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This work presents a unique approach to the design, fabrication, and characterization of paper-based origami robotic systems consisting of stackable pneumatic actuators. These paper-based actuators (PBAs) use materials with high elastic modulus-to-mass ratios, accordion-like structures, and direct coupling with pneumatic pressure for extension and bending. The study contributes to the scientific and engineering understanding of foldable components under applied pneumatic pressure by constructing stretchable and flexible structures with intrinsically nonstretchable materials. Experiments showed that a PBA possesses a power-to-mass ratio greater than 80 W/kg, which is more than four times that of human muscle. This work also illustrates the stackability and functionality of PBAs by two prototypes: a parallel manipulator and a legged locomotor. The manipulator consisting of an array of PBAs can bend in a specific direction with the corresponding actuator inflated. In addition, the stacked actuators in the manipulator can rotate in opposite directions to compensate for relative rotation at the ends of each actuator to work in parallel and manipulate the platform. The locomotor rotates the PBAs to apply and release contact between the feet and the ground. Furthermore, a numerical model developed in this work predicts the mechanical performance of these inflatable actuators as a function of dimensional specifications and folding patterns. Overall, we use stacked origami actuators to implement functionalities of manipulation, gripping, and locomotion as conventional robotic systems. Future origami robots made of paper-like materials may be suitable for single use in contaminated or unstructured environments or low-cost educational materials.

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.

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.

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.

Paper mill effluent has been characterized as recalcitrant because of containing lignin and its derivatives. Since biofilm system exhibits a notable potential for the removal of recalcitrant contaminants, a sequencing batch biofilm reactor (SBBR) was employed to treat coagulated recycled paper mill effluent in this study. The results indicated that the SBBR removed 91.3 % of chemical oxygen demand (COD), whilst total suspended solid (TSS) and color removal reached 83.1 % and 71.0 %, respectively. The microbial analysis suggested that three typical heterotrophic phyla, Proteobacteria, Bacteroidetes and Acidobacteria are dominant bacteria and reflected the removal of recalcitrant contaminants. The COD removal rate of SBBR is evidently superior to conventional activated sludge process due to high sludge concentration as well as long sludge retention time (SRT). Whilst the problem of sludge bulking can be successfully avoided, the blockage of reactor caused by TSS accumulation and microbial growth deserve further investigation.

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.

Background The screening of biological hazards, chemical contaminants and allergens in food products is a major concern of food industry since they can cause serious illnesses and even lead to death. Therefore, there is a significant interest in developing low-cost, robust, and rapid detection methods for food safety and quality analysis. Conventional methods provide accurate analytical characteristics, but require well-equipped laboratories, trained personnel, costly reagents, and complicated sample preparation procedures prior to the detection in order to obtain reliable results. Hence, they are not always ideal for on-site food surveillance. Scope and approach This paper discusses the fundamentals of microfluidic paper-based analytical devices (μPADs) and reviews the recent progress in their usage for screening biological hazards, harmful chemical residues, and allergens in food products to systematically evaluate the strengths and weaknesses of this technology. It then covers future trends and useful strategies that could be employed in μPADs design and fabrication procedures to address the critical challenges in equipment-free food analysis. Key findings and conclusions μPADs offer promising avenues to revolutionize food safety and quality analysis with merits of equipment-free sample preparation and detection at low-cost. Despite the advancement in the microfluidic technology, the manufacturing of user-friendly sample-to-answer μPADs still requires intensive research studies to be employed for robust and sensitive food safety and quality analysis.

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.

Purpose The purpose of this study is to reveal the usability of waste paper sludge on the production of composite materials and the printability of their surfaces were investigated. Design/methodology/approach First, composite plates were produced by using dried and milled waste sludge together with polyester resin and epoxy. Screen printing using water, solvent and UV-based inks were carried out. Findings It was determined that UV and solvent-based inks in both resin groups were permanently attached to the surface of composite plates produced using paper mill waste sludge, while it was found that the adhesion was not achieved sufficiently in cardboard factory waste sludge. Originality/value The unique aspect of this study is obtained the composite plates from paper mill and cardboard mill waste sludge and improved the printability of them.

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.

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.

Poly ( p-phenylene benzoisoxazole; PBO) paper is a potential raw material for use in honeycomb sandwich composites in the aerospace industry, which are able to sustain high temperatures exceeding 300°C. This work presents a wet-forming method of making PBO paper, consisting of PBO chopped fibers. The paper was impregnated with phenolic resin to simulate honeycomb wall material. The structure and mechanical and dynamic mechanical properties of the raw and impregnated paper were characterized. The performance of PBO paper was tested against p-aramid paper. The comparative results showed the tensile strength of PBO raw paper was 2.17 kN/m, which was slightly worse than p-aramid raw paper: 2.66 kN/m. After impregnation, the tensile strength of the PBO paper was 13.93 kN/m due to the increase in the number of bonding points—better than p-aramid paper: 7.99 kN/m. The tearing resistance value for PBO raw paper versus p-aramid raw paper was 3252 mN against 845 mN. The morphology of the torn samples in the impregnated paper revealed higher levels of PBO fiber pullout than p-aramid fiber, therefore the tearing resistance value was 6000 mN for PBO impregnated paper, which was again superior to p-aramid impregnated paper: 675 mN. The PBO paper also showed higher storage modulus than p-aramid paper after impregnation. Experimental studies showed that PBO paper could be used in load-bearing structures and in honeycomb components where high resistance to deformation and thermal stability is necessary.

Purpose In flexible electronics applications, organic inks are mostly used for inkjet printing. Three-dimensional (3 D) printing technology has the advantages of low cost, high speed and good precision in modern electronic printing. The purpose of this study is to solve the high cost of traditional printing and the pollution emissions of organic ink. It is necessary to develop a water-based conductive ink that is easily degradable and can be 3 D printed. A nano-silver ink printed circuit pattern with high precision, high conductivity and good mechanical properties is a promising strategy. Design/methodology/approach The researched nano-silver conductive ink is mainly composed of silver nanoparticles and resin. The effect of adding methyl cellulose on the ink was also explored. A simple 3 D circuit pattern was printed on photographic paper. The line width, line length, line thickness and conductivity of the printed circuit were tested. The influence of sintering temperature and sintering time on pattern resistivity was studied. The relationship between circuit pattern bending performance and electrical conductivity is analyzed. Findings The experimental results show that the ink has the characteristics of low silver content and good environmental protection effect. The printing feasibility of 3 D printing circuit patterns on paper substrates was confirmed. The best printing temperature is 160°C–180°C, and the best sintering time is 30 min. The circuit pattern can be folded 120°, and the cycle is folded more than 60 times. The minimum resistivity of the circuit pattern is 6.07 µΩ·cm. Methyl cellulose can control the viscosity of the ink. The mechanical properties of the pattern have been improved. The printing method of 3 D printing can significantly reduce the sintering time and temperature of the conductive ink. These findings may provide innovation for the flexible electronics industry and pave the way for alternatives to cost-effective solutions. Originality/value In this study, direct ink writing technology was used to print circuit patterns on paper substrates. This process is simple and convenient and can control the thickness of the ink layer. The ink material is nonpolluting to the environment. Nano-silver ink has suitable viscosity and pH value. It can meet the requirements of pneumatic 3 D printers. The method has the characteristics of simple process, fast forming, low cost and high environmental friendliness.

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.

Paper-based fluorescence devices, with smartphone aids, bring considerable operation convenience for tetracycline (TC) sensing. Nevertheless, they must meet the challenge in real determination against complicated backgrounds. Considering that, we present a programmable-printing paper-based device and then apply it to TC determination for various natural samples. MoS2 NPs and Gmp/Eu-Cit are synthetized as composite probes. A static quenching process is found with MoS2 NP fluorescence at 430 nm, while significant magnification of Gmp/Eu-Cit emission is obtained at 617 nm, establishing a valuable ratiometric indicator. Remarkably, two-stage programmable printing maximizes the proposed sensing capability. A transitive device, containing a gradually changing amount of a certain probe, is prepared to sense TC. With a homemade smartphone application and 3D-printed measurement chamber, the corresponding signals are examined to explore optimal setups. These setups are automatically processed to prepare the final-version device, not requiring manual operations. Benefitting from this interesting feature, the proposed device gains many rewards in performances. It effectively senses TC in a wide range from 12.7 nM to 80 μM and simultaneously provides naked eye-legible signals and smartphone-based readouts with confident selectivity and stability. This device is consequently applied for various samples of soil, river water, milk, and serum and meets well with HPLC-MS and recovery tests.

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.

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.

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.

The paper presents a research on the disposal of the toxic waste of pulp and paper mill (sludge-lignin with the empirical formula CH1.51N0.05S0.03Cl0.01O0.54through its oxidation in supercritical water-oxygen fluid, including the case of using methane as a co-fuel. The experiments were carried out with a flow reactor of original design at a pressure of 25 MPa, temperature gradient along the vertical axis (from top to bottom: 390–600°C), and variation in the flow rate of the sludge-lignin (with the addition of NaOH, 1.6 wt %), oxygen, and methane. The experiments yielded data on the content of phenols in the water and the composition of the gaseous products collected at the outlet of the reactor versus the oxygen excess ratio. From these data, as well as the time dependences of the reactor wall temperature and the power of the ohmic heaters, it follows that using distributed supply of methane to compensate for the energy for heating of the reagents is preferable as compared with local inlet of methane to the upper part of the reactor. It has been shown that the addition of methane makes it possible to reduce the oxygen excess required for complete oxidation of the organic components of sludge-lignin.

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.

This study optimizes a novel surfactant-assisted green liquor dregs (GLD) pretreatment of paper mill sludge (PMS), both of which are wastes from the kraft pulping industry, using a combined Response Surface Methodology (RSM) design. Optimized conditions give a maximal reducing sugar release of 16.38 g/L. A substantial reduction in heavy metals aluminum, chromium, cobalt, arsenic, lead, and copper after pretreatment illustrates the enhancement of substrate digestibility by reducing toxic elements. Separate hydrolysis and fermentation (SHF) and simultaneous saccharification and fermentation (SSF) for hydrogen production are assessed. SSF produced a hydrogen yield of 3.72 mL/g, displaying a 36.26% increase from pretreated PMS compared to SHF. These findings provide insights into possible methods of reducing process duration, energy input, and costs incurred with waste disposal within the paper industry. Furthermore, improved hydrogen yield using an SSF process demonstrates the potential beneficiation of pulp and paper GLD and PMS wastes.

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.

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.

The present study investigated the phycoremediation efficacy of two freshwater green microalgae Chlorella ellipsoidea and Desmodesmus opoliensis for treatment of water of Ellenga beel, a wetland lo...

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.

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.

Urinary incontinence is a common problem among older adults that is often complicated by many nuanced ethical considerations. Unfortunately, there is a lack of guidance for healthcare professionals on how to navigate such concerns. This International Continence Society white paper aims to provide healthcare professionals with an ethical framework to promote best care practices in the care of older adults with urinary incontinence.

Time-limited exposure of electrode-free optically rewritable electronic paper is essential for applications, but performance characteristics can be modest. In this study we investigate whether imag...

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.

In this study, the removal of UV254, phenol, and calcium from paper industry wastewater by persulfate oxidation was investigated. Fe2+ addition and heat application methods were used for persulfate...

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.

We demonstrated the thermally robust reduced graphene oxide (rGO)/boron nitride nanotube (BNNT) papers and their application in electromagnetic interference shielding. In order to overcome the thermal durability shortcomings of electromagnetic wave shielding paper based on rGO nanomaterial, rGO/BNNT electromagnetic interference (EMI) shielding paper having excellent thermal durability could be manufactured using BNNT nanomaterials having excellent chemical and thermal stability at high temperature. With the addition of a little BNNT, the durability against temperature can be increased by more than two times while there is little reduction in EMI performance.

Paper-based photodetectors have attracted extensive research interest owing to their environmentally friendly and highly deformable properties. Although perovskite crystals with outstanding optoelectronic properties have proved to be one of the most promising candidates for photodetectors, the development of paper-based photodetectors is hindered by the moisture absorptivity of paper and the instability of perovskite crystals in a humid atmosphere. In this study, we demonstrate a highly deformable and high-performance paper-based perovskite photodetector. The photodetector maintains its excellent performance even after exposure to a relative humidity of 60% for 120 h.

More than 50 billion disposable paper cups used for cold and hot beverages are sold within the United States each year. Most of the cups are coated with a thin layer of plastic — low density polyethylene (LDPE) — to prevent leaking and staining. While the paper in these cups is both recyclable and compostable, the LDPE coating is neither. In recycling a paper cup, the paper is separated from the plastic lining. The paper is sent to be recycled and the plastic lining is typically sent to landfill. In an industrial composting environment, the paper and lining can be composted together if the lining is made from compostable materials. Coating paper cups with a compostable performance material uniquely allows for used cups to be processed by either recycling or composting, thus creating multiple pathways for these products to flow through a circular economy. A segment of the paper converting industry frequently uses an extrusion grade of polylactic acid (PLA) for zero-waste venues and for municipalities with ordinances for local composting and food service items. The results among these early adopters reveal process inefficiencies that elevate manufacturing costs while increasing scrap and generally lowering output when using PLA for extrusion coating. NatureWorks and Sung An Machinery (SAM) North America researched the extrusion coating process utilizing the incumbent polymer (LDPE) and PLA. The trademarked Ingeo 1102 is a new, compostable, and bio-based PLA grade that is specifically designed for the extrusion coating process. The research team identified the optimum process parameters for new, dedicated PLA extrusion coating lines. The team also identified changes to existing LDPE extrusion lines that processors can make today to improve output. The key finding is that LDPE and PLA are significantly different polymers and that processing them on the same equipment without modification of systems and/or setpoints can be the root cause of inefficiencies. These polymers each have unique processing requirements with inverse responses. Fine tuning existing systems may improve over-all output for the biopolymer without capital investment, and this study showed an increase in line speed of 130% by making these adjustments. However, the researchers found that highest productivity can be achieved by specifying new systems for PLA. A line speed increase to more than 180% and a reduction in coat weight to 8.6 µm (10.6 g/m2 or 6.5 lb/3000 ft2) was achieved in this study. These results show that Ingeo 1102 could be used as a paper coating beyond cups.

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.

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.