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The pulp and paper (P&P) sector is a dynamic manufacturing industry and plays an essential role in the Austrian economy. However, the sector, which consumes about 20 TWh of final energy, is responsible for 7% of Austria’s industrial CO2 emissions. This study, intending to assess the potential for improving energy efficiency and reducing emissions in the Austrian context in the P&P sector, uses a bottom-up approach model. The model is applied to analyze the energy consumption (heat and electricity) and CO2 emissions in the main processes, related to the P&P production from virgin or recycled fibers. Afterward, technological options to reduce energy consumption and fossil CO2 emissions for P&P production are investigated, and various low-carbon technologies are applied to the model. For each of the selected technologies, the potential of emission reduction and energy savings up to 2050 is estimated. Finally, a series of low-carbon technology-based scenarios are developed and evaluated. These scenarios’ content is based on the improvement potential associated with the various processes of different paper grades. The results reveal that the investigated technologies applied in the production process (chemical pulping and paper drying) have a minor impact on CO2 emission reduction (maximum 10% due to applying an impulse dryer). In contrast, steam supply electrification, by replacing fossil fuel boilers with direct heat supply (such as commercial electric boilers or heat pumps), enables reducing emissions by up to 75%. This means that the goal of 100% CO2 emission reduction by 2050 cannot be reached with one method alone. Consequently, a combination of technologies, particularly with the electrification of the steam supply, along with the use of carbon-free electricity generated by renewable energy, appears to be essential.

An origami three-dimensional design of a paper-based potentiometric sensor is described. In its simplest form, this electrochemical paper-based analytical device (ePAD) is made from three small parts of the paper. Paper layers are folded on each other for the integration of a solid contact ion selective electrode (here a carbon-paste composite electrode) and a solid-state pseudo-reference electrode (here writing pencil 6B on the paper), which are in contact with a hydrophilic channel fabricated on the middle part (third part) of the paper. In this case, the pseudo-reference and working electrodes are connected to the two sides of the hydrophilic channel and hence the distance between them is as low as the width of paper. The unmodified carbon paste electrode (UCPE) and modification with the crown ether benzo15-crown-5 (B15C5) represented a very high sensitivity to Cu (II) and Cd2+ ions, respectively. The sensor responded to H2O2 using MnO2-doped carbon paste electrode (CPE). Furthermore, a biosensor was achieved by the addition of glucose oxidase to the MnO2-doped CPE and hence made it selective to glucose with ultra-sensitivity. In addition to very high sensitivity, our device benefits from consuming a very low volume of sample (10.0 µL) and automatic sampling without need for sampling devices.

Objective Communication in healthcare has influenced and been influenced by the COVID-19 pandemic. In this position paper, we share observations based on the latest available evidence and experiential knowledge that have emerged during the pandemic, with a specific focus on policy and practice. Methods This is a position paper that presents observations relating to policy and practice in communication in healthcare related to COVID-19. Results Through our critical observations as experts in the field of healthcare communication, we share our stance how healthcare communication has occured during the pandemic and suggest possible ways of improving policy and professional practice. We make recommendations for policy makers, healthcare providers, and communication experts while also highlighting areas that merit further investigation regarding healthcare communication in times of healthcare crises. Conclusion We have witnessed an upheaval of healthcare practice and the development of policy on-the-run. To ensure that policy and practice are evidence-based, person-centred, more inclusive and equitable, we advocate for critical reflection on this symbiotic relationship between COVID-19 and the central role of communication in healthcare. Practice implications This paper provides a summary of the key areas for development in communication in healthcare during COVID-19. It offers recommendations for improvement and a call to review policies and practice to build resilience and inclusive and equitable responsiveness in communication in healthcare.

Endothelial cells (ECs) are sentinels of cardiovascular health. Their function is reduced by the presence of cardiovascular risk factors, and is regained once pathological stimuli are removed. In this European Society for Cardiology Position Paper, we describe endothelial dysfunction as a spectrum of phenotypic states and advocate further studies to determine the role of EC subtypes in cardiovascular disease. We conclude that there is no single ideal method for measurement of endothelial function. Techniques to measure coronary epicardial and micro-vascular function are well established but they are invasive, time-consuming, and expensive. Flow-mediated dilatation (FMD) of the brachial arteries provides a non-invasive alternative but is technically challenging and requires extensive training and standardization. We, therefore, propose that a consensus methodology for FMD is universally adopted to minimize technical variation between studies, and that reference FMD values are established for different populations of healthy individuals and patient groups. Newer techniques to measure endothelial function that are relatively easy to perform, such as finger plethysmography and the retinal flicker test, have the potential for increased clinical use provided a consensus is achieved on the measurement protocol used. We recommend further clinical studies to establish reference values for these techniques and to assess their ability to improve cardiovascular risk stratification. We advocate future studies to determine whether integration of endothelial function measurements with patient-specific epigenetic data and other biomarkers can enhance the stratification of patients for differential diagnosis, disease progression, and responses to therapy.

Commercially available health technologies such as smartphones and smartwatches, activity trackers and eHealth applications, commonly referred to as wearables, are increasingly available and used both in the leisure and healthcare sector for pulse and fitness/activity tracking. The aim of the Position Paper is to identify specific barriers and knowledge gaps for the use of wearables, in particular for heart rate (HR) and activity tracking, in clinical cardiovascular healthcare to support their implementation into clinical care. The widespread use of HR and fitness tracking technologies provides unparalleled opportunities for capturing physiological information from large populations in the community, which has previously only been available in patient populations in the setting of healthcare provision. The availability of low-cost and high-volume physiological data from the community also provides unique challenges. While the number of patients meeting healthcare providers with data from wearables is rapidly growing, there are at present no clinical guidelines on how and when to use data from wearables in primary and secondary prevention. Technical aspects of HR tracking especially during activity need to be further validated. How to analyse, translate, and interpret large datasets of information into clinically applicable recommendations needs further consideration. While the current users of wearable technologies tend to be young, healthy and in the higher sociodemographic strata, wearables could potentially have a greater utility in the elderly and higher-risk population. Wearables may also provide a benefit through increased health awareness, democratization of health data and patient engagement. Use of continuous monitoring may provide opportunities for detection of risk factors and disease development earlier in the causal pathway, which may provide novel applications in both prevention and clinical research. However, wearables may also have potential adverse consequences due to unintended modification of behaviour, uncertain use and interpretation of large physiological data, a possible increase in social inequality due to differential access and technological literacy, challenges with regulatory bodies and privacy issues. In the present position paper, current applications as well as specific barriers and gaps in knowledge are identified and discussed in order to support the implementation of wearable technologies from gadget-ology into clinical cardiology.

