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Chronic pancreatitis is associated with impaired quality of life, high incidence of comorbidities, serious complications and mortality. Healthcare costs are exorbitant. Some medical societies have developed guidelines for treatment based on scientific evidence, but the gathered level of evidence for any individual topic is usually low and, therefore, recommendations tend to be vague or weak. In the present position papers on chronic pancreatitis from the Societat Catalana de Digestologia and the Societat Catalana de Pàncrees we aimed at providing defined position statements for the clinician based on updated review of published literature and on multidisciplinary expert agreement. The final goal is to propose the use of common terminology and rational diagnostic/therapeutic circuits based on current knowledge. To this end 51 sections related to chronic pancreatitis were reviewed by 21 specialists from 6 different fields to generate 88 statements altogether. Statements were designed to harmonize concepts or delineate recommendations. Part 2 of these paper series discuss topics on treatment and follow-up. The therapeutic approach should include assessment of etiological factors, clinical manifestations and complications. The complexity of these patients advocates for detailed evaluation in multidisciplinary committees where conservative, endoscopic, interventional radiology or surgical options are weighed. Specialized multidisciplinary units of Pancreatology should be constituted. Indications for surgery are refractory pain, local complications, and suspicion of malignancy. Enzyme replacement therapy is indicated if evidence of exocrine insufficiency or after pancreatic surgery. Response should be evaluated by nutritional parameters and assessment of symptoms. A follow-up program should be planned for every patient with chronic pancreatitis. © 2021 Elsevier España, S.L.U.

The prevalence of diabetes has increased over the past years. Therefore, developing minimally invasive, user-friendly and cost-effective glucose biosensors is necessary especially in low-income and developing countries. Cellulose paper-based analytical devices have attracted the attention of many researchers due to affordability, not requiring trained personnel, and complex equipment. This paper describes a microfluidic paper-based analytical device for the detection of glucose in tear with the naked eye. The paper-based biosensor fabricated by laser CO2, and GOx/HRP enzymatic solution coupled with TMB was utilized as reagents. A sample volume of 10 µl was needed for the biosensor operation and the results were observable within 5 minutes. To evaluate the device performance, color intensity-based and distance-based results were analyzed by ImageJ and Tracker. Distance-based results showed a linear behavior in the range of 0.1–0.6 mM with an R2 = 0.967 and LOD of 0.2 mM. The results could be perceived by the naked eye without any need to further equipment or trained personnel in a relatively short time (3–5 minutes). Moreover, glucose concentration could be obtained non-invasively by tears collected by this µPAD.

In recent decades, there has been a growing interest in the recycling of organic materials such as paper mill biosolids (PB) and biochar for use as soil amendments. However, the benefits of co-application of PB and biochar and its effects on soil phosphorus (P) availability remain unknown. An incubation study was conducted on two acidic soils to assess the effect of two PB types (2.5% w/w) co-applied with three rates (0%, 2.5%, and 5% w/w) of pine (Pinus strobus L.) biochar on soil P fractions. An unfertilized control and a mineral NP fertilizer were used as a reference. Soil P fractions were determined by Hedley procedure after 2 and 16 wk of incubation. Material fractionation indicated that the PB containing the highest total P and the lowest Al content had the highest proportion of labile P, whereas most P in the biochar was in a stable form. The incubation study revealed that the P-rich PB increased P availability in both soils to a level comparable to mineral fertilizer at the end of the incubation. The addition of biochar to PB, however, did not affect soil P availability, but the highest rate induced a conversion of P fixed to Al and Fe oxides towards recalcitrant forms, particularly in the sandy loam soil. We conclude that co-applying biochar and PB could be more beneficial than application biochar alone and soils amended with such a mixture would be expected to release part of their P slowly over a longer period of time.

Objective The purpose of this study was to develop a natural language processing (NLP) pipeline to identify incidental thyroid nodules (ITNs) meeting criteria for sonographic follow-up and to assess both adherence rates to white paper recommendations and downstream outcomes related to these incidental findings. Methods 21583 non-contrast chest CT reports from 2017 and 2018 were retrospectively evaluated to identify reports which included either an explicit recommendation for thyroid ultrasound, a description of a nodule ≥ 1.5 cm, or description of a nodule with suspicious features. Reports from 2018 were used to train an NLP algorithm called fastText for automated identification of such reports. Algorithm performance was then evaluated on the 2017 reports. Next, any patient from 2017 with a report meeting criteria for ultrasound follow-up was further evaluated with manual chart review to determine follow-up adherence rates and nodule-related outcomes. Results NLP identified reports with ITNs meeting criteria for sonographic follow-up with an accuracy of 96.5% (95% CI 96.2-96.7) and sensitivity of 92.1% (95% CI 89.8-94.3). In 10006 chest CTs from 2017, ITN follow-up ultrasound was indicated according to white paper criteria in 81 patients (0.8%), explicitly recommended in 46.9% (38/81) of patients, and obtained in less than half of patients in which it was appropriately recommended (17/35, 48.6%). Discussion NLP accurately identified chest CT reports meeting criteria for ITN ultrasound follow-up. Radiologist adherence to white paper guidelines and subsequent referrer adherence to radiologist recommendations showed room for improvement.

