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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.

Background The study tests the effects of data collection modes on patient responses associated with the multi-item measures such as Patient-Reported Outcomes Measurement System (PROMIS®), and single-item measures such as Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE), and Numerical Rating Scale (NRS) measures. Methods Adult cancer patients were recruited from five cancer centers and administered measures of anxiety, depression, fatigue, sleep disturbance, pain intensity, pain interference, ability to participate in social roles and activities, global mental and physical health, and physical function. Patients were randomized to complete the measures on paper (595), interactive voice response (IVR, 596) system, or tablet computer (589). We evaluated differential item functioning (DIF) by method of data collection using the R software package, lordif. For constructs that showed no DIF, we concluded equivalence across modes if the equivalence margin, defined as ± 0.20 × pooled SD, completely surrounds 95% confidence intervals (CI's) for difference in mean score. If the 95% CI fell totally outside the equivalence margin, we concluded systematic score difference by modes. If the 95% CI partly overlaps the equivalence margin, we concluded neither equivalence nor difference. Results For all constructs, no DIF of any kind was found for the three modes. The scores on paper and tablet were more comparable than between IVR and other modes but none of the 95% CI’s were completely outside the equivalence margins, in which we established neither equivalence nor difference. Percentages of missing values were comparable for paper and tablet modes. Percentages of missing values were higher for IVR (2.3% to 6.5% depending on measures) compared to paper and tablet modes (0.7% to 3.3% depending on measures and modes), which was attributed to random technical difficulties experienced in some centers. Conclusion Across all mode comparisons, there were some measures with CI’s not completely contained within the margin of small effect. Two visual modes agreed more than visual-auditory pairs. IVR may induce differences in scores unrelated to constructs being measured in comparison with paper and tablet. The users of the surveys should consider using IVR only when paper and computer administration is not feasible.

Background Microfluidic chip detection technology is considered a potent tool for many bioanalytic applications. Rapid detection of foodborne pathogens in the early stages is imperative to prevent the outbreak of foodborne diseases, known as a severe threat to human health. Conventional bacterial culture methods for detecting foodborne pathogens are time-consuming, laborious, and lacking in pathogen diagnosis. To overcome this problem, we have created an embedded paper-based microchip based on isothermal loop amplification (LAMP), which can rapidly and sensitively detect foodborne pathogens. Results We embed paper impregnated with LAMP reagent and specific primers in multiple reaction chambers of the microchip. The solution containing the target pathogen was injected into the center chamber and uniformly distributed into the reaction chamber by centrifugal force. The purified DNA of Escherichia coli O157:H7, Salmonella spp., Staphylococcus aureus, and Vibrio parahaemolyticus has been successfully amplified and directly detected on the microchip. The E. coli O157:H7 DNA was identified as low as 0.0134 ng μL− 1. Besides, the potential of this microchip in point-of-care testing was further tested by combining the on-chip sample purification module and using milk spiked with Salmonella spp.. The pyrolyzed milk sample was filtered through a polydopamine-coated paper embedded in the inside of the sample chamber. It was transported to the reaction chamber by centrifugal force for LAMP amplification. Then direct chip detection was performed in the reaction chamber embedded with calcein-soaked paper. The detection limit of Salmonella spp. in the sample measured by the microchip was approximately 12 CFU mL− 1. Conclusion The paper embedded LAMP microchip offers inexpensive, user-friendly, and highly selective pathogen detection capabilities. It is expected to have great potential as a quick, efficient, and cost-effective solution for future foodborne pathogen detection.

The indiscriminate use of herbicides in agriculture contributes to soil and water pollution, with important endangering consequences on the ecosystems. Among the available analytical systems, algal biosensors have demonstrated to be valid tools thanks to their high sensitivity, cost-effectiveness, and eco-design. Herein, we report the development of a dual electro-optical biosensor for herbicide monitoring, based on Chlamydomonas reinhardtii whole cells immobilised on paper-based screen-printed electrodes modified with carbon black nanomaterials. To this aim, a systematic study was performed for the selection and characterisation of a collection among 28 different genetic variants of the alga with difference response behaviour towards diverse herbicide classes. Thus, CC125 strain was exploited as case study for the study of the analytical parameters. The biosensor was tested in standard solutions and real samples, providing high sensitivity (detection limit in the pico/nanomolar), high repeatability (RSD of 5% with n = 100), long lasting working (10 h) and storage stability (3 weeks), any interference in the presence of heavy metals and insecticides, and low matrix effect in drinking water and moderate effect in surface one. Supplementary Information The online version contains supplementary material available at 10.1186/s12951-021-00887-4.

OBJECTIVES: The aims of this position paper are to (i) summarize research on precarious employment (PE) in the context of occupational health; (ii) develop a theoretical framework that distinguishes PE from related concepts and delineates important contextual factors; and (iii) identify key methodological challenges and directions for future research on PE and health. METHODS: This position paper is the result of a working group consisting of researchers from the EU, Turkey and the USA, who have discussed the issue over the course of six months (October 2018–April 2019), meeting both online and face-to-face on several occasions. RESULTS: The lack of a common theoretical framework of PE hinders it from becoming an established part of occupational and public health research. There are also issues regarding operationalization in surveys and registers. Further, previous research on PE and health suffers from methodological limitations including inadequate study designs and biased assessments of exposure and outcomes. PE is highly dependent on contextual factors and cross-country comparison has proven very difficult. We also point to the uneven social distribution of PE, ie, higher prevalence among women, immigrants, young and low educated. We propose a theoretical framework for understanding precarious employment as a multidimensional construct. CONCLUSIONS: A generally accepted multidimensional definition of PE should be the highest priority. Future studies would benefit from improved exposure assessment, temporal resolution, and accounting for confounders, as well as testing possible mechanisms, eg, by adopting multi-level and intersectional analytical approaches in order to understand the complexity of PE and its relation to health.