The symposium "New criteria of resectability for pancreatic cancer" was held during the 33nd meeting of the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS) in 2021 to discuss the potential modifications that could be made in the current resectability classification. The meeting focused on setting the foundation for developing a new prognosis-based resectability classification that is based on the tumor biology and the response to neoadjuvant treatment (NAT). The symposium included selected experts from Western and Eastern high-volume centers who have discussed their concept of resectability status through published literature. During the symposium, presenters reported new resectability classifications from their respective institutions based on tumor biology, conditional status, pathology, and genetics, in addition to anatomical tumor involvement. Interestingly, experts from all the centers reached the agreement that anatomy alone is insufficient to define resectability in the current era of effective NAT. On behalf of the JSHBPS, we would like to summarize the content of the conference in this position paper. We also invite global experts as internal reviewers of this paper for intercontinental cooperation in creating an up-to-date, prognosis-based resectability classification that reflects the trends of contemporary clinical practice.

This White Paper provides a step-by-step approach on how to procure e-mobility solutions. Chapter 1 covers the implementation of a so-called innovation procurement. Chapter 2 covers all relevant aspects that are related to the Government Procurement Agreement (GPA) of the World Trade Organization with a link to the most relevant aspects of EU Trade Agreements that enhance the competitiveness of European companies. The chapter also presents an overview of the most recent and relevant EU initiatives to maintain a level playing field in public procurement within and across the boundaries of the EU Internal Market. Chapter 3 covers the possibilities to include social and environmental criteria within government procurements. Chapter 4 concludes on the findings of the e-Mobility paper and provides the reader with useful practices and tools to follow up on the procurement of e-mobility solutions. For the context of this White Paper, e-mobility solutions are transport solutions which are based on heavy duty vehicles with a zero-emission tailpipe pollution, which are a category under article 4 (5) of the Directive 2009/33/EC of 23 April 2009 on the promotion of clean road transport vehicles in support of low-emission mobility amended by Directive (EU) 2019/1161 of the European Parliament and of the Council of 20 June 2019

A new process for the production of bioethanol from paper mill sludge (PMS) is described in this work. PMS biomass feedstock was processed via the simultaneous saccharification and fermentation (SSF) with and without accelerants. The enzymatic hydrolysis and fermentation were first evaluated, and the energy demand was 2.2 MJ/L of produced ethanol. When the enzymatic hydrolysis and fermentation were combined, the energy demand was reduced to 1.0 MJ/L ethanol, the sugars production increased, and the overall capital cost of the process decreased. The sugar yield was improved by adding accelerant and selecting the optimal fiber recovery method. The accelerant improved the enzymatic hydrolysis via a pathing/bridging mechanism. The SSF with the chemical fiber recovery method coupled with accelerant addition would be the best process configuration. Upon this combination, the glucose profile was enhanced from 9.8 g/L to 17.0 g/L. The sludge fiber conversion by SSF was improved by selecting an efficient fiber recovery method combined with the accelerant addition. SSF in chemical fiber recovery with accelerant addition was the best process by a 10% improvement of ethanol yield. The proposed process configuration offers a lower cost and sustainable process and contributes to the circular economy of zero waste discharges.

The main aim of the study was to assess the environmental performance, through the application of the life cycle assessment, of a recycled paper production process focusing on the energy aspect. The production process occurred in a paper mill that produces packaging paper using paper and cardboard from source separation of municipal solid waste as raw materials. Two scenarios (S1 and S2) were defined by their energy supply sources. A cogeneration (CHP) system using natural gas for the combined production of thermal and electric energy was the source in S1. The Italian electricity grid (using the Italian country mix) and a natural gas boiler were the separate sources for electric and thermal energy, respectively, in S2. Finally, in order to evaluate the environmental effects on the results of the study about the variation in the natural gas supply source, four alternative Italian import mixes (M1, M2, M3, and M4) were defined by varying the contribution of the supplier countries. The environmental impacts were evaluated with ReCiPe 2016 (H) using both midpoint and endpoint approaches. The results showed that for both the scenarios, the energy consumption was the main cause of impacts mainly because of the natural gas contribution. The presence of the cogeneration (CHP) system generated significant environmental benefits compared with the use of energy provided by more conventional sources. The production and use of chemicals as well as the disposal of waste produced during the paper production were other environmental hotspots. The variation in the composition of the Italian import mix of natural gas, in terms of the supplier country’s contribution, had a significant influence on the results. The import of natural gas from Russia was the most impactful option. Since Russia is the country that contributes to the Italian import mix the most, in the next years, the use of natural gas in Italy could become increasingly impactful. Therefore, the replacement of natural gas with renewable sources is an urgent priority.

A novel miniaturized and sustainable platform exploiting two merged paper-based substrates has been applied for the programmable pre-concentration of analytes of interest and electrochemical detection of mercury traces in drinking water using printable sensor strips. This strategy represents a novel versatile possibility in merging humble materials maximizing their impacts on analytical and remediation challenges.

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

PurposeThis position paper urges a drive towards clarity in the key definitions, terminologies and habits of speech associated with digital engineering and building information modelling (BIM). The ultimate goal of the paper is to facilitate the move towards arriving at an ideal definition for both concepts.Design/methodology/approachThis paper takes the “explanation building” review approach in providing prescriptive guidelines to researchers and industry practitioners. The aim of the review is to draw upon existing studies to identify, describe and find application of principles in a real-world context.FindingsThe paper highlights the definitional challenges surrounding digital engineering and BIM in Australia, to evoke a debate on BIM and digital engineering boundaries, how and why these two concepts may be linked, and how they relate to emerging concepts.Originality/valueThis is the first scholarly attempt to clarify the definition of digital engineering and address the confusion between the concepts of BIM and digital engineering.