Amending croplands with forest residues may help in restoring soil properties in fields subject to intensive land management. Despite their known benefits when applied separately, co-application of wood biochar with paper mill biosolids (PB) has seen little investigation under field conditions. A study was initiated in Québec, QC, Canada, to determine the effect of a single application of wood biochar with and without PB on the nitrogen (N) and phosphorus (P) availability of two pH-neutral to alkaline loamy soils. Biochar at 0, 10, and 20 Mg dry weight·ha−1 and PB at 30 Mg wet weight·ha−1 were applied before planting of corn (Zea mays L.) and soybean [Glycine max (L.) Merr.] in 2018. Residual effect of this co-application was determined under soybean and corn in the subsequent year. In both years, corn received supplemental N and P from mineral fertilizers according to local agronomic recommendations. Co-applying biochar and PB reduced soil NO3-N availability in the year of application and decreased corn yield by 1.0 Mg·ha−1 compared with biochar or PB applied alone, but these amendments did not affect soybean yields. In the following year, the previous biochar addition increased soybean yield by 0.6 Mg·ha−1 but had little effect on corn. For both years, biochar addition induced a large increase in soil Mehlich-3 P. This study revealed that wood biochar positively impacted P status of these soils but was not a source of N to crops even when co-applied with PB.

Acidification and metal mobility may present challenges in soil receiving paper mill biosolids (PB). Co-applying biochar and PB could help prevent these issues, but its effect must be assessed. The objective of this 224 d incubation study was to evaluate the effect of amending two acidic soils, a clay and sandy loam, with two PB types varying in pH (PB1, pH = 7.80; and PB2, pH = 4.51) co-applied with three rates (0%, 2.5%, and 5% w/w) of pine (Pinus strobus L.) biochar on soil pH and macro- (P, K, Ca, and Mg) and micronutrients (Cu, Zn, Fe, and Mn). In both soils, co-applying biochar and PB significantly increased soil pH and extractable K concentration compared with PB-only application, whereas amending with PB significantly increased soil extractable P concentration compared with the unamended soil. In comparison with PB only, co-applying 5% biochar and PB decreased extractable Cu concentration in both soils and extractable Fe concentration in the sandy loam soil. This study showed that co-applying biochar and PB can be more beneficial to agricultural soils than application of PB alone by supplying nutrients and helping prevent metal toxicity by raising pH, especially in acidic sandy soils.

Laser-induced graphene (LIG) technology featuring low-cost, high-efficiency and scalability has presented great advantages in micro-supercapacitors (MSCs) fabrication. However, the limited capacitance of LIG based MSCs is still hindering their further development. Herein, we introduce joule heating as a critical in-situ treatment merged with the assembly of laser-induced graphene paper based MSCs (LIGP-MSCs) toward capacitive enhancement. By increasing heating-treatment temperature from ∼20 to 500 °C, the number of nanopores in LIGP continuously increases, attributed to the gradual decomposition of amorphous carbon components. The resulting joule-heated LIGP (J-LIGP) with improved specific surface area (160.97–533.49 m2/g) and pore volume (0.179–0.553 cm3/g) as well as superhydrophilic surface is highly suitable to be employed as J-LIGP-MSCs microelectrodes. By investigating process dependent performance, the J-LIGP-MSCs heated at 500 °C for 60 min delivers a significantly improved specific areal capacitance (CA) of 13.71 mF/cm2 at 10 mV/s, which is approximately six-fold higher than that of unheated LIGP-MSCs. By further exploring and optimizing the process efficiency, J-LIGP-MSCs with a CA of 12.61 mF/cm2 has been achieved by 550 °C heating for only 5 min. Along with superior mechanical flexibility, cyclability and structural modularity, the proposed in-situ joule heating treatment is finally proved to be a universal approach for consistently enhancing the CA of LIG based MSCs processed under various chemical modifications.

Antimicrobial stewardship programs (ASPs) have made immense strides in optimizing antibiotic, antifungal, and antiviral use in clinical settings. However, although ASPs are required institutionally by regulatory agencies in the United States and Canada, they are not mandated for transplant centers or programs specifically. Despite the fact that solid organ transplant recipients in particular are at increased risk of infections from multidrug-resistant organisms, due to host and donor factors and immunosuppressive therapy, there currently are little rigorous data regarding stewardship practices in solid organ transplant populations, and thus, no transplant-specific requirements currently exist. Further complicating matters, transplant patients have a wide range of variability regarding their susceptibility to infection, as factors such as surgery of transplant, intensity of immunosuppression, and presence of drains or catheters in situ may modify the risk of infection. As such, it is not feasible to have a “one-size-fits-all” style of stewardship for this patient population. The objective of this white paper is to identify opportunities, risk factors, and ASP strategies that should be assessed with solid organ transplant recipients to optimize antimicrobial use, while producing an overall improvement in patient outcomes. We hope it may serve as a springboard for development of future guidance and identification of research opportunities.

Mitigation of global warming, energy security and industrial competitiveness urge the energy-intensive pulp and paper industry (PPI) to transform energy use practices. This study investigates how the PPI has responded to the need for the energy transition in the 2000s. Finland and Sweden as forerunners of energy-efficient operation and decarbonization of the PPI are used as target countries. Understanding of changes in energy consumption is complemented using decomposition analysis (Logarithmic Mean Divisia Index Method) and the energy efficiency index approach. Analysis of companies’ investments in energy technologies is used for explaining changes in energy production. Evidence of significant development towards the more sustainable operation of the PPI was found. Energy consumption per produced unit has decreased, i.e., energy efficiency has improved. Fossil fuels have been partially replaced with bio-based alternatives. Thus, the CO2 intensity has decreased substantially. The generation of renewable electricity has increased in both countries. Examples of Finland and Sweden indicate that the PPI has great potential to contribute to CO2 emission reduction worldwide in the future as energy efficiency can be further improved, and the share of fossil fuels can be decreased increasing the use of biofuels and self-generated green electricity at least in kraft pulp mills.