Horizon Europe is one of the world’s largest international funding programme for science and innovation. With a total budget of €95.5 billion over seven years, Horizon Europe is indispensable to European science. The programme is key for taking on big social challenges such as climate change, inequality of opportunity and health disparities. For example, it has made a solid contribution to greater cooperation in European research and to an increase in pioneering basic research. Nonetheless, the Dutch universities, the university medical centres and the Royal Netherlands Academy of Arts and Sciences (KNAW) have found that the Horizon programme could still be better equipped to make a real difference with regard to the great challenges we face. The current Horizon programme will run until the end of 2027. The European Commission is taking this opportunity to take a long and hard look at its research programme. In a large public consultation, the Commission is canvassing for experiences with Horizon 2020 (the programme that ended in 2020) and the current Horizon Europe programme, as well as looking ahead at policy priorities for the coming years. Universities, university medical centres and the KNAW benefit greatly from a smoothly running programme. They offer the EU five recommendations.

Background The National Cancer Institute Informatics Technology for Cancer Research (ITCR) program provides a series of funding mechanisms to create an ecosystem of open-source software (OSS) that serves the needs of cancer research. As the ITCR ecosystem substantially grows, it faces the challenge of the long-term sustainability of the software being developed by ITCR grantees. To address this challenge, the ITCR sustainability and industry partnership working group (SIP-WG) was convened in 2019. Objective The charter of the SIP-WG is to investigate options to enhance the long-term sustainability of the OSS being developed by ITCR, in part by developing a collection of business model archetypes that can serve as sustainability plans for ITCR OSS development initiatives. The working group assembled models from the ITCR program, from other studies, and from the engagement of its extensive network of relationships with other organizations (eg, Chan Zuckerberg Initiative, Open Source Initiative, and Software Sustainability Institute) in support of this objective. Methods This paper reviews the existing sustainability models and describes 10 OSS use cases disseminated by the SIP-WG and others, including 3D Slicer, Bioconductor, Cytoscape, Globus, i2b2 (Informatics for Integrating Biology and the Bedside) and tranSMART, Insight Toolkit, Linux, Observational Health Data Sciences and Informatics tools, R, and REDCap (Research Electronic Data Capture), in 10 sustainability aspects: governance, documentation, code quality, support, ecosystem collaboration, security, legal, finance, marketing, and dependency hygiene. Results Information available to the public reveals that all 10 OSS have effective governance, comprehensive documentation, high code quality, reliable dependency hygiene, strong user and developer support, and active marketing. These OSS include a variety of licensing models (eg, general public license version 2, general public license version 3, Berkeley Software Distribution, and Apache 3) and financial models (eg, federal research funding, industry and membership support, and commercial support). However, detailed information on ecosystem collaboration and security is not publicly provided by most OSS. Conclusions We recommend 6 essential attributes for research software: alignment with unmet scientific needs, a dedicated development team, a vibrant user community, a feasible licensing model, a sustainable financial model, and effective product management. We also stress important actions to be considered in future ITCR activities that involve the discussion of the sustainability and licensing models for ITCR OSS, the establishment of a central library, the allocation of consulting resources to code quality control, ecosystem collaboration, security, and dependency hygiene.

Background The discovery of bioactive compounds in traditional Chinese medicine (TCM) has become an important field in TCM modernization. Ligand fishing is a suitable method for discovery of bioactive compounds in complex mixtures such as TCM with high selectivity. Because of unique advantage of low cost and convenience, paper-based microdevices can be good carriers for enzyme immobilized ligand fishing. Methods As an important enzyme for glucose metabolism, α-glucosidase was immobilized on polycaprolactone–chitosan-modified paper to prepare the microdevice with unique microfluid structure generated by 3D printing technology, which can be easily applied to screen active compounds in herbal extracts. The preparation conditions of the paper microarray were optimized. The activity of immobilized α-glucosidase was verified by colorimetric reactions which can be easily monitored by cellphone. The paper microarray with α-glucosidase immobilized was used to screen active compounds in the water extracts of mulberry leaves and lotus leaves. Results Several key parameters including Na2CO3 solution concentration, Na2CO3 solution volume, glutaraldehyde concentration, crosslinking time of glutaraldehyde and time of α-glucosidase immobilization were optimized. The proposed paper-based microarray was successfully applied in screening active compounds in two herbal extracts. Four compounds including chlorogenic acid, quercetin-3-O-glucuronide, isoquercetin, and quercetin were identified as α-glucosidase inhibitors. The compounds with significant non-specific adsorption caused by chitosan, such as isoquercitrin, astragalin, quercetin, were also found to be active compounds. Conclusions An enzyme immobilized paper microarray was designed and fabricated in this work. Polycaprolactone and chitosan were used to modify filter paper to prepare paper microarrays. Parameters of paper device preparation were optimized. Our findings suggested that 3D-printing paper-based microarrays can be a simple and low-cost approach for discovery of active compounds of TCM. Electronic supplementary material The online version of this article (10.1186/s13020-019-0236-y) contains supplementary material, which is available to authorized users.

© 2020 Federation of European Biochemical Societies, Bibliometric quantification is frequently used as metrics for the evaluation of the scientific performance of researchers and institutions. The researchers’ merit is usually assessed by the analysis of quantitative parameters such as the number of publications, the impact factor of journals, the total number of citations, or the h-index, although the limitations in translating these indicators into the impact of the outcome of scientific production are a matter of harsh criticism. To assess, based on factual evidences, the validity of traditional bibliometric analyses to conclude on the impact of papers to advance the state of the art, we carried out an innovative methodology on selected publications (test set). This methodology is based on identifying those citations of the test set papers that truly embed the methods, concepts, or hypotheses to build new knowledge and formulate conclusions. The results show that the percentage of citations that reflect the real impact of the papers of the test set has an average value of 12.4% of total citations and is not related to the impact factor of the journal where the test set papers were published. In conclusion, our analysis demonstrates factually, using experimental data, the total failure of using quantitative bulk citation analyses to conclude on the scientific impact of publications. Only a careful analysis of how the work described in papers was embedded on the subsequent work and/or conclusions of others can tell about the real contribution of a published work to the development of new knowledge and advancement of science., This work was supported by ‘La Caixa’ Foundation (grant reference: IMM/BPD/107-2018).