Patients with heart failure (HF) who contract SARS-CoV-2 infection are at a higher risk of cardiovascular and non-cardiovascular morbidity and mortality. Regardless of therapeutic attempts in COVID-19, vaccination remains the most promising global approach at present for controlling this disease. There are several concerns and misconceptions regarding the clinical indications, optimal mode of delivery, safety and efficacy of COVID-19 vaccines for patients with HF. This document provides guidance to all healthcare professionals regarding the implementation of a COVID-19 vaccination scheme in patients with HF. COVID-19 vaccination is indicated in all patients with HF, including those who are immunocompromised (e.g. after heart transplantation receiving immunosuppressive therapy) and with frailty syndrome. It is preferable to vaccinate against COVID-19 patients with HF in an optimal clinical state, which would include clinical stability, adequate hydration and nutrition, optimized treatment of HF and other comorbidities (including iron deficiency), but corrective measures should not be allowed to delay vaccination. Patients with HF who have been vaccinated against COVID-19 need to continue precautionary measures, including the use of facemasks, hand hygiene and social distancing. Knowledge on strategies preventing SARS-CoV-2 infection (including the COVID-19 vaccination) should be included in the comprehensive educational programmes delivered to patients with HF. This article is protected by copyright. All rights reserved. [Abstract copyright: This article is protected by copyright. All rights reserved.]

Patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions but to date only one official position paper related to left circulation thromboembolism has been published. This interdisciplinary paper, prepared with the involvement of eight European scientific societies, reviews the available evidence and proposes a rationale for decision making for other PFO-related clinical conditions. In order to guarantee a strict evidence-based process, we used a modified grading of recommendations, assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements were weighed and graded according to predefined scales. Despite being based on limited and observational or low-certainty randomised data, a number of position statements were made to frame PFO management in different clinical settings, along with suggestions for new research avenues. This interdisciplinary position paper, recognising the low or very low certainty of existing evidence, provides the first approach to several PFO-related clinical scenarios beyond left circulation thromboembolism and strongly stresses the need for fresh high-quality evidence on these topics.

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.

The world is passing through a global pandemic of COVID 19. The number of positive cases has crossed over twenty thousand as of April 2020. Like everyone else, it is indeed a very challenging situation for family physicians and primary care providers as most of the guidelines presently have focused on screening, quarantine, isolation, and hospital-based management. Limited information or clarity is available on running small private clinics during pandemic times. The key concern is professional obligation versus risks of community transmission. Family physicians see routine flu-like illnesses throughout the year with seasonal variation within their practices. This document is intended to develop consensus and standard practices for the family physicians and other primary care providers during the pandemic, ensuring optimal continuity of care. This document was reviewed by the national executive of the Academy of Family Physicians of India and approved for dissemination among members. However, due to the dynamic status of the pandemic, all practitioners are advised to closely follow the instructions, guidelines, and advisories of national, state and local health authorities as well.

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.

For many patients, notably among elderly nursing home residents, no plans about end-of-life decisions and palliative care are made. Consequently, when these patients experience life-threatening events, decisions to withhold or withdraw life-support raise major challenges for emergency healthcare professionals. Emergency department premises are not designed for providing the psychological and technical components of end-of-life care. The continuous inflow of large numbers of patients leaves little time for detailed assessments, and emergency department staff often lack training in end-of-life issues. For prehospital medical teams (in France, the physician-staffed mobile emergency and intensive care units known as SMURs), implementing treatment withholding and withdrawal decisions that may have been made before the acute event is not the main focus. The challenge lies in circumventing the apparent contradiction between the need to make immediate decisions and the requirement to set up a complex treatment project that may lead to treatment withholding and/or withdrawal. Laws and recommendations are of little assistance for making treatment withholding and withdrawal decisions in the emergency setting. The French Intensive Care Society (Société de Réanimation de Langue Française, SRLF) and French Society of Emergency Medicine (Société Française de Médecine d’Urgence, SFMU) tasked a panel of emergency physicians and intensivists with developing a document to serve both as a position paper on life-support withholding and withdrawal in the emergency setting and as a guide for professionals providing emergency care. The task force based its work on the available legislation and recommendations and on a review of published studies.

Oteros, Jose/0000-0002-9369-8633; Fonseca, Joao Almeida/0000-0002-0887-8796; Alvarez-Perea, Alberto/0000-0001-7417-7309; Oteros, Jose/0000-0002-9369-8633; Gevaert, Philippe/0000-0002-1629-8468; Antolin, Dario/0000-0001-5699-4022; Apfelbacher, Christian/0000-0003-3805-8219; Buters, Jeroen/0000-0003-3581-5472; Berger, Uwe E./0000-0002-9265-2131; Blank, Simon/0000-0002-5649-1078; Cardona, Victoria/0000-0003-2197-9767; Dramburg, Stephanie/0000-0002-9303-3260 WOS: 000486665800001 PubMed: 31230373 Mobile health (mHealth) uses mobile communication devices such as smartphones and tablet computers to support and improve health-related services, data and information flow, patient self-management, surveillance, and disease management from the moment of first diagnosis to an optimized treatment. The European Academy of Allergy and Clinical Immunology created a task force to assess the state of the art and future potential of mHealth in allergology. The task force endorsed the "Be He@lthy, Be Mobile" WHO initiative and debated the quality, usability, efficiency, advantages, limitations, and risks of mobile solutions for allergic diseases. The results are summarized in this position paper, analyzing also the regulatory background with regard to the "General Data Protection Regulation" and Medical Directives of the European Community. The task force assessed the design, user engagement, content, potential of inducing behavioral change, credibility/accountability, and privacy policies of mHealth products. The perspectives of healthcare professionals and allergic patients are discussed, underlining the need of thorough investigation for an effective design of mHealth technologies as auxiliary tools to improve quality of care. Within the context of precision medicine, these could facilitate the change in perspective from clinician- to patient-centered care. The current and future potential of mHealth is then examined for specific areas of allergology, including allergic rhinitis, aerobiology, allergen immunotherapy, asthma, dermatological diseases, food allergies, anaphylaxis, insect venom, and drug allergy. The impact of mobile technologies and associated big data sets are outlined. Facts and recommendations for future mHealth initiatives within EAACI are listed.

