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Abstract In this study, zinc oxide (ZnO) nanoparticles were prepared and modified using a wet chemical method with different concentrations of Ag and Cu nanoparticles. The objective was to improve the mechanical, optical, and antibacterial properties of the coated paper by using the prepared pigments. The long-term antimicrobial effects of the coated paper were evaluated over 25 years. The successful synthesis of a hexagonal structure of ZnO nanoparticles decorated with spherical Ag and Cu nanoparticles ranging from 20 to 50 nm was confirmed using X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), and transmission electron microscopy (TEM). By increasing the concentrations of Ag and Cu from 0.01% to 1.0%, the mechanical properties of the coated paper were enhanced. The tensile strength reached a maximum of 6.77 kN/m and 7.03 kN/m, elongation increased to 1.69% and 1.70%, tensile energy absorption improved to approximately 77 and 80 J/m2, and burst strength rose to 218 and 219 kPa, respectively. The use of Ag-modified ZnO maintains the optical properties, while Cu-modified ZnO reduces brightness and whiteness without affecting opacity. The antimicrobial inhibition activity was improved with higher silver (Ag) and copper (Cu) content. The formulations containing 1% Ag/ZnO and 1%Cu/ZnO showed long-lasting antibacterial effects against gram-positive Staphylococcus aureus bacteria. Even after 25 years of aging, they maintained inhibition rates of 92.2% and 62.2%, respectively. The molecular docking and GeneMANIA analysis revealed the potential of ZnO, Ag-modified ZnO, and Cu-modified ZnO nanoparticles to disrupt the S. aureus cell wall biosynthesis pathway by targeting the MurA enzyme and associated cell wall synthesis genes.

Abstract Rifampicin-resistant tuberculosis (RR-TB) is a critical issue with significant implications for patient care, public health, and TB control efforts that necessitate comprehensive strategies for detection. This study presents a novel point-of-care diagnostic tool for RR-TB detection employing a peptide nucleic acid (PNA)-paper-based sensor combined with isothermal recombinase polymerase amplification (RPA). The sensor targets mutations in codons 516, 526, and 531 of the rpoB gene, the top three common mutations associated with rifampicin-resistant strains. PNA probes specifically recognised wild-type sequences, generating a visual signal through a reverse hybridisation assay. The absence of a signal was observed when the mutant strains were detected because of the inability to bind the mutant sequence. Our proof-of-concept assay displayed high accuracy (100% for detecting mutations at codons 516, 526, and 531), a short turnaround time (110 min), no cross-reactivity with other bacterial pathogens, and ultrasensitivity. This PNA-paper-based sensor model can be a valuable diagnostic tool for RR-TB detection, providing an accessible diagnostic platform that can be advantageous in resource-limited settings where sophisticated laboratory infrastructure may be lacking.

Abstract The pulp and paper manufacturing wastewater is as complicated as any other industrial effluent. A promising approach to treating water is to combine photocatalysis and membrane processes. This paper demonstrates a novel photocatalytic membrane technique for solar-powered water filtration. The method is based on creating green-prepared TiO2, and MnO2 nanoparticles (NPs) using Pomegranate peels and Seder leaf extracts and incorporation into polyvinylidene chloride to produce a novel water purification system that combines semiconductor photocatalysis with membrane filtration. The prepared heterostructure of the TiO2/MnO2 nanocomposite membrane provides photogenerated charge separation. To ensure chemical bonding at the membrane surface, Raman and Fourier transform infrared spectroscopy (FT-IR) were employed. The modified membrane’s hydrophilicity and roughness increased significantly. Additionally, the modified nanocomposite membrane’s porosity was measured. The integrated process demonstrated much higher removal of humic acid and high efficiency of wastewater treatment for pulp and paper. In sunlight, humic acid removal was 98% from synthetic wastewater. While using the produced membrane on pulp and paper effluent, these studies indicate that: in the dark, the removal was 50%, while in the sunlight, the removal increased to 70%, with a reduction in the COD from 1500 mg/L to 247 mg/L. Additionally, the TDS decreased from 1630 to 452 ppt in the sunlight. This research sheds light on how solar energy can clean wastewater from the pulp and paper industry while improving membrane separation. Also, an alternative source to sunlight was used to manufacture a photocatalytic membrane with high efficiency for wastewater treatment and an inexpensive price.

Abstract This research investigates the pulp and paper industry's transition to sustainability by valorizing unused roadside and natural grasses for paper production. Large-scale production from residual grass poses multifaceted challenges, requiring collaboration across stakeholders, from biomass collection to manufacturing. To understand key drivers and barriers within this complex system, experts from various fields, including local farmers, researchers, policymakers, and industry executives were interviewed, leading to the development of a Fuzzy Cognitive Map (FCM). The analysis explores various scenarios to assess how socio-economic, technological, and political factors influence the transition to low-carbon practices. These scenarios highlight the effects of varying levels of technology development, economic conditions, and policy support on the transition's progress and outcomes. Results show that the system is highly sensitive to shifts in socio-economic and political conditions. Political interventions play a crucial role, especially during energy crises and increased public demand for sustainable solutions. Grass-based paper production is seen as a viable pathway, but challenges such as the economic feasibility of emerging technologies remain. We recommend targeted policies to improve the economic viability of grass-based products and optimize biomass allocation between energy and bio-based products, ensuring a more balanced and sustainable transition.

Abstract This manuscript proposes the Jellyfish Search Optimization (JSO) algorithm-based Fractional Order Proportional-Integral-Derivative (FOPID) controller tuning for a paper machine headbox. The novelty of this method lies in integrating the JSO technique for optimizing the parameters of the FOPID controller to monitor and control headbox pressure and stock level efficiently and effectively. The JSO algorithm ensures optimal tuning of controller parameters by minimizing error indices such as Integral of Squared Error (ISE), Integral of Time Absolute Error (ITAE), and Integral of Absolute Error (IAE). Simulations conducted on the MATLAB/Simulink platform demonstrate that the FOPID controller tuned using JSO achieves superior performance compared to conventional PI (Proportional-Integral) and PID (Proportional-Integral-Derivative) controllers. Specifically, the JSO-tuned FOPID controller exhibited a 25% reduction in rise time, a 30% improvement in settling time, and a 20% decrease in overshoot when compared to the PID controller. Furthermore, comparative analyses with other optimization techniques, including Moth Flame Optimization (MFO), Ant Lion Optimization (ALO), and Elephant Herding Optimization (EHO), reveal that the JSO algorithm provides higher accuracy and stability in diverse operating conditions. This study underscores the efficacy of the JSO-tuned FOPID controller as a robust solution for complex industrial applications, such as paper machine headbox systems, and highlights its potential to enhance process efficiency and control precision.