We present how harmful different wood extractives carried over to paper mill with unbleached softwood Kraft pulp are for the strength of packaging papers and boards. The investigations were done by simulating industrial papermaking conditions in laboratory-scale trials for handsheet production. It was found that fatty acids are the most relevant compounds in the carryover pitch extractives (CPEs), as they readily interfere in fiber–fiber bonding strength, control the properties of CPE micelles, and are furthermore the most abundant compounds. Addition of cationic starch improved strength and evened out the strength differences of handsheets with different CPE compounds. Oleic acid (unsaturated fatty acid) was an exception, as it was above average harmful for paper strength without cationic starch and also heavily impaired the functioning of cationic starch. As a whole, these findings demonstrate that fatty acids, especially unsaturated ones, are the most relevant CPE compounds contributing to the reduced efficiency of cationic starch and decreased strength of unbleached softwood Kraft paper. This makes the cleaning of process waters by precipitating CPEs on the pulp fibers harmful for paper strength.

The pulp and paper industry is highly energy-intensive. In mills that use chemical pulping, roughly half of the higher heating value of the cellulosic material used to manufacture the product typically is incinerated to generate steam and electricity that is needed to run the processes. Additional energy, much of it non-renewable, needs to be purchased. This review considers publications describing steps that pulp and paper facilities can take to operate more efficiently. Savings can be achieved, for instance, by minimizing unnecessary losses in exergy, which can be defined as the energy content relative to a standard ambient condition. Throughout the long series of unit operations comprising the conversion of wood material to sheets of paper, there are large opportunities to more closely approach a hypothetical ideal performance by following established best-practices.

Parenteral and enteral nutrition support are key components of care for various medical and physiological conditions in infants, children, and adults. Nutrition support practices have advanced over time, driven by the goals of safe and sufficient delivery of needed nutrients and improved patient outcomes. These advances have been, and continue to be, dependent on research and development studies. Such studies address aspects of enteral and parenteral nutrition support: formulations, delivery devices, health outcomes, cost-effectiveness, and related metabolism. The studies are supported by public funding from the government and by private funding from foundations and from the nutrition support industry. To build public trust in nutrition support research findings, it is important to underscore ethical research conduct and reporting of results for all studies, including those with industry sponsors. In 2019, American Society for Parenteral and Enteral Nutrition's (ASPEN's) Board of Directors established a task force to ensure integrity in nutrition support research that is done as collaborative partnerships between the public (government and individuals) and private groups (foundations, academia, and industry). In this ASPEN Position Paper, the Task Force presents principles of ethical research to guide administrators, researchers, and funders. The Task Force identifies ways to curtail bias and to minimize actual or perceived conflict of interests, as related to funding sources and research conduct. Notably, this paper includes a Position Statement to describe the Task Force's guidance on Public-Private Partnerships for research and funding. This paper has been approved by the ASPEN Board of Directors.

Since the end of 2019, the whole world has been seized by the COVID-19 pandemic caused by the SARS-CoV2 virus. To date, the infection has led to more than 4 million deaths worldwide, and to more than 140 thousand deaths in Russia. COVID-19 (abbreviation for COronaVIrus Disease 2019) is a potentially severe acute respiratory infection caused by the SARS-CoV-2 coronavirus (2019-nCoV). Vaccination against COVID-19 plays a key role in stopping the pandemic. According to existing experience in infections prevention, mass vaccination will reduce the virus’s expansion and the risk of vaccine-resistant strains’ development. In the context of the COVID-19 the question of the feasibility and safety of vaccination of patients with Primary Immunodeficiency and Hereditary Angioedema arises. The Russian Association of Allergists and Clinical Immunologists and the National Association of Experts in Primary Immunodeficiencies have developed and approved a position paper on vaccination of patients with Primary Immunodeficiency and Hereditary Angioedema against COVID-19. This position paper provides answers to key questions regarding the vaccination of patients with these diseases.

Neonatal and infantile cholestasis (NIC) can represent the onset of a surgically correctable disease and of a genetic or metabolic disorder worthy of medical treatment. Timely recognition of NIC and identification of the underlying etiology are paramount to improve outcomes. Upon invitation by the Italian National Institute of Health (ISS), an expert working grouped was formed to formulate evidence-based positions on current knowledge about the diagnosis of NIC. A systematic literature search was conducted to collect evidence about epidemiology, etiology, clinical aspects and accuracy of available diagnostic tests in NIC. Evidence was scored using the GRADE system. All recommendations were approved by a panel of experts upon agreement of at least 75% of the members. The final document was approved by all the panel components. This position document summarizes the collected statements and defines the best-evidence diagnostic approach to cholestasis in the first year of life.

The spread of Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2), resulting in a global pandemic with around four million deaths. Although there are a variety of nucleic acid-based tests for detecting SARS-CoV-2, these methods have a relatively high cost and require expensive supporting equipment. To overcome these limitations and improve the efficiency of SARS-CoV-2 diagnosis, we developed a microfluidic platform that collected serum by a pulling-force spinning top and paper-based microfluidic enzyme-linked immunosorbent assay (ELISA) for quantitative IgA/IgM/IgG measurements in an instrument-free way. We further validated the paper-based microfluidic ELISA analysis of SARS-CoV-2 receptor-binding domain (RBD)-specific IgA/IgM/IgG antibodies from human blood samples as a good measurement with higher sensitivity compared with traditional IgM/IgG detection (99.7% vs 95.6%) for early illness onset patients. In conclusion, we provide an alternative solution for the diagnosis of SARS-CoV-2 in a portable manner by this smart integration of pulling-force spinning top and paper-based microfluidic immunoassay.

