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Background Propionic acidemia (PA) is an inherited disorder caused by deficiency of propionyl CoA carboxylase. Most patients with this disorder are diagnosed during the neonatal period because of severe metabolic acidosis and hyperammonemia. Patients are required to undergo blood and urine analysis at least 3 to 4 times per year, depending on age and metabolic control. Methods We designed a prospective study in which we investigated the results from blood and urinary samples collected monthly in filter paper from 10 PA patients followed in a single metabolic reference center from January 2015 to September 2017. The aim of this study was to evaluate the usefulness of filter paper samples in the follow‐up of the PA patients. Results During the follow‐up period, 163 dried blood spot (DBS) and 119 urine dried spot samples were analyzed and compared with 160 plasma and 103 liquid urine specimens; 64 specimens of plasma were analyzed for odd‐numbered long‐chain fatty acids (OLCFAs). A total of 40 metabolic crises, 18 of them with hyperammonemia were documented. We observed a strong correlation between the filter paper and the urine/plasma samples for the main PA parameters both in stable metabolic conditions as well as in acute decompensations. Also, there was a strong correlation between OLCFAs measured in plasma and quantification of odd number acylcarnitines in DBS. Conclusions We conclude that filter paper blood and urinary samples can be used for the follow‐up of the patients with PA, correctly reflecting their metabolic situation.

Background: The cost-effectiveness of using a mobile diary app as an adjunct in dialectical behavior therapy (DBT) in patientswith borderline personality disorder is unknown.Objective: This study aims to perform an economic evaluation of a mobile diary app compared with paper-based diary cardsin DBT treatment for patients with borderline personality disorder in a psychiatric outpatient facility.Methods: This study was conducted alongside a pragmatic, multicenter, randomized controlled trial. The participants wererecruited at 5 Danish psychiatric outpatient facilities and were randomized to register the emotions, urges, and skills used in amobile diary app or on paper-based diary cards. The participants in both groups received DBT delivered by the therapists. Acost-consequence analysis with a time horizon of 12 months was performed. Consequences included quality-adjusted life years(QALYs), depression severity, borderline severity, suicidal behavior, health care use, treatment compliance, and system usability.All relevant costs were included. Focus group interviews were conducted with patients, therapists, researchers, and industryrepresentatives to discuss the potential advantages and disadvantages of using a mobile diary app.Results: A total of 78 participants were included in the analysis. An insignificantly higher number of participants in the papergroup dropped out before the start of treatment (P=.07). Of those starting treatment, participants in the app group had an averageof 37.1 (SE 27.55) more days of treatment and recorded an average of 3.16 (SE 5.10) more skills per week than participants inthe paper group. Participants in both groups had a QALY gain and a decrease in depression severity, borderline severity, andsuicidal behavior. Significant differences were found in favor of the paper group for both QALY gain (adjusted difference −0.054;SE 0.03) and reduction in depression severity (adjusted difference −1.11; SE 1.57). The between-group difference in total costsranged from US $107.37 to US $322.10 per participant during the 12 months. The use of services in the health care sector wassimilar across both time points and groups (difference: psychiatric hospitalization and 2.02; SE 3.19). Overall, the patients showed high acceptability and considered the app as being easy to use. Therapists worriedabout potential negative influences on the therapist-patient interaction from new work tasks accompanying the introduction ofthe new technology but pointed at innovation potential from digital database registrations.Conclusions: This study suggests both positive and negative consequences of mobile diary apps as adjuncts to DBT comparedwith paper diary cards. More research is needed to draw conclusions regarding its cost-effectiveness. Background:The cost-effectiveness of using a mobile diary app as an adjunct in dialectical behavior therapy (DBT) in patients with borderline personality disorder is unknown.Objective:This study aims to perform an economic evaluation of a mobile diary app compared with paper-based diary cards in DBT treatment for patients with borderline personality disorder in a psychiatric outpatient facility.Methods:This study was conducted alongside a pragmatic, multicenter, randomized controlled trial. The participants were recruited at 5 Danish psychiatric outpatient facilities and were randomized to register the emotions, urges, and skills used in a mobile diary app or on paper-based diary cards. The participants in both groups received DBT delivered by the therapists. A cost-consequence analysis with a time horizon of 12 months was performed. Consequences included quality-adjusted life years (QALYs), depression severity, borderline severity, suicidal behavior, health care use, treatment compliance, and system usability. All relevant costs were included. Focus group interviews were conducted with patients, therapists, researchers, and industry representatives to discuss the potential advantages and disadvantages of using a mobile diary app.Results:A total of 78 participants were included in the analysis. An insignificantly higher number of participants in the paper group dropped out before the start of treatment (P=.07). Of those starting treatment, participants in the app group had an average of 37.1 (SE 27.55) more days of treatment and recorded an average of 3.16 (SE 5.10) more skills per week than participants in the paper group. Participants in both groups had a QALY gain and a decrease in depression severity, borderline severity, and suicidal behavior. Significant differences were found in favor of the paper group for both QALY gain (adjusted difference −0.054; SE 0.03) and reduction in depression severity (adjusted difference −1.11; SE 1.57). The between-group difference in total costs ranged from US $107.37 to US $322.10 per participant during the 12 months. The use of services in the health care sector was similar across both time points and groups (difference: psychiatric hospitalization Conclusions:This study suggests both positive and negative consequences of mobile diary apps as adjuncts to DBT compared with paper diary cards. More research is needed to draw conclusions regarding its cost-effectiveness.