Abstract Concrete’s widespread use in construction is increasing due to urbanization and population growth. While it offers durability and strength, its production poses environmental challenges. Researchers and global initiatives are working towards more sustainable concrete production methods and effective waste management, particularly for paper waste (WPA) and polyethylene terephthalate waste (PET). This study aims to investigate the effects of waste paper aggregate (WPA) on the flow time, compressive strength, flexural strength, and thermal conductivity of mortars. Furthermore, it explores the potential of polyethylene terephthalate (PET) to enhance the compressive and flexural strengths of these mortars. To conduct this study, the materials were characterized using EDX spectroscopy and SEM analysis. Gwyddion software was employed to conduct a comprehensive analysis of the grain segmentation and microstructural characteristics of the WPA mortars. Subsequently, four distinct mixtures were selected for further investigation. The first mixture involved substituting sand with various percentages of waste paper aggregate (WPA) (1–4%) without PET. The second mixture included WPA (1–4%) and 5% PET. Due to the ineffective plasticizer in the first two mixtures, the third mixture replaced 20% of quarry sand with dune sand (DS) while maintaining the same percentages of WPA and PET as in the previous mixtures. The results indicate that mortars RM1 (0% WPA + 0% PET) and RM2 (0% WPA + 0% PET + 20% DS) demonstrated the best flow time. This suggests that incorporating WPA and PET into the mortar mix can negatively impact its workability, making it more challenging to handle, shape, and apply. Sample PW4, composed of 4% WPA and 0% PET, displayed a significant increase in compressive strength from 46.36 MPa to 49.81 MPa and flexural strength from 10.5 MPa to 11.47 MPa, indicating that incorporating WPA into the mortars can enhance resistance to both compressive and flexural strengths. This same mixture, PW4, demonstrated that the mortars are poor conductors of heat and would be more effective as thermal insulators. Grain segmentation of WPA mortars using Gwyddion software revealed that shorter WPA fibers tend to align with the width, while longer WPA fibers tend to align with the length of the section.

Abstract Background Paracetamol is the most consumed medicine globally. Its accessibility contributes to common overdose. Paracetamol overdose is responsible for > 50% of acute liver failure cases, making it the second most common reason for a liver transplant. Rapid quantitation of paracetamol is crucial to guide treatment of paracetamol overdose. Current tests require invasive sampling and relatively long turnaround times. Paper arrow-mass spectrometry (PA-MS) combines sample collection, extraction, separation, enrichment and ionisation onto a single paper strip, achieving rapid, accurate, cost-effective and eco-friendly analysis direct from raw human saliva. Methods To validate PA-MS against an established test, 17 healthy adults were recruited. Samples were collected before and at 15, 30, 60, 120 and 240 min after ingesting 1 g of paracetamol. Plasma measured with an established clinical test served as the reference standard to validate PA-MS with three biofluids—plasma, resting saliva (RS) and stimulated saliva (SS). Participants’ views of blood, RS and SS sampling procedures were assessed qualitatively. Cross-validation was assessed using Lin’s concordance correlation coefficients (CCC), Bland–Altman difference plots, and ratios of PA-MS to the reference standard test. Results PA-MS using stimulated saliva offers a reliable alternative to intravenous blood sampling. The CCC is 0.93, the mean difference with the reference test is − 0.14 mg/L, and the ratios compared to the reference test are 0.84–1.27 from correlated samples collected at 5 intervals over 4 h for each participant. Conclusions Paracetamol detection from SS with PA-MS provides a reliable result that can aid timely treatment decisions. Differences between paracetamol concentration in resting and stimulated saliva were also identified for the first time, highlighting the importance of standardising saliva collection methods in general. This study marks a major milestone towards rapid and convenient saliva analysis.

Abstract Expansive soils have a high tendency for volume change in case of fluctuations in moisture content, potentially causing significant damage to light structures, particularly road pavements. This paper investigates the influence of waste paper sludge ( $$\:WPS$$ ) as an alternative sustainable stabilizer on the volume change behavior of expansive road subgrade soils of different origins. For this purpose, $$\:WPS$$ was added to the expansive soils at ratios of 3%, 6%, 9%, 12%, and 15% by dry weight of the soils. A series of Atterberg’s limit, swelling, shrinkage, compaction, and consolidation tests were performed on pure soils and soil specimens with $$\:WPS$$ to attain a comprehensive understanding of the role that $$\:WPS$$ plays in the volume change behavior of expansive soils. The experimental test results showed that the addition of $$\:WPS\:$$ led to a considerable decrease in the plasticity and swell-shrink potentials of subgrade soils. The consolidation settlement of expansive road subgrades was also reduced to some extent with $$\:WPS$$ . Moreover, the statistical analysis of the test data indicated a significant relationship among different swelling-shrinkage parameters. The experimental results presented here suggest that the $$\:WPS$$ may be a cost-effective, environmentally friendly, and sustainable stabilizer to reduce the volume change sensitivity of expansive road subgrade soils.

Background: Numerous studies have explored the most productive and influential authors in a specific field. However, 2 challenges arise when conducting such research. First, some authors may have identical names in the study data, and second, the contributions of coauthors may vary in the article by line, requiring consideration. Failure to address these issues may result in biased research findings. Our objective was to illustrate how the author-weighted scheme (AWS) and betweenness centrality (BC) can be employed to identify the 10 most frequently cited authors in a particular journal and analyze their research themes., Methods: We collected 24,058 abstracts from the PubMed library between 2000 and 2020 using the keyword "Medicine [Journal]." Author names, countries/regions, and medical subject headings (MeSH terms) were collected. The AWS to identify the top 10 authors with a higher x-index was applied. To address the issue of authors with identical names affiliated with different research institutes, we utilized the BC method. Social network analysis (SNA) was conducted, and 10 major clusters were identified to highlight authors with a higher x-index within the corresponding clusters. We utilized SNA to analyze the MeSH terms from articles of the 10 top-cited authors to identify their research themes., Results: Our findings revealed the following: within the top 10 cited authors, 2 authors from China shared identical names with Jing Li and Tao-Wang; JA Winkelstein from Maryland (US) had the highest x-index (15.58); Chia-Hung Kao from Taiwan was the most prolific author, having published 115 articles in Medicine since 2003; and the 3 primary research themes, namely, complications, etiology, and epidemiology, were identified using MeSH terms from the 10 most frequently cited authors., Conclusions: Using AWS and BC, we identified the top 10 most cited authors. The research methods we utilized in this study (BC and AWS) have the potential to be applied to other bibliometric analyses in the future., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc.)

