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Patients with the dual burden of chronic kidney disease (CKD) and cardiovascular disease (CVD) experience unacceptably high rates of morbidity and mortality, which also entail unfavorable effects on healthcare systems. Currently, concerted efforts to identify, prevent and treat CVD in CKD patients are lacking at the institutional level, with emphasis still being placed on individual specialty views on this topic. The authors of this position paper endorse the need for a dedicated interdisciplinary team of subspecialists in cardio-nephrology that manages appropriate clinical interventions across the inpatient and outpatient settings. There is a critical need for training programs, guidelines and best clinical practice models, and research funding from nephrology, cardiology and other professional societies, to support the development of the subspecialty of cardio-nephrology. This position paper from the coordinating committee from the Working Group for Cardiorenal Medicine of the Spanish Society of Nephrology (S.E.N.) is intended to be the starting point to develop the subspecialty of cardio-nephrology within the S.E.N.. The implementation of the subspecialty in day-to-day nephrological practice will help to diagnose, treat, and prevent CVD in CKD patients in a precise, clinically effective, and health cost-favorable manner. Resumen: Los pacientes con enfermedad renal crónica (ERC) que presentan enfermedad cardiovascular (ECV) tienen índices de morbilidad y mortalidad inaceptablemente elevados, que impactan desfavorablemente sobre los sistemas de salud. En la actualidad, se requieren actuaciones multidisciplinares para identificar, prevenir y tratar la ECV en los pacientes con ERC, debiendo pues superarse la época de las actuaciones de las especialidades individuales. Los autores de este artículo respaldan la necesidad de un equipo interdisciplinar de subespecialistas en cardionefrología que gestione las intervenciones clínicas adecuadas en el entorno hospitalario y en el ambulatorio. Existe una gran necesidad de programas de formación, de guías y modelos de práctica clínica, y de fondos para la investigación en las sociedades de nefrología, cardiología y otras, para apoyar el desarrollo de la subespecialidad de cardio-nefrología. Este documento de opinión del comité coordinador del Grupo de Trabajo de Medicina Cardiorenal de la Sociedad Española de Nefrología (S.E.N.) pretende ser el inicio del desarrollo de la subespecialidad de Cardionefrología en el marco de la S.E.N. La implementación de la subespecialidad en la práctica nefrológica diaria contribuirá a diagnosticar, tratar y prevenir la ECV en los pacientes con ERC de una manera precisa, clínicamente efectiva y sanitariamente rentable.

Although considered one of the major energy-intensive industries (EIIs), the pulp and paper industry has also the potential for energy production from an industrial waste, black liquor. This study proposes black liquor gasification (BLG) coupled with calcium looping (CaL) as a CO2 capture route for the pulp and paper industry. BLG with H2 production (BLG-CaL-H2), BLG with gas turbine combined cycle (BLG-CaL-GT) or with solid oxide fuel cell (BLG-CaL-SOFC) were considered. The dependence of carbon capture and storage (CCS) cost on the natural gas, limestone, electricity imported and H2 sale prices aside the expenditures related with BLG-CaL were evaluated. The CCS route, based on CaL retrofitted to the pulp and paper plant, was found to have a lower cost of CO2 avoided (39.0 €/tCO2) when compared with BLG-CaL (48.8–57.1 €/tCO2). Between the BLG-CaL scenarios, BLG-CaL-H2 presented the lowest cost of CO2 avoided (48.8 €/tCO2) but the highest energy penalty. Based on the thermodynamic performance, it was shown that CaL retrofit and BLG-CaL-SOFC presented the best overall performance, turning the electricity importer reference plant into electricity exporter. The economic sensitivity showed that the capital requirement of BLG-CaL has a strong effect on the cost of CO2 avoided for all alternatives. The H2 production is also strongly affected by the H2 sale price while BLG-CaL-SOFC and BLG-CaL-GT are strongly dependent on natural gas price.