Governance for centralized organizational structures has long roots and well-developed frameworks, including for various specialty areas, such as IT or data governance. However, the introduction of blockchain technology as a supportive tool for implementing decentralized organizations requires a renewed focus for research in the area. The paper utilizes empirical data from blockchain ecosystems in the form of white papers (public communique of intention) to analyze their governance intentions. The empirical findings are based on a review of 241 blockchains and distributed ledger technology white papers, out of which 67 include explicit descriptions of how governance should be organized in the ecosystem. Our empirical research distinguishes between three categories of governance: objectives, mechanisms, and stakeholders. We further identify 28 features for these categories, which are described in an open encoding format. Hence, the paper contributes to the emerging blockchain research field, particularly to the decentralized aspects of blockchain governance research. This research also reveals that blockchain governance does not receive the attention it should as a large majority of ecosystems have not disclosed their governance intentions. The results can be utilized as a framework for future research. The results can also be helpful for industry when designing and developing governance systems.

Tissue paper production frequently combines two main types of raw materials: cellulose fibers from renewable sources and polymer-based additives. The development of premium products with improved properties and functionalities depends on the optimization of both. This work focused on the combination of innovative experimental and computational strategies to optimize furnish. The main goal was to improve the functional properties of the most suitable raw materials for tissue materials and develop new differentiating products with innovative features. The experimental plan included as inputs different fiber mixtures, micro/nano fibrillated cellulose, and biopolymer additives, and enzymatic and mechanical process operations. We present an innovative tissue paper simulator, the SimTissue, that we have developed, to establish the correlations between the tissue paper process inputs and the end-use paper properties. Case studies with industrial interest are presented in which the tissue simulator was used to design tissue paper materials with different fiber mixtures, fiber modification treatments, micro/nano fibrillated cellulose, and biopolymer formulations, and to estimate tissue softness, strength, and absorption properties. The SimTissue was able to predict and optimize a broader range of formulations containing micro/nanocellulose fibers, biopolymer additives, and treated-fiber mixtures, saving laboratory and industrial resources.

Proteinuria is a condition in which an excessive amount of protein is excreted in urine. It is, among others, an indicator of kidney disease or risk of cardiovascular disease. Rapid and reliable diagnosis and monitoring of proteinuria is of great importance for both patients and their physicians. For that reason, a paper-based sensor for proteinuria diagnosis was designed, optimized, and validated utilizing smartphone-assisted signal acquisition. In the first step, a few commonly employed protein assays were optimized and compared in terms of analytical performance on paper matrix. The tetrabromophenol blue method was selected as the one providing a sufficiently low limit of detection (39 mg·L−1) on the one hand and appropriate long-term stability (up to 3 months) on the other hand. The optimized assay was employed for protein-to-creatinine ratio (PCR) determination on a single paper-based sensor. For both analytes the linear ranges were within the clinically relevant range. The analytical usefulness of the developed sensors was demonstrated by a PCR recovery study in artificial urine. The obtained PCR recoveries were from ca. 80 to 150%.