Abstract Electrochemical analysis of glucose monitoring without painful blood collection provides a new noninvasive route for monitoring glucose levels. Thus, in this study, biobased cellulosic papers (methylated and phosphorylated one) based glucose monitoring sensor is developed. To achieve high hydrophilicity, microfibrillated cellulose (MFC) were functionalized using hexokinase mediated phosphorylation (–OH to – $$\text{SO}_{3}^{2-}$$ ). The instinctive increased surface charge density from 36.2 ± 3.4 to 118.4 ± 1.2 µmol/g and decrease contact angle (45°–22°) confirms the increased hydrophilicity of paper. Furthermore, functionalized phos-MFC paper increase the capillary flow of sweat, required low quantity (1 µl) of sweat for accurate analysis of glucose level. Additionally, chemically induced methyl groups (–CH3) make the sensor more barrier to other chemicals. In addition, a multilayer patch design combined with sensor miniaturization was used to lead to an increase in the efficiency of the sweat collection and sensing processes. Besides, this paper sensor integrated with artificial transdermal drug delivery unit (agarose gel as skin) for monitoring glucose levels in sweat. The patch monitoring system increase the accuracy of sensing with fluctuation in sweat vol. (1–4 µl), temperature (20–70 °C), and pH (4.0–7.0). In addition, temperature dependency artificial transdermal delivery (within agarose gel) of drug metformin agrees the measurement accuracy of sensor, called “switch system” without any error. As a result, the reported MFC paper based multi-patch disposable sensing system provides a novel closed-loop solution for the noninvasive sweat-based management of diabetes mellitus.

Abstract Flax (Linum usitatissimum) is a bast fiber plant known for its long fibers, making it an excellent source of pulp for paper production. In Ethiopia, flax is primarily cultivated for oil, with the residual straw utilized for papermaking. This study focuses on pulping flax straw using the Kraft process and investigates its chemical composition, proximate analysis, and morphological properties. The proximate analysis revealed an ash content of 4.13% and moisture content of 11%. Chemical composition analysis showed cellulose at 51.34%, hemicellulose at 25.20%, lignin at 14.12%, ash at 4.13%, and extractives at 5.21%. The morphological properties included a fiber length of 1.41 mm, diameter of 16.78 μm, lumen width of 9.45 μm, and cell wall thickness of 3.77 μm. Flax straw exhibited an acceptable Runkel ratio (0.8) and flexibility coefficient (56.32), placing it within the range of non-wood fibers. SEM analysis of the pulp’s morphology was conducted to assess fiber structure, including the presence of cracks. Pulp quality and length are directly linked to paper strength. Various pulping conditions were studied using a full-factorial design, with optimum conditions being 10% alkaline, 131.74°C, and 120 min of cooking time, yielding a pulp with a Kappa number of 10.45 and a yield of 40.56%. The resulting paper demonstrated standard tensile, tearing, and burst strengths, indicating that flax straw is a promising raw material for paper production.

Abstract The pulp and paper industry generates vast quantities of paper sludge, posing significant environmental challenges due to its disposal in landfills or incineration. This study explores the potential of valorizing paper sludge by incorporating it into particleboard production. It aims to optimize sludge content and particle size to enhance board properties—a novel approach to waste management in the wood composites industry. Through systematic variation of sludge content (0–25%) and particle size ( 2 mm), we assessed the mechanical and physical properties such as internal bond strength (IB), modulus of rupture (MOR), modulus of elasticity (MOE), water absorption (WA), and thickness swelling (TS). The findings indicate that incorporating paper sludge at moderate levels (5–15%) with optimized particle sizes (

The widely accepted model of prevention, including primary, secondary and tertiary prevention, focuses predominantly on diseases. The WHO provides a comprehensive model of health conceptualized on the basis of the International Classification of Functioning, Disability and Health (ICF). This paper develops a conceptual description of prevention aimed at functioning on the basis of the ICF model. Starting from the ICF-based conceptual descriptions of rehabilitation as a health strategy, a conceptual description of functioning prevention has been developed. Prevention aiming at functioning is the health strategy that applies approaches to avoid or reduce risks of impairing bodily functions and structures, activity limitations and participation restrictions; to strengthen the resources of the person; to optimize capacity and performance; to prevent impairments of bodily functions and structures; to prevent activity limitations and participation restrictions; to reduce contextual risk factors and barriers, including personal and environmental factors; to promote and strengthen contextual facilitators, with the goal of enabling people with impairments and people at risk of disability; and to maintain or improve the level of functioning in interactions with the environment. The proposed concept widens the scope of prevention to all aspects of functioning, including contextual factors.

Abstract This work proposed an approach to multi-component non-metallic materials, namely regular polygonal paper honeycomb sandwich tubes filled with polyethylene (PE) foam, and focused on the influence of drop impact parameters and structural parameters on the deformation characteristics and energy absorption of the filled tubes. Axial drop impact tests were employed to exert drop impact loading on cross-sections of the specimens with a square drop weight. The results showed that the X-direction filled tube (X-DFT) had a higher crushing strength and yield strength than that of the Y-direction filled tube (Y-DFT). As the tubular cross-section edge number of the filled tube increased, the specific energy absorption (SEA) and specific total efficiency (STE) decreased. Under the same axial drop impact loading conditions, the SEA and STE of the X-DFT were superior to those of the Y-DFT. As the edge number of the tubular cross-section or the tubular length ratio increased, the SEA and STE of the filled honeycomb tube decreased significantly. While the impact energy increased, the SEA and STE of the filled tubes increased approximately linearly. This work investigated the influence of drop-impact and structural parameters on deformation characteristics and energy absorption. It is expected to provide supplementary documentation for the advancement of cushion protection technology and the optimization of product structure.

Diagnostic blood tests can guide the administration of healthcare to save and improve lives. Most clinical biosensing blood tests require a trained technician and specialized equipment to process samples and interpret results, which greatly limits test accessibility. Colorimetric paper-based diagnostics have an equipment-free readout, but raw blood obscures a colorimetric response which has motivated diverse efforts to develop blood sample processing techniques. This work uses inexpensive readily-available materials to engineer user-friendly dilution and filtration methods for blood sample collection and processing to enable a proof-of-concept colorimetric biosensor that is responsive to glutamine in 50 µL blood drop samples in less than 30 min. Paper-based user-friendly blood sample collection and processing combined with CFPS biosensing technology represents important progress towards the development of at-home biosensors that could be broadly applicable to personalized healthcare.