Costela Lacrimioara Serban,1 Ancuta Mioara Banu,2 Sandra Putnoky,3 Stefania Ioana Butica,4 Mihai Dinu Niculescu,5 Salomeia Putnoky6 1Department of Functional Sciences, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timișoara, Romania; 2Department 2, Maxilo-Facial Surgery Discipline, Faculty of Dental Medicine, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timișoara, Romania; 3Psychiatric Clinic, Emergency Clinical County Hospital, Timișoara, Romania; 4University of Medicine and Pharmacy “Victor Babes” Timișoara, Timișoara, Romania; 5Advanced Nutrigenomics, Cary, NC, 27511, USA; 6Department of Microbiology, University of Medicine and Pharmacy “Victor Babes” Timișoara, Timișoara, RomaniaCorrespondence: Ancuta Mioara BanuDepartment 2, Maxilo-Facial Surgery Discipline, Faculty of Dental Medicine, University of Medicine and Pharmacy “Victor Babes” Timișoara, Take Ionescu Bvd 5, Timi&scedil;oara, 300890, RomaniaTel +40722273268Email banu.ancuta@umft.roPurpose: This study assessed potential differences in estimating short-term dietary intake of energy and nutrients and food consumption, between 4-week food frequency questionnaires (FFQs) and 7-day food records in Romanian adults.Patients and Methods: A total of 116 participants (age range 18– 74 years, 31% males and 28.4% of participants being overweight and obese) were recruited. Estimates for energy and macro- and micronutrient intakes, and food group intakes were compared between the two methods using Wilcoxon-sign-rank test, correlation coefficients, Cohen’s Kappa, Bland–Altman plots with 95% limits of agreement, and quartile classifications.Results: Cohen’s Kappa values for energy and macronutrient intakes indicated moderate agreement, ranging from 0.402 (protein) to 0.470 (fat), fair agreement for most micronutrients (0.2– 0.4) and poor agreement for most food groups (< 0.2). When data were cross-classified into quartiles for energy and macronutrients, about 58% of participants were cross-classified in the same quartile using both methods, while 33% of participants were cross-classified in adjacent quartiles of one method versus the other. Micronutrients (such Na, Mg, Ca, K, Fe, vitamins) had the highest degree of misclassification, on average 40% being cross-classified in the same quartile and another 40% in adjacent quartiles. Bland–Altman plots suggested that both methods were comparable for energy and all macronutrients. When the consumption of food groups was compared, correlation coefficients between methods ranged from 0.09 (legumes) to 0.26 (whole grain), indicating poor correlation.Conclusion: These results showed that the relative match of a standard FFQ, as compared to the 7-day food records, was moderate in estimating macronutrient and energy, fair for most micronutrient intakes and poor for others and as for food groups.Keywords: food-frequency questionnaire, FFQ, validation, adults, dietary assessment, food-record

Pancreatic cancer (PC) is a common cause of cancer-related death, due to difficulties in detecting early-stage disease, to its aggressive behaviour, and to poor response to systemic therapy. Therefore, developing strategies for early diagnosis of resectable PC is critical for improving survival. Diabetes mellitus is another major public health problem worldwide. Furthermore, diabetes can represent both a risk factor and a consequence of PC: nowadays, the relationship between these two diseases is considered a high priority for research. New-onset diabetes can be an early manifestation of PC, especially in a thin adult without a family history of diabetes. However, even if targeted screening for patients at higher risk of PC could be a promising approach, this is not recommended in asymptomatic adults with new-onset diabetes, due to the much higher incidence of hyperglycaemia than PC and to the lack of a safe and affordable PC screening test. Prompted by a well-established and productive multidisciplinary cooperation, the Italian Association of Medical Oncology (AIOM), the Italian Medical Diabetologists Association (AMD), the Italian Society of Endocrinology (SIE), and the Italian Society of Pharmacology (SIF) here review available evidence on the mechanisms linking diabetes and PC, addressing the feasibility of screening for early PC in patients with diabetes, and sharing a set of update statements with the aim of providing a state-of-the-art overview and a decision aid tool for daily clinical practice., Highlights • The incidence of PC is increasing and its prognosis is very poor; therefore, early detection is fundamental. • New-onset diabetes may be an early manifestation of PC, often disappearing after its resection. • Screening for PC is not currently recommended among people with new-onset diabetes, due to its high incidence. • Thin subjects >50 years old at the time of diabetes onset, with sudden weight loss and severe hyperglycaemia are at higher risk. • Currently some clinical models are promising for stratifying cancer risk in people with new-onset diabetes.

Executive SummaryWith an increasing variety of radiopharmaceuticals for diagnostic or therapeutic nuclear medicine as valuable diagnostic or treatment option, radiobiology plays an important role in supporting optimizations. This comprises particularly safety and efficacy of radionuclide therapies, specifically tailored to each patient. As absorbed dose rates and absorbed dose distributions in space and time are very different between external irradiation and systemic radionuclide exposure, distinct radiation-induced biological responses are expected in nuclear medicine, which need to be explored. This calls for a dedicated nuclear medicine radiobiology. Radiobiology findings and absorbed dose measurements will enable an improved estimation and prediction of efficacy and adverse effects. Moreover, a better understanding on the fundamental biological mechanisms underlying tumor and normal tissue responses will help to identify predictive and prognostic biomarkers as well as biomarkers for treatment follow-up. In addition, radiobiology can form the basis for the development of radiosensitizing strategies and radioprotectant agents. Thus, EANM believes that, beyond in vitro and preclinical evaluations, radiobiology will bring important added value to clinical studies and to clinical teams. Therefore, EANM strongly supports active collaboration between radiochemists, radiopharmacists, radiobiologists, medical physicists, and physicians to foster research toward precision nuclear medicine.

