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The COVID-19 pandemic represents an unprecedented event that has brought deep changes in hospital facilities with reshaping of the health system organization, revealing inadequacies of current hospital and local health systems. When the COVID-19 emergency will end, further evaluation of the national health system, new organization of acute wards, and a further evolution of the entire health system will be needed to improve care during the chronic phase of disease. Therefore, new standards for healthcare personnel, more efficient organization of hospital facilities for patients with acute illnesses, improvement of technological approaches, and better integration between hospital and territorial services should be pursued. With experience derived from the COVID-19 pandemic,new models, paradigms, interventional approaches, values and priorities should be suggested and implemented.

Approximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.

Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, Switzerland).Die Multiple Sklerose ist eine komplexe, autoimmun vermittelte Erkrankung des zentralen Nervensystems, charakterisiert durch inflammatorische Demyelinisierung sowie axonalen/neuronalen Schaden. Die Zulassung verschiedener verlaufsmodifizierender Therapien und unser verbessertes Verständnis der Krankheitsmechanismen und -entwicklung in den letzten Jahren haben die Prognose und den Verlauf der Erkrankung deutlich verändert. Diese Aktualisierung der Behandlungsempfehlung der Multiple Sklerose Therapie Konsensus Gruppe konzentriert sich auf die wichtigsten Empfehlungen für verlaufsmodifizierende Therapien der Multiplen Sklerose im Jahr 2021. Unsere Empfehlungen basieren auf aktuellen wissenschaftlichen Erkenntnissen und gelten für diejenigen Medikamente, die in weiten Teilen Europas, insbesondere in den deutschsprachigen Ländern (Deutschland, Österreich, Schweiz), zugelassen sind.

Fraudulent papers from paper mills are a serious threat to the entire scientific community. Naunyn-Schmiedeberg’s Archives of Pharmacology has become the target of a massive attack of fraudulent papers originating from paper mills. This editorial highlights 20 important features we observed with paper mills and explains how the journal is responding to this serious threat to restore the integrity of science. Hopefully, this editorial is also helpful for editors of other scientific journals.

Measuring line efficiency and productivity are very important to do to find out in which level the efficiency and productivity of the business process has been carried out by the company. This paper aims to determine line efficiency analysis and provide suggestions for improvements to increase line efficiency at the finishing department of PT Pura Nusapersada. Measurement of line efficiency in the finishing department of PT Pura Nusapersada paper mill unit 7 has not yet reached the company's line efficiency value target. The initial line efficiency assessment obtained a percentage of 65.14% while the company's target was 70%. In this paper, a fishbone diagram is used to determine the root cause of the problem. Based on the research results, it was found that the most dominant cause of the problem was the inefficient work elements at the cutter, sorting, pollar, and packing work stations. Improvements were made using the eliminate, combine, re-arrange, and simplify (ECRS) method and the results of the line efficiency improvements in the finishing department increased to 71.90% and the company's target can be met.

Due to great advantages, such as simple operation, high porosity, and good fiber continuity, the working principle and research progress of electrospinning technology was studied and polyvinyl alcohol (PVOH) nanofibers were prepared via this process. Air filter paper was used as the receiving substrate to prepare electrospun nano air filter paper (NAFP). The PVOH concentration, static voltage, and receiving distance, were tested to explore the influence of spinning parameters on the filtration performance. Further, the microfiber morphology of the electrospun NAFP was observed. The performance of filter paper, including air permeability, pore size, initial resistance, filtration efficiency, and dust retention, were tested. The results showed that the electrospun NAFP had better filtration performance compared to the air filter paper, and simultaneously they had lower initial resistance and higher precision filtration efficiency. The nanofiber influenced the surface of the air filter paper, as it sharply reduced the pore size. When the spinning condition was 10%, 21 kV, and 15 cm, the pore size decreased approximately 0.6 times of the original, which meant the electrospun NAFP could capture particles ≥ 0.2 μm in size. Finally, after three repeated uses, the good filtration performance was maintained.

From the moment of production, paper as a printing substrate is exposed to the process of natural ageing regardless of the type of cellulose fibres in its composition. Accordingly, the prints produced by the various printing techniques are also exposed to several factors that impair the quality of the print i.e. its colour over time. Therefore, it is very important to properly select the printing substrate for achieving a high quality of graphic products. For that purpose, three types of papers with hemp fibres were used as printing substrates which were printed with laboratory hand-operated instrument Esiproof using flexographic cyan (C), magenta (M), yellow (Y) and black (K) water-based inks. Prints were artificially aged in SunTEST XLS+ test chamber according to standard ASTM D 6789-02 for 48 and 96 hours. Based on changes in the reflectance spectra of each printed ink after exposure to electromagnetic radiation it was noticed how composition of printing substrate strongly influence on colour stability of prints due time. An increase of exposure time to electromagnetic radiation leads to a decrease in the value of the reflectance of the printing substrate and cyan, magenta and yellow prints. It was confirmed how electromagnetic radiation have the greatest impact on the reflectance of yellow print, while the black one is the most stabile regardless of the substrate it was printed on.