Abstract Nucleic acid amplification testing has great potential for point-of-need diagnostic testing with high detection sensitivity and specificity. Current sample preparation is limited by a tedious workflow requiring multiple steps, reagents and instrumentation, hampering nucleic acid testing at point of need. In this study, we present the use of mixed cellulose ester (MCE) paper for DNA binding by ionic interaction under molecular crowding conditions and fluid transport by wicking. The poly(ethylene) glycol-based (PEG) reagent simultaneously provides the high pH for alkaline lysis and crowding effects for ionic binding of the DNA under high salt conditions. In this study, we introduce Paper-based Abridged Solid-Phase Extraction with Alkaline Poly(ethylene) Glycol Lysis (PASAP). The anionic mixed cellulose ester (MCE) paper is used as solid phase and allows for fluid transport by wicking, eliminating the need for pipetting skills and the use of a magnet to retain beads. Following the release of DNA from the cells due to the lytic activity of the PASAP solution, the DNA binds to the anionic surface of the MCE paper, concentrating at the bottom while the sample matrix is transported towards the top by wicking. The paper was washed by dipping it in 40% isopropanol for 10 s. After air-drying for 30 s, the bottom section of the paper (3 mm × 4 mm) was snapped off using the cap of a PCR tube and immersed in the colourimetric loop-mediated isothermal amplification (cLAMP) solution for direct amplification and colourimetric detection. The total sample processing was completed in 15 min and ready for amplification. cLAMP enabled the detection of 102 CFU/mL of Escherichia coli (E. coli) from culture media and the detection of E. coli in milk

Abstract The paper industry is a major environmental polluter due to paper waste sludge (PWS), often disposed of in hazardous ways. The techniques are employed to disposing of PWS are posing significant environmental hazards and risks to well-being. This study aims to evaluate PWS as a potential replacement for commercial adsorbents like AC and ZEO in treating stabilized leachate. Contact angle analysis of PWS was 92.60°, reveals that PWS to be hydrophobic. Batch adsorption experiments were conducted with parameters set at 200 rpm stirring speed, 120 min contact time, and pH 7. Optimal conditions for COD and NH3–N removal were identified at 120 min contact time, 200 rpm stirring speed, pH 7, and 2.0 g PWS ratio. Removal percentages for COD and NH3–N were 62% and 52%, respectively. Based on the results of the isotherm and kinetic studies, it was observed that the Langmuir and Pseudo second order (PSO) model exhibited greater suitability compared to the Freundlich and Pseudo first order (PFO) model, as indicated by higher values of R-squared (R2). The R-squared of Langmuir for COD and NH3–N were 0.9949 and 0.9919 and for Freundlich model were 0.9855 and 0.9828 respectively. Whereas the R-squared of PFO for COD and NH3–N were 0.9875 and 0.8883 and for PSO were 0.9987 and 0.9909 respectively.

Despite technological advances in the analysis of digital images for medical consultations, many health information systems lack the ability to correlate textual descriptions of image findings linked to the actual images. Images and reports often reside in separate silos in the medical record throughout the process of image viewing, report authoring, and report consumption. Forward-thinking centers and early adopters have created interactive reports with multimedia elements and embedded hyperlinks in reports that connect the narrative text with the related source images and measurements. Most of these solutions rely on proprietary single-vendor systems for viewing and reporting in the absence of any encompassing industry standards to facilitate interoperability with the electronic health record (EHR) and other systems. International standards have enabled the digitization of image acquisition, storage, viewing, and structured reporting. These provide the foundation to discuss enhanced reporting. Lessons learned in the digital transformation of radiology and pathology can serve as a basis for interactive multimedia reporting (IMR) across image-centric medical specialties. This paper describes the standard-based infrastructure and communications to fulfill recently defined clinical requirements through a consensus from an international workgroup of multidisciplinary medical specialists, informaticists, and industry participants. These efforts have led toward the development of an Integrating the Healthcare Enterprise (IHE) profile that will serve as a foundation for interoperable interactive multimedia reporting., (© 2022. The Author(s).)

Abstract Cervical cancer, while preventable through screening and treatment of cervical precancer, remains a global challenge with a disproportionately high burden of disease in resource-limited settings, especially in low- and middle-income countries (LMICs). Lack of affordable, easy-to-use screening and diagnostic tests contributes to this disparity. Most commercially available tests are not appropriate for use in LMICs due to resource constraints. Specifically, HPV mRNA and oncoprotein tests that have high specificity for cervical precancer and cancer require complex sample preparation protocols and expensive instrumentation. To address these limitations, an HPV E7 oncoprotein assay for HPV16, 18, and 45 was developed that is appropriate for use at the point of care. The assay is paper-based, involves only five simple steps, and does not require instrumentation. A clinically relevant limit of detection was demonstrated with cellular samples. Additionally, clinical performance was demonstrated with a small pilot study (n = 19), in which the HPV E7 paper-based assay was found to have 95% accuracy when compared to histopathologic diagnosis of cervical intraepithelial neoplasia grade 2 or more severe (CIN2+). With further clinical validation, this assay could enable highly specific point-of-care testing for cervical precancer and cancer that is instrumentation-free, affordable, and ideal for use in resource-limited settings.

Abstract Background Education was affected during the COVID-19 pandemic, and there was a need to adapt the learning approaches to the situation. At the University of Gadjah Mada, many essential soft skills of healthcare professionals are taught using the interprofessional education (IPE) approach on-site. Our university responded to this crisis by offering online classes and similar types of training. Post-administration of the course, a peer-assessment was conducted, and it was used to provide feedback on the work or performance of peers among students. Peer assessment was done using paper-based and a mobile application during COVID-19. This study aimed to share a best practice for the implementation of a rank-based peer-assessment application for longitudinal interprofessional education in the community setting and to compare the score distribution of a rank-based peer-assessment before and after using mobile application. Methods Quantitative research design was used by processing secondary data on student peer assessment scores from 3 bachelor programs (medicine, nursing, nutritionist) Community and Family Health Care with Interprofessional Education (CFHC-IPE) in Faculty of Medicine, Nursing, and Public Health, Universitas Gadjah Mada. 4,790 students from 2018 to 2022 (5 years) were tracked before, during, and after the COVID-19 pandemic. The assessments carried out were offline, online, and blended learning, respectively. The assessment was carried out using a paper-based method before and during the pandemic, online-based with a mobile application was used. Thus, the peer-assessment was conducted manually or using paper-based method using a 5-rank scoring system. In 2019, the peer assessment was carried out using a mobile application and applied a 10-rank scoring system. Results The rank-based peer assessment can be well implemented to make students assess their friends more objectively, with an average score 82.02 ± 8.68. The rightward shift in the distribution of scores indicates that the average score has improved after using the mobile application compared to before its use. (82.02 ± 8.68 vs. 62.39 ± 11.13, p

Background/Objectives: Lymphocytic esophagitis is a rare inflammatory disease of the esophagus, first described in 2006. Since that time, interest in this disease entity has steadily increased, yet specific data on the etiology of the disease are still lacking. Lymphocytic esophagitis co-occurs with esophageal motility disorders, Crohn’s disease, hypersensitivity (allergy, asthma), the use of certain medications, or immune disorders. Risk factors include smoking and alcohol abuse. The disease is more prevalent in women, developing predominantly within the sixth decade of life. The most important symptom is dysphagia, with odynophagia, epigastric, and chest pain or heartburn being less common. No particular endoscopic presentation is pathognomonic for lymphocytic esophagitis, the findings not infrequently resembling those of eosinophilic esophagitis. Conclusions: There is great need for an international consensus defining strict histopathological criteria for the diagnosis of lymphocytic esophagitis as well as relevant diagnostic and therapeutic management. This review paper presents the current state of knowledge on lymphocytic esophagitis.