Background The COVID-19 pandemic has caused unprecedented global demand for personal protective equipment (PPE). A paucity of data on PPE burn rate (PPE consumption over time) in pandemic situations exacerbated these issues as there was little historic research to indicate volumes of PPE required to care for surges in infective patients and thus plan procurement requirements. Methods To better understand PPE requirements for care of suspected or confirmed COVID-19 patients in our Australian quaternary referral hospital, the number of staff-to-patient interactions in a 24-h period for three patient groups (ward-based COVID suspect, ward-based COVID confirmed, intensive care COVID confirmed) was audited prospectively from 1st to 30th April 2020. Results The average number of staff-to-patient interactions in a 24-h period was: 13.1 ± 5.0 (mean ± SD) for stable ward-managed COVID-19 suspect patients; 11.9 ± 3.8 for stable ward-managed confirmed COVID-19 patients; and 30.0 ± 5.3 for stable, mechanically ventilated, ICU-managed COVID-19 patients. This data can be used in PPE demand simulation modelling for COVID-19 and potentially other respiratory illnesses. Conclusion Data on the average number of staff-to-patient interactions needed for the care of COVID-19 patients is presented. This data can be used for PPE demand simulation modelling.

Drug hypersensitivity reactions (DHRs) in childhood are mainly caused by betalactam or non-betalactam antibiotics, and non-steroidal anti-inflammatory drugs (NSAIDs). Laboratory tests for identifying children who are allergic to drugs have low diagnostic accuracy and predictive value. The gold standard to diagnose DHR is represented by the drug provocation test (DPT), that aims of ascertaining the causative role of an allergen and evaluating the tolerance to the suspected drug. Different protocols through the administration of divided increasing doses have been postulated according to the type of drug and the onset of the reaction (immediate or non immediate reactions). DPT protocols differ in doses and time interval between doses. In this position paper, the Italian Pediatric Society for Allergy and Immunology provides a practical guide for provocation test to antibiotics and NSAIDs in children and adolescents.

Background: Professional support in childbearing has beneficial effects on childbirth experience, interactions within the family, breastfeeding and medical outcomes. However, more knowledge is needed about prerequisites for professional support to be valuable and satisfactory during childbearing. Aim: The aim of this discourse paper is to describe and explore prerequisites for professional support that are of value for women and their families during childbearing as well as how healthcare organizations can be formed to facilitate these prerequisites. Design: Discourse paper. Methods: This discourse paper is based on our own experiences and is supported by literature and theory. Results: Well-functioning structures and processes facilitate professional support that leads to safe, secure, calm and prepared parents with the ability to handle the challenges of childbearing and parenting. When organizing care in childbearing, prerequisites for support needs must also be considered. CC BY 4.0© 2021 The Authors. Nursing Open published by John Wiley & Sons Ltd.First published: 06 November 2021CorrespondenceAnette Ekström-Bergström, Department of Health Sciences, University West, SE-461 86 Trollhättan, Sweden.Email: anette.ekstrom-bergstrom@hv.se

This paper utilizes a hybrid Debye model to accurately simulate the relaxation response process of the oil‐paper insulation of a transformer to explore the application of frequency domain dielectric spectroscopy (FDS) in nondestructive diagnosis of the aging condition of oil‐paper insulation. Via FDS test data, the model parameters can be identified, and the influence laws of FDS can be obtained through the variation of model parameters. To explore the effects of insulating paper moisture content, insulating paper layers, and test temperature on FDS characteristics, an FDS experimental platform is established. The results show that the hybrid Debye model can effectively reflect the relaxation response process of oil‐paper insulation under different conditions, as well as that a physical relationship between the model parameters and oil‐paper dielectric polarization exists. In addition, the parameters of the hybrid Debye model can be used as the characteristic quantities for the non‐destructive evaluation of the oil‐paper insulation state, providing new ideas for the non‐destructive evaluation of the oil‐paper insulation state.

The fabrication of underwater devices is necessary for the exploration of water environments and interactions in the Human–Computer Interaction (HCI) field. However, there are fewer approaches to support prototyping used in water environments. The existing prototype methods lack systematic waterproof treatments and provide insufficient software for balance and buoyancy analysis. To address these limitations, we present ElectroPaper, a new approach for the design and fabrication of prototypes used in water environments (surface or beneath) with paper-based electronic interfaces with a crease layer, hardware distribution layer, and hollow-out layer to support physical properties, such as waterproofing, foldability, and conformability. The approach includes a computational design tool for assisting in balance analysis, three-dimensional (3D) model unfolding, and circuit drawing. We describe the design and fabrication process and provide several example applications to illustrate the feasibility and utility of our approach. ElectroPaper provides an inexpensive and effective medium for the fabrication of customized digital prototypes for water environment use.

International audience; This position paper was intended to update the former consensus between the French Societies of Radiology and Cardiology about the use of stress cardiac magnetic resonance imaging (MRI) in chronic coronary syndrome published in 2009. The Delphi method was used to build the present consensus. This expert panel consensus includes recommendations for indications, procedure with patient preparation, stress inducing drugs, acquisition protocol, interpretation and risk stratification by stress MRI.

Publisher Copyright: © 2020, The Author(s). Severe blood disorders and cancer are the leading cause of death and disability from noncommunicable diseases in the global pediatric population and a major financial burden. The most frequent of these conditions, namely sickle cell disease and severe thalassemia, are highly curable by blood or bone marrow transplantation (BMT) which can restore a normal health-related quality of life and be cost-effective. This position paper summarizes critical issues in extending global access to BMT based on ground experience in the start-up of several BMT units in middle-income countries (MICs) across South-East Asia and the Middle East where close to 700 allogeneic BMTs have been performed over a 10-year period. Basic requirements in terms of support systems, equipment, and consumables are summarized keeping in mind WHO’s model essential lists and recommendations. BMT unit setup and maintenance costs are summarized as well as those per transplant. Low-risk BMT is feasible and safe in MICs with outcomes comparable to high-income countries but at a fraction of the cost. This report might be of assistance to health care institutions in MICs interested in developing hematopoietic stem cell transplantation services and strengthening context appropriate tertiary care and higher medical education.