Simple Summary In this position paper, we aim to summarize state-of-the-art treatments for patients with leiomyosarcomas in order to identify knowledge gaps and current unmet needs, thereby guiding the community to design innovative clinical trials and basic research and close these research gaps. This white paper arose from a leiomyosarcoma research meeting in October 2020 hosted by the National LeioMyoSarcoma Foundation (NLMSF) and Sarcoma Patients EuroNet (SPAEN). Abstract As leiomyosarcoma patients are challenged by the development of metastatic disease, effective systemic therapies are the cornerstone of outcome. However, the overall activity of the currently available conventional systemic treatments and the prognosis of patients with advanced or metastatic disease are still poor, making the treatment of this patient group challenging. Therefore, in a joint effort together with patient networks and organizations, namely Sarcoma Patients EuroNet (SPAEN), the international network of sarcoma patients organizations, and the National LeioMyoSarcoma Foundation (NLMSF) in the United States, we aim to summarize state-of-the-art treatments for leiomyosarcoma patients in order to identify knowledge gaps and current unmet needs, thereby guiding the community to design innovative clinical trials and basic research and close these research gaps. This position paper arose from a leiomyosarcoma research meeting in October 2020 hosted by the NLMSF and SPAEN.

Gender disparities in scientific publications have been identified in oncological research. Oral research presentations at major conferences enhance visibility of presenters. The share of women presenting at such podia is unknown. We aim to identify gender‐based differences in contributions to presentations at two major oncological conferences. Abstracts presented at plenary sessions of the American Society of Clinical Oncology (ASCO) Annual Meetings and European Society for Medical Oncology (ESMO) Congresses were collected. Trend analyses were used to analyze female contribution over time. The association between presenter's sex, study outcome (positive/negative) and journals' impact factors (IFs) of subsequently published papers was assessed using Chi‐square and Mann–Whitney U tests. Of 166 consecutive abstracts presented at ASCO in 2011–2018 (n = 34) and ESMO in 2008–2018 (n = 132), 21% had female presenters, all originating from Northern America (n = 17) or Europe (n = 18). The distribution of presenter's sex was similar over time (p = 0.70). Of 2,425 contributing authors to these presented abstracts, 28% were women. The proportion of female abstract authors increased over time (p, What's new? Presenting one's research at a conference is a great way to get your name and ideas heard within the professional community. In this study, the authors investigated how often women served as presenters at plenary sessions of ASCO Annual Meetings and ESMO Congresses. Looking through 166 abstracts over a period of 8 years, they found that 21% had female presenters, while 28% of study authors were female. Lack of visibility for female researchers at conferences can slow their career progress, and greater representation should be encouraged.

Background COVID-19, caused by SARS-CoV-2 has become the most threatening issue to all populations around the world. It is, directly and indirectly, affecting all of us and thus, is an emerging topic dealt in global health. To avoid the infection, various studies have been done and are still ongoing. COVID-19 cases are reported all over the globe, and among the millions of cases, genetic similarity may be seen. The genetical common features seen within confirmed cases may help outline the tendency of infection and degree severity of the disease. Here, we reviewed multiple papers on SNPs related to SARS-CoV-2 infection and analyzed their results. Methods The PubMed databases were searched for papers discussing SNPs associated with SARS-CoV-2 infection and severity. Clinical studies with human patients and statistically showing the relevance of the SNP with virus infection were included. Quality Assessment of all papers was done with Newcastle Ottawa Scale. Results In the analysis, 21 full-text literature out of 2956 screened titles and abstracts, including 63,496 cases, were included. All were human-based clinical studies, some based on certain regions gathered patient data and some based on big databases obtained online. ACE2, TMPRSS2, and IFITM3 are the genes mentioned most frequently that are related to SARS-CoV-2 infection. 20 out of 21 studies mentioned one or more of those genes. The relevant genes according to SNPs were also analyzed. rs12252-C, rs143936283, rs2285666, rs41303171, and rs35803318 are the SNPs that were mentioned at least twice in two different studies. Conclusions We found that ACE2, TMPRSS2, and IFITM3 are the major genes that are involved in SARS-CoV-2 infection. The mentioned SNPs were all related to one or more of the above-mentioned genes. There were discussions on certain SNPs that increased the infection and severity to certain groups more than the others. However, as there is limited follow-up and data due to a shortage of time history of the disease, studies may be limited.

The scientific publication landscape is changing quickly, with an enormous increase in options and models. Articles can be published in a complex variety of journals that differ in their presentation format (online-only or in-print), editorial organizations that maintain them (commercial and/or society-based), editorial handling (academic or professional editors), editorial board composition (academic or professional), payment options to cover editorial costs (open access or pay-to-read), indexation, visibility, branding, and other aspects. Additionally, online submissions of non-revised versions of manuscripts prior to seeking publication in a peer-reviewed journal (a practice known as pre-printing) are a growing trend in biological sciences. In this changing landscape, researchers in biochemistry and molecular biology must re-think their priorities in terms of scientific output dissemination. The evaluation processes and institutional funding for scientific publications should also be revised accordingly. This article presents the results of discussions within the Department of Biochemistry, University of Sao Paulo, on this subject.

Objective Oral cancer and precancers are a major public health challenge in developing countries. Researchers in Saudi Arabia have constantly been directing their efforts on oral cancer research and have their results published. Systematic analysis of such papers is the need of the hour as it will not only acknowledge the current status but will also help in framing future policies on oral cancer research in Saudi Arabia. Method The search string "oral cancer" OR "Oral Squamous Cell Carcinoma" OR "oral premalignant lesion" OR "oral precancer" OR "Oral Potentially malignant disorder" AND AFFIL (Saudi AND Arabia ) was used for retrieval of articles from Scopus database. Various tools available in Scopus database were used for analyzing the bibliometric related parameters. Results The search revealed a total of 663 publications based on the above query. Maximum affiliations were from King Saud University (163) followed by Jazan University (109) and then King Abdulaziz University (106). A large number of international collaborations were observed, the maximum with India (176) and the USA (127). The maximum number of articles were published in the Asia Pacific Journal of Cancer Prevention (34) followed by the Journal of Contemporary Dental Practice (33) and Journal of Oral Pathology and Medicine (19). Conclusion Saudi researchers are directing their efforts towards the public health menace of oral cancer. However, it was also observed that some institutions have emerged as front runners in research, whereas others are contributing significantly less. The health department should encourage and take necessary steps to increase the involvement of other institutions.