Abstract Due to the scarcity of wood in some countries, it is necessary to replace it with other raw materials and at the same time use the waste material. The aim of this research is to use poppy waste straw for the efficient conversion of possible lignocellulosic materials – pulps and particleboards. Their suitability for the production of composites is assessed on the basis of selected physical or mechanical properties. Tensile strength index, burst strength index and air permeability by Gurley have been identified as critical properties of pulp made from poppy straw through two delignification methods. The better mechanical properties, i.e., tensile strength index, were achieved at 52.7 N·m/g for the sodium pulp, but the nitrate-alkali method also showed corresponding values at 45.9 N·m/g. Similar parameters to those of bagasse or similar fast-growing plants were achieved in particleboard production. The results of this research are used to evaluate poppy straw as an alternative raw material to produce biocomposites.

Objective: Understanding the impact different journal articles have in any academic field is important - particularly in emerging professions. A bibliometric analysis like this does not yet exist for paramedicine, despite the rapid increase in its primary literature. The objective of the present study was to identify and analyse the 100 top-cited articles about paramedicine., Methods: We searched the Scopus database in August 2020 for studies relating to paramedicine. After screening titles and abstracts, we extracted the citation count, journal name, publication year, and country of origin. We manually assessed whether the study was clinical or not, noted the sex of the authors, the profession of first and last authors and the study design used., Results: The median citation count for the top 100 papers in paramedicine was 58 (interquartile range 46-84 citations). The articles were published across 48 different journals, with Resuscitation and Prehospital Emergency Care being the two most frequent. The top-cited paramedic papers originated from 16 different countries and were written predominantly by medical doctors. Three quarters (73%) of the studies had a clinical focus, and a quarter (26%) were randomised controlled trials., Conclusions: The evolution of paramedicine towards professionalism is backed up by the growth of its own body of knowledge. This analysis of the 100 most cited studies in paramedicine is the first of its kind and highlights that paramedicine articles have a high citation count and are published across numerous journals, but with a relative lack of contribution from paramedic practitioners and female researchers., (© 2021 Australasian College for Emergency Medicine.)

This article is a narrative review that focuses on the common shortcomings that one researcher faces. The aim of the article is to provide some key ideas to the novice researcher how to overcome those hurdles. The electronic database such as PubMed, Google Scholars, Science Direct, ProQuest are searched to find the related articles. Only the full text articles were considered. Mostly, the consensus views are presented in most of the topics. Some of the gray zones are discussed. The article will help the aspirant author to complete their research and academic writing in a presentable manner.

Abstract Micro-credentials are an element of the European Skills Agenda 2020. This five-year plan aims to develop improved applied and broader work skills in response to system demands from employers, industry and communities. Within the labour market, employees increasingly want to obtain new skills-based qualifications in a relatively short period of time. Micro-credentials, as a form of lifelong learning, in the health care sector provide significant opportunities for upskilling the workforce in response to rapid changes in health care and service delivery. Moreover, micro-credentials have also been introduced in the context of undergraduate and postgraduate education within the process of accelerated digitalisation during the pandemic. However, despite its relevance, there is limited discussion about the implications and challenges of micro-credentials in the healthcare sciences. According to the findings that emerged from a review of policy documents and scientific papers, a reflective exercise has been conducted to debate the possibilities and challenges of emerging education based on micro-credentials within health care education and employment. Health care delivery is multidisciplinary and statutorily regulated to protect citizens. In such a complex sector, developing a micro-credential friendly ecosystem will require cooperation between various stakeholders if its potential is to be effectively realised.

Abstract This viewpoint paper focuses on challenges for Swiss physiotherapy education institutes related to the transition towards evidence-based practice and the incorporation of advanced roles within the profession. To tackle such challenges, it is essential to establish structured pathways and competency frameworks and position physiotherapists as integral contributors to innovative healthcare.

The Bündnis Junger Ärztinnen und Ärzte (BJÄ, Alliance of Young Physicians in Germany) has presented a position paper (PP) on Postgraduate Medical Education (PGME) against the background of an unfolding hospital reform in Germany, and they describe existing deficits of PGME in Germany. Based on this, demands were made of legislators, employers and medical associations which could result in a sweeping reformation of PGME. Hospital reforms can only be accomplished with well trained and motivated physicians. In this respect the BJÄ regards the reform of hospitals and the health-care system as a chance for a reform of PGME, which is long overdue. Legislative competence for PGME lies with the States of the Federal Republic of Germany and this warrants an adjustment of state medical association laws to accommodate the demands of the BJÄ. Generally PGME must be taken into consideration in all health-care legislation, in analogy to the meanwhile globally adopted principle of “Health in all Politics (HiAP)”. The BJÄ has made every endeavour to produce this PP. The responsible stakeholders and actors in the health-care system would be well-advised to take the position paper seriously with a dwindling physician work force in hospitals and serious quality deficits in PGME. Hence, the BJÄ must be comprehensively supported. They need congenial partners to define the scientific foundation of all their demands, to test their application under real life conditions in hospital and outpatient care, to pursue research on the impact on patient care and on the intended transformation of the health-care system. This might best be accomplished by partnering with a scientific as has been the case in many countries for decades.

Objectives COVID-19, a public health emergency affecting the world in 2019, not only greatly promoted the development and application of vaccines but also effectively shortened the publishing time of scientific papers. In view of these facts, the current situation, status, problems and development trends of vaccine research and application were explored through bibliometric analysis of highly cited papers in the vaccine field within the time frame of 2014–2024, and the countries, institutions, authors, funding agencies and other relevant information that contributed most to vaccine research and application were summarised.Design Bibliometric analysis through data analysis and visual mapping.Data sources Scientific articles.Data extraction and synthesis ‘Vaccine’ and ‘vaccines’ were used in the WoS database to retrieve the publications and to adequately collect the data; Microsoft Excel was used for data analysis; and VOSviewer was used for visual description of data. Overall publication trends, countries, institutions and funding agencies, authors and articles, journals and languages, and research areas and co-occurrence keywords were analysed by bibliometrics.Results A total of 3258 highly cited papers were published in the field of vaccines in the past decade, from 735 different journals. With the COVID-19 pandemic in 2019, the number of highly cited papers in the field of vaccine research increased significantly from 2020 to 2024, accounting for 76.12%. The number of highly cited papers for vaccines peaked in 2021 and 2022, followed by a rapid decline. Highly cited papers came from 7133 institutions in 153 countries, and the most influential country in the field of vaccines was the USA, which published 1733 highly cited papers, accounting for 53.19% of the highly cited papers. The top 15 institutions with the largest influence were all from the USA or UK with 2567 published papers in total, accounting for 78.79% of highly cited papers. 4787 funding agencies were recognised in funding 2368 highly cited papers. A total of 30 926 authors in 90 research areas contributed significantly to global vaccine research. The most highly cited paper was ‘Safety and Efficacy of the BNT162b2 mRNA COVID-19 Vaccine’ from the New England Journal of Medicine, which was cited 9435 times in total. Among the 9848 co-occurrence keywords, COVID-19 (including SARS-CoV-2, 2019-COVID and SARS2) was the most frequently co-occurrence keyword. It appeared in 1720 articles, accounting for 52.79%, indicating that COVID-19 was the most popular study in the last decade.Conclusions This study visualised the research and application of vaccines in the world from the perspective of papers output, drew the knowledge map and identified the important research hotspots and development trends in the vaccine field in the recent 10 years (2014–2024), which is helpful for Centres for Disease Control and Prevention, clinicians, researchers and health policymakers to better understand the research status and problems in vaccine research and application and predict its future development direction.