This article aims to list environmental practices used by Latin American companies in the pulp and paper industry, to create a list, through a scientific method, that can direct other researchers and managers interested in the subject. The research strategies used were bibliographic research and content analysis. The content analysis used 36 sustainability reports published by Latin American companies in the industry between 2018 and 2019. Although 264 companies were mapped, only 36 of them presented sustainability report possible to be accessed. Through the sample of 36 sustainability reports, 36 sustainable environmental practices were identified that could be grouped into five groups, namely: (1) Reuse of waste, efficiency in the production process and effluents treatment; (2) Preservation and area recovery; (3) Energy efficiency; (4) Initiatives with stakeholders; (5) Control of gas emission. Despite the exploratory nature, the information presented here can be used by managers in the area and researchers interested in improving environmental practices of the pulp and paper industry.

© 2021 Sociedade Portuguesa de Cardiologia. Published by Elsevier España, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/), Heart failure (HF) with reduced ejection fraction (HFrEF) is associated with high rates of hospitalization and death. It also has a negative impact on patients' functional capacity and quality of life, as well as on healthcare costs. In recent years, new HFrEF prognosis-modifying drugs have emerged, leading to intense debate within the international scientific community toward a paradigm shift for the management of HFrEF. In this article, we report the contribution of a Portuguese HF expert panel to the ongoing debate. Based on the most recently published clinical evidence, and the panel members' clinical judgment, three key principles are highlighted: (i) sacubitril/valsartan should be preferred as first-line therapy for HFrEF, instead of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker; (ii) the four foundation HFrEF drugs are the angiotensin receptor/neprilysin inhibitor, beta-adrenergic blocking agents, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter 2 inhibitors, regardless of the presence of type-2 diabetes mellitus; (iii) these four HFrEF drug classes should be introduced over a short-term period of four to six weeks, guided by a safety protocol, followed by a dose up-titration period of 8 weeks., A insuficiência cardíaca (IC) com fração de ejeção reduzida (ICFEr) está associada a níveis elevados de hospitalização e mortalidade. A ICFEr também tem um impacto negativo na capacidade funcional e na qualidade de vida dos doentes, bem como na despesa em saúde. Nos últimos anos, surgiram novos medicamentos modificadores do prognóstico da ICFEr, originando um intenso debate na comunidade científica internacional em relação a uma mudança de paradigma para o tratamento da ICFEr. Neste artigo, relatamos a contribuição de um painel de especialistas portugueses em IC para o debate em curso. Com base na evidência clínica publicada mais recentemente e no julgamento clínico dos membros do painel, três princípios-chave são destacados: (i) sacubitril/valsartan deve ser preferido como terapia de primeira linha para a ICFEr, em vez de um inibidor da enzima de conversão da angiotensina ou um bloqueador do recetor da angiotensina; (ii) os quatro medicamentos básicos para a ICFEr são o inibidor do recetor da angiotensina e da neprilisina, os agentes bloqueadores beta-adrenérgicos, os antagonistas do recetor mineralocorticoide e os inibidores do cotransportador sódio-glucose 2, independentemente da presença de diabetes mellitus tipo 2; (iii) essas quatro classes de medicamentos para a ICFEr devem ser rapidamente introduzidas num período curto de 4-6 semanas, seguindo um protocolo de segurança, e depois tituladas durante as oito semanas seguintes.