The pulp and paper industry is primarily dependent on fibrous wood for pulp and paper production. However, this over-dependence on fibrous wood poses serious environmental challenges such as the diminishing of the fibrous wood stocks, deforestation, emission of greenhouse gases, and global warming. Therefore, to mitigate these environmental challenges associated with its utilization for paper and pulp production, other sustainable raw material sources can also be considered for the production of paper and pulp. There are enormous benefits associated with the utilization of non-wood fibres as an alternative and sustainable raw materials source for the production of paper and pulp. These benefits have in the recent past prompted millers in China, India, Brazil, and the USA to consider the utilization of non-wood fibres in paper and pulp production. In Kenya, the pulp and paper industry is very much dependent on fibrous wood for production and the industry is yet to fully embrace the utilization of nonwood fibres for paper and pulp production. Further, the dependence on fibrous wood has contributed significantly to the decline of paper pulp and paper production, deforestation, and rise in paper importations due to insufficient raw material supplies. The importation of paper and pulp products has further led to the collapse of the paper industry in Kenya. The sector stands a chance of revival and vibrancy through the utilization of the abundant agricultural residues and feedstocks lying in the agricultural fields across the country. Similar experiences elsewhere have proved that the abundance of agricultural waste can be utilized for the production of paper and pulp due to their excellent fibre content for specialty papers, and easy pulpability. The agricultural residues are therefore considered a quintessential alternative and sustainable source of raw materials for the pulp and paper industry. Moreover, their utilization will mitigate environmental impacts such as deforestation, climate change, and pollution .

With the increased awareness of reusing solid wastes for higher sustainability and the concern of water pollution associated with phosphorus over-emission, there are strong interests in developing solid waste based adsorbents for purifying phosphorus-containing wastewater. As a rich calcium resource, paper mill sludge (i.e., a major solid waste from pulping industry) can be used as phosphorus removal adsorbent after calcination. Thus, in this work, a simple and clean thermally treating route has been proposed for preparing calcium-containing biochar from paper mill sludge. The effect of the physicochemical properties of paper mill sludge and its carbonization condition on phosphorus adsorption has been analyzed. Moreover, the influence of some key adsorption parameters, e.g., biochar dosage, initial pH of solution, co-existing anions, initial phosphorus concentration and contact time has also been investigated. The results showed that the phosphorus adsorption data could be fitted well with pseudo-second-order kinetic and Langmuir isothermal models. The calculated maximum adsorption capacity of the as-prepared optimal calcium-containing biochar could reach to 68.49 mg·g−1 at 25 °C. Combined with the characterization results, it can be reasonably inferred that the adsorption process was chemisorption-dominated. Lastly, the application of this spent adsorbent in agriculture field has also been discussed. In brief, this work provided a feasible strategy for converting paper mill solid waste to an environmental functional material (i.e., calcium-rich biochar) for remediation of eutrophic water.

Palliative radiation therapy (pRT) is an effective tool for people with incurable cancer, in the treatment of many cancer-related symptoms such as pain, bleeding and dyspnea. As utilization rates for palliative radiation therapy increase, the demands on the healthcare system continue to grow. Radiation Therapists with advanced knowledge, skills and judgements began demonstrating their ability to practice autonomously in 2004, with the development of the Clinical Specialist Radiation Therapist (CSRT) role. Since this time, CSRTs with a specific focus in pRT (pCSRT) have been increasing in both numbers as well as their positive effects on the cancer care system. Integrating a pCSRT into the existing pRT system has resulted in increased access to and quality of pRT being delivered to palliative cancer patients. The benefits of the addition of pCSRTs to the cancer care system include increasing system capacity and increasing quality of care. This white paper provides information related to the improvements that can be realized in a RT program related to the care and treatment of its palliative patients by adding a pCSRT to the interprofessional healthcare team and suggest it as one of many strategies that can be undertaken to make improvements to access and quality of care.

Lean manufacturing (LM) is established as a best practice to improve the performance of manufacturing industries. Not all the manufacturing industries realize the benefits of LM practices specifically continuous process industries. The present research work is intended to study the advantages of implementing LM practices in an ethical paper industry which is a continuous production industry. Presently, the industry suffers with the problems such as lack of productivity, raw material wastes, underutilized resources, and lack of standard practices in the production. Gemba technique is adapted to record the information related to the present manufacturing environment. Based on the current state analysis, the feasible lean tools are selected and implemented such as 5S, Kaizen, and Total Productive Maintenance (TPM). The improvements have been noted as reduced tool change over time, reduced material wastes, effective utilization of resources and provide safety guidelines to workers and operations. The implications of these improvements increased the productivity also.

Chemotherapeutic drugs have been widely used in the treatment of cancer disease for about 70 years. The development of new treatments has not hindered their use, and oncologists still prescribe them routinely, alone or in combination with other antineoplastic agents. However, all chemotherapeutic agents can induce hypersensitivity reactions (HSRs), with different incidences depending on the culprit drug. These reactions are the third leading cause of fatal drug-induced anaphylaxis in the United States. In Europe, deaths related to chemotherapy have also been reported. In particular, most reactions are caused by platinum compounds, taxanes, epipodophyllotoxins and asparaginase. Despite their prevalence and relevance, the ideal pathways for diagnosis, treatment and prevention of these reactions are still unclear, and practice remains considerably heterogeneous with vast differences from center to center. Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology organized a task force to provide data and recommendations regarding the allergological work-up in this field of drug hypersensitivity reactions. This position paper aims to provide consensus on the investigation of HSRs to chemotherapeutic drugs and give practical recommendations for clinicians that treat these patients, such as oncologists, allergologists and internists. Key sections cover risk factors, pathogenesis, symptoms, the role of skin tests, in vitro tests, indications and contraindications of drug provocation tests and desensitization of neoplastic patients with allergic reactions to chemotherapeutic drugs. Statements, recommendations and unmet needs were discussed and proposed at the end of each section.