This ESC Council on Stroke/EAPCI/EBNI position paper summarizes recommendations for training of cardiologists in endovascular treatment of acute ischaemic stroke. Interventional cardiologists adequately trained to perform endovascular stroke interventions could complement stroke teams to provide the 24/7 on call duty and thus to increase timely access of stroke patients to endovascular treatment. The training requirements for interventional cardiologists to perform endovascular therapy are described in details and should be based on two main principles: (i) patient safety cannot be compromised, (ii) proper training of interventional cardiologists should be under supervision of and guaranteed by a qualified neurointerventionist and within the setting of a stroke team. Interdisciplinary cooperation based on common standards and professional consensus is the key to the quality improvement in stroke treatment.

The COVID-19 pandemic has had a huge influence in almost all areas of life, affecting societies, economics, and health care systems worldwide. The paediatric cardiology community is no exception. As the challenging battle with COVID-19 continues, professionals from the Association for the European Paediatric and Congenital Cardiology receive many questions regarding COVID-19 in a Paediatric and Congenital Cardiology setting. The aim of this paper is to present the AEPC position on frequently asked questions based on the most recent scientific data, as well as to frame a discussion on how to take care of our patients during this unprecedented crisis. As the times are changing quickly and information regarding COVID-19 is very dynamic, continuous collection of evidence will help guide constructive decision-making.

Peanuts are Leguminosae, commonly known as the legume or pea family, and peanut allergy is among the most common food allergies and the most common cause of fatal food reactions and anaphylaxis.The prevalence of peanut allergy increased 3.5-fold over the past two decades reaching 1.4–2% in Europe and the United States. The reasons for this increase in prevalence are likely multifaceted. Sensitization via the skin appears to be associated with the development of peanut allergy and atopic eczema in infancy is associated with a high risk of developing peanut allergy.Until recently, the only possible management strategy for peanut allergy was strict allergen avoidance and emergency treatment including adrenaline auto-injector in cases of accidental exposure and reaction.This paper discusses the various factors that impact the risks of peanut allergy and the burden of self-management on peanut-allergic children and their caregivers.

In many manufacturing industries, the production process involves the production of objects and the cutting of such objects into smaller pieces in order to meet a specific demand. In the optimization of these processes, one can identify the lot sizing and the cutting stock problems. In the literature, these problems are mostly separately dealt. However, treating these two problems in an integrated approach can decrease overall costs. In this research, we deal with the coupled lot sizing and cutting stock problem. It is proposed a mathematical formulation for the production and cutting of paper based on a real case, which considers setup costs and limited machine capacity in the production process of the objects. For the solution of the proposed model, we used a column generation approach and a relax-and-fix heuristic. Computational tests were carried out in order to analyze the methodology used in the resolution of the model. The results showed to be competitive in a reasonable computational time.

This paper is a contribution to the EUMETNET AutoPollen Programme, which is developing a prototype automatic pollen monitoring network in Europe covering all aspects of the information chain from measurements through to communicating information to the public., Background: Information about airborne pollen concentrations is required by a range of end users, particularly from the health sector who use both observations and forecasts to diagnose and treat allergic patients. Manual methods are the standard for such measurements but, despite the range of pollen taxa that can be identified, these techniques suffer from a range of drawbacks. This includes being available at low temporal resolution (usually daily averages) and with a delay (usually 3–9 days from the measurement). Recent technological developments have made possible automatic pollen measurements, which are available at high temporal resolution and in real time, although currently only scattered in a few locations across Europe. Materials & Methods: To promote the development of an extensive network across Europe and to ensure that this network will respond to end user needs, a stakeholder workshop was organised under the auspices of the EUMETNET AutoPollen Programme. Participants discussed requirements for the groups they represented, ranging from the need for information at various spatial scales, at high temporal resolution, and for targeted services to be developed. Results: The provision of real-time information is likely to lead to a notable decrease in the direct and indirect health costs associated with allergy in Europe, currently estimated between €50–150 billion/year.. Discussion & Conclusion: A European measurement network to meet end user requirements would thus more than pay for itself in terms of potential annual savings and provide significant impetus to research across a range of disciplines from climate science and public health to agriculture and environmental management.

Contemporary cardiovascular medicine is complex, dynamic, and interactive. Therefore, multidisciplinary dialogue between different specialists is required to deliver optimal and patient-centred care. This has led to the concept of explicit collaborations of different specialists caring for patients with complex cardiovascular diseases—that is ‘heart teams’. These teams are particularly valuable to minimize referral bias and improve guideline adherence as so to be responsive to patient preferences, needs, and values but may be challenging to coordinate, especially in the acute setting. This position paper—jointly developed by four cardiovascular associations—is intended to provide conceptual and practical considerations for the composition, structure, and function of multidisciplinary teams. It focuses on patients with complex coronary artery diseases in both elective and urgent setting and provide guidance on how to implement the heart team both in chronic and in acute coronary syndromes patients, including cases with mechanical complications and haemodynamic instability; it also discusses strategies for clear and transparent patient communication and provision of a patient-centric approach. Finally, gaps in evidence and research perspectives in this context are discussed.

Male infertility affects millions of males worldwide and is rising in prevalence due to social and environmental conditions. However, men often feel too embarrassed to receive a semen analysis in the hospital due to social stigmas. To overcome this problem, we developed a 3‐(4,5‐Dimethyl‐2‐thiazolyl)‐2,5‐diphenyl‐2H‐tetrazolium bromide test strip to distinguish semen samples with low total motile sperm concentration from those with normal motile sperm concentration. This is a point‐of‐care colorimetric semen analytical method with a one‐step, inexpensive, equipment‐free evaluation process, and adequate accuracy validated in a 42‐sample clinical trial. In this study, results were evaluated visually and with a smartphone application. Using visual observation methods, the area under the curve (AUC) was 0.71 (95% of confidence interval = 0.55–0.86; p = 0.021), sensitivity was 41%, specificity was 95%, positive predictive value was 90%, negative predictive value (NPV) was 59.4%, and accuracy was 67%. Using a smartphone recording and analytical system, AUC was 0.766 (95% of confidence interval = 0.612–0.92; p = 0.003), sensitivity was 96%, specificity was 65%, PPV was 75%, NPV was 92.9%, and accuracy was 80.9%. This work demonstrated a screening tool that could elevate semen analysis to the level of routine healthcare and provide for private, in‐home self‐assessment.