International audience; In 2014 leading publishers withdrew more than 120 nonsensical publications automatically generated with the SCIgen program. Casual observations suggested that similar problematic papers are still published and sold, without follow-up retractions. No systematic screening has been performed and the prevalence of such nonsensical publications in the scientific literature is unknown. Our contribution is 2-fold. First, we designed a detector that combs the scientific literature for grammar-based computer-generated papers. Applied to SCIgen, it has a 83.6% precision. Second, we performed a scientometric study of the 243 detected SCIgen-papers from 19 publishers. We estimate the prevalence of SCIgen-papers to be 75 per million papers in Information and Computing Sciences. Only 19% of the 243 problematic papers were dealt with: formal retraction (12) or silent removal (34). Publishers still serve and sometimes sell the remaining 197 papers without any caveat. We found evidence of citation manipulation via edited SCIgen bibliographies. This work reveals metric gaming up to the point of absurdity: fraudsters publish nonsensical algorithmically generated papers featuring genuine references. It stresses the need to screen papers for nonsense before peer-review and chase citation manipulation in published papers. Overall, this is yet another illustration of the harmful effects of the pressure to publish or perish.

BACKGROUND Medical and dental education is highly dependent on the development of students’ clinical skills in addition to their theoretical knowledge. The use of logbooks to monitor the clinical procedures performed by students provides a great advantage in the educational process. Because of the pandemic, utilisation of digital logbooks may prove to be more advantageous. This study aims to investigate the effective use of online progress records and as to whether they actually decrease the chance of error compared to the traditional paper-based logbooks. METHODS In this quasi-experimental study, 139 student logbooks were studied to compare online and paper-based clinical procedures. Logbook monitoring of undergraduate dental students reported by the students themselves vs. instructors was compared. Students filled mandatory individual paper-based logbooks, reporting the number of clinical procedures performed in that year. Additionally, they filled online log- sheets, and updated them regularly. Instructors proofread and signed the paper-based students’ logbooks. Instructors also separately submitted individual online forms recording each student’s clinical procedure performed in clinical sessions. A total of 556 logbook records was collected. The mean number of procedures recorded by the students and instructors (online and paper-based) were statistically compared. RESULTS The mean number of procedures recorded in student-reported online logbooks were significantly lower than that in all other logbooks. Paper-based and online instructorreported logbook data was identical to that of student reported paper-based logbooks. CONCLUSIONS Within the scope of the study, it was concluded that online tools are an asset and may be used as a substitute for paper-based monitoring of clinical activity for instructors. However, students’ compliance updating and uploading online forms is a factor, which is a matter of concern. KEY WORDS Undergraduate Dental Logbooks, Clinical Progress Records, Monitoring Methods, Monitoring Tools, Undergraduate Dental Monitoring, Undergraduate Clinical Procedures Records

Aims The epidemiologic Study of Women's Health Across the Nation (SWAN) includes urinary incontinence (UI) questionnaire items. We introduced an independently self-administered paper towel test (PTT-ISA; invention disclosure #2021-347) to objectively demonstrate UI. Aims were to determine: (1) PTT-ISA compliance and (2) relationship to questionnaire results. Methods 276 community women were invited to complete both SWAN questionnaire and PTT-ISA. For PTT-ISA, a woman holds a trifold brown paper towel against her perineum while coughing hard three times. She checks the towel for wetness and compares it with pictorial showing wetted area gradations (dry towel through >6 ml/saturated). She then selects the best photo match for her towel. A newly conceptualized variable constructed as PTT-ISA plus questionnaire results was formed. Results Of 276 women, noncompliance with PTT-ISA was 2.2% (6 women). Four others (1.5%) were missing questionnaires. For the remaining 266 women, conceptual cohesiveness between questionnaire-only and PTT-ISA + questionnaire was demonstrated in 165 (62.0%). Lack of cohesiveness occurred in 101 (38.9%), including 41 women who said "no" to the questionnaire item indicative of stress UI and had leakage on PTT-ISA; leakage degree varied across the full pictorial spectrum from drops to saturated. Conclusion PTT-ISA demonstrates high compliance, with rate comparable to survey compliance. It is a novel measure for objective sign of urine loss when independently self-administered by community women outside of a clinic environment. Further research comparing PTT-ISA with clinician-observed cough test is warranted. As independently self-administered, PTT-ISA is simple, noninvasive, inexpensive, and an acceptable test that adds value to otherwise survey-dependent research.

To provide an international standard for the safe management and operation of ships and for pollution prevention, the International Maritime Organization (IMO) introduced the International Safety Management (ISM) Code (adopted in 1993 and entered in force on 1st July 1998). The Code, through its guidelines and recommendations, provides seafarers (ship’s crew) the course of action for the safety and quality assurance process on ships. Traditionally a paper-based system, the ISM Code is now being digitalized in every aspect to streamline the processes to improve ship operations. This paper presents findings of a review of existing literature available on the world wide web to highlight areas of the Code that have been impacted by technology and the benefits that are being reaped. However, recent cyber attacks on ships and the maritime industry require a discussion on various implications associated with ships becoming increasingly reliant on technology and the advancing digital world. This paper highlights and explains the related implications and suggests strategies to address them.