Despite significant advances in the diagnosis and treatment of cardiovascular diseases, recent calls have emphasized the unmet need to improve precision-based approaches in cardiovascular disease. Although some studies provide preliminary evidence of the diagnostic and prognostic potential of circulating coding and non-coding RNAs, the complex RNA biology and lack of standardization have hampered the translation of these markers into clinical practice. In this position paper of the CardioRNA COST action CA17129, we provide recommendations to standardize the RNA development process in order to catalyse efforts to investigate novel RNAs for clinical use. We list the unmet clinical needs in cardiovascular disease, such as the identification of high-risk patients with ischaemic heart disease or heart failure who require more intensive therapies. The advantages and pitfalls of the different sample types, including RNAs from plasma, extracellular vesicles, and whole blood, are discussed in the sample matrix, together with their respective analytical methods. The effect of patient demographics and highly prevalent comorbidities, such as metabolic disorders, on the expression of the candidate RNA is presented and should be reported in biomarker studies. We discuss the statistical and regulatory aspects to translate a candidate RNA from a research use only assay to an in-vitro diagnostic test for clinical use. Optimal planning of this development track is required, with input from the researcher, statistician, industry, and regulatory partners., peer-reviewed

One of the key tasks of the previous year is to stop the spread of coronavirus disease (COVID-19), which became a pandemic that led to the deaths of more than 4 million people worldwide and more than 140 thousand deaths in Russia. COVID-19 is caused by the severe acute respiratory syndrome coronavirus 2 (2019-nCoV) virus of the coronavirus family. Vaccination plays a leading role in ending the pandemic. Currently, five vaccines against COVID-19 have been registered in Russia, namely, Sputnik V, Sputnik light, EpiVacCorona, EpiVacCorona-Н, and СoviVak. The short follow-up period and absence of randomized placebo-controlled trials of COVID-19 vaccines in certain patients with chronic diseases lead to several questions about the effectiveness/safety of vaccination in these patients. Given the wide spread of allergic diseases and the heterogeneity of patients with allergopathology, experts of the Russian Association of Allergology and Clinical Immunology have developed and approved a position paper on vaccination of patients with allergopathology.

Introduction. The Shchuchiy Bay is located in the western part of the skerry area of Lake Ladoga near the town of Priozersk. For almost 20 years, the bay has experienced an anthropogenic impact from the ingress of untreated wastewater from the Priozersk Pulp and Paper Mill (PPM). Systematic microbiological studies of the Shchuchiy Bay ecosystem were started in the middle of the 1970s by the Institute of Limnology of the Russian Academy of Sciences and continued after the PPM closure in 1986. Materials and methods. The ecosystem of the bay was studied in detail during the growing season of 2013–2014; periodic studies were carried out in 2015–2018. Retrospective data were also used for the analysis. Water samples were taken at four stations from the surface horizon. The following microbiological indicators were determined: the abundance of bacterioplankton and the percentages of various morphological types of bacterial cells. Results and discussion. A comparison of the quantitative level of development of the bacterial community in the bay in different periods showed a gradual decrease in the abundance of bacterioplankton as the anthropogenic impact weakened after the closure of the Priozersky PPM from 12.40 million cells ml–1 in 1987 to an average value of 2.62±1.03 million cells ml–1 in 2013–2018. A positive correlation was found between the concentration of bacteria and water temperature. The percentage of rod-shaped microorganisms in the water of the bay also decreased as the anthropogenic impact weakened from 73.4 % in 1987 to 53.1±7.6 % in 2013–2018, which indicated an improvement in water quality. Conclusion. A stable decrease in the abundance of bacteria from the level characteristic of highly polluted and eutrophic water bodies to the level characteristic of mesotrophic and mesotrophic-eutrophic water bodies is a reliable criterion for the restoration of the ecosystem of the Shchuchiy Bay to the state characteristic of similar bays of Lake Ladoga.

The performance of modified anaerobic hybrid baffled (MAHB) bioreactor treating recycled paper mill effluent (RPME) was investigated at various organic loading rates (OLR) of 1, 2, 3 and 4 g COD/ L.day. The bioreactor was operated continuously at constant hydraulic retention time (HRT) of a day without effluent recycled and chemicals adjustment/addition. Throughout 70 days of operation, a maximum removal efficiency up to 97% of chemical oxygen demand (COD) and 98% of volatile fatty acid, biogas production of 12.51 L/day equivalent to methane (CH4) yield of 0.108L CH4/ g COD and a stable pH system between 6.6 to 7.2 were achieved. Additionally, alkalinity of the bioreactor system shows a stable profile that indicates the whole system was well buffered with a quit high degradation of volatile solid (VS) up to 18%. These results indicated that MAHB bioreactor has been successfully treated RPME at various OLR.

