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

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.

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.

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.

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.

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.

Intra-operative ultrasound has become a relevant imaging modality in neurosurgical procedures. While B-mode, with its intrinsic limitations, is still considered the primary ultrasound modality, intra-operative contrast-enhanced ultrasound (ioCEUS) has more recently emerged as a powerful tool in neurosurgery. Though still not used on a large scale, ioCEUS has proven its utility in defining tumor boundaries, identifying lesion vascular supply and mapping neurovascular architecture. Here we propose a step-by-step procedure for performing ioCEUS analysis of the brain, highlighting its neurosurgical applications. Moreover, we provide practical advice on the use of ultrasound contrast agents and review technical ultrasound parameters influencing ioCEUS imaging.

Human trafficking is a pandemic human rights violation with an emerging paradigm shift that reframes an issue traditionally seen through a criminal justice lens to that of a public health crisis, particularly for children. Children and adolescents who are trafficked or are at risk for trafficking should receive evidence-based, trauma-informed, and culturally responsive care from trained health care providers (HCPs). The purpose of this article was to engage and equip pediatric HCPs to respond effectively to human trafficking in the clinical setting, improving health outcomes for affected and at-risk children. Pediatric HCPs are ideally positioned to intervene and advocate for children with health disparities and vulnerability to trafficking in a broad spectrum of care settings and to optimize equitable health outcomes.

Paper-based microfluidic devices based on electrowetting principle, more specifically electrowetting on dielectric (EWOD), have attracted increasing attention due to their powerful liquid handling capability as compared to continuous-flow paper-based analytical devices (μPAD) that use capillary effects to control liquids. Here, we demonstrate fabrication of paper-based EWOD devices using cellulose paper as substrate and paraffin wax as dielectric hydrophobic layer by a simple pressing treatment for the cellulose paper and melting or spray-coating of paraffin wax. We optimized the key fabrication parameters according to the surface morphology and hydrophobicity of the obtained wax film, including the pressing pressure, thermal annealing temperature and amount of paraffin wax. Moreover, the EWOD devices fabricated by the spray-coating method demonstrate larger contact angle changes but with smaller contact angle hysteresis under DC electric field when compared with the devices fabricated by the melting method. Our study opens up potential fabrication of hybrid paper-based microfluidic device combining advantages of continuous-flow and electrowetting using cellulose paper and paraffin wax.

Photonic crystals film that possesses periodic dielectric structure have shown great prospect in developing environmentally friendly paper alternatives due to the unique properties of dye free and non-photobleaching, but their practical application is limited by the weak interaction between colloidal particles. Although some progress has been obtained, it is still a challenge to develop photonic paper with the desired mechanical and optical properties. Herein, multifunctional hard core/soft shell nanoparticles with controlled size are fabricated by semi-continuous seed emulsion polymerization method. Compared with convention colloidal particles, these core/shell nanoparticles can facile self-assemble into large-scale dense ordered structure film via dried at room temperature due to the relatively low glass transition temperature (Tg) of the shell layers. The facile fabrication route enables the continuous high-through put production of the photonic papers. The as-formed papers not only possess the capacity to solvent (water/ethanol) rewritable and multicolor painting, but also can rapidly reversible mechanochromic. Moreover, due to the good compatibility of core/shell interface, these photonic films possess excellent mechanical properties, demonstrating that this multifunctional film makes the fabrication of novel robust rewritable papers possible and enables visual monitoring of deformation degree.

Objectives A recent paper by Doi et al. advocated completely replacing the relative risk (RR) with the odds ratio (OR) as the effect measure in clinical trials and meta-analyses with binary outcomes. Besides some practical advantages of RR over OR, Doi et al.’s key assumption that the OR is “portable” in the meta-analysis, that is, study-specific ORs are likely not correlated with baseline risks, was not well justified. Study designs and settings We summarized Spearman's rank correlation coefficient between study-specific ORs and baseline risks in 40,243 meta-analyses from the Cochrane Database of Systematic Reviews. Results Study-specific ORs tend to be higher in studies with lower baseline risks of disease for most meta-analyses in Cochrane Database of Systematic Reviews. Using an actual meta-analysis example, we demonstrate that there is a strong negative correlation between OR (RR or RD) with the baseline risk and the conditional effects notably vary with baseline risks. Conclusions Replacing RR or RD with OR is currently unadvisable in clinical trials and meta-analyses. It is possible that no effect measure is “portable” in a meta-analysis. In addition to the overall (or marginal) effect, we suggest presenting the conditional effect based on the baseline risk using a bivariate generalized linear mixed model.