Objective: Registries are important data sources for randomised controlled trials (RCTs), but reporting of how they are used may be inadequate. The objective was to describe the current adequacy of reporting of RCTs using registries. Study Design and Setting: We used a database of trials using registries from a scoping review supporting the development of the 2021 CONSORT extension for Trials Conducted Using Cohorts and Routinely Collected Data (CONSORT-ROUTINE). Reporting completeness of 13 CONSORT-ROUTINE items was assessed. Results: We assessed reports of 47 RCTs that used a registry, published between 2011 and 2018. Of the 13 CONSORT-ROUTINE items, 6 were adequately reported in at least half of reports (2 in at least 80%). The 7 other items were related to routinely collected data source eligibility (32% adequate), data linkage (8% adequate), validation and completeness of data used for outcome assessment (8% adequate), validation and completeness of data used for participant recruitment (0% adequate), participant flow (9% adequate), registry funding (6% adequate) and interpretation of results in consideration of registry use (25% adequate). Conclusion: Reporting of trials using registries was often poor, particularly details on data linkage and quality. Better reporting is needed for appropriate interpretation of the results of these trials. Keywords: registries, CONSORT, CONSORT-ROUTINE, randomised controlled trials, reporting guideline, routinely collected data Running Title: Completeness and Transparency of Reporting of RCTs using Registries

Background: \ud Nutrition related publications in pediatric population cover wide range of topics and therefore it is usually difficult for clinicians to get an overview of recent nutrition related guidelines or recommendations.\ud \ud Methods: \ud The Special Interest Group (SIG) of Pediatrics of European Society for Clinical Nutrition and Metabolism (ESPEN) performed a literature search to capture publications in the last five years aiming to provide the latest information concerning nutritional issues in children in general and in specific diseases and to discuss progression in the field of pediatric nutrition evidence-based practice.\ud \ud Results: \ud Eight major topics were identified as the most frequently reported including allergy, critical illness, neonatal nutrition, parenteral and enteral nutrition, micronutrients, probiotics and malnutrition. Furthermore, it was noted that many reports were disease focused or included micronutrients and were, therefore, represented as tables.\ud \ud Conclusion: \ud Overall, it has been shown that most reports on nutrition topics in pediatrics were systematic reviews or guidelines/position papers of relevant societies, but many of them basing the conclusion on a limited number of high-quality randomized controlled trials or large observational cohort studies.

When academics’ opinions, which are published in academic journals as letters to the editor or commentaries, are retracted based on sensitivities and objections that are raised for example on social media, there needs to be a reflection on what this might represent. On one hand, an opinion is precisely that, i.e., a subjective and biased view about an issue. Those views might even be radical, unpopular, or insensitive, but ultimately approved by editors for publication nonetheless. To maintain a truly sustainable scholarly discourse, the best academic way to counter such opinions is by allowing disagreeing voices to express themselves, also as letters to the editor or commentaries. Pressure-induced retractions of opinions not only stifle academic debate, they send the message that opinions need to be moderated and standardized to meet a publishing market that is being increasingly driven by legal parameters, political correctness, as well as business and commercial values rather than academic ones. In an environment of restrictive academic freedom, what emerges is an academia in which the way things are said, tone, and the sensitivity of those that might be affected are given greater weight than the message itself. By cherry-picking parts of the message that detractors or critics might disagree with, the original message may be drowned out by the noise of the objectors. The struggle of academics to liberally voice their opinions in the scholarly publishing realm, and to preserve those opinions, has never been more acute in this age of misinformation and radicalism fueled by polarized social and mass media. Is the politicization and/or commercialization of academia, alongside the retraction of opinions, stifling open and healthy academic debate, or expressing itself as the retraction of opinions, and does this represent a distinct form of “cancel culture” in academia and academic publishing?

IMPORTANCE: Exercise therapies are advocated in osteoarthritis (OA) clinical guidelines. However, challenges to accessing exercise may be limiting widespread uptake. OBJECTIVE: To evaluate the effects of a self-directed web-based strengthening exercise and physical activity program supported by automated behavior-change text messages on knee pain and function for people with knee OA. DESIGN, SETTING, AND PARTICIPANTS: The participant-blinded and assessor-blinded randomized clinical trial enrolled 206 people who met clinical criteria for knee OA in communities across Australia from July 2018 to August 2019, with follow-up taking place at 24 weeks. INTERVENTIONS: The control group was given access to a custom-built website with information on OA and the importance of exercise and physical activity. The intervention group was given access to the same information plus a prescription for a 24-week self-directed strengthening regimen and guidance to increase physical activity, supported by automated behavior-change text messages encouraging exercise adherence. MAIN OUTCOMES AND MEASURES: Primary outcomes were change in overall knee pain (numeric rating scale, 0-10) and difficulty with physical function (Western Ontario and McMaster Universities Osteoarthritis Index, 0-68) over 24 weeks. Secondary outcomes were another knee pain measure, sport and recreation function, quality of life, physical activity, self-efficacy, overall improvement, and treatment satisfaction. RESULTS: Of 206 participants, 180 (87%; mean [SD] age, 60 [8.4] years; 109 [61%] women) completed both 24-week primary outcomes. The intervention group showed greater improvements in overall knee pain (mean difference, 1.6 units; 95% CI, 0.9-2.2 units; P

Objective Clinicians may use implicit or explicit motor learning approaches to facilitate motor learning of patients with stroke. Implicit motor learning approaches have shown promising results in healthy populations. The purpose of this study was to assess whether an implicit motor learning walking intervention is more effective compared with an explicit motor learning walking intervention delivered at home regarding walking speed in people after stroke in the chronic phase of recovery. Methods This randomized, controlled, single-blind trial was conducted in the home environment. The 79 participants, who were in the chronic phase after stroke (age = 66.4 [SD = 11.0] years; time poststroke = 70.1 [SD = 64.3] months; walking speed = 0.7 [SD = 0.3] m/s; Berg Balance Scale score = 44.5 [SD = 9.5]), were randomly assigned to an implicit (n = 38) or explicit (n = 41) group. Analogy learning was used as the implicit motor learning walking intervention, whereas the explicit motor learning walking intervention consisted of detailed verbal instructions. Both groups received 9 training sessions (30 minutes each), for a period of 3 weeks, targeted at improving quality of walking. The primary outcome was walking speed measured by the 10-Meter Walk Test at a comfortable walking pace. Outcomes were assessed at baseline, immediately after intervention, and 1 month postintervention. Results No statistically or clinically relevant differences between groups were obtained postintervention (between-group difference was estimated at 0.02 m/s [95% CI = −0.04 to 0.08] and at follow-up (between-group difference estimated at −0.02 m/s [95% CI = −0.09 to 0.05]). Conclusion Implicit motor learning was not superior to explicit motor learning to improve walking speed in people after stroke in the chronic phase of recovery. Impact To our knowledge, this is the first study to examine the effects of implicit compared with explicit motor learning on a functional task in people after stroke. Results indicate that physical therapists can use (tailored) implicit and explicit motor learning strategies to improve walking speed in people after stroke who are in the chronic phase of recovery.

Over the past few years, what might not unreasonably be described as a true revolution has taken place in the field of machine vision, radically altering the way many things had previously been done and offering new and exciting opportunities for those able to quickly embrace and master the new techniques. Rapid developments in machine learning, largely enabled by faster GPU-equipped computing hardware, has facilitated an explosion of machine vision applications into hitherto extremely challenging or, in many cases, previously impossible to automate industrial tasks. Together with developments towards an internet of things and the availability of big data, these form key components of what many consider to be the fourth industrial revolution. This transformation has dramatically improved the efficacy of some existing machine vision activities, such as in manufacturing (e.g. inspection for quality control and quality assurance), security (e.g. facial biometrics) and in medicine (e.g. detecting cancers), while in other cases has opened up completely new areas of use, such as in agriculture and construction (as well as in the existing domains of manufacturing and medicine). Here we will explore the history and nature of this change, what underlies it, what enables it, and the impact it has had - the latter by reviewing several recent indicative applications described in the research literature. We will also consider the continuing role that traditional or classical machine vision might still play. Finally, the key future challenges and developing opportunities in machine vision will also be discussed.