Although crucial in improving health outcomes in the preterm infants, parenteral nutrition (PN) is not without risk, especially if handled improperly. A growing body of evidence suggests that components of PN admixtures, including lipid injectable emulsions (ILEs), are susceptible to degradation, including oxidation when exposed to light (ie, photo-oxidation), resulting in the production of reactive oxygen species. Infants, especially those born preterm, are considered more susceptible to consequences of oxidative stress than children and adults. Oxidative stress is associated with bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and intestinal failure-associated liver disease. The American Society for Parenteral and Enteral Nutrition (ASPEN) assembled a working group to provide recommendations on clinical practice surrounding photoprotection of PN.This Position Paper reviews the scientific literature on the formation of quantifiable peroxides and other degradation products when PN admixtures and ILEs are exposed to light and reports adverse clinical outcomes in premature infants exposed to PN. Recommendations for photoprotection of PN admixtures and ILEs are provided, as well as the challenges in achieving complete photoprotection with the equipment, supplies, and materials currently available in the US. ASPEN and the authors understand that the full implementation of complete photoprotection may not currently be feasible given current product availability; recommendations provided in this paper serve to represent the goal to which to strive as well as to highlight the importance of product availability to achieve these practices. This paper has been approved by the ASPEN Board of Directors.

The study attempted to assess the water quality around paper mill effluents discharge areas. Several physicochemical parameters and the Canadian Council of Ministers of the Environment (CCME) Water Quality Index (WQI) were considered to determine the pollution level of surface and groundwater in the selected paper mills areas located in Saidpur, Gobindaganj, and Dupchanchia Upazilas of Bangladesh. Physicochemical characterization of the surface water around the paper mills areas showed that the concentration of EC, TSS, BOD5, COD, phenols, NO3−-N, and K+were exceeded the surface water standard, whereas the DO level ranged from 1.63 to 3.5 were found below the Environmental Conservation Rules (ECR), 1997 standard. Besides, the BOD, COD, and Mn ion concentrations of groundwater exceeded the drinking water standard. In most sampling sites, the WQI of the surface water showed ‘marginal’ category, and the groundwater quality showed 'fair' category. The study observed that the toxic effluents discharged from the paper mills caused harm to the aquatic ecosystem.

Cardiac arrhythmias are a major cause of death and disability. A large number of experimental cell and animal models have been developed to study arrhythmogenic diseases. These models have provided important insights into the underlying arrhythmia mechanisms and translational options for their therapeutic management. This position paper from the ESC Working Group on Cardiac Cellular Electrophysiology provides an overview of (i) currently available in vitro, ex vivo, and in vivo electrophysiological research methodologies, (ii) the most commonly used experimental (cellular and animal) models for cardiac arrhythmias including relevant species differences, (iii) the use of human cardiac tissue, induced pluripotent stem cell (hiPSC)-derived and in silico models to study cardiac arrhythmias, and (iv) the availability, relevance, limitations, and opportunities of these cellular and animal models to recapitulate specific acquired and inherited arrhythmogenic diseases, including atrial fibrillation, heart failure, cardiomyopathy, myocarditis, sinus node, and conduction disorders and channelopathies. By promoting a better understanding of these models and their limitations, this position paper aims to improve the quality of basic research in cardiac electrophysiology, with the ultimate goal to facilitate the clinical translation and application of basic electrophysiological research findings on arrhythmia mechanisms and therapies.

Objective The objective of this study was to develop the first edition of a Chinese evidence-based position paper on the management of oral leukoplakia (OLK). Study Design The consultant group for drafting the position paper consisted of 31 oral medicine specialists and 2 evidence-based medicine specialists. English studies (searched in PubMed, EMBASE, and the Cochrane Library) and Chinese studies (searched in China National Knowledge Infrastructure and WanFang) published before January 2018 were used. The quality of the study was assessed using the Grading of Recommendations Assessment, Development, and Evaluation grid, and the strength of the recommendations was determined based on the results of 3 rounds of voting among the consultant group members using the Delphi method. Results Twenty-two evidence-based guidelines for clinical management and monitoring of OLK were established in this position paper. A clinical path diagram for oral health practitioners was constructed based on the recommendations. Conclusion Current evidence suggests that management and monitoring of patients with OLK should be performed by experienced clinicians to control the lesion and for early detection of malignant transformation. However, all recommendations are based on evidence of low or extremely low quality and may require further modification as new evidence is produced.

Nitrogen-fixing bacteria (NFB) can reduce nitrogen at ambient pressure and temperature. In this study, we treated effluent from a paper mill in sequencing batch reactors (SBRs) and monitored the abundance and activity of NFB with a view to producing a sludge that could work as a biofertilizer. Four reactors were inoculated with activated sludge enriched with NFB and fed with a high C/N waste (100:0.5) from a paper mill. Though the reactors were able to reduce the organic load of the wastewater by up to 89%, they did not have any nitrogen-fixing activity and showed a decrease in the putative number of NFB (quantified with qPCR). The most abundant species in the reactors treating high C/N paper mill wastewater was identified by Illumina MiSeq 16S rRNA gene amplicon sequencing as Methyloversatilis sp. (relative abundance of 4.4%). Nitrogen fixation was observed when the C/N ratio was increased by adding sucrose. We suspect that real-world biological nitrogen fixation (BNF) will only occur where there is a C/N ratio ≤100:0.07. Consequently, operators should actively avoid adding or allowing nitrogen in the waste streams if they wish to valorize their sludge and reduce running costs. PRACTITIONER POINTS: Efficient biological wastewater treatment of low nitrogen paper mill effluent was achieved without nutrient supplementation. The sludge was still capable of fixing nitrogen although this process was not observed in the wastewater treatment system. This high C/N wastewater treatment technology could be used with effluents from cassava flour, olive oil, wine and dairy industries.