The rapid development of information technology and data processing capabilities has led to the creation of new tools known as artificial intelligence (AI). Medical applications of AI are emerging, and the French radiology community felt it was therefore timely to issue a position paper on AI as part of its role as a leader in the development of digital projects. Essential information about the application of AI to radiology includes a description of the available algorithms with a glossary; a review of the issues raised by healthcare data, notably those pertaining to imaging (imaging data and co-variables, metadata); a look at research and innovation; an overview of current and future applications; a discussion of AI education; and a scrutiny of ethical issues. In addition to the principles set forth at the Asilomar Conference on Beneficial AI, the French radiology community has developed ten principles aimed at governing the use and development of AI tools in a manner that will create a concerted approach centered on benefits to patients, while also ensuring good integration within clinical workflows. High-quality care in radiology and opportunities for managing large datasets are two avenues relevant to the development of a precision, personalized, and participative radiology practice characterized by improved predictive and preventive capabilities.

ObjectivesOriginally developed as a paper questionnaire, the electronic Epworth Sleepiness Scale (ESS) is widely used in sleep clinics and sleep population research. Despite potential differences between computer-based and conventional questionnaire delivery, studies have not evaluated the agreement between electronic and paper versions of the ESS. Given the widespread use of the ESS, a bias between results would present considerable data concerns. Thus, the aim of this study was to examine agreement between electronic and paper ESS responses in obstructive sleep apnoea (OSA).DesignWe undertook a secondary analysis of baseline data from a randomised controlled trial (ANZCTR: ACTRN12611000847910).SettingData were collected in a tertiary sleep research laboratory located in Sydney, Australia.ParticipantsData were analysed from 112 adult patients with OSA.MeasurementsPatients were given the English version of the ESS as part of a battery of sleep laboratory questionnaires. They completed electronic and subsequently paper ESS questionnaires on the same day.ResultsWe found no significant difference between electronic and paper ESS questionnaires (mean=0.1, SD=2.1, 95% CI −0.3 to 0.5, P=0.57) or heteroscedasticity. There was no evidence of bias along the range of the measure. 95% limits of agreement at 4.3 and −4.1 were comparable with previous data.ConclusionsWe found no evidence of bias between electronic and paper ESS questionnaires in this sample of patients with OSA, as the two formats displayed sufficient agreement to be clinically comparable. Regardless of severity, patients reported the same level of daytime sleepiness with the same level of accuracy across both measures.Trial registration numberACTRN12611000847910; Pre-results.

Introduction Biomedical researchers have lamented the lengthy timelines from manuscript submission to publication and highlighted potential detrimental effects on scientific progress and scientists’ careers. In 2015, Himmelstein identified the mean time from manuscript submission to acceptance in biomedicine as approximately 100 days. The length of publication timelines in health professions education (HPE) is currently unknown. Methods This study replicates Himmelstein’s work with a sample of 14 HPE journals published between 2008–2018. Using PubMed, 19,182 article citations were retrieved. Open metadata for each were downloaded, including the date the article was received by the journal, date the authors resubmitted revisions, date the journal accepted the article, and date of entry into PubMed. Journals without publication history metadata were excluded. Results Publication history data were available for 55% (n = 8) of the journals sampled. The publication histories of 4,735 (25%) articles were analyzed. Mean time from: (1) author submission to journal acceptance was 180.93 days (SD = 103.89), (2) author submission to posting on PubMed was 263.55 days (SD = 157.61), and (3) journal acceptance to posting on PubMed was 83.15 days (SD = 135.72). Discussion This study presents publication metadata for journals that openly provide it—a first step towards understanding publication timelines in HPE. Findings confirm the replicability of the original study, and the limited data suggest that, in comparison to biomedical scientists broadly, medical educators may experience longer wait times for article acceptance and publication. Reasons for these delays are currently unknown and deserve further study; such work would be facilitated by increased public access to journal metadata.

Several examples are discussed in this review, where substances without proven effects were proposed for practical use within the scope of evidence-based medicines. The following is discussed here: generalizations of the hormesis concept and its use in support of homeopathy; phytoestrogens and soy products potentially having feminizing effects; glycosaminoglycans for the treatment of osteoarthritis and possibilities of their replacement by diet modifications; flavonoids recommended for the treatment of chronic venous insufficiency and varicose veins; acetylcysteine as a mucolytic agent and its questionable efficiency especially by an oral intake; stem cells and cell therapies. In conclusion, placebo therapies can be beneficial and ethically justifiable but it is not a sufficient reason to publish biased information. Importantly, placebo must be devoid of adverse effects, otherwise, it is named pseudo-placebo. Therapeutic methods with unproven effects should be tested in high-quality research shielded from the funding bias. Some issues discussed in this review are not entirely clear, and the arguments provided here can initiate a constructive discussion.

The primary focus of the urban agriculture literature has been on landscapes as biophysical spaces in which to grow food rather than on them as humanized places in which to grow experience. There is a need to leave the desk behind and enter the field to invigorate case study descriptions through the reflexive tool of narrative scholarship.

Electronic waste or e-waste is a serious and concerning issue globally. Exponential increase in the production of these instrument have created a man-made problem of e-waste; United Nations has called it as “tsunami of e-waste.” Informal management and unsafe disposals have compounded the problem further. The hazardous chemicals, metals, and organic pollutants released from e-waste can lead to serious health consequences such as organ damage, genetic defects, neuropsychiatric illness, and cancer. Problem of e-waste is colossal and should be seen as major public health emergency. In India, use of electronic instrument has increased considerably with less focus on formal waste management and safe disposal. This has created a major health hazard. International health agencies, Indian Council of Medical Research, e-waste regulating bodies, academic institutes, and various government and non-government organizations should join hands together to effectively manage the problems of e-waste. Swacch Bharat Abhiyan started by the honorable Prime Minster should consider e-waste as the top most priority in terms of its safe management and disposal.