Renewable and bio-based materials have gained great interest on an industrial scale owing to environmental issues. Paper industries also are constantly exploring bio-resources for intrinsic chemico-physical property enhancement of paper and paper products. These bio-resources will potentially increase their cyclability besides making paper compatible beyond traditional uses. Mechanical beating or use of chemical additives or the combination of these methods are widely used to improve critical paper characteristics such as strength, surface smoothness, density, brightness, filler retention, water and grease resistivity etc. These chemical additives as mill effluents are hazardous and have detrimental effect on environment. So, to move ahead of traditional practices, the present review discusses about the production and utility of abundantly available renewable bio-polymers and their products such as starch, cellulose, plant-based proteins, microbial biopolymers, animal-based biopolymers, and natural gums etc. They represent ample prospect in terms of research and development on their functionality and industrial applications.

Pulp and paper mills are known large emitters of air pollution creating potential environmental challenges and human health impacts. This study assesses air pollution and associated impacts from connected pulp and paper facilities which operate in Edmundston, New Brunswick, Canada, and Madawaska, Maine, United States (US). Despite operating within two regulatory jurisdictions on both sides of the international border (in Canada and the US), the mills have exceeded their approvals to operate and national air quality regulations multiple times between 2010 and 2017. Previous studies have linked many types of cancer as well as respiratory and cardiovascular diseases to air pollution emitted by pulp and paper mills, making this an important regional issue in Canada and the US. While potential environmental and community impacts are likely similar on both sides of the international border, emissions from each side are not reported on the other, and few studies have been conducted on either side. Historic and ongoing lack of local epidemiological health and environmental impact studies and recommendations for improvements to mill operations to improve environmental and human health are presented.

Background In Victoria, Australia, public hospitals are administered through a system of devolved governance. Overall, Victoria's public health system has a record of good performance when comparing measurable safety outcomes to the rest of Australia. However, in 2015 a cluster of preventable perinatal deaths were identified at a health service in Melbourne's outer fringes. Questions What were the factors that contributed to these preventable deaths, and what were the outcomes of the four key inquiries commissioned by the Victorian government after the identification of the cluster? What can be learnt by comparing this crisis in one Victorian health service to similar events at other health services in Australia and the United Kingdom? Methods This paper discusses the crisis at the Victorian health service and expands on the factors that contributed to the crisis, the inquiries, subsequent recommendations, and the response from the Victorian state government. Similarities between this case and others in Australia and the United Kingdom are discussed. Findings A common theme in the four inquiries into the crisis at the health service in Victoria was that inadequate clinical governance was a key factor that led to these events. As a result, a number of significant changes were implemented across the state to improve patient safety across all areas of health care. When comparing this Victorian crisis to similar events at other health services across the world, inadequate clinical governance consistently appears as a key contributing factor to poor clinical outcomes. Discussion All cases discussed had a delay in the identification of clusters of poor clinical outcomes. This was found to be a direct result of inadequate clinical governance structures at both a local and government level. Conclusion A robust clinical governance framework that is enacted at both the government and the health organisation level is essential to deliver high quality and safe patient care.

Background Over the last number of years, the healthcare system has become more complex in managing increasing costs and outcomes within a defined budget. To be effective through reform, especially moving forward from the COVID-19 pandemic, healthcare leaders, specifically in nursing, have an increased need for business acumen beyond traditional leadership and management principles. Aim This paper examines the concept of business acumen in the profession of nursing, specifically for managers and higher nurse leaders, establishing whether these skills are optional or essential. Discussion Nurses learn and develop broad skills in leadership and management, but less specifically about business or the broader system. With a contemporary Australian health system aiming to be more effective, nurses may require a greater level of business acumen to adequately understand the mechanics of business decision making in the system when designing care models, as well as representing the business potential of nursing in balance with clinical outcomes through reform. Conclusion The modern nurse, in addition to clinical skills, may need a foundational understanding of business evolving throughout their career, to maximise innovative growth across the system, in meeting the healthcare needs of our community now and into the future. Without a foundation level of business acumen and an understanding of the system across the profession, nurses may not be empowered with their full potential of being a strong voice influencing health system reform.