Recognizing the increase in cancer incidence globally and the need for effective cancer control interventions, several organizations, professional bodies, and international institutions have proposed strategies to improve treatment options and reduce mortality along with minimizing overall incidence. Despite these efforts, an estimated 9.6 million deaths in 2018 was attributed to this noncommunicable disease, making it the second leading cause of death worldwide. Left unchecked, this will further increase in scale, with an estimated 29.5 million new cases and 16.3 million deaths occurring worldwide in 2040. Although it is known and generally accepted that cancer services must include radiotherapy, such access is still very limited in many parts of the world, especially in low- and middle-income countries. After thorough review of the current status of radiotherapy including programs worldwide, as well as achievements and challenges at the global level, the International Atomic Energy Agency convened an international group of experts representing various radiation oncology societies to take a closer look into the current status of radiotherapy and provide a road map for future directions in this field. It was concluded that the plethora of global and regional initiatives would benefit further from the existence of a central framework, including an easily accessible repository through which better coordination can be done. Supporting this framework, a practical inventory of competencies needs to be made available on a global level emphasizing the knowledge, skills, and behavior required for a safe, sustainable, and professional practice for various settings. This white paper presents the current status of global radiotherapy and future directions for the community. It forms the basis for an action plan to be developed with professional societies worldwide.

Aims Quality indicators (QIs) are tools to improve the delivery of evidence-base medicine. In 2017, the European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC) developed a set of QIs for acute myocardial infarction (AMI), which have been evaluated at national and international levels and across different populations. However, an update of these QIs is needed in light of the accumulated experience and the changes in the supporting evidence. Methods and results The ESC methodology for the QI development was used to update the 2017 ACVC QIs. We identified key domains of AMI care, conducted a literature review, developed a list of candidate QIs, and used a modified Delphi method to select the final set of indicators. The same seven domains of AMI care identified by the 2017 Study Group were retained for this update. For each domain, main and secondary QIs were developed reflecting the essential and complementary aspects of care, respectively. Overall, 26 QIs are proposed in this document, compared to 20 in the 2017 set. New QIs are proposed in this document (e.g. the centre use of high-sensitivity troponin), some were retained or modified (e.g. the in-hospital risk assessment), and others were retired in accordance with the changes in evidence [e.g. the proportion of patients with non-ST segment elevation myocardial infarction (NSTEMI) treated with fondaparinux] and the feasibility assessments (e.g. the proportion of patients with NSTEMI whom risk assessment is performed using the GRACE and CRUSADE risk scores). Conclusion Updated QIs for the management of AMI were developed according to contemporary knowledge and accumulated experience. These QIs may be applied to evaluate and improve the quality of AMI care.

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Much of these diseases burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that with respect to low density lipoprotein cholesterol (LDL-C), “lower is better for longer”, and the recent data have strongly emphasized the need of also “the earlier the better”. In addition to statins, which have been available for several decades, the availability of ezetimibe and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) are additional very effective approach to LLT, especially for those at very high and extremely high cardiovascular risk. LLT is initiated as a response to an individual’s calculated risk of future ASCVD and is intensified over time in order to meet treatment goals. However, in real-life clinical practice goals are not met in a substantial proportion of patients. This Position Paper complements existing guidelines on the management of lipids in patients following ACS. Bearing in mind the very high risk of further events in ACS, we propose practical solutions focusing on immediate combination therapy in strict clinical scenarios, to improve access and adherence to LLT in these patients. We also define an ‘Extremely High Risk’ group of individuals following ACS, completing the attempt made in the recent European guidelines, and suggest mechanisms to urgently address lipid-medicated cardio-vascular risk in these patients.

BACKGROUND: The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper from 2015 on percutaneous endoscopic gastrostomy (PEG) required updating in the light of recent clinical knowledge and data published in medical journals since 2014. METHODS: A systematic review of medical literature from 2014 to 2020 was carried out. Consensus on the content of the manuscript, including recommendations, was achieved by the authors through electronic and virtual means. The expert opinion of the authors is also expressed in the manuscript when there was a lack of good scientific evidence regarding PEGs in children in the literature. RESULTS: The authors recommend that the indication for a PEG be individualized, and that the decision for PEG insertion is arrived at by a multidisciplinary team (MDT) having considered all appropriate circumstances. Well timed enteral nutrition is optimal to treat faltering growth to avoid complications of malnutrition and body composition. Timing, device choice and method of insertion is dependent on the local expertise and after due consideration with the MDT and family. Major complications such as inadvertent bowel perforation should be avoided by attention to good technique and by ensuring the appropriate experience of the operating team. Feeding can be initiated as early as 3 hours after tube placement in a stable child with iso-osmolar feeds of standard polymeric formula. Low-profile devices can be inserted initially using the single-stage procedure or after 2-3 months by replacing a standard PEG tube, in those requiring longer-term feeding. Having had a period of non-use and reliance upon oral intake for growth and weight gain-typically 8-12 weeks-a PEG may then safely be removed after due consultation. In the event of non-closure of the fistula the most successful method for closing it, to date, has been a surgical procedure, but the Over-The-Scope-Clip (OTSC) has recently been used with considerable success in this scenario. CONCLUSIONS: A multidisciplinary approach is mandatory for the best possible treatment of children with PEGs. Morbidity and mortality are minimized through team decisions on indications for insertion, adequate planning and preparation before the procedure, subsequent monitoring of patients, timing of the change to low-profile devices, management of any complications, and optimal timing of removal of the PEG.