Influenza virus infection is a major worldwide public health problem. Influenza virus infections are associated with a high hospitalization rate in children between the ages of 5 and 14. The predominant reason for poor influenza prognosis is the lack of any effective means for early diagnosis. Early diagnosis of severe illness is critical to improving patient outcome, and could be especially useful in areas with limited medical resources. Accurate, inexpensive, and easy-to-use diagnostic tools could improve early diagnosis and patient outcome, and reduce overall healthcare costs. We developed an interleukin-6 paper-based test strip that used colloidal gold-conjugated antibodies to detect human interleukin-6 protein. These complexes were captured on a paper-based test strip patterned with perpendicular T lines that were pre-coated with anti-human interleukin-6 antibodies. Applied serum samples interacted with these antibodies and presented as colored bands that could be read using a spectrum-based optical reader. The full-spectrum of the reflected light interleukin-6 protein signal could be obtained from the spectral optics module, and the standard could be used to quantitatively analyze interleukin 6 level in serum. We retrospectively evaluated 10 children (23 serum samples) with severe influenza virus infections, 26 children (26 serum samples) with mild influenza virus infections, and 10 healthy children (10 serum samples). Our system, the combined use of a paper-based test strip and a spectrum-based optical reader, provided both qualitative and quantitative information. When used with the optical reader, the detection limit was improved from a qualitative, naked-eye level of 400 pg/ml to a quantitative, optical reader level of 76.85 pg/ml. After monitoring serum interleukin-6 level via our system, we found a high correlation between our system results and those obtainable using a conventional sandwich enzyme-linked immunosorbent assay method (Rho = 0.706, p < 0.001). The sensitivity and specificity for differentiating between severe and mild influenza using our combined method (test strip coupled with optical reader) were 78.3 and 50.0%, respectively. When interleukin-6 was combined with serum C-reaction protein, the sensitivity and specificity were 85.7 and 95.5%, and the receiver operating characteristic area-under-the-curve was quite high (AUC = 0.911, p < 0.001). The potential advantages of our system, i.e., a paper-based test strip coupled with a spectrum-based optical reader, are as follows: 1) simple user operation; 2) rapid turnaround times–within 20 min; 3) high detection performance; and, 4) low-cost fabrication.

The pulp and paper industry has a high potential to contribute to negative emissions through carbon capture and storage (CCS) applied to existing processes. However, there is a need to investigate how CCS solutions also can be combined with implementation of other emerging technologies in pulp and paper mills. This paper investigates the integration of a novel calcination process in two kraft mills and evaluates its potential combination with capture and storage of CO2 from the calcination plant. The alternative calcination process uses electric gas-plasma technology combined with steam slaking and allows replacing the conventional fuel-driven lime kilns with a process driven by electricity. The novel calcination process generates a pure, biogenic, CO2 stream, which provides an opportunity to achieve negative emissions at relatively lower costs. The potential reduction of greenhouse gas emissions when replacing the lime kiln with the plasma calcination concept depends strongly on the emissions intensity of grid electricity, and on whether fossil fuel or biomass was used as a fuel in the lime kiln. If fossil fuel is replaced and electricity is associated with very low emissions, avoided CO2 emissions reach ~50 kt/a for the smaller mill investigated in the paper (ca 400 kt pulp per year) and almost 100 kt/a for the larger mill (ca 700 kt pulp per year). Further emission reductions could then be achieved through CCS from the electrified calcination process, with capture potentials for the two mills of 95 and 164 kt/a, respectively, and capture and storage costs estimated to 36–60 EUR/tCO2.

PURPOSE: Main insight of the study was to evaluate the potential of Perionyx excavatus, an indigenous earthworm of India towards bioconversion of toxic paper mill wastes. The study had considered a comprehensive study over succession of different enzymes and microbial biomasses alongside removal of heavy metals to reflect the qualitative enrichment of the toxic waste through valorisation procedure. METHODS: The process of vermicomposting was performed using ratio of paper mill sludge: cow dung: straw as 5:4:1 and Perionyx excavatus for a period of 60 days. Qualitative enrichment was considered through detailed evaluation of physicochemical parameters and succession of 19 enzymes using API ZYM technology. Heavy metal loads in terms of Zn, Cr, Cu, Pb along with bioaccumulation factor (BAF) were considered to establish functional role of earthworm in bioremediation. Microbial succession was measured in terms of PLFA biomarkers. RESULTS: Enzymatic enrichment of different isozymes of esterase, aminopeptidase and glycosyl hydrolase were found in the vermicompost. A significant reduction of heavy metals was noticed in vermicomposting of primary sludge as Zn > Pb > Cr > Cu and secondary sludge as Zn > Pb > Cu > Cr. An increase in density of Gram positive bacterial and fungal populations was found at the end phase of vermicomposting process which supports maturity of vermicompost. CONCLUSION: Presence of different enzyme activities, reduction of heavy metal loads along with rise of eukaryotic PLFA markers, had illustrated the efficiency of vermicomposting as a valorisation procedure in the qualitative enrichment of toxic organic paper mill sludge.

[Abstract] The improvement in left ventricular assist device (LVAD) technology and scarcity of donor hearts have increased dramatically the population of the LVAD-supported patients and the probability of those patients to present to the emergency department with expected and non-expected device-related and patient-device interaction complications. The ageing of the LVAD-supported patients, mainly those supported with the 'destination therapy' indication, increases the risk for those patients to suffer from other co-morbidities common in the older population. In this second part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, definitions and structured approach to the LVAD-supported patient presenting to the emergency department with bleeding, neurological event, pump thrombosis, chest pain, syncope, and other events are presented. The very challenging issue of declaring death in an LVAD-supported patient, as the circulation is artificially preserved by the device despite no other signs of life, is also discussed in detail.