The main barrier for a young researcher in the field of endoscopy is that too much is known about virtually every aspect not only of the natural history, but also of the efficacy and safety of different Gastrointestinal (GI) techniques. The main fuel for research remains uncertainty, and this has been the primary characteristic of COVID-19. The unprecedented visibility of the main papers on the natural history and medical management of COVID-19 on all the main worldwide medical Journals has had an effect of drainage on the reports of COVID-19 in GI endoscopy, suddenly opening up the interest of main GI journals to this topic. Furthermore, given the nature and the urgency of the topic, these high-ranking journals have accepted study designs outside rigorous randomized controlled trials and/or systematic reviews and meta-analysis, what used to be the “conditio sine qua non” for being considered for publication. Suddenly, rigorous guidelines have been replaced by expert-derived suggestions on the basis that the best possible guidance is better than no guidance. This situation has been a great occasion for young researchers to gain visibility even without having access to the complex means and long time-spans needed to finalize a randomized trial.

Research within the anatomical sciences often relies on human cadaveric tissues. Without the good will of these donors who allow us to use their bodies to push forward our anatomical knowledge, most human anatomical research would come to a standstill. However, many research papers omit an acknowledgement to the donor cadavers or, as no current standardized versions exist, use language that is extremely varied. To remedy this problem, 20 editors-in-chiefs from 17 anatomical journals joined together to put together official recommendations that can be used by authors when acknowledging the donor cadavers used in their studies. The goal of these recommendations is to standardize the writing approach by which donors are acknowledged in anatomical studies that use human cadaveric tissues. Such sections in anatomical papers will not only rightfully thank those who made the donation but might also encourage, motivate, and inspire future individuals to make such gifts for the betterment of the anatomical sciences and patient care.

This article deals with formulating a suitable title and an appropriate abstract for an original research paper. The "title" and the "abstract" are the "initial impressions" of a research article, and hence they need to be drafted correctly, accurately, carefully, and meticulously. Often both of these are drafted after the full manuscript is ready. Most readers read only the title and the abstract of a research paper and very few will go on to read the full paper. The title and the abstract are the most important parts of a research paper and should be pleasant to read. The "title" should be descriptive, direct, accurate, appropriate, interesting, concise, precise, unique, and should not be misleading. The "abstract" needs to be simple, specific, clear, unbiased, honest, concise, precise, stand-alone, complete, scholarly, (preferably) structured, and should not be misrepresentative. The abstract should be consistent with the main text of the paper, especially after a revision is made to the paper and should include the key message prominently. It is very important to include the most important words and terms (the "keywords") in the title and the abstract for appropriate indexing purpose and for retrieval from the search engines and scientific databases. Such keywords should be listed after the abstract. One must adhere to the instructions laid down by the target journal with regard to the style and number of words permitted for the title and the abstract.

Radiology has not been spared in recent economic crises with a substantial reduction in the turnover of imaging equipment. These problems are exacerbated by increasing demand for healthcare across Europe. Therefore, using existing radiological services while rigorously following evidence-based guidelines might improve patient care. Thus, diagnostic pathways should be assessed not only for technical and diagnostic performance but also for their impact on medical and social outcome. In this paper, we report the advice of the Research Committee of ESSR on how we may guide musculoskeletal radiological research towards studies that have useful clinical impact. The ESSR Research Committee intends to encourage research with potential to influence treatment, patient outcome, and social impact. Key Points • Research in medical imaging has the potential to improve human health. • High-level studies have the potential to place radiology at the pinnacle of quality in evidence-based practice. • The ESSR Research Committee intends to encourage research with potential to influence treatment, patient outcome, and social impact.

The FAIR principles formulate guidelines for the sustainable reusability of research data. FAIR stands for Findability, Accessibility, Interoperability, and Reusability of data and metadata. While there is a growing body of general implementation guidelines, so far there is a lack of specific recommendations on how to apply the FAIR principles to the specific needs of social, behavioural and economic science data. These disciplines work with highly diverse data types that often contain confidential information on individuals, companies, or institutions. These features pose some challenges to the useful implementation of the FAIR principles - especially regarding the machine-actionability of data and metadata that is at the core of the FAIR principles. This White Paper defines the FAIR principles for the social, behavioural and economic sciences. For each of the 15 FAIR (sub)principles, the paper proposes minimum requirements and provides a vision for a full-implementation of the FAIR principles by repositories and data centres. The paper was authored by members of the Economic and Social Sciences goINg FAIR Implementation Network (EcoSoc-IN) and addresses research data centres and other stakeholders who strive for a FAIR research data infrastructure in the disciplines of KonsortSWD.

Objective. To investigate the number of authors and unique institutions per paper published in the American Journal of Pharmaceutical Education (AJPE) in 2015 through 2019, and to examine the number of authors and unique institutions for papers that were nominated for the Rufus A. Lyman Award in the same period. Methods. Articles published in AJPE from 2015 through 2019 were reviewed. Data collected for each article included article type, number of authors, and number of institutions. Results. Of the 811 articles published in AJPE during this period, the number of authors increased significantly from a mean (SD) of 3.5 (1.8) to 4.5 (2.2). The number of unique institutions also increased significantly from 1.7 (1.1) to 2.4 (1.8). Conclusion. There is a trend toward a greater number of authors and unique institutions for the publications in one pharmacy education journal. Explanations for this trend may include pressure to publish, increased research complexity, and expanded interprofessional collaboration.

An increasing interest in a healthy lifestyle raises questions about optimal body weight. Evidently, it should be clearly discriminated between the standardised “normal” body weight and individually optimal weight. To this end, the basic principle of personalised medicine “one size does not fit all” has to be applied. Contextually, “normal” but e.g. borderline body mass index might be optimal for one person but apparently suboptimal for another one strongly depending on the individual genetic predisposition, geographic origin, cultural and nutritional habits and relevant lifestyle parameters—all included into comprehensive individual patient profile. Even if only slightly deviant, both overweight and underweight are acknowledged risk factors for a shifted metabolism which, if being not optimised, may strongly contribute to the development and progression of severe pathologies. Development of innovative screening programmes is essential to promote population health by application of health risks assessment, individualised patient profiling and multi-parametric analysis, further used for cost-effective targeted prevention and treatments tailored to the person. The following healthcare areas are considered to be potentially strongly benefiting from the above proposed measures: suboptimal health conditions, sports medicine, stress overload and associated complications, planned pregnancies, periodontal health and dentistry, sleep medicine, eye health and disorders, inflammatory disorders, healing and pain management, metabolic disorders, cardiovascular disease, cancers, psychiatric and neurologic disorders, stroke of known and unknown aetiology, improved individual and population outcomes under pandemic conditions such as COVID-19. In a long-term way, a significantly improved healthcare economy is one of benefits of the proposed paradigm shift from reactive to Predictive, Preventive and Personalised Medicine (PPPM/3PM). A tight collaboration between all stakeholders including scientific community, healthcare givers, patient organisations, policy-makers and educators is essential for the smooth implementation of 3PM concepts in daily practice.