Teaching about biodiversity and its conservation could be an effective way to teach the importance of different species and human dependence on ecological support systems. This study compares the effectiveness of a digital and a paper-based dichotomous identification key for teaching pre-service teachers about plantspecies diversity. Twenty-four Slovenian teachers in pre-service training used a digital version of the key on tablet computers and twenty-nine used a paper-based version to identify woody species in the garden near their university faculty. Both keys contained the same species, identical photographs and the same sequence of steps to identify the species. The accuracy and time taken to identify the five species were measured. The participants also completed a questionnaire about the usability of the identification key. Overall, both versions of the key were equally good for determining species names. The digital version of the key was found to be more time-effective than the paper version only when multiple identification steps were required to identify species. The results confirm that those who scored better on the identification tasks have a better general opinion about the usability of the key especially students using digital version of the key. Implications for teachers using or creating identification keys are discussed in the conclusion.

Cellulose paper derived from plants is used for daily writing and recording, and has historically played an important role in promoting cultural dissemination and inheritance. However, it attracted more and more attentions in recent years serving as a flexible platform or substrate for application in environment and energy, attributing from its many inherent advantages such as biocompatibility, biodegradability, sustainability, low cost, and great capability to be modified. With the development of various industries, especially the flexible electronics industry, the demand for two-dimensional (2D) paper-like materials has increased. Several kinds of inorganic paper are manufactured and have been widely used in many fields. Among them, there are hydroxyapatite (HAP)-based and carbon-based inorganic paper that give play to their own advantages and have been well applied in some fields. In addition, there are many composite papers, which are assembled from several raw materials (cellulose fibers, HAP, carbon), exhibiting excellent characteristics. Cellulose paper is no longer limited to traditional writing applications, but has great potential to be used in many aspects, achieving a gorgeous change in its role. The emergence of inorganic paper and hybrid paper has further demonstrated the application prospects of paper-like two-dimensional materials. This paper will start from the characteristics of the three types of paper and composite paper, and summarize their typical applications in the environment and energy fields.

In this study, Taguchi experimental design was used to the optimize operating parameters for the degradation of paper mill effluent using electrochemical (EC) process with two-dimensional concentric aluminum tube electrodes (CATE). For this purpose, four significant experimental factors were used in four levels pH (6–9), electrolysis time (10–40 min), voltage (6–12 V) and surface area (357–624 cm(2)). The process parameters were optimized, through performing L16 orthogonal array of Taguchi technique, for the removal of chemical oxygen demand (COD) and turbidity. The percent COD and turbidity reductions were transferred into an accurate S/N ratio for a larger value is the better (LBT) response. The study presents a unique method of finding optimum combination of process parameters to illustrate their effect on the turbidity and COD reduction. The treatment conditions for the maximum elimination of the pollutants were second level of pH (7), third level of ET (30 min), fourth level of voltage (12 V) and second level of surface area (446 cm(2)). The confirmation experiment results were within the confidence intervals (CI) indicating an acceptable agreement between predicted and observed values. Based on the p-values, the electrolysis time and voltages were found to be the most significant factors for both COD and turbidity reduction. The findings of research indicated, that the Taguchi method can be used successfully for the treatment of paper industry effluent by electrochemical technique.

Anaerobic digestion (AD) is an essential technology for wastewater management, resource recovery and biogas production, and it is considered as an efficient and reliable treatment method for many wastewaters. Operating parameters have been shown to directly affect the stability and treatment performance of AD, especially temperature. For 180 days, the AD of recycled paper mill wastewater (RPMW) was carried out in a modified anaerobic inclining-baffled (MAIB) reactor under various temperature conditions, i.e. 29 °C (low mesophilic), 37 °C (mesophilic) and 55 °C (thermophilic). It was found that total COD removal of 94, 96 and 76%, and methane yields of 0.125, 0.196 and 0.256 L CH4/g CODremoved were attained at temperatures of 29, 37 and 55 °C, respectively. Throughout the three transition periods, the pH level in the MAIB reactor fluctuated slightly within the range of 5.8–6.5 without affecting the system stability. The results concluded that thermophilic condition strongly influenced the MAIB reactor performance, leading to lower COD removal, higher methane yield and gradually recovered pH level. Highlights Novel modified anaerobic inclining-baffled (MAIB) reactor, which combines the development of attached and settled microorganisms, was operated for the treatment of recycled paper mill wastewater (RPMW).; The operational temperature intensive analysis of MAIB was investigated at thermophilic and mesophilic conditions.; The system compartmental characteristics were also analyzed and discussed.

COVID 19 struck us all like a bolt of lightning and for the past 10 months, it has tested our resilience, agility, creativity, and adaptability in all aspects of our lives and work. Simulation centers and simulation-based educational programs have not been spared. Rather than wait for the pandemic to be over before commencing operations and training, we have been actively looking at programs, reviewing alternative methods such as e-learning, use of virtual learning platforms, decentralization of training using in situ simulation (ISS) modeling, partnerships with relevant clinical departments, cross-training of staff to attain useful secondary skills, and many other alternatives and substitutes. It has been an eye-opening journey as we maximize our staff's talent and potential in new adoptions and stretching our goals beyond what we deemed was possible. This paper shares perspectives from simulation centers; The SingHealth Duke NUS Institute of Medical Simulation which is integrated with an Academic Medical Center in Singapore, The Robert and Dorothy Rector Clinical Skills and Simulation Center, which is integrated with Thomas Jefferson University, Oakhill Emergency Department, Florida State University Emergency Medicine Program, Florida, USA and The Wellington Regional Simulation and skills center. It describes the experiences from the time when COVID 19 first struck countries around the world to the current state whereby the simulation centers have stWWarting functioning in their “new norm.” These centers were representative examples of those in countries which had extremely heavy (USA), moderate (Singapore) as well as light (New Zealand) load of COVID 19 cases in the nation. Whichever categories these centers were in, they all faced disruption and had to make the necessary adjustments, aligning with national policies and advisories. As there is no existing tried and tested model for the running of a simulation center during an infectious disease pandemic, this can serve as a landmark reference paper, as we continue to fine-tune and prepare for the next new, emerging infectious disease or crisis.

BackgroundThe analysis of the quality of food is important to protect humans from food-borne or food-based illnesses caused by pathogens, such as bacteria, fungi, viruses, and protozoa. Rapid identification of these pathogens is critical to ensure food safety. Various detection and identification strategies exist; however, they are laborious and time consuming and hence the detection takes longer time. The aim of this study was to develop the specific and fast method for the detection of contaminants in milk.ResultsIn this study, we have developed a simple paper-based PCR method with minimum sample preparation process. The 16S rDNA universal primers were used for the detection of bacterial contaminants. LacZ primers were used for coliform detection which causes serious illness and hence their detection is crucial. ITS region primers were used for fungal detection. The most unique thing about this study is use of Whatman paper no. 1 as sample carrier material. We developed and validated the paper-based PCR method and used it for the detection of microbes and coliforms using milk as a representative sample.ConclusionWe evaluated this method for its suitability in the detection of contaminant microbes using different milk samples. The paper-based method could successfully detect contaminants in the milk samples and the results were comparable to the traditional microbial detection method. The traditional microbiological method takes at least 18–20 h for detecting the presence of microbes in any sample but the developed paper-based PCR method can confirm the microbial presence in 2–3 h. This is very promising especially in the testing where sample sterility is crucial.

© European Stroke Organisation 2021, Purpose: Many daily-life clinical decisions in patients with cerebrovascular disease and cognitive impairment are complex. Evidence-based information sustaining these decisions is frequently lacking. The aim of this paper is to propose a practical clinical approach to cognitive impairments in patients with known cerebrovascular disease. Methods: The document was produced by the Dementia Committee of the European Stroke Organisation (ESO), based on evidence from the literature where available and on the clinical experience of the Committee members. This paper was endorsed by the ESO. Findings: Many patients with stroke or other cerebrovascular disease have cognitive impairment, but this is often not recognized. With improvement in acute stroke care, and with the ageing of populations, it is expected that more stroke survivors and more patients with cerebrovascular disease will need adequate management of cognitive impairment of vascular etiology. This document was conceived for the use of strokologists and for those clinicians involved in cerebrovascular disease, with specific and practical hints concerning diagnostic tools, cognitive impairment management and decision on some therapeutic options. Discussion and conclusions: It is essential to consider a possible cognitive deterioration in every patient who experiences a stroke. Neuropsychological evaluation should be adapted to the clinical status. Brain imaging is the most informative biomarker concerning prognosis. Treatment should always include adequate secondary prevention.

Purpose To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. Methods Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. Results Twenty-four sections on HNC-specific OD topics. Conclusion This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.

The development of industry and of the Internet of Things (IoTs) have brought energy issues and huge challenges to the environment. The emergence of triboelectric nanogenerators (TENGs) has attracted wide attention due to their advantages, such as self-powering, lightweight, and facile fabrication. Similarly to paper and other fiber-based materials, which are biocompatible, biodegradable, environmentally friendly, and are everywhere in daily life, paper-based TENGs (P-TENGs) have shown great potential for various energy harvesting and interactive applications. Here, a detailed summary of P-TENGs with two-dimensional patterns and three-dimensional structures is reported. P-TENGs have the potential to be used in many practical applications, including self-powered sensing devices, human–machine interaction, electrochemistry, and highly efficient energy harvesting devices. This leads to a simple yet effective way for the next generation of energy devices and paper electronics.

Cellulose triacetate (CTA) forward osmosis (FO) membrane from Hydration Technology Innovation (HTI), USA was tested in a locally fabricated FO system to concentrate synthetic and pulp and paper mill wastewater. The industry is among the 17 most polluted industries with intensive water consumption and wastewater generation (MoEFCC, Government of India). The CTA membrane was studied with deionized water as feed solution and 1 M NaCl as draw solution, which resulted into water flux of 5.8 L/m2h and reverse salt flux of 0.2 g/L. A concentration stepping method was used to determine the critical draw concentration with lignin solution as the model feed. There was no deviation in flux between the baseline (deionized water feed) and the lignin solution up to 1.5 M NaCl, but a marginal deviation (8% and 21% respectively at 2 M and 3 M) was seen thereafter. The average water flux after 24 h FO study with synthetic wastewater as feed solution (draw solution 2 M NaCl) was 8 L/m2h, and 80% water recovery. Similar study with pulp and paper wastewater as feed solution (draw solution of 1.5 M NaCl) was 5.4 L/m2h was with 62% water recovery. Lignin and COD rejection in pulp and paper mill wastewater was 90% and 64% respectively. The preliminary results indicate that FO is promising for water and lignin recovery from waste streams.

Paper and pulp mills generate substantial quantities of cellulose-rich sludge materials that are disposed in landfills at a large scale. For sustainability purposes, sludge materials can be bioprocessed to produce renewable fuels and useful chemicals. The enzymatic hydrolysis of cellulose is the process bottleneck that affects the conversion economics directly by using zero-cost raw materials. In order to study and optimize the process, the characteristics of the sludge raw materials should be first evaluated. In this work, sludge samples were obtained from paper mills located at different locations in Wisconsin and Minnesota. Part of the sludge samples was washed (de-ashed) with hydrochloric acid while the other part remained unwashed. The samples were subjected to multiple spectroscopic analyses techniques to evaluate the morphological properties of cellulose fibers and to estimate the total structural carbohydrate content. The results showed that the de-ashing process changed some fiber characteristics and cellulose crystallinity structure in all sludge samples. Sludge sample A (obtained from Kraft pulp and recycled paper mill region) showed a high percentage of fiber, with crystalline cellulose, compared to the other two sludge samples suggesting that sludge A is a valuable source to make value-added products. Aspen Plus mass and energy calculations performed in view of the ‘zero’ cost and the reliable supply of sludge raw materials producing 2 mol H2/mol glucose. Moreover, the results showed that extracting crystalline cellulose from these sludge samples is more profitable than crystalline cellulose made from the other lignocellulosic feedstocks. The results reported here showed that the utilization of these sludge materials would be an economically attractive and promising alternative for the production of hydrogen.

Background Coronavirus Disease 2019 (COVID-19), firstly reported in China last November 2019, became a global pandemic. It has been shown that periods of isolation may induce a spike in alcohol use disorder (AUD). In addition, alcohol-related liver disease (ALD) is the most common consequence of excessive alcohol consumption worldwide. Moreover, liver impairment has also been reported as a common manifestation of COVID-19. Aims The aim of our position paper was to consider some critical issues regarding the management of ALD in patients with AUD in the era of COVID-19. Methods A panel of experts of the Italian Society of Alcohology (SIA) met via “conference calls” during the lockdown period to draft the SIA’s criteria for the management of ALD in patients with COVID-19 as follows: (a) liver injury in patients with ALD and COVID-19 infection; (b) toxicity to the liver of the drugs currently tested to treat COVID-19 and the pharmacological interaction between medications used to treat AUD and to treat COVID-19; (c) reorganization of the management of compensated and decompensated ALD and liver transplantation in the COVID-19 era. Results and Conclusions The COVID-19 pandemic has rapidly carried us toward a new governance scenario of AUD and ALD which necessarily requires an in-depth review of the management of these diseases with a new safe approach (management of out-patients and in-patients following new rules of safety, telemedicine, telehealth, call meetings with clinicians, nurses, patients, and caregivers) without losing the therapeutic efficacy of multidisciplinary treatment.

COVID‐19 has infected millions of patients and impacted healthcare workers worldwide. Personal Protective Equipment (PPE) is a key component of protecting frontline clinicians against infection. The benefits of PPE far outweigh the risks, nonetheless, many clinicians are exhibiting skin injury caused by PPE worn incorrectly. These skin injuries, ranging from lesions to open wounds are concerning because they increase the susceptibility of viral infection and transmission to other individuals. Early into the COVID‐19 pandemic (April 2020), the U.S. National Pressure Injury Advisory Panel (NPIAP) developed a series of position statements to improve wear‐ability of PPE and protect healthcare professionals and their patients as safe from harm as possible under the circumstances. The NPIAP positions, which were formed by conducting a systematic review of what was known at the time, include: (1) Prepare skin before and after wearing PPE with skin sealants, barrier creams and moisturizers; (2) Frequent PPE offloading to relieve pressure and shear applied to skin; (3) treat visible skin injuries immediately caused by PPE to minimize future infection; (4) non‐porous dressings may provide additional skin protection, but lack evidence; (5) health systems should take care to educate clinicians about placement and personal hygiene related to handling PPE. Throughout all of these practices, handwashing remains a top priority to handle PPE. These NPIAP positions provided early guidance to reduce the risk of skin injury caused by PPE based on available research regarding PPE injuries, a cautious application of evidence‐based recommendations on prevention of device related pressure injuries in patients and the expert opinion of the NPIAP Board of Directors. Clinicians who adhere to these recommendations reduce the prospects of skin damage and long‐term effects (e.g. scarring). These simple steps to minimize the risk of skin injury and reduce the risk of coronavirus infection from PPE can help.

Feedback is beneficial to students’ learning process and overall achievement, but one of the common complaints from students about college education is regarding feedback. So, this study aimed to examine whether digital written feedback positively influences students’ learning experience and attitude toward learning. Digital written feedback refers to feedback provided through a learning management system as handwritten feedback added to a scanned copy of the student’s paper-based assessment using a smart pad and smart pencil. The study surveyed a diverse set of college students’ (n = 175) perceptions regarding feedback satisfaction, learning satisfaction, the usefulness of digital written feedback, and perceived achievement via an online survey. A one-way analysis of variance found a significant difference between feedback satisfaction and learning satisfaction according to the feedback method. A multiple regression analysis indicated the satisfaction and perceived usefulness of digital written feedback predicted perceived achievement. From the students’ open responses regarding the benefits of digital written feedback, five themes emerged, namely usability, psychological relief, accessibility, self-regulation, and acceptance. The implications for digital written feedback are discussed.

We report a paper-based photodetector made from mixed cation organic perovskite halide MA1–xFAxPbI3 (MA = methylammonium (CH3NH3); FA = formamidium CH(NH2)2). The detector shows a substantial photo...

Social aggression is a pervasive feature of insect societies. In eusocial Hymenoptera, aggression among females can affect task performance and competition over direct reproduction (egg laying); in most species males participate in social interactions relatively rarely. Males of the independent-founding paper wasp Mischocyttarus mastigophorus are exceptional: they are aggressive toward female nestmates, leading us to explore the function of this unusual behavior. We applied social network analyses to data on M. mastigophorus social aggression to quantify sex differences in giving and receiving social aggression. The network analyses supported the pattern of biased male aggression toward female nestmates; females are relatively rarely aggressive to males. We then asked whether male aggression toward females was biased by females’ relative ovary development. Males were more aggressive toward females with better-developed ovaries, opposite to patterns of aggression among females. Because food brought to the colonies is often monopolized by dominant females, we suggest that males direct aggression toward socially dominant females with better-developed ovaries to obtain food. The implications of biased male aggression for female task performance and physiology are unknown.

This research presents a solar-blind (UVC) office paper-based photodetector that is self-biased, superflexible, nonwettable, high-performance, and high-voltage stable. In contrast to the traditiona...

The entire world seems to have responded to COVID-19 pandemic in a knee-jerk manner with a short mindset without building on the existing strengths of public health infrastructure. National governments cannot be blamed for this as we are dealing with a crisis that comes once in a lifetime. Realising this, the Organized Medicine Academic Guild (OMAG) an association of major health associations in this country has suggested measures for long-term solutions to COVID-19-like pandemics in the form of a policy paper by OMAG.

Herein, paper mill waste sludge (PMS) from two different sources has been investigated to extract calcium hydroxide, Ca(OH)2 by a facile and inexpensive extraction process. This green process exploits typical chemical precipitation (CP) in an aqueous medium at room temperature to develop an economically and industrially viable technique for the effective utilization of calcium-containing waste sludge. PMS samples, collected from local paper mill plants of Bangladesh, were the main precursors wherein HCl and NaOH were utilized for chemical treatment. The as-synthesized products were analyzed by a variety of characterization tools including X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, Raman spectroscopy, Scanning electron microscopy (SEM), and Energy Dispersive X-ray (EDX) elemental analyses. Our studies confirm that the extracted product contains Ca(OH)2 as a major content, albeit it also includes CaCO3 phase formed owing to the inescapable carbonation process from the surrounding environment. The particle size of the synthesized products is in the range of 450 - 500 nm estimated from SEM micrographs. The crystallite domain size of the same estimated from XRD analyses and was found to be ~47 nm and ~31 nm respectively for product-A and product-B considering major (101) Bragg peak of Ca(OH)2. The yield percentage of the isolated products is about 65% for samples collected from both sources.

This paper presents the research results that established the main technological conditions in the production of greaseproof paper, used as the packaging of dry food as the proportion of pulp types, the degree of the beating of pulp, the use of chemicals and oil and greaseproof resistant agent to the properties of the paper on a laboratory scale. At the same time, experimental production and technology conditions were regulated on a 3 ton/day capacity line. The paper quality produced is equivalent to the imported paper products of the same type which is consumed in the market: basis weight: 42.5 g/m2; tensile breaking length: MD (Machine Direction): 7,520 m, CD (Cross Direction): 3,740 m; tear index: MD: 6.8 mN.m2/g, CD: 5.4 mN.m2/g; burst index: 5.6 kPa.m2/g; Cobb60: 17.2 g/m2; KIT rating: 8; ensuring food safety and hygiene.

The work aims to explore a microscopic observation system of paper surface and achieve high-precision stereoscopic observation with detail characterization of paper surface morphology. Based on the DT-400E precision program-controlled three-dimensional translation stage and KEYENCE LJV-7200 two-dimensional laser scanner, the hardware parts of our own system are developed to scan and transmit point cloud data of paper surface morphology to the computer. The corresponding system software will automatically process the point cloud data acquired from the laser scanner and generate the corresponding vivid 3D model and height histogram. This system scans and characterizes four different types of paper samples, allowing the human eye to visually distinguish the differences in surface morphology as well as automatically calculate the numerical differences in paper surface morphology parameters. The results of the applicability test show that the system is highly efficient in acquiring, observing, and evaluating the topography of the paper surface. The system can not only predict the paper surface quality of printed paper, but can also be extended to the evaluation of 3D printed surfaces.

Plant fiber classified as environmentally friendly material is a promising renewable engineering material rich in lignocellulose that can be employed in the pulp and paper industry as a substitutio...

In this paper, the implementation of artificial neural networks (multilayer perceptron [MLP] and radial base functions [RBF]) and the upgraded Markov chain model have been studied and performed to identify the human behavior patterns during rock, paper, and scissors game. The main motivation of this research is the design and construction of an intelligent robot with the ability to defeat a human opponent. MATLAB software has been used to implement intelligent algorithms. After implementing the algorithms, their effectiveness in detecting human behavior pattern has been investigated. To ensure the ideal performance of the implemented model, each player played with the desired algorithms in three different stages. The results showed that the percentage of winning computer with MLP and RBF neural networks and upgraded Markov model, on average in men and women is 59%, 76.66%, and 75%, respectively. Obtained results clearly indicate a very good performance of the RBF neural network and the upgraded Markov model in the mental modeling of the human opponent in the game of rock, paper, and scissors. In the end, the designed game has been employed in both hardware and software which include the Zana intelligent robot and a digital version with a graphical user interface design on the stand. To the best knowledge of the authors, the precision of novel presented method for determining human behavior patterns was the highest precision among all of the previous studies.

The 14th edition of the Workshop on Recent Issues in Bioanalysis (14th WRIB) was held virtually on June 15-29, 2020 with an attendance of over 1000 representatives from pharmaceutical/biopharmaceutical companies, biotechnology companies, contract research organizations, and regulatory agencies worldwide. The 14th WRIB included three Main Workshops, seven Specialized Workshops that together spanned 11 days in order to allow exhaustive and thorough coverage of all major issues in bioanalysis, biomarkers, immunogenicity, gene therapy and vaccine. Moreover, a comprehensive vaccine assays track; an enhanced cytometry track and updated Industry/Regulators consensus on BMV of biotherapeutics by LCMS were special features in 2020. As in previous years, this year's WRIB continued to gather a wide diversity of international industry opinion leaders and regulatory authority experts working on both small and large molecules to facilitate sharing and discussions focused on improving quality, increasing regulatory compliance and achieving scientific excellence on bioanalytical issues. This 2020 White Paper encompasses recommendations emerging from the extensive discussions held during the workshop, and is aimed to provide the Global Bioanalytical Community with key information and practical solutions on topics and issues addressed, in an effort to enable advances in scientific excellence, improved quality and better regulatory compliance. Due to its length, the 2020 edition of this comprehensive White Paper has been divided into three parts for editorial reasons. This publication covers the recommendations on (Part 2A) BAV, PK LBA, Flow Cytometry Validation and Cytometry Innovation and (Part 2B) Regulatory Input. Part 1 (Innovation in Small Molecules, Hybrid LBA/LCMS & Regulated Bioanalysis), Part 3 (Vaccine, Gene/Cell Therapy, NAb Harmonization and Immunogenicity) are published in volume 13 of Bioanalysis, issues 4, and 6 (2021), respectively.

In this paper, we present a system for automatic evaluation of the quality of a question paper. Question paper plays a major role in educational assessment. The quality of a question paper is crucial to fulfilling the purpose of the assessment. In many education sectors, question papers are prepared manually. A prior analysis of a question paper might help in finding the errors in the question paper, and better achieving the goals of the assessment. In this experiment, we focus on higher education in the technical domain. First, we conducted a student survey to identify the key factors that affect the quality of a question paper. The top factors we identified are question relevance, question difficulty, and time requirement. We explored the strategies to handle these factors and implemented them. We employ various concepts and techniques for the implementation. The system finally assigns a numerical quality score against these factors. The system is evaluated using a set of question papers collected from various sources. The experimental results show that the proposed system is quite promising.

In the industrialized world, increasing productivity and profitability is very important for companies as a benchmark of success in business processes. Some literature has defined the success factor of the successful application of the concept of TPM as a tool to improve the productivity performance of the company, therefore improving the productivity performance of the company becomes the main thing in improving long-term sustainable profitability for the company . In the manufacturing industry pulp and paper mills, the contribution of the highest production costs is in raw materials (Pulp and chemical raw materials), followed by energy and packaging. The energy sector occupies the top three in the cost contributor to variable costs, it is triggered because in the pulp paper industry sector, the consumption value for electrical energy and heat is very high. Therefore, success in eliminating eight major losses is a major success factor in improving the profitability of the company. To analyze the effects of elimination of eight major losses, reduction of production costs and increase in profitability can be solved by evaluating the influence of all indicators of eight major losses using PLS-SEM. The data used is operational data co-generation plant production of PT. XYZ in 2019. From the research conducted it is known that the variable Overall Plant Effectiveness (OPE) is significantly influenced by 2 (two) of the 3 (three) constituent indicators, namely Availability and Performance, both indicators affect: Productivity Improvement, Decreased Production Costs and Increased Profitability of the Company. The priority of improvement that must be done by considering the production cost performance data from the review of variable costs of energy is elimination: Loss Shutdown losses (A1), Loss Production adjustment loss (A2), Equipment failure (A3), Process failure ( A4), Normal Production (A5), and abnormal production (A6).

Background Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers. Method A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology. Results Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts’ opinion. Conclusions The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.