Abstract Obesity is the one of the most important components of metabolic syndrome. Because obesity related hypertension accounts for two thirds of essential hypertension, managing obesity and metabolic syndrome is a crucial task in the management of hypertension. However, the current non-pharmacological therapies have limitations for achieving or maintaining ideal body weight. Recently, glucagon-like peptide-1 receptor agonists (GLP1-RAs) have demonstrated excellent weight control effects, accompanied by corresponding reductions in blood pressure. GLP1-RAs have shown cardiovascular and renal protective effects in cardiovascular outcome trials both in primary and secondary prevention. In this document, the Korean Society of Hypertension intends to remark the current clinical results of GLP1-RAs and recommend the government and health-policy makers to define obesity as a disease and to establish forward-looking policies for GLP1-RA treatment for obesity treatment, including active reimbursement policies.

Abstract Inquiry-based learning (IBL) is a type of problem-based learning. While IBL aims at reflecting the work of practicing researchers, only some students will pursue an academic career. We therefore designed a course that provides opportunities for IBL by applying participant observation to internship work experience inside and outside academia. Using this internship course as an example, we investigated, how master’s students in health science executed an IBL assignment regarding the application of participant observation and presentation of findings. In addition, the understanding of occupational fields provided through the IBL assignment was examined. To determine whether learning objectives were met, a document analysis of IBL assignments comprising presentation slides and field protocols was performed. Within content analysis, a category grid was used examining (a) suitability of chosen research objectives, (b) execution of field protocols, (c) sufficiency of reporting and (d) extent of reflection. 49 IBL assignments from the years 2020–2022 were included. Sides of IBL observations were: (a) organizations providing health care (n = 28); (b) administrations of health care (n = 8); and (c) research institutes (n = 13). Within students’ field protocols, the level of detail of descriptions differed. 30 assignments included reflection on the methods used and research experience. In about a third of IBL assignments, indication of observation type, theoretical background and data analysis was missing. Using participant observation of internship work-experience for IBL can serve as a teaching tool for students to develop methodological skills. For future courses, we developed a checklist to strengthen reporting, reflection and use of theory. As internships are often integrated in degree programs in health sciences similar courses could be implemented in different programs, given qualified methodological guidance.

Basic computer skills are essential for authors writing research papers as it has the potential to make the task easier for a researcher. This article provides a glimpse about the essential software programs for a novice author writing a research paper. These software applications help streamline the writing process, improve the quality of work, and ensure that papers are formatted correctly. It covers word processing software, grammar correction software, bibliography management software, paraphrasing tool, writing tools, and statistical software. All of the tools described are free to use. Hence, it would help researchers from resource-limited settings or busy physicians who get lesser time for research writing. We presume this review paper would help provide valuable insights and guidance for novice authors looking to write a high-quality research paper.

In order for enterprise imaging to be successful across a multitude of specialties, systems, and sites, standards are essential to categorize and classify imaging data. The HIMSS-SIIM Enterprise Imaging Community believes that the Digital Imaging Communications in Medicine (DICOM) Anatomic Region Sequence, or its equivalent in other data standards, is a vital data element for this role, when populated with standard coded values. We believe that labeling images with standard Anatomic Region Sequence codes will enhance the user's ability to consume data, facilitate interoperability, and allow greater control of privacy. Image consumption-when a user views a patient's images, he or she often wants to see relevant comparison images of the same lesion or anatomic region for the same patient automatically presented. Relevant comparison images may have been acquired from a variety of modalities and specialties. The Anatomic Region Sequence data element provides a basis to allow for efficient comparison in both instances. Interoperability-as patients move between health care systems, it is important to minimize friction for data transfer. Health care providers and facilities need to be able to consume and review the increasingly large and complex volume of data efficiently. The use of Anatomic Region Sequence, or its equivalent, populated with standard values enables seamless interoperability of imaging data regardless of whether images are used within a site or across different sites and systems. Privacy-as more visible light photographs are integrated into electronic systems, it becomes apparent that some images may need to be sequestered. Although additional work is needed to protect sensitive images, standard coded values in Anatomic Region Sequence support the identification of potentially sensitive images, enable facilities to create access control policies, and can be used as an interim surrogate for more sophisticated rule-based or attribute-based access control mechanisms. To satisfy such use cases, the HIMSS-SIIM Enterprise Imaging Community encourages the use of a pre-existing body part ontology. Through this white paper, we will identify potential challenges in employing this standard and provide potential solutions for these challenges.

Introduction Despite unprecedented pressures on urgent and emergency care services, there is no clear consensus on how to provide acute medical care delivery in the UK. These pressures can lead to significant delays in care for patients presenting with emergencies when admitted via traditional routes through the emergency department. Historically, a separate pathway has existed where patients are directly admitted to acute medicine services without attending the emergency department. It is suspected that there is a significant variation in how these patients are selected, triaged and managed in the UK. This systematic review will assess the methods and evidence base used for direct patient admissions to acute medicine services compared with traditional admission pathways through the emergency department.Methods and analysis A systematic review of the literature will be conducted and a total of six databases will be searched: MEDLINE (Ovid), The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE in process, Web of Science, CINAHL and Embase. This will include studies from the period 01 January 1975 to 24 January 2024. Covidence software will be the platform for the extraction of data and paper screening with the selection process reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Both title and abstract screening and full-text screening will be done by two reviewers independently. The risk of bias of included studies will be assessed using the methods introduced in the Cochrane Handbook for Systematic Reviews of Interventions and the tool used will be dependent on the type of study. Where possible, outcomes will be dealt with as continuous variables. Change percentage will be assessed between any pathway characteristic or outcome. The χ² test and I² test will be used to evaluate the heterogeneity of included studies. Where appropriate, relevant meta-analysis techniques will be used to compare studies and forest plot produced.Ethics and dissemination This systematic review does not require ethical approval. Findings will be disseminated widely in peer-reviewed publication and media, including conferences.PROSPERO registration number CRD42023495786.

