followed by acid washing (PW materials). All the materials were characterized by proximate analysis, total organic carbon (TOC) and inorganic carbon (IC), attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) and N2 adsorption isotherms (specific surface area (SBET)and porosity determination). Sludge from the two factories proved to have distinct physicochemical properties, mainly in what concerns IC. After pyrolysis, the washing step was essential to reduce IC and to considerably increase SBET, yet with high impact in the final production yield. Among the materials here produced, PW materials from PS were those having the highest SBET values (387-488 m2 g-1). Overall, it was found that precursors from different factories might originate final materials with distinct characteristics, being essential to take into account this source of variability when considering paper mill sludge as a raw material. Nevertheless, for PS, low variability was found between batches, which points out to the reliability of such residues to be used as precursors of carbon adsorbents. L'Oreal Portugal published

Background: \ud Nutrition related publications in pediatric population cover wide range of topics and therefore it is usually difficult for clinicians to get an overview of recent nutrition related guidelines or recommendations.\ud \ud Methods: \ud The Special Interest Group (SIG) of Pediatrics of European Society for Clinical Nutrition and Metabolism (ESPEN) performed a literature search to capture publications in the last five years aiming to provide the latest information concerning nutritional issues in children in general and in specific diseases and to discuss progression in the field of pediatric nutrition evidence-based practice.\ud \ud Results: \ud Eight major topics were identified as the most frequently reported including allergy, critical illness, neonatal nutrition, parenteral and enteral nutrition, micronutrients, probiotics and malnutrition. Furthermore, it was noted that many reports were disease focused or included micronutrients and were, therefore, represented as tables.\ud \ud Conclusion: \ud Overall, it has been shown that most reports on nutrition topics in pediatrics were systematic reviews or guidelines/position papers of relevant societies, but many of them basing the conclusion on a limited number of high-quality randomized controlled trials or large observational cohort studies.

Over the past few years, what might not unreasonably be described as a true revolution has taken place in the field of machine vision, radically altering the way many things had previously been done and offering new and exciting opportunities for those able to quickly embrace and master the new techniques. Rapid developments in machine learning, largely enabled by faster GPU-equipped computing hardware, has facilitated an explosion of machine vision applications into hitherto extremely challenging or, in many cases, previously impossible to automate industrial tasks. Together with developments towards an internet of things and the availability of big data, these form key components of what many consider to be the fourth industrial revolution. This transformation has dramatically improved the efficacy of some existing machine vision activities, such as in manufacturing (e.g. inspection for quality control and quality assurance), security (e.g. facial biometrics) and in medicine (e.g. detecting cancers), while in other cases has opened up completely new areas of use, such as in agriculture and construction (as well as in the existing domains of manufacturing and medicine). Here we will explore the history and nature of this change, what underlies it, what enables it, and the impact it has had - the latter by reviewing several recent indicative applications described in the research literature. We will also consider the continuing role that traditional or classical machine vision might still play. Finally, the key future challenges and developing opportunities in machine vision will also be discussed.

This work demonstrates a stand-alone power source that integrates a paper-based hydrogen fuel cell with a customized chemical heater that produces hydrogen in-situ upon the addition of a liquid. The presented approach operates by capillary action and takes advantage of the hydrogen released as a by-product of an exothermic reaction used in point-of-care diagnostics. The paper-based fuel cell produces a maximum power of 25.8 mW (103.2 mW cm−2), which is suitable for powering a diversity of electrical devices such as commercially available digital pregnancy tests and glucometers. While device shape and dimensions can be customized, here it is shown that the fuel cell can be designed in a compact form factor and footprint comparable to a lateral flow test while providing a remarkable power output. This approach holds great promise for powering portable diagnostics, as the generated electric power could enable device functionalities required for advanced assays, such as device timing, actuation, and signal quantification. Part of the same liquid sample that is to be analyzed (urine, saliva, water, etc) could be used to trigger the hydrogen generation and start the fuel cell operation., J.P. Esquivel acknowledges support from Marie Curie International Outgoing Fellowship (APPOCS - GA.328144) within the 7th European Community Framework Programme. J. Buser and P. Yager were supported by a grant from DARPA DSO/BTO--HR0011-11-2-0007, awarded to Yager at the University of Washington. P. Yager was supported in part by funds from the Department of Bioengineering at the University of Washington. S. Rojas acknowledges financial support from project ENE2013-42322R. N. Sabaté would like to thank financial support received from ERC Consolidator Grant (SUPERCELL - GA.648518).