Liver and kidney are strictly connected in a reciprocal manner, in both the physiological and pathological condition. The Italian Association for the Study of Liver, in collaboration with the Italian Society of Nephrology, with this position paper aims to provide an up-to-date overview on the principal relationships between these two important organs. A panel of well-recognized international expert hepatologists and nephrologists identified five relevant topics: 1) The diagnosis of kidney damage in patients with chronic liver disease; 2) Acute kidney injury in liver cirrhosis; 3) Association between chronic liver disease and chronic kidney disease; 4) Kidney damage according to different etiology of liver disease; 5) Polycystic kidney and liver disease. The discussion process started with a review of the literature relating to each of the five major topics and clinical questions and related statements were subsequently formulated. The quality of evidence and strength of recommendations were graded according to the GRADE system. The statements presented here highlight the importance of strong collaboration between hepatologists and nephrologists for the management of critically ill patients, such as those with combined liver and kidney impairment.

The European Large Geotechnical Institutes Platform (ELGIP) is a group of 14 European research organizations, leading in geotechnical engineering, which aims to promote internationally the profession, its network and its societal relevance. One ELGIP vision is that all transport infrastructure should aim for an optimal geotechnical design. The present paper shows the relationship between the pressing challenges on European transport infrastructures and the crucial role that geotechnical engineering plays in solving them, emphasising the need for improved knowledge and understanding of ground properties in transport infrastructure.

Stroke, a vascular disease of the brain, is the #1 cause of disability and a major cause of death worldwide. Stroke has a major negative impact on the life of stroke-affected individuals, their families and the society. A significant proportion of stroke victims indicate that would have preferred death over their after-stroke quality of life. Mechanical thrombectomy (MT), opening the occluded artery using mechanical aspiration or a thrombus-entrapment device, is a guideline-mandated (class I, level of evidence A) treatment modality in patients with large vessel occlusion stroke. MT clinical benefit magnitude indicates that a universal access to this treatment strategy should be the standard of care. Today there is a substantial geographic variation in MT deliverability, with large-scale disparities in MT implementation. In many countries effective access to MT remains severely limited. In addition, many of the MT-treated patients are treated too late for a good functional outcome because of logistic delays that include transportations to remotely located, scarce, comprehensive stroke centres. Position Paper from the European Society of Cardiology Council on Stroke and European Association for Percutaneous Cardiovascular Interventions on interdisciplinary management of acute ischaemic stroke, developed with the support of the European Board of Neurointervention fills an important gap in systematically enabling interventional cardiologists to support stroke intervention in the geographic areas of unmet needs in particular. We review strengths and weaknesses of the document, and suggest directions for the next steps that are swiftly needed to deliver MT to stroke patients more effectively.

At the beginning of October, the member organisations of the European Association of Hospital Pharmacists (EAHP) adopted a new position paper on pharmacy preparations and compounding. The position aims at providing information about the practice of pharmacy preparations and compounding in hospitals and asks for a stronger embedment of compounding and reconstitution practices in European hospital pharmacies, linked to increasing capacity and training. The different sections of EAHP’s position paper touch on the importance of compounding for addressing patient needs, the involvement of hospital pharmacies in reconstitution practices and the role of hospital pharmacists in the preparation and use of advanced therapy medicinal products (ATMPs). Linked to personalised medication, it shares information on the engagement of hospital pharmacists and the adjustments …

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is emerging as a global pandemic outbreak. To date, approximately one million deaths and over 32 million cases have been reported. This ongoing pandemic urgently requires an accurate testing device that can be used in the field in a fast manner. Serological assays to detect antibodies have been proven to be a great complement to the standard method of reverse transcription-polymerase chain reaction (RT-PCR), particularly after the second week of infection. We have developed a specific and sensitive immunosensor for immunoglobulin detection produced against SARS-CoV-2. Unlike other lateral flow-based assays (LFAs) involving the utilization of multiple antibodies, we have reported a label-free paper-based electrochemical platform targeting SARS-CoV-2 antibodies without the specific requirement of an antibody. The presence of SARS-CoV-2 antibodies will interrupt the redox conversion of the redox indicator, resulting in a decreased current response. This electrochemical sensor was proven effective in real clinical sera from patients with satisfactory results. In addition, the proposed format was also extended to antigen detection (the spike protein of SARS-CoV-2), which presents new possibilities for diagnosing COVID-19., Highlights • Electrochemical sensor for COVID-19 diagnostic. • Serological assay for SARS-CoV-2 antibodies was demonstrated. • Sensitivity enhancement compared to the traditional LFA devices. • Applicable to real clinical sera with satisfactory results.

This study develops a framework of internal and external factors that influence the adoption of eco-innovation. We studied 80 adoption processes in the Dutch brewing industry and the Dutch paper industry and analysed the relative importance of different factors. We find that internal factors were more important than external factors. The analysis also shows differences between the industries. The financial advantage was important for both industries, but especially for the paper industry. For the brewing industry, ethical responsibility and stakeholders played a more important role in the adoption. The analysis also revealed differences for small and large firms. Ethical responsibility and stakeholders are relatively more often mentioned by small firms, whereas clear objectives and regulations were mentioned more by large firms. Our study highlights that the adoption of eco-innovation is a complex process and the position in the supply chain as well as the size of a firm influence what is important in the adoption of eco-innovation.

Paper-based surface-enhanced Raman spectroscopy (SERS) sensors can be fabricated easily by dropcasting or inkjet printing colloidal Au nanoparticles onto cellulose-based filter papers. They are flexible, economical, and sensitive and provide the crucial advantage of point-of-need sampling for application in the field. In this study, paper-based SERS sensors are fabricated through inkjet printing of a colloidal Au sol onto a filter paper substrate. We have characterized their SERS performances with benzenethiol and pyridine molecules using a handheld Raman analyzer. Due to the heterogeneous loading of the Au nanoclusters on the paper substrate, we introduce the concept of receiver operating characteristic as an alternate measurand to quantify the performance of these sensors. With their inherent filtration sampling capability, we demonstrate the use of paper SERS sensors for the detection of chemical aerosols. Lastly, we present the use of a precision materials printer to deposit quantifiable amounts of analyte (fentanyl) uniformly across the active sensing area of a paper SERS sensor. This will allow for analyte-loaded certified references to be prepared and used in the field as standards for comparison.