Introduction Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a disabling condition that can affect adolescents during a vulnerable period of development. The underlying biological mechanisms for ME/CFS remain unclear and have rarely been investigated in the adolescent population, despite this period representing an age peak in the overall incidence. The primary objective of this is to provide a foundational set of biological data on adolescent ME/CFS patients. Data generated will be compared with controls and over several time points within each patient to potentially develop a biomarker signature of the disease, identify subsets or clusters of patients, and to unveil the pathomechanisms of the disease.Methods and analysis This protocol paper outlines a comprehensive, multilevel, longitudinal, observational study in paediatric ME/CFS. ME/CFS patients aged 12–19 years and controls will donate biosamples of urine, blood, and peripheral blood mononuclear cells for an in-depth omics profiling analysis (whole-genome sequencing, metabolomics and quantitative proteomics) while being assessed by gold-standard clinical and neuropsychological measures. ME/CFS patients will then be provided with a take-home kit that enables them to collect urine and blood microsamples during an average day and during days when they are experiencing postexertional malaise. The longitudinal repeated-measures study design is optimal for studying heterogeneous chronic diseases like ME/CFS as it can detect subtle changes, control for individual differences, enhance precision and boost statistical power. The outcomes of this research have the potential to identify biomarker signatures, aid in understanding the underlying mechanisms, and ultimately, improve the lives of children with ME/CFS.Ethics and dissemination This project was approved by the Royal Children’s Hospital’s Human Research Ethics Committee (HREC 74175). Findings from this study will be disseminated through peer-reviewed journal publications and presentations at relevant conferences. All participants will be provided with a summary of the study’s findings once the project is completed.

Introduction Recent decades have seen a growth in multisectoral and transdisciplinary approaches to improving global health, particularly across human, animal and environmental health-related sciences that advocate for participatory, systems-based perspectives to understanding and promoting health and well-being in the context of social and ecological interactions. For several issues, including human health, animal health and food security, researchers have highlighted the need for transdisciplinary One Health approaches to assess the sustainability of interventions. To understand the current thinking and conceptualisation of sustainability across One Health disciplines, we present a protocol paper for an umbrella systematic review study planned in 2024.Methods and analysis A search strategy based on Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines was developed. The Medline, Embase, Global Health and Web of Science Core Collection were the four databases interrogated through the search strategy and included all articles found in the English language up to 14 April 2024. Meta-analyses, systematic, structured literature reviews and narrative reviews on sustainability will be included and a full-text review of all articles will be undertaken. The articles will be quality appraised using the AMSTAR 2 tool. Data that cover proposed factors influencing and characterising sustainability will be extracted across One Health disciplines including similarities and differences, and a summative content analysis will be completed to identify any emerging themes and develop an analytical framework. The conceptualisation of sustainability in the context of One Health multisectoral approaches will be summarised, a definition of sustainability proposed and include an identification of tools for measuring and assessing sustainability.Ethics and dissemination No primary data will be collected; therefore, ethical approval will not be required. The results will be disseminated in peer-reviewed literature and conference presentations. The findings will also be directly disseminated to the Quadripartite agencies.Prospero registration number CRD42018094031

This study assessed the progression of stroke using bibliometric methods. By March 31, 2024, highly cited papers on stroke were collected from the Web of Science Core Collection. Collaboration and keyword conjunction analyses, along with their visual representations, were conducted using VOSviewer. CiteSpace was employed to identify keywords and reference sources. A comprehensive review of 2,509 highly cited studies on stroke was conducted. Notably, the United States, China, and the United Kingdom have emerged as leading contributors to this research domain, with the New England Journal of Medicine having the highest number of publications. YUSUF S had the highest H-index among all authors. The key terms frequently encountered were “stroke,” “atrial fibrillation,” and “cardiovascular disease.” This study performed a detailed bibliometric review of stroke research over the past decade, shedding light on the participation of various countries, organizations, authors, journals, and articles in the field. These insights offer a broad snapshot of the global stroke research trends.

Abstract Software that employs screening prioritization through active learning (AL) has accelerated the screening process significantly by ranking an unordered set of records by their predicted relevance. However, failing to find a relevant paper might alter the findings of a systematic review, highlighting the importance of identifying elusive papers. The time to discovery (TD) measures how many records are needed to be screened to find a relevant paper, making it a helpful tool for detecting such papers. The main aim of this project was to investigate how the choice of the model and prior knowledge influence the TD values of the hard-to-find relevant papers and their rank orders. A simulation study was conducted, mimicking the screening process on a dataset containing titles, abstracts, and labels used for an already published systematic review. The results demonstrated that AL model choice, and mostly the choice of the feature extractor but not the choice of prior knowledge, significantly influenced the TD values and the rank order of the elusive relevant papers. Future research should examine the characteristics of elusive relevant papers to discover why they might take a long time to be found.

Abstract Background Academic paper writing holds significant importance in the education of medical students, and poses a clear challenge for those whose first language is not English. This study aims to investigate the effectiveness of employing large language models, particularly ChatGPT, in improving the English academic writing skills of these students. Methods A cohort of 25 third-year medical students from China was recruited. The study consisted of two stages. Firstly, the students were asked to write a mini paper. Secondly, the students were asked to revise the mini paper using ChatGPT within two weeks. The evaluation of the mini papers focused on three key dimensions, including structure, logic, and language. The evaluation method incorporated both manual scoring and AI scoring utilizing the ChatGPT-3.5 and ChatGPT-4 models. Additionally, we employed a questionnaire to gather feedback on students’ experience in using ChatGPT. Results After implementing ChatGPT for writing assistance, there was a notable increase in manual scoring by 4.23 points. Similarly, AI scoring based on the ChatGPT-3.5 model showed an increase of 4.82 points, while the ChatGPT-4 model showed an increase of 3.84 points. These results highlight the potential of large language models in supporting academic writing. Statistical analysis revealed no significant difference between manual scoring and ChatGPT-4 scoring, indicating the potential of ChatGPT-4 to assist teachers in the grading process. Feedback from the questionnaire indicated a generally positive response from students, with 92% acknowledging an improvement in the quality of their writing, 84% noting advancements in their language skills, and 76% recognizing the contribution of ChatGPT in supporting academic research. Conclusion The study highlighted the efficacy of large language models like ChatGPT in augmenting the English academic writing proficiency of non-native speakers in medical education. Furthermore, it illustrated the potential of these models to make a contribution to the educational evaluation process, particularly in environments where English is not the primary language.