Perforation is used in multilayer tissue products, such as toilet and kitchen papers, as part of the converting process. Perforation facilitates the detachment of consecutive sheets by the user. The compromise between the strength required to detach a perforated sheet and the strength required to break a sheet affects the perforation efficiency. In this work, the mechanical behaviors of 15 commercial papers from different European producers were studied. A morphological analysis of the materials was performed, followed by the determination of their perforation efficiency (through tensile tests). A qualitative analysis of the cuts quality, along with a quantitative analysis of the same cuts dimensions was performed through an optical system. Finally, the stress concentration in the holes and the influence of the cuts distance were analyzed using a finite element model implemented in Abaqus/Standard finite element software. The results showed that a cut distance of 2.0 mm should not be used in these types of papers, and the perforation efficiency increased with the cut distance, regardless of the number of plies in the toilet paper. The stress concentration factor was also determined to have a limit value of 0.11. Papers above this limit value tear at the perforation line, as desired.

The environmental conditions of paper mills are suitable for the growth of slime-forming microorganisms due to the supply of nutrients, favorable temperature, and moisture. The slime formation causes the spoilage of raw materials & additives, breaks in the paper during papermaking, loss of production, reduces the hygienic quality of the end products, produces off-spec and rejected products, creates microbiological corrosion, and produces harmful gases. The main microorganisms are Bacteria (mainly Bacillus spp., Achromobacter spp., Enterobacter spp., Pseudomonas spp., Clostridium, etc.), Fungi (Aspergillus, Penicillium, Saccharomyces, etc.), and Algae. Besides the use of conventional toxic chemical biocides or slimicides, slime formation can also be controlled in an eco-friendly way using enzymes, bacteriophages, biodispersants, and biocontrol agents alone or along with biocides to remove the slime. Enzymes have shown their effectiveness over conventional chemicals due to nontoxic and biodegradable nature to provide clean and sustainable technology. Globally enzymes are being used at some of the paper mills and many enzymatic products are presently being prepared and under the trail at laboratory scale. The specificity of enzymes to degrade a specific substrate is the main drawback of controlling the mixed population of microorganisms present in slime. The enzyme has the potential to provide the chemical biocide-free solution as a useful alternative in the future with the development of new technologies. Microorganisms control in the paper mill may appear as a costly offer but the cost of uncontrolled microbial growth can be much higher leading to slime production and large economic drain.

Graphical abstract Enzyme-linked immunosorbent assay (ELISA) is widely used for the detection of disease biomarkers. However, it utilizes time-consuming procedures and expensive instruments, making it infeasible for point-of-care (POC) analysis especially in resource-limited settings. In this work, a multicolorimetric ELISA biosensor integrated on a paper/polymer hybrid microfluidic device was developed for rapid visual detection of disease biomarkers at point of care, without using costly equipment. This multicolormetric ELISA platform was built on multiple distinct color variants resulted from the catalytic oxidation of 3,3′,5,5′-tetramethylbenzidine (TMB) and the etching of gold nanorods (AuNRs). The vivid color changes could be easily distinguished by the naked eye, and their red mean values allowed quantitative biomarker detection, without using any sophisticated instruments. When this multicolorimetric ELISA was integrated on a paper/polymer hybrid analytical device, it not only provided integrated processing and high portability but also enabled fast assays in about 50 min due to the unique advantages of paper/polymer hybrid devices. The limit of detection of 9.1 ng/μL of the hepatitis C virus core antigen, a biomarker for hepatitis C, was achieved using this multicolorimetric ELISA platform. This multicolor ELISA analytical device provides a new versatile, user-friendly, affordable, and portable immunosensing platform with high potential for on-site detections of various viruses, proteins, and biomarkers for low-resource settings such as at home, public venues, rural areas, and developing nations. Supplementary Information The online version contains supplementary material available at 10.1007/s00216-021-03359-8.

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.

Malnutrition, muscle loss, and cachexia are prevalent in cancer and remain key challenges in oncology today. These conditions are frequently underrecognized and undertreated and have devastating consequences for patients. Early nutrition screening/assessment and intervention are associated with improved patient outcomes. As a multifaceted disease, cancer requires multimodal care that integrates supportive interventions, specifically nutrition and exercise, to improve nutrient intake, muscle mass, physical functioning, quality of life, and treatment outcomes. An integrated team of healthcare providers that incorporates societies’ recommendations into clinical practice can help achieve the best possible outcomes. A multidisciplinary panel of experts in oncology, nutrition, exercise, and medicine participated in a 2-day virtual roundtable in October 2020 to discuss gaps and opportunities in oncology nutrition, alone and in combination with exercise, relative to current evidence and international societies’ recommendations. The panel recommended five principles to optimize clinical oncology practice: (1) position oncology nutrition at the center of multidisciplinary care; (2) partner with colleagues and administrators to integrate a nutrition care process into the multidisciplinary cancer care approach; (3) screen all patients for malnutrition risk at diagnosis and regularly throughout treatment; (4) combine exercise and nutrition interventions before (e.g., prehabilitation), during, and after treatment as oncology standard of care to optimize nutrition status and muscle mass; and (5) incorporate a patient-centered approach into multidisciplinary care.