The 14th edition of the Workshop on Recent Issues in Bioanalysis (14th WRIB) was held virtually on June 15-29, 2020 with an attendance of over 1000 representatives from pharmaceutical/biopharmaceutical companies, biotechnology companies, contract research organizations, and regulatory agencies worldwide. The 14th WRIB included three Main Workshops, seven Specialized Workshops that together spanned 11 days in order to allow exhaustive and thorough coverage of all major issues in bioanalysis, biomarkers, immunogenicity, gene therapy and vaccine. Moreover, a comprehensive vaccine assays track; an enhanced cytometry track and updated Industry/Regulators consensus on BMV of biotherapeutics by LCMS were special features in 2020. As in previous years, this year's WRIB continued to gather a wide diversity of international industry opinion leaders and regulatory authority experts working on both small and large molecules to facilitate sharing and discussions focused on improving quality, increasing regulatory compliance and achieving scientific excellence on bioanalytical issues. This 2020 White Paper encompasses recommendations emerging from the extensive discussions held during the workshop and is aimed to provide the Global Bioanalytical Community with key information and practical solutions on topics and issues addressed, in an effort to enable advances in scientific excellence, improved quality and better regulatory compliance. Due to its length, the 2020 edition of this comprehensive White Paper has been divided into three parts for editorial reasons. This publication (Part 3) covers the recommendations on Vaccine, Gene/Cell Therapy, NAb Harmonization and Immunogenicity). Part 1 (Innovation in Small Molecules, Hybrid LBA/LCMS & Regulated Bioanalysis), Part 2A (BAV, PK LBA, Flow Cytometry Validation and Cytometry Innovation) and Part 2B (Regulatory Input) are published in volume 13 of Bioanalysis, issues 4 and 5 (2020), respectively.

Combined paper mill biosolids (PB) are a well-known fertilizing source of nitrogen (N) and phosphorus (P). Many jurisdictions have established default values for estimating their agronomic N and P contribution, but nutrient release can vary with their chemical properties, and this has been little studied. The objective of this incubation study was to compare four PB of different sources along with a de-inking paper sludge (DPS) for their N and P release in three contrasting soils under controlled conditions (25 °C, 60% water-filled pore space). Treatments consisted of PB or DPS at 50 Mg fresh mass ha−1, PB at 30 Mg fresh mass ha−1 plus inorganic N to supply 100 kg available N ha−1, inorganic NP fertilizer, and an unfertilized control. Measurements of NO3 + NH4-N were made after 3 d and 1, 2, 3, 4, 6, 8, 12, and 16 wk of incubation. Mehlich-3 P was measured after 2 and 16 wk of incubation. Nitrogen mineralization generally declined a few days after PB addition and then gradually and constantly increased. The P mineralization of PB also increased with time. By the end of incubation, net N and P release averaged 30% (7%–49%) and 75% (16%–116%) of the NP fertilizer, respectively. The intensity of release, however, varied with material characteristics and soil type. Mineral N addition to the 30 Mg PB ha−1 promoted N release to a level comparable to NP fertilizer. Soil N immobilization occurred with the DPS application. Current default N value used for PB in Quebec and Ontario is appropriate but not P.

In 2015 the Spanish Society of Rheumatology (Sociedad Espanola de Reumatologia [SER]) published its position paper on biosimilar drugs. In this update, the SER, continues to manifest its unequivocal commitment to the sustainability of the health system of our country and is aligned with the measures that, without reducing quality of care, are aimed at ensuring its continuity. Since the publication of the previous position paper, the European Commission has authorized new biosimilar drugs, which provides an excellent opportunity to advance the efficiency of health care. In this new scenario of increased therapeutic offer of biologics, the SER considers it crucial to preserve the freedom of prescription of physicians who prescribe drugs based exclusively on the characteristics and individual circumstances of each patient, without forgetting the economic aspects there of.

In this study, we developed a microfluidic paper analysis device (μPAD) for distance-based detection of Ag+ in water. The μPAD was manufactured by wax printing method on filter paper. Then, a layer of gold nanoparticles (AuNPs) was deposited and ascorbic acid was printed on the channel. In the detection, Ag+ was reduced by ascorbic acid and coated on the surface of the AuNPs on the channel, forming Au@Ag core/shell nanoparticles. Based on the capillary flow principle, different concentrations of Ag+ formed different distances of color ribbons. Thus, quantitative detection of Ag+ can be achieved by measuring the distance of the color ribbon. The detection limit of this method was as low as 1 mg·L−1 within 15 min and the interference of common metal ions in water can be eliminated. In conclusion, this method had successfully realized the leap from colorimetry to direct reading, realizing fast read and easy manipulation with low-cost.

The American Society for Parenteral and Enteral Nutrition (ASPEN) Position Paper focus is on applying the 4 ethical principles for clinician's decision-making in the use of artificially administered nutrition and hydration (AANH) for adult and pediatric patients. These basic principles are (1) autonomy, respect the patient's healthcare preferences; (2) beneficence, provide healthcare in the best interest of the patient; (3) nonmaleficence, do no harm; and (4) justice, provide all individuals a fair and appropriate distribution of healthcare resources. Preventing and resolving ethical dilemmas is addressed, with an emphasis on a collaborative, interdisciplinary approach. Optimizing early communication and promoting advance care planning, involving completion of an advance directive, including designation of a surrogate decision-maker, are encouraged. Clinicians achieve respect for autonomy when they incorporate the patient, family, community, country, geographical, and presumed cultural values and religious belief considerations into ethical decision-making for adults and children with a shared decision-making process. These discussions should be guided by the 4 ethical principles. Hospital committees and teams, limited-time trials, clinician obligation with conflicts, and forgoing of AANH are addressed. Specific patient conditions are addressed because of the concern for potential ethical issues: coma, decreased consciousness, and dementia; advanced dementia; cancer; eating disorders; and end-stage disease/terminal illness. Incorporated in the Position Paper are ethical decisions during a pandemic and a legal summary involving ethical issues. International authors presented the similarities and differences within their own country or region and compared them with the US perspective.