The Indian education system has produced top-class global corporate leaders in recent decades. The combination of a solid educational foundation, work ethic, adaptability, technical and analytical skills, leadership abilities, networking, entrepreneurial spirit, and cultural values collectively contribute to the success of Indian students and professionals in the corporate world. On the contrary, India’s overall performance in Olympic sports has been modest compared to its population and potential. The education system of any country has a significant role in sporting success. To fully harness the potential of sports in schools, addressing these challenges and creating a supportive environment that values and promotes sporting abilities alongside academic excellence is essential. This will require concerted efforts from various stakeholders, including the schooling system, educational institutions, government, sports organizations, corporate sponsors, and the community. This white paper aims to systematically organize the available knowledge and debates around India’s sporting performance in the background of mainstream education culture. This paper also addresses the systemic devaluation, exclusion, disfranchisement, and stereotyping of sports and sportspersons in India. One key argument put forward in this paper is to extend absolute equivalence to Olympic sports disciplines (e.g., football) at par with general academic disciplines (e.g., mathematics) in terms of examinations and award of qualifications within the mainstream education system of India. And India must host the Olympics before 2047.

Abstract Microfluidic paper-based analytical devices often are combined with scanners as detectors. In this work, different scanning options offered by scanners: resolution, scanning mode, exposure to radiation, colour restoration, and saving format were tested. Moreover, different attempts to mathematical data treatment based on intensities of three channels—Red, Green and Blue, were studied. All measurements presented in this article were conducted for a model dye—bromothymol blue and a model analyte—zinc(II) ion (complexed with xylenol orange in a paper matrix). The article summarizes the scanning options and possibilities of mathematical calculations. Nevertheless, it is suggested that the best option is to use the prior prepared calculation file to paste obtained intensities and compare all presented in this article (and the most frequently used) equations to process intensities and decide which one should be used in the particular analysis.

Background The primary endpoint in diabetes-related foot ulcer (DFU) trials is often time to healing, defined as complete re-epithelialisation with absence of drainage, requiring clinical expert assessment as the gold standard. Central blinded photograph review for confirmation of healing is increasingly being undertaken for internal validity. The Diabetic Foot Ulcer Photography study aims to determine the agreement between blinded independent review panel members for assessing ulcer healing status in patients with DFUs.Methods and analysis Photographs of ulcers clinically assessed as healed or not healed across 300 participants recruited to one of two randomised controlled trials (MIDFUT and CODIFI2), will be independently reviewed by a central blinded panel consisting of four clinicians with expertise in ulcer healing assessment. Staff at recruiting sites will take photographs using a standardised camera and protocol. Photographs will be reviewed at three levels of magnification: raw image, image standardised to a measurement scale included in the photograph and standardised image with magnification permitted. Reviewers will assess the healing status and their confidence level in making a healing judgement, with reasons reported for a low confidence rating. Analysis at each level of magnification will estimate inter- and intra-rater reliability on the assessments of healing of photographs with the clinical assessment (primary) and confidence rating using multivariable logistic mixed models. Analysis of the learning curve for the assessment of healing and confidence rating will use exponential and two-phase models.Ethics and dissemination Ethics approval has been granted by the National Research Ethics Service Committees (MIDFUT 17/YH/0055; CODIFI2 18-WS-0235). All participants will provide a written informed consent for photography before recruited onto the respective study. Photographs will be transferred to the trials’ coordinating centre via a secure file transfer service and saved in a restricted access folder on a secure server. Results will be disseminated via publications in scientific journals and conference presentations.Trial registration number MIDFUT (ISRCTN64926597) and CODIFI2 (ISRCTN74929588).

Introduction Prostate cancer (PCa) is the most common cancer in men. Recurrence may occur in up to half of patients initially treated with curative intent for high-risk localised/locally advanced PCa. Pelvic nodal recurrence is common in this setting, but no clear standard of care exists for these patients, with potential therapeutic approaches including stereotactic body radiotherapy (SBRT) to the involved node(s) alone, extended nodal irradiation (ENI) to treat sites of potential micrometastatic spread in addition to involved node(s) and androgen deprivation therapy with or without additional systemic anticancer therapies. Based on observational studies, ENI is associated with promising metastasis-free survival (MFS) compared with SBRT and appears to result in low rates of severe late toxicity.Methods and analysis Pelvis Or Involved Node Treatment: Eradicating Recurrence in Prostate Cancer is a UK multicentre, open-label, phase III randomised controlled trial, which will deliver much needed, high-quality evidence of the impact on metastatic progression from ENI compared with SBRT in patients with PCa pelvic nodal recurrence. The trial will also evaluate the long-term toxicity of 5-fraction ENI compared with a standard 20-fraction schedule. The trail will randomise 480 participants in a ratio of 2:1:1 to SBRT, 5-fraction ENI or 20-fraction ENI from 35 to 40 UK radiotherapy sites over 4 years. Coprimary endpoints are MFS at 3 years and participant-reported late bowel toxicity at 3 years. Secondary endpoints include overall survival, biochemical progression-free survival, failure-free survival, patterns of failure, participant-reported/clinician-reported toxicity and health-related quality of life. Collection of blood and tissue samples will enable future evaluation of biomarkers of disease and toxicity and support stratification of salvage therapeutic approaches.Ethics and dissemination Ethical approval was obtained from NHS Health Research Authority, East of England – Cambridgeshire and Hertfordshire Research Ethics Committee (24/EE/0099). Trial results will be published in peer-reviewed journals and adhere to International Committee of Medical Journal Editors guidelines.Trial registration number ISRCTN11089334, registered on 23 September 2024.

Il ruolo dell’internista nel co-management perioperatorio D. Carrara, A. Azzinnaro, M. Scatizzi, V. Bottino, F. Dentali Gestione perioperatoria della terapia antitrombotica: uno sguardo condiviso tra specialisti A. Abenante, M. Guarascio, A. Giordano, L. Campiglia, V. Pavoni, R. Re, D. Imberti In collaborazione con SISET (Società Italiana per lo Studio dell’Emostasi e della Trombosi) Febbre e terapia antibiotica nel periodo post-operatorio N. Osti, M. Bertoldi, M. Cuoghi, S. Meini, A. Perrella In collaborazione con SIMIT (Società Italiana di Malattie Infettive e Tropicali) La fluidoterapia perioperatoria G. Ricchiuti, L. Sacchetta, P. Ossola, M. Meschi In collaborazione con SIN (Società Italiana Nefrologia) Nutrizione perioperatoria nella chirurgia digestiva maggiore M. Guadagni, C. Fiorindi, A. Sagnotta, G. Lamacchia, M. Ossola, C. Belcari In collaborazione con SINPE (Società Italiana di Nutrizione Artificiale e Metabolismo