Oral corticosteroids (OCS) are frequently used for asthma treatment. This medication is highly effective for both acute and chronic diseases, but evidence indicates that indiscriminate OCS use is common, posing a risk of serious side effects and irreversible harm. There is now an urgent need to introduce OCS stewardship approaches, akin to successful initiatives that optimized appropriate antibiotic usage. The aim of this TSANZ (Thoracic Society of Australia and New Zealand) position paper is to review current knowledge pertaining to OCS use in asthma and then delineate principles of OCS stewardship. Recent evidence indicates overuse and over-reliance on OCS for asthma and that doses >1000 mg prednisolone-equivalent cumulatively are likely to have serious side effects and adverse outcomes. Patient perspectives emphasize the detrimental impacts of OCS-related side effects such as weight gain, insomnia, mood disturbances and skin changes. Improvements in asthma control and prevention of exacerbations can be achieved by improved inhaler technique, adherence to therapy, asthma education, smoking cessation, multidisciplinary review, optimized medications and other strategies. Recently, add-on therapies including novel biological agents and macrolide antibiotics have demonstrated reductions in OCS requirements. Harm reduction may also be achieved through identification and mitigation of predictable adverse effects. OCS stewardship should entail greater awareness of appropriate indications for OCS prescription, risk–benefits of OCS medications, side effects, effective add-on therapies and multidisciplinary review. If implemented, OCS stewardship can ensure that clinicians and patients with asthma are aware that OCS should not be used lightly, while providing reassurance that asthma can be controlled in most people without frequent use of OCS.

Hyperpolarized (HP) 129 Xe MRI uniquely images pulmonary ventilation, gas exchange, and terminal airway morphology rapidly and safely, providing novel information not possible using conventional imaging modalities or pulmonary function tests. As such, there is mounting interest in expanding the use of biomarkers derived from HP 129 Xe MRI as outcome measures in multi-site clinical trials across a range of pulmonary disorders. Until recently, HP 129 Xe MRI techniques have been developed largely independently at a limited number of academic centers, without harmonizing acquisition strategies. To promote uniformity and adoption of HP 129 Xe MRI more widely in translational research, multi-site trials, and ultimately clinical practice, this position paper from the 129 Xe MRI Clinical Trials Consortium (https://cpir.cchmc.org/XeMRICTC) recommends standard protocols to harmonize methods for image acquisition in HP 129 Xe MRI. Recommendations are described for the most common HP gas MRI techniques-calibration, ventilation, alveolar-airspace size, and gas exchange-across MRI scanner manufacturers most used for this application. Moreover, recommendations are described for 129 Xe dose volumes and breath-hold standardization to further foster consistency of imaging studies. The intention is that sites with HP 129 Xe MRI capabilities can readily implement these methods to obtain consistent high-quality images that provide regional insight into lung structure and function. While this document represents consensus at a snapshot in time, a roadmap for technical developments is provided that will further increase image quality and efficiency. These standardized dosing and imaging protocols will facilitate the wider adoption of HP 129 Xe MRI for multi-site pulmonary research.

Colorimetric gas detectors have been widely applied in many fields such as environmental sciences, industrial hygiene, process control, forensic science and indoor air quality monitoring. They have a history of about 100 years and include devices such as gas detector tubes and paper-based gas detectors. The sensitivity and selectivity of the colorimetric gas detector are relatively high compared to other types of gas detectors such as semiconductor, catalytic combustion and electrochemical gas detectors. Detection of gas concentration can be performed by the naked eye in some colorimetric gas detectors. These methods do not require an electrical power source and are simple, so they are suitable for field operations. This review introduces the history and provides a general overview of the development in the research of colorimetric gas detectors. Recently, the sensitivity and selectivity of colorimetric gas detectors have improved. New materials such as enzymes or particles with a large surface area have been utilized to improve selectivity and sensitivity. Moreover, new gas detectors without toxic materials have been developed to reduce the environmental load. At present, there is a rapid development of IoT sensors in many industrial fields, which might extend the applications of colorimetric gas detectors in the near future.

The goal of this position paper on ventilatory support at home for children is to provide expert consensus from Australia and New Zealand on optimal care for children requiring ventilatory support at home, both non-invasive and invasive. It was compiled by members of the Thoracic Society of Australia and New Zealand (TSANZ) and the Australasian Sleep Association (ASA). This document provides recommendations to support the development of improved services for Australian and New Zealand children who require long-term ventilatory support. Issues relevant to providers of equipment and areas of research need are highlighted.

The treatment of patients with advanced acute heart failure is still challenging. Intra-aortic balloon pump (IABP) has widely been used in the management of patients with cardiogenic shock. However, according to international guidelines, its routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian Association of Hospital Cardiologists, reviews the available data derived from clinical studies. It also provides practical recommendations for the optimal use of IABP in the treatment of cardiogenic shock and advanced acute heart failure.

The European Society of Cardiology guidelines on non-ST-elevation acute coronary syndromes suggest different temporal strategies for the angiographic study depending on the risk profile. The scientific evidence underlying the guideline recommendations and the critical issues currently existing in Italy, that often do not allow either an extended strategy of revascularization within 24 h or the application of the principle of the same day transfer from a spoke to a hub centre, are analysed. The position paper focuses, in particular, on the subgroup of patients with a defined diagnosis of non-ST-elevation myocardial infarction by proposing a timing of coronary angiography/revascularization that takes into account the available scientific evidence and the organizational possibilities of a considerable part of national cardiology services.

The present paper provides an update of previous recommendations on Home Blood Pressure Monitoring from the European Society of Hypertension (ESH) Working Group on Blood Pressure Monitoring and Cardiovascular Variability sequentially published in years 2000, 2008 and 2010. This update has taken into account new evidence in this field, including a recent statement by the American Heart association, as well as technological developments, which have occurred over the past 20 years. The present document has been developed by the same ESH Working Group with inputs from an international team of experts, and has been endorsed by the ESH. ispartof: JOURNAL OF HYPERTENSION vol:39 issue:9 pages:1742-1767 ispartof: location:Netherlands status: published

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.

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.

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.