Preclinical and clinical pain science have since long suffered from lack of joint ventures that, as securely as possible, have approached problems that are relevant for the understanding of clinical pain phenomenologies and treatment (Yezierski & Hansson, 2018), the core of translational pain medicine. The uncoupling of the two has led to loss of momentum and few novel efficacious treatment remedies where needed the most, i.e., in long term pain states. Here, the area of translational pain medicine is craving for a road map so that preclinical and clinical scientists can walk hand in hand into the future with a common agenda on how to approach the search for much needed improved treatment strategies.

Background Social support services such as day care centres are important in post-diagnostic dementia care to enable people living with dementia stay at home for longer. Little research has addressed potential inequalities in access, with no research on variations before and since COVID-19. The aim of this study was to explore inequalities in social support service usage before and since the pandemic. Methods Unpaid carers and people living with dementia were interviewed over the phone about their experiences of accessing social support services before and since the COVID-19 pandemic. Transcripts were analysed for key themes using inductive and deductive thematic analysis. Results Fifty participants (42 unpaid carers; eight people living with dementia) were interviewed, and five themes identified: (1) Service issues; (2) Access issues; (3) Relying on own initiative; (4) New inequalities due to COVID-19; and (5) Missing out on the benefits of support services. Participants reported transport, finances, and location as factors reducing their ability to access support service pre-COVID, with inequalities remaining and at times exacerbated since. Carers and people living with dementia also reported struggling with accessing basic necessities during COVID, including food and medicines. Conclusions Considering the benefits of accessing support services, resourced procedures and facilities are needed to maintain access to support services with more accessible remote support provision, enabling people from all backgrounds to access the care they need.

This study is the first comprehensive investigation of enzyme-producing bacteria isolated from four sludge samples (primary, secondary, press and machine) collected in a Kraft paper mill. Overall, 41 strains encompassing 11 different genera were identified by 16S rRNA gene analysis and biochemical testing. Both biodiversity and enzymatic activities were correlated with sludge composition. Press sludge hosted the largest variety of bacterial strains and enzymatic activities, which included hydrolytic enzymes and ligninolytic enzymes. In contrast, strains isolated from secondary sludge were devoid of several enzymatic activities. Most strains were found to metabolize Kraft liquor at its alkaline pH and to decolorize industrial lignin-mimicking dyes. Resistance to lignin or the ability to metabolize this substrate is a prerequisite to survival in any paper mill sludge type. We demonstrate here that the bacterial strains found in a typical Kraft paper mill represent a source of potential novel enzymes for both industrial applications and bioremediation. Electronic supplementary material The online version of this article (doi:10.1186/s40064-016-3147-8) contains supplementary material, which is available to authorized users.

A lo largo de la segunda mitad siglo XX en la Argentina diferentes actores inscriptos en las instituciones de formacion de profesores de Educacion Fisica procuraron promover disimiles discursos y practicas con el objeto de legitimar en distintas esferas sociales a la disciplina. En esos procesos se establecieron dialogos con diversos saberes cientificos constituyendose lo que los actores de la Educacion Fisica denominaron como “tradiciones disciplinares”, asimismo promovieron desiguales inscripciones dentro del sistema de educacion superior. En este articulo profundizaremos en los procesos de configuracion de las saberes y practicas que hicieron a la construccion de la identidad de los profesores de educacion fisica en las decadas de 1970 y 1980. Para ello, analizaremos fuentes primarias y secundarias entre ellas se destacan los planes de estudio y los expedientes administrativos de distintas instituciones de formacion. En cada uno de los casos atenderemos a las tramas de construccion de los mismos. El recorrido posibilitara evidenciara que en el periodo considerado las producciones identitarias de los profesores de educacion fisica comenzaran a pensarse en una relacion de necesidad y de tension entre la investigacion y la docencia., Ao longo da segunda metade do século XX, na Argentina, diversos atores matriculados nas instituições de formação de professores de Educação Física buscaram promover discursos e práticas díspares para legitimar a disciplina em diferentes esferas sociais. Nestes processos, estabeleceram-se diálogos com saberes científicos diversos, constituindo o que os atores da Educação Física denominaram de “tradições disciplinares”, promovendo também matrículas desiguais no sistema de ensino superior. Este artigo tenta analisar tais processos. Nos aprofundaremos nos processos de configuração dos saberes e práticas que fizeram a construção da identidade dos professores de educação física nas décadas de 1970 e 1980. Para tanto, analisaremos fontes primárias e secundárias, entre elas, os planos de estudos e os arquivos administrativos de diferentes instituições de formação. Em cada um dos casos, atenderemos aos planos de construção do mesmo. O passeio permitirá mostrar que, no período considerado, as produções identitárias dos professores de educação física passam a pensar numa relação de necessidade e tensão entre pesquisa e ensino., Throughout the second half of the 20th century, in Argentina, different actors registered in Physical Education teacher training institutions tried to promote different discourses and practices to legitimize the discipline in different social spheres. In these processes, dialogues were established with diverse scientific knowledge, constituting what the actors of Physical Education called “disciplinary traditions”, also promoting unequal enrollment in the higher education system. This article seeks to analyze such processes. We will delve into the processes of configuration of knowledge and practices that built the identity of physical education teachers in the 1970s and 1980s. For this, we will analyze primary and secondary sources, including the study plans and administrative records of various training institutions. In each of the case, we will attend to the plans of its construction. The tour will show that, in the period considered, the identity productions of physical education teachers start thinking about a relationship of need and tension between research and teaching., Facultad de Humanidades y Ciencias de la Educación

“There is no problem that a library card can't solve” according to author Eleanor Brown [1]. This advice is sound, probably for both life and science, but even the best tool (like the library) is most effective when accompanied by instructions and a basic understanding of how and when to use it. For many budding scientists, the first day in a new lab setting often involves a stack of papers, an email full of links to pertinent articles, or some promise of a richer understanding so long as one reads enough of the scientific literature. However, the purpose and approach to reading a scientific article is unlike that of reading a news story, novel, or even a textbook and can initially seem unapproachable. Having good habits for reading scientific literature is key to setting oneself up for success, identifying new research questions, and filling in the gaps in one’s current understanding; developing these good habits is the first crucial step. Advice typically centers around two main tips: read actively and read often. However, active reading, or reading with an intent to understand, is both a learned skill and a level of effort. Although there is no one best way to do this, we present 10 simple rules, relevant to novices and seasoned scientists alike, to teach our strategy for active reading based on our experience as readers and as mentors of undergraduate and graduate researchers, medical students, fellows, and early career faculty. Rules 1–5 are big picture recommendations. Rules 6–8 relate to philosophy of reading. Rules 9–10 guide the “now what?” questions one should ask after reading and how to integrate what was learned into one’s own science.

Background Rifampicin or rifampin (R) is a common drug used to treat inactive meningitis, cholestatic pruritus and tuberculosis (TB), and it is generally prescribed for long-term administration under regulated dosages. Constant monitoring of rifampicin is important for controlling the side effects and preventing overdose caused by chronic medication. In this study, we present an easy to use, effective and less costly method for detecting residual rifampicin in urine samples using protein (bovine serum albumin, BSA)-stabilized gold nanoclusters (BSA-Au NCs) adsorbed on a paper substrate in which the concentration of rifampicin in urine can be detected via fluorescence quenching. The intensity of the colorimetric assay performed on the paper-based platforms can be easily captured using a digital camera and subsequently analyzed. Results The decreased fluorescence intensity of BSA-Au NCs in the presence of rifampicin allows for the sensitive detection of rifampicin in a range from 0.5 to 823 µg/mL. The detection limit for rifampicin was measured as 70 ng/mL. The BSA-Au NCs were immobilized on a wax-printed paper-based platform and used to conduct real-time monitoring of rifampicin in urine. Conclusion We have developed a robust, cost-effective, and portable point-of-care medical diagnostic platform for the detection of rifampicin in urine based on the ability of rifampicin to quench the fluorescence of immobilized BSA-Au NCs on wax-printed papers. The paper-based assay can be further used for the detection of other specific analytes via surface modification of the BSA in BSA-Au NCs and offers a useful tool for monitoring other diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12951-015-0105-5) contains supplementary material, which is available to authorized users.

Purpose. Using the Problem Oriented Screening Instrument for Teenagers (POSIT), the effect of mode of administration on (1) students' willingness to disclose sensitive information and (2) response rates was investigated. Design. A2 × 2 unequal N factorial analysis of variance (ANOVA) design was employed. Mode of administration (paper-and-pencil vs. Web-based) was crossed with grade level (middle vs. high school). Setting. The study was conducted in two middle and two high schools. Subjects. A total of 628 middle and high school students completed the survey. Measures. The POSIT is a self-report measure with 139 yes/no items that identifies stressors in 10 functional areas (e.g., Substance Use). Analysis. An unequal N 2 (mode) × 2 (grade level) factorial ANOVA was employed. Results. No statistically significant differences were found for self-reported risk across modes of administration. Students completing the Web-based version of the survey were four times more likely to skip an item. Conclusions. Effect of Mode on Reporting of Sensitive Information—Students completed the Web-based surveys in computer labs with other students. The intent of the Web-based survey was to increase perceived privacy but the environment likely negated any effect. Effect of Mode on Response Rates—The higher response rate for the paper-and-pencil survey was the opposite of what was expected and revealed that students were more likely to skip sensitive items on the Web survey. (Am J Health Promot 2011;25[5]:349-352.)

ObjectiveTo compare online and paper-based screening for depression and anxiety in adults with cystic fibrosis (CF).Design and settingCross-sectional study in CF clinics in Ireland and through the Cystic Fibrosis Ireland online community.Participants160 adult patients aged 18 or above were recruited. Of these, 147 were included in the analysis; 83 online and 64 paper-based. The remaining 13 were excluded because of incomplete data.MeasuresDepression and anxiety were measured using the Hospital Anxiety and Depression Scale (HADS). Data on pulmonary function (forced expiratory volume in 1 s %) and body mass index were self-reported based on clinical assessments. Sociodemographic data were collected.ResultsCompared with the paper-based participants, the online participants were more likely to be female (61.7% vs 48.4%), older (mean 32.2 vs 28.2 years) and were more likely to be married (32.5% vs 15.6%), living with their spouse or partner (42.5% vs 22.6%) and working either full time (33.7% vs 15.9%) or part time (30.1%vs 17.5%). The prevalence rates of elevated anxiety and depression were not significantly different (P=0.71 and P=0.56). HADS anxiety and depression scores were not statistically different between online (P=0.83) and paper-based (P=0.92) participants based on Mann-Whitney U test. A significant negative correlation was found between depression and pulmonary function (r=−0.39, P=0.01) and anxiety and pulmonary function (r=−0.36, P=0.02). Based on Cronbach’s alpha, there were no statistically significant differences between the online and paper-based participants on the internal consistency of the HADS anxiety (P=0.073) and depression (P=0.378) scales.ConclusionsOur findings suggest that online and paper-based screening for depression and anxiety in adult patients with CF yield comparable findings on prevalence rates and scores, associations with health and internal consistency of subscales. This study highlights that online screening offers an alternative method to paper-based screening. Further research with a larger sample and assessment of measurement equivalence between online and paper based screening is needed to confirm our results.

The management and widespread sharing of publicly funded research data has gained significant momentum among governments, funders, institutions, journals and data service providers around the world. However, there is no ‘one-size-fits-all’ approach to open research data across academic disciplines. Different disciplines produce different types of data and have various procedures for analysing, archiving and publishing it. This briefing paper presents the current state of open research data across academic disciplines. It describes disciplinary characteristics inhibiting a larger take-up of open research data mandates. Additionally itpresents the current strategies and policies established by funders, institutions, journals and data service providers alongside general data policies.&nbsp

Background Little is known about the surgical discipline in North Korea from the perspective of the outside world. This study aimed to examine the disease entities covered by articles published in the major medical journal in North Korea, “Surgery.” Methods Content and frequency analyses of 2,132 articles published in “Surgery” from 2006 to 2017 were conducted. Two medical doctors who majored in surgery and anesthesiology perused the articles and compiled the diseases being elucidated in each article. The diseases described in each article were stratified into 13 surgical subspecialties. Results Articles from “Surgery,” similar to articles from the Western surgical community, also covered a wide variety of surgical diseases from different subspecialties, and the number of publications continued to grow consistently. Moreover, a number of studies focused on the fields of orthopedics and general surgery dealing with benign diseases. Some articles focused on minimally invasive surgeries using laparoscopy. Conclusion The studies published in the North Korean journal “Surgery” encompass various clinical areas, but their quality is unclear., Graphical Abstract

This study explored how undergraduate students and their tutors in an English Language Teaching Department of a Turkish university conceptualised a good research paper and whether there was a match between the conceptions of both parties. In line with this purpose, the study specifically sought answers to what the students’ concerns and what their tutors’ views were on students’ potential problems during the process of writing a research paper. The findings revealed a match between the students’ and tutors’ perceptions of a good research paper. However, the parties conceived the constructs valued and problems faced differently.

Background Isothermal amplification techniques are emerging as a promising method for malaria diagnosis since they are capable of detecting extremely low concentrations of parasite target while mitigating the need for infrastructure and training required by other nucleic acid based tests. Recombinase polymerase amplification (RPA) is promising for further development since it operates in a short time frame (

Non

Background This is the third in a series of three papers describing the use of qualitative evidence syntheses (QES) to inform the development of clinical and health systems guidelines. WHO has recognised the need to improve its guideline methodology to ensure that decision-making processes are transparent and evidence based, and that the resulting recommendations are relevant and applicable to end users. In addition to the standard data on effectiveness, WHO guidelines increasingly use evidence derived from QES to provide information on acceptability and feasibility and to develop important implementation considerations. Methods WHO convened a group drawn from the technical teams involved in formulating recent (2010–2018) guidelines employing QES. Using a pragmatic and iterative approach that included feedback from WHO staff and other stakeholders, the group reflected on, discussed and identified key methods and research implications from designing QES and using the resulting findings in guideline development. As members of WHO guideline technical teams, our aim in this paper is to explore how we have used findings from QES to develop implementation considerations for these guidelines. Results For each guideline, in addition to using systematic reviews of effectiveness, the technical teams used QES to gather evidence of the acceptability and feasibility of interventions and, in some cases, equity issues and the value people place on different outcomes. This evidence was synthesised using standardised processes. The teams then used the QES to identify implementation considerations combined with other sources of information and input from experts. Conclusions QES were useful sources of information for implementation considerations. However, several issues for further development remain, including whether researchers should use existing health systems frameworks when developing implementation considerations; whether researchers should take confidence in the evidence into account when developing implementation considerations; whether qualitative evidence that reveals implementation challenges should lead guideline panels to make conditional recommendations or only point to implementation considerations; and whether guideline users find it helpful to have challenges pointed out to them or whether they also need solutions. Finally, we need to explore how QES findings can be incorporated into derivative products to aid implementation.

Background Skin neurofibromas represent one of the main clinical manifestations of neurofibromatosis 1, and their number varies greatly between individuals. Quantifying their number is an important step in the methodology of many clinical studies, but counting neurofibromas one by one in individuals with thousands of tumors is arduous, time-consuming, and subject to intra and interexaminer variability. We aimed to evaluate the efficacy of a new methodology for skin neurofibromas quantification using paper frames. Methods The sample comprised 92 individuals with NF1. Paper frames, with a central square measuring 100 cm2, were placed on the back, abdomen and thigh. Images were taken, transferred to a computer and two independent examiners counted the neurofibromas. The average number of neurofibromas/100 cm2 of skin was obtained from the mean of the three values. The differences in the quantity of neurofibromas counted by two examiners were evaluated with Intraclass correlation coefficient (ICC), paired t-test, Bland-Altman and survival-agreement plots. To evaluate the predictive value of the method in obtaining the total number of neurofibromas, 49 participants also had their tumors counted one by one. Reproducibility was assessed with Pearson’s correlation coefficients and simple linear regression model. Results There was excellent agreement between examiners (ICC range 0.992-0.997) and the total number of skin neurofibromas could be predicted by the adhesive frames technique using a specific formula (P

Based on the analysis of over 120 mandatory policies from ROARMAP, this briefing paper lays out the main issues that affect the effectiveness of a policy in providing high levels of Open Access research material.&nbsp

Based on the results of the analysis of over 120 mandatory policies in ROARMAP, this briefing paper lays out the main issues that affect the effectiveness of a policy in providing high levels of Open Access research material.&nbsp

This briefing paper lays out the main issues that affect the effectiveness of a policy in providing high levels of Open Access research material.&nbsp

Objective We assessed the measurement equivalence and feasibility of the paper-and-pencil and touch-screen modes of administration of the Taiwan Chinese version of the EORTC QLQ-PR25, a commonly used questionnaire to evaluate the health-related quality of life (HRQOL) in patients with prostate cancer in Taiwan. Methods A cross-over design study was conducted in 99 prostate cancer patients at an urology outpatient clinic. Descriptive exact and global agreement percentages, intraclass correlation, and equivalence test based on minimal clinically important difference (MCID) approach were used to examine the equity of HRQOL scores between these two modes of administration. We also evaluated the feasibility of computerized assessment based on patients’ acceptability and preference. Additionally, we used Rasch rating scale model to assess differential item functioning (DIF) between the two modes of administration. Results The percentages of global agreement in all domains were greater than 85% in the EORTC QLQ-PR25. All results from equivalence tests were significant, except for Sexual functioning, indicating good equivalence. Only one item exhibited DIF between the two modes. Although nearly 80% of the study patients had no prior computer-use experience, the overall proportion of acceptance and preference for the touch-screen mode were quite high and there was no significant difference across age groups or between computer-use experience groups. Conclusions The study results showed that the data obtained from the modes of administration were equivalent. The touch-screen mode of administration can be a feasible and suitable alternative to the paper-and-pencil mode for assessment of patient-reported outcomes in patients with prostate cancer.