Herein, we describe a sustainable and inexpensive approach to monitor Zn(II) in biological fluids by fabricating an office paper-based electrochemical sensor. By following two easy steps, consisting of wax patterning and electrode screen-printing, the office paper provides an effective electroanalytical tool that is easily extensible to a broad range of analytes. This approach would be able to develop affordable user-friendly sensing devices, tackling the lack of resources in regions with poor-settings/facilities. In order to provide more details regarding the screen-printed electrodes fabrication, office paper, Whatman #1 chromatrographic paper, and polyester have been characterized with electrochemical, morphological, and mechanical tests and compared. Using office paper, Zn(II) has been detected linearly up to 2 μg/mL with a detection limit equal to 25 ng/mL and a relative standard deviation of 8%. To highlight the feasibility, reliability, and easiness of the proposed electrochemical sensor, Zn(II) has been detected in serum and sweat at physiological level (μg/mL), and the accuracy of the method has been verified by satisfactory recoveries close to 100%.

This paper introduces a novel enzymatic fuel cell design that employs cellulose paper-based quasi-2D microfluidic system to supply biofuel to the enzymatic layer. The state of the art nanoarchitectural design, employing carbon nanotube-based papers for the bioelectrodes, allows a single cell to maintain 400 mV for 16 days of continuous operation in glucose solution and reach 1 mA of current output. Stacks of cells connected in series show successful performance using glucose in Gatorade® resulting in stack-cell potential of 1.8 V, employed to power a digital clock for 36 h, continuously. These designs open the possibility for obtaining enzymatic fuel cells that can run small portable devices on easily available ubiquitous liquids while addressing environmental concerns that are prevalent in traditional fuel cells. Keywords: Enzyme, Bioelectrodes, Enzymatic biofuel cells, Microfluidic system, Capillary driven flow, Bucky paper

Background: Forestry and field workers who work outdoors are at high risk for Hymenoptera stings and may develop occupation-related allergies from being stung. However, clinical and immunological surveys of Hymenoptera stings in the occupational setting have rarely been reported. We surveyed the natural history of Hymenoptera stings in Japanese forestry workers (FWs) and electrical facility field workers (EFFWs), and we assessed the utility of measuring specific (s)IgE Ab to Hymenptera venom. Methods: Questionnaires on hornet and paper wasp stings were completed by 999 FWs, 354 EFFWs, and 365 office workers as controls between July and November 2009. Sera from these participants were tested for sIgE Ab levels to Hymenptera venom with a CAP system using a fluoroenzyme immunoassay. Results: Of the participants who had experienced Hymenoptera stings, 914 (91.5%) were FWs, 293 (82.8%) were EFFWs, and 295 (80.8%) were controls. Of the participants who had experienced systemic reactions, 210 (21.0%) were FWs, 51 (14.4%) were EFFWs, and 39 (10.7%) were controls. sIgE Ab in response to hornet and wasp venom was positive (≥ class 2) in 42.4% and 41.4% of FWs, 30.1% and 31.4% of EFFWs, and 15.1% and 18.1% of controls, respectively. The likelihood of being sIgE-positive to wasp and hornet venom was significantly higher in FWs and EFFWs than in controls (P Conclusions: 21% of FWs and 14% of EFFWs had experienced systemic reactions to Hymenoptera stings with a higher frequency compared with office workers in the same area. 40% of FWs and 30% of EFFWs had sera that were sIgE positive to Hymenoptera venom.

Background A large number of published articlesexists, centered on pediatric and adult medulloblastomas. Objective To accomplish a systematic review and meta-analysis concerningmedulloblastoma, focusing on the clinical features, diagnostic and currenttreatment modalities, as well as prognostic factors. Methods In March 2020, we performed a title- focused search using Thomson Reuters Web of Science database in order to identify the most cited articles centered on adult and pediatric medulloblastomas. Results Our search resulted in 4.779 articles, published from 1975 until March 2020. All of them combined have been cited 118,703 times, with an average citation per item of 24.84. The most cited article was published by Pomeroy SL, et al. in 2002 in Nature Journal, whereas the least cited one was published by Huang E., et al, in 2002. Conclusions The aim of the study is, via the presentation of the 100 most cited papers focused on medulloblastoma, to describe their relevant contribution regarding advances in therapeutic prospects, prognosis, molecular characteristics andreconsideration of treatment protocols. We describe how, and to what degree, the treatment guidelines and management of this tumor have changed from 1975 to 2020. We reviewrecent advances in cancer genomics which have revealed 4 distinct subgroups of medulloblastomas, as well asthe importance of molecular biology on the development of new treatment features. We aim not only to answer the question: WHAT were the most cited publications, but also to approach the question of WHY the most-cited sources were so.