Gas diffusion layer is one of the most important components of fuel cell, which supports the catalytic layer, collects the current and facilitates mass transfer. However, current carbon paper is mainly composed of long carbon fibers (CF), which brings drawbacks including rough surface, poor body homogeneity, excessive thickness, and preparation difficulty, etc. In this research, we invent a combination method to produce a highly flat, highly homogeneous, ultra-thin and high-performance carbon paper for proton exchange membrane fuel cell (PEMFC). The method combines the advantages of two materials, i.e. few-walled carbon nanotube (FWCNT) with high flatness and short CF with high porosity. And the combination method only contains three steps, material dispersion, carbon paper formation and heat treatment. The highest temperature for the heat treatment process is only 350 °C, which is much lower than the traditional 2000 °C. Due to the small size and fine distribution of FWCNT and CF, the new carbon paper exhibits highly flat (

Triboelectric nanogenerators (TENGs) have been investigated as a promising device to harvest mechanical energy into electricity. At present, paper-based triboelectric nanogenerators (P-TENGs) have been widely researched because paper features with lightweight, low cost, abundance, renewability and biodegradability. In this paper, the operating principles and operation modes of TENGs, the development progress and performance enhancement routes of P-TENGs are comprehensively reviewed. Additionally, the overview, challenges and opportunities of P-TENGs applications are also presented.

Multi-mode liquid handling system integrated different types of liquid behaviors on super-wetting surfaces has attracted great interest from both academia and industries due to their promising applications in the field of surface science. Herein, a paper-based dual-mode droplet manipulation system that combines oil/water separation and time-delay droplet switch was designed by spray-coating α-cellulose 10-undecenoyl ester (CUE) particles on filter paper with further “reverse sizing” by polydimethylsiloxane (PDMS) based on capillary action and “like dissolve like” principle. Such novel binding technique leaded to a remarkably robust superhydrophobicity of the as-fabricated PDMS@CUE-coated paper (PDMS@CCP), including outstanding mechanical resistance and environmental durability. In particular, the front side of PDMS@CCP displayed excellent separation efficiency (higher than 99.89%) for light oil/water mixture, heavy oil/water mixture, and even surfactant-stabilized water-in-oil emulsion. Interestingly, based on the hydrophobicity of the back side of PDMS@CCP and the intrinsic hygroscopicity of paper itself, a time-delay droplet switch was simply achieved in between by the Laplace pressure derived from the curvature difference of the droplet on two paper surfaces with surface energy gradient. By adjusting the width of the filter paper and the volume of the droplet, the switch time could be rationally modulated between 0.8 and 202.1 s. The designed functional paper would enrich the application field of the liquid manipulation system.

Both trade and production of graphic paper have decreased over the last three decades. While this general decrease can partially be attributed to increased prominence of information technology, the overall figure is devoid of context and thus of most of its meaning to global economy. In this study we aim to break this trend down across the geographical and temporal scope, across its supply-chain commodities and to find out what drives the global trade patterns. Econometric trade models focus on the trading countries and direct exports or imports but fail to consider the structural and the indirect trade relations. We take the approach of network analysis, where the emphasis is on the structure of trade and not on country-level descriptors. We focus on 1995–2017 period as within it this decrease can be observed and assess the entire graphic paper and pulp supply chain, consisting out of printing and writing paper, mechanical wood pulp, chemical wood pulp, semichemical wood pulp, pulp made from fiber other than wood, recovered paper and paperboard. We employ descriptive statistical and network analysis, grouping and role analysis, and end with an inferential logistic regression quadratic assignment procedure model. Results show that newsprint trade decline is mirrored in printing and writing paper and mechanical wood pulp. The trade network densities have remained generally stable throughout the observed period, but the topological proprieties of the individual product groups vary greatly. Although no stabile grouping of countries throughout the assessed period could be observed, role analysis shows that countries tend to trade within their continent, that European countries are at the core of the trade network, and that the structural shift of decline of the trade value is followed by increasing prominence of several Asian countries, such as China and Indonesia. The most important finding of the study is that internal trade effects such as reciprocity and transitivity are much more explanatory than classical effects used in trade models such as GDP per capita, geographical distance or forest endowment.

Activating flux is made up of inorganic material mixed with a volatile medium. The objective of this study is to identify and review the literature in activating flux, and different type of welding techniques. For that purpose, a structured review method is adopted and the Scopus database is used as a primary source for the selection of papers. The papers were identified using the string term of “Activating flux” OR “Activated flux” in the title of papers. And a total of 238 papers were identified for the study. Besides the above few other papers were also reviewed and the materials used, the type of flux used, and the findings of different combinations were highlighted in the form of tables. The findings of the study provide a comprehensive understanding of the different type of welding techniques focusing on TIG welding, and the different combination of flux used and their impact was summarized.

Space Resource Utilization could reduce the mass, cost, and risks of future space activities. The many nonlinear and compounding effects mean that seemingly insignificant concept of operations choices can invalidate the conclusions of sophisticated analyses. Here we successively relax self-imposed constraints in a recent publication to demonstrate that the proximity of a market and the benefits of aerobraking cannot be omitted.

Demand on the quick screening of gastric cancer (GC) has significantly stimulated the development of biomarker sensing techniques. Herein, we report the novel fluorescent paper-based analytical devices (PADs) for detections of GC-related microRNA-21 (miRNA-21) and circular RNA from Hippocampus Abundant Transcript 1 gene (circRNA-HIAT1) with prominent reliability and sensitivity. The PADs, constructed by in-situ synthesis of blue-emissive carbon dots (CDs) and conjugations of probe DNAs, exhibit the superior uniformity and stability. In the presence of targets, rolling circle amplifications (RCA) are triggered to generate long DNA strands for the assemblies of green-/red-emissive labels. Consequently, remarkable blue-to-green and blue-to-red emission color transitions of the PADs are achieved, implementing the color-analysis of miRNA-21 and circRNA-HIAT1, respectively. Benefited from the efficient RCA, coupled with the drastic ratiometric fluorescent changes, the limit of detections (LODs) of PADs are found to be several fM with the upper limit of the linear detection range at 1 nM. More importantly, the fluorescent PADs possess excellent specificity, as well as anti-interference capability in biological settings, enabling their applications in accurate GC screening with plasma samples. Overall, the proposed fluorescent PADs are featured with robust sensing platform, facile signal readout, and exceptional dual-type RNA sensing performance, holding high potential in point-of-care testing (POCT).

The aim of the study was to use black liquor produced during the soda pulping process in a pulp and paper mill to increase methane production during pulp and paper industry sludge treatment and decrease the treatment cost. The effects of black liquor on sludge solubilization and methane production were assessed and the economic feasibility of the process was evaluated. Black liquor and NaOH were found to be equivalent in the thermochemical pretreatment process to solubilize sludge and disintegrate flocs. However, adding black liquor increased the background chemical oxygen demand and volatile fatty acid concentration and increased the amount of methane produced by approximately 7-30%. A start-up delay was emphasized by first-order kinetics model due to black liquor addition while methane production remained stable. Economic assessments of five scenarios were performed. It was found to be economically feasible to use black liquor to replace NaOH for the thermal pretreatment process. The surplus methane generated suggested that co-digestion of sludge and black liquor allows surplus bioenergy to be produced during the thermochemical pretreatment anaerobic digestion process.

Microfluidic paper-based analytical devices (μPADs) have attracted much attention over the past decade. They embody many advantages, such as abundance, portability, cost-effectiveness, and ease of fabrication, making them superior for clinical diagnostics, environmental monitoring, and food safety assurance. Despite these advantages, μPADs lack the high sensitivity to detect many analytes at trace levels than other commercial analytical instruments such as mass spectrometry. Therefore, a preconcentration step is required to enhance their sensitivity. This review focuses on the techniques used to separate and preconcentrate the analytes onto the μPADs, such as ion concentration polarization, isotachophoresis, and field amplification sample stacking. Other separations and preconcentration techniques, including liquid-solid and liquid-liquid extractions coupled with μPADs, are also reviewed and discussed. In addition, the fabrication methods, advantages, disadvantages, and the performance evaluation of the μPADs concerning their precision and accuracy were highlighted and critically assessed. Finally, the challenges and future perspectives have been discussed.

Objectives Unlike the technological advances in cross-sectional imaging, the adoption of CR and DR has been relatively overlooked in terms of the additional radiographer skills and competences required for optimal practice. Furthermore, projection radiography is often referred to as basic, plain or other words suggesting simplicity or entry-level skill requirements. Radiographers’ professional identity is connected with the discourse expressed via the language used in daily practice and consequently, if the perception of projection radiography is regarded as simple practice not requiring much reflection or complex decision-making, apathy and carelessness may arise. The purpose of this narrative review was to raise projection radiography from its longstanding lowly place and re-position it as a specialist imaging field. Key findings Danish pre-registration radiography curricula contain little mention of projection radiography and a low proportion (n = 17/144; 11.8%) of Danish radiography students chose to focus on projection radiography within publicly available BSc. theses between 2016 and 2020 as compared to topics related to CT and MRI (n = 60/144; 41.7%). Conclusion By changing how we as the profession perceive the role and position of projection radiography, we can start to rebuild its lost prestige and demand a greater, more detailed and clinically relevant educational offering from academic partners. For this to commence, the language and terminology we use to describe ourselves and tasks undertaken must reflect the complexity of the profession. Implications for practice Regardless of imaging modality, every patient should be assured that a radiographer with expertise in acquiring images of diagnostic quality undertakes their examination. Reclaiming the prestige of projection radiography may lead students and radiographers to recognize projection radiography as a demanding specialist field for the benefit of the patients.

Paper mill wastewater is a complex mixture of different organometallic pollutants with alkaline pH and toxicity to aquatic organisms. This study investigates major physicochemical parameters such as BOD (814.0 ± 2.84), COD (2289.0 ± 3.54), TDS (4128.0 ± 5.21), dissolved solid (3520.0 ± 4.85), suspended solids (608.0 ± 1.53), lignin (628 ± 2.24) and heavy metals along with organometallic pollutants from paper mill wastewater detected by gas chromatography and mass spectrophotometer technique. The organometallic pollutants such as decane, 2,9-dimethyl, eicosane, 2-bromotetradecane, 1,2-dihydro-1,4-diphenylphthalazine, benzene acetic acid, 4-[(trimethylsilyl)oxy]-, trimethylsilyl ester, and docosane were detected via. gas chromatography and mass spectrophotometry (GC–MS). These pollutants are highly toxic and cause significant adverse effects on aquatic organisms. The toxic effects of organometallic pollutants were tested on Heteropneustes fossilis (Stinging catfish) and Tubifex-tubifex (sludge worm) using different concentrations of wastewater (25%, 50%, 75%, and 100%). Due to wastewater exposure Heteropneustes fossilis, toxic effects were observed, showing notable changes in the secondary lamellae (SL); primary lamellae (PL); mucous cell (MC); epithelial cell (EC); chloride cell (CHC). In Tubifex tubifex, minimum toxic effects were noted at the concentration of less than 25% up to 24 h of exposure and maximum at 48 h of exposure at 50% of the wastewater concentration. After 24 h wastewater exposure, the hemoglobin content was decreased, the body’s rear part became white, and body disintegration was observed in worms. In conclusion, the present study investigates that paper mill wastewater is toxic to the aquatic ecosystem and must be treated and assessed before discharge.

l-dopa is a catecholamine neurotransmitter used to treat Parkinson's disease. This paper presents a low-cost paper-based biosensor aimed at enhancing the convenience of monitoring l-dopa concentrations. ZnO nanorods (ZnO-NRs) were synthesized on papers in less than 90 min using a microwave-assisted hydrothermal method. The ZnO-NRs amplify green fluorescence signals to enhance the detection sensitivity of l-dopa, best measured at excitation/emission wavelengths of 475/537 nm. We systematically characterized the effect of reaction conditions on the corresponding fluorescence enhancements. The proposed ZnO NRs-paper biosensor presented a ∼3-fold increase in green fluorescence compared to unmodified papers. The linear range of detection for l-dopa was 25-2000 nM, with a limit of detection of 24 nM, which meets the clinical requirements for the monitoring of l-dopa in Parkinson's patients.

Graphene-based papers have recently triggered considerable interests in developing the application as thermal interface materials (TIMs) for addressing the interfacial heat transfer issue, but their low through-plane thermal conductivity (κ⊥), resulting from the layer-by-layer stacked architecture, limits the direct use as TIMs. Although various hybrid graphene papers prepared by combining the graphene sheets and the thermally conductive insertions have been proposed to solve this problem, achieving a satisfactory κ⊥ higher than that of commercial TIMs (>5 W m−1 K−1) remains challenging. Here, a strategy aimed at the construction of heat pathways along the through-plane direction inside the graphene paper for achieving a high κ⊥ was demonstrated through the simultaneous filtration of graphene sheets with two different lateral sizes. The as-prepared graphene paper presented a hierarchical structure composed of loosely stacked horizontal layers formed by large graphene sheets, intercalated by a random arrangement of small graphene sheets. Due to the heat pathways formed by small graphene sheets along the through-plane direction, the hierarchically structured graphene paper exhibited an improved κ⊥ as high as 12.6 W m−1 K−1 after a common graphitization post-treatment. In the practical test, our proposed paper as an all-graphene TIM achieved an enhancement in cooling efficiency of ≈ 2.2 times compared to that of the state-of-the-art TIM, demonstrating its superior performance to meet the ever-increasing heat dissipation requirement.

This study explored the relationship between syntactic complexity and rhetorical functions and the relationship between syntactic complexity and level of move/step realization in learner-generated research paper introductions. We created a corpus of 79 introductions written by undergraduate L2 students at intermediate to high-intermediate levels. We annotated the introductions for moves and steps, measured their syntactic complexity at the global, clausal, and phrasal levels, and rated their level of move/step realization across four levels (no, low, intermediate, and high). We conducted one-way MANOVA, one-way ANOVA, Pearson correlation, and stepwise multiple linear regression analyses. We found sentences realizing Reviewing items of previous research function to be significantly longer than other steps in Move1 and to contain significantly more clausal and phrasal complexity features. Sentences performing Claiming centrality function also demonstrated significantly more phrasal complexity features as measured by complex nominals per clause. We also found a higher level of phrasal complexity in introductions with a higher level of move/step realization, which can be attributed to introductions including Step1 and Step3, rather than containing all steps. Our findings imply that there is value in developing explicit instructions on how to use complex structures in performing rhetorical steps in research paper introductions. © 2021 Elsevier Ltd

Membrane heat exchangers were used for moisture and heat recovery from a hot and humid natural gas stream in indirect contact with an air stream. A plate membrane module with spiral channels on each side was designed to configure gas and air streams in co-current and counter-current flow. Two types of membranes, a commercial kraft paper, and a laboratory-made thin-film composite membrane, were used as the module core. The thermal efficiency and the water recovery from the humid gas were calculated and compared under different operating conditions. At a unit flow ratio of air/gas, the greatest effectiveness was achieved at a methane flow of 100 cm3/min, but water recovery increased at higher gas flows. For the counterflow configuration, an air/methane flow ratio of 2 was sufficient to achieve the highest total effectiveness and water recovery; however, larger air/gas ratios were beneficial to improve heat and moisture transfer for the co-current configuration. The highest water recovery by the kraft paper and composite membrane was achieved (approximately 15 mgH2O/cm2.h) for the input gas with the highest humidity. The dehumidification performance of kraft paper as a porous and hydrophilic membrane was slightly better than that of the composite membrane containing a dense hydrophilic polymer thin film in most cases. A relatively low heat transfer coefficient was found for the module, which was increased by using higher gas flow rates at higher humidity conditions.

Valorisation involves conversion of toxic compounds into value added products. The present study has tried to evaluate the potential of vermicomposting in management of different types of toxic paper mill wastes such as primary waste (VCP) and secondary waste (VCS) using Eisenia fetida for 60 days. The procedure was performed using sundried samples of paper mill wastes, cow dung and straw in different trial sets using different ratios. The study had revealed that the trial sets (VCP1 and VCS1) using ratio of paper mill waste: Cow dung: Straw (5:4:1) were effective in maintaining physiochemical parameters and different population attributes of earthworm. The present study had also demonstrated the enzymatic enrichment of vermicompost in terms of 19 enzymes such as α-Glucosidase, lipase, leucine aminopeptidase etc. in maintenance of C/N ratio of the compost. A significant reduction of heavy metals were noticed in vermicomposting of primary waste (VCP1) as Zn (40%) ​> ​Pb (36%) ​> ​Cr (28%) ​> ​Cu (25%) and secondary waste (VCS1) as Zn (44%) ​> ​Pb (41%) ​> ​Cu (19%) ​> ​Cr (13%). Such reduction of heavy metal was highly correlated with the reduction of C/N ratio of the vermicompost. The process of bioremediation was further manifested through the regular monitoring of bioaccumulation factor (BAF) among earthworm population in vermicomposting of primary waste (VCP1) as Zn (0.40) ​> ​Cu (0.23) ​> ​Cr (0.18) ​> ​Pb (0.11) and secondary waste (VCS1) as Zn (0.47) ​> ​Cu (0.25) ​> ​Cr (0.21) ​> ​Pb (0.14). Therefore, the study concludes that the ratio of paper mill waste, cow dung and straw (5:4:1) can be an efficient formulation in qualitative enrichment of different toxic organic paper mill wastes through vermicomposting.

Eight contaminants were used to perform a surrogate contamination test to evaluate safety of the process for producing recycled pulp for adult paper diapers. We performed a safety evaluation of the recycling process for producing recycled pulp following the European Food Safety Authority safety assessment for polyethylene terephthalate (PET) bottles using recycled PET. We also compared the first tier safety limit established on the basis of TTC (Climit) in the pulp that contained recycled pulp with residual contaminant concentrations (Cres). If Climit > Cres, there is no concern regarding safety of the recycling process. Climit was determined to be 0.46 mg/kg-pulp based on the human exposure threshold of 0.15 μg/person/day using the scenario in which a bedridden senior citizen uses four adult paper diapers manufactured with pulp containing 10% recycled pulp per day. Cres was derived from the initial concentration in used pulp (0.17 mg/kg-pulp), and decontamination rate was obtained from the surrogate contamination test. The Cres of the eight contaminants were between 0.0017 and 0.10 mg/kg-pulp, which were all below the Climit of 0.46 mg/kg-pulp. These results indicated there was no safety problem regarding this process for producing recycled pulp for adult paper diapers.

This position paper, sponsored by the Asociación Española de Gastroenterología [Spanish Association of Gastroenterology], the Sociedad Española de Endoscopia Digestiva [Spanish Gastrointestinal Endoscopy Society] and the Sociedad Española de Anatomía Patológica [Spanish Anatomical Pathology Society], aims to establish recommendations for performing an high quality upper gastrointestinal endoscopy for the screening of gastric cancer precursor lesions (GCPL) in low-incidence populations, such as the Spanish population. To establish the quality of the evidence and the levels of recommendation, we used the methodology based on the GRADE system (Grading of Recommendations Assessment, Development and Evaluation). We obtained a consensus among experts using a Delphi method. The document evaluates different measures to improve the quality of upper gastrointestinal endoscopy in this setting and makes recommendations on how to evaluate and treat the identified lesions. We recommend that upper gastrointestinal endoscopy for surveillance of GCPL should be performed by endoscopists with adequate training, administering oral premedication and use of sedation. To improve the identification of GCPL, we recommend the use of high definition endoscopes and conventional or digital chromoendoscopy and, for biopsies, NBI should be used to target the most suspicious areas of intestinal metaplasia. Regarding the evaluation of visible lesions, the risk of submucosal invasion should be evaluated with magnifying endoscopes and endoscopic ultrasound should be reserved for those with suspected deep invasion. In lesions amenable to endoscopic resection, submucosal endoscopic dissection is considered the technique of choice.

Paper mill sludge biochar (PMSB) was produced via pyrolysis in a muffle furnace at 750 °C. Subsequently, PMSB was soaked in the HCl solution and washed by deionized water to obtain minerals and organic materials. The organics were named as demineralized paper mill sludge biochar (DPMSB). It was found that PMSB and minerals had larger pore diameters than DPMSB. Also, the removal efficiencies of Cu, Zn and As were above 95.00% by using PMSB and minerals because of the large pores, abundant carbonates and OH groups, while the removal efficiencies of Cu, Zn and As by using DPMSB were 40.92%, 87.93% and 94.99%, respectively, owing to the H + competition to Cu and Zn adsorption but more micropores to enhance As adsorption. The adsorption behavior of PMSB showed that the adsorption isotherms of Cu, Zn and As could be well simulated by the Freundlich model, and the pseudo-second-order model fitted the adsorption kinetics of Zn and As, and the Elovich model fitted the adsorption kinetics of Cu. Moreover, the optimal dosages of PMSB to adsorb Cu, Zn and As were 0.3, 0.3 and 0.1 g/L, respectively. And the pH values of the solution for the efficient adsorption of Cu, Zn and As were 4.00, 6.00 and 2.00, respectively. This work provided basic data for the potential commercial application of PMSB for heavy metals removal from wastewater.

The present study has aimed to evaluate the role of vermitechnology in the qualitative enrichment of compost during the valorization process of solid paper mill wastes. A maximum mass reduction of 77% (primary sludge) and 76% (secondary sludge) were noticed through thermogravimetric (TG) analysis. The biodegradation of complex xenobiotics such as lignin, cellulose, etc. were found in spectral bands of FTIR spectroscopy which had attributed to extent of mineralization among compost samples. A significant correlation between the decrease of the C/N ratio and the rise of the 2921/1633 peak ratio of FTIR had conferred the maturity among vermicompost samples. Furthermore, the presence of different macromolecular humic acid-like substances such as benzene dicarboxylic acid, propanedioic acid, glutaric acid, etc. was found in the vermicompost samples through GC–MS analysis. In addition to such qualitative enrichment, microbial diversity was manifested using PLFA biomarkers which had revealed a huge bottleneck in terms of microbial populaces designating ecological succession upon vermicomposting. Therefore, the present study can be considered as a comprehensive eco-biochemical approach which will open up a new vista the importance in context to paper mill solid waste management.

Summary Skin-interfaced wearable electronics can find a broad spectrum of applications in healthcare, human-machine interface, robotics, and others. The state-of-the-art wearable electronics usually suffer from costly and complex fabrication procedures and nonbiodegradable polymer substrates. Paper, comprising entangled micro- or nano-scale cellulose fibers, is compatible with scalable fabrication techniques and emerges as a sustainable, inexpensive, disposable, and biocompatible substrate for wearable electronics. Given various attractive properties (e.g., breathability, flexibility, biocompatibility, and biodegradability) and rich tunability of surface chemistry and porous structures, paper offers many exciting opportunities for wearable electronics. In this review, we first introduce the intriguing properties of paper-based wearable electronics and strategies for cellulose modifications to satisfy specific demands. We then overview the applications of paper-based devices in biosensing, energy storage and generation, optoelectronics, soft actuators, and several others. Finally, we discuss some challenges that need to be addressed before practical uses and wide implementation of paper-based wearable electronics., Graphical abstract, Biodevices; Bioelectronics; Electronic materials

As a kind of industrial hazardous solid waste, paper mill sludge (PMS) was hard to treated by conventional process because of its high moisture, high organic content and and high environmental risk. The hydrothermal liquefaction (HTL) shows excellent potential for the conversion to a wide variety of organic matter with high water contents including various kinds sludge into fuels or value-added chemicals. In this paper, the liquefaction potential for PMS under different reaction temperatures were investigated, and the products were classified into several main components based on the results of GC-MS. The results showed that the highest yield of bio-oil was 44 % (wt/wt dry PMS without ash) at 340 °C with simply compound composition. And the bio-oil product has above 26 % long chain hydrocarbon and 22 % cycloketones. It has potential for conversion to biomass platform compounds. It can be used as bio-fuel for heat recovery of alkali recovery system of paper mill. So, adjusting different reaction temperatures of HTL, the properties of products can meet the different requirements for platform chemical and/or bio-oil fuel.

Multiple myeloma is the second most common hematological malignancy in the USA and Europe. Despite improvements in the 5-year and overall survival rates over the past decade, older adults (aged ≥65 years) with multiple myeloma continue to experience disproportionately worse outcomes than their younger counterparts. These differences in outcomes arise from the increased prevalence of vulnerabilities such as medical comorbidities and frailty seen with advancing age that can influence treatment-delivery and tolerance and impact survival. In general, geriatric assessments can help identify those patients more likely to benefit from enhanced toxicity risk-prediction and aid treatment decision-making. Despite the observed benefits of geriatric assessments and other screening frailty tools, provider and systems-level barriers continue to influence the overall perception of the feasibility of geriatric assessments in clinical practice settings. Clinical trials are underway evaluating the efficacy and safety of various multiple myeloma therapies in less fit/frail older adults, with a minority examining fitness-based/risk-adapted approaches. Thus, significant gaps exist in knowing which myeloma therapies are most appropriate for older and more vulnerable adults with multiple myeloma. The purpose of this Review is to discuss how geriatric assessments can be used to guide the management of transplant-ineligible patients; and to highlight frontline therapies for standard-risk and high-risk cytogenetic abnormalities [i.e., t(4;14), t(14;16), and del(17p)] associated with multiple myeloma. We also discuss the current shortcomings of the existing clinical approaches to care and highlight ongoing clinical trials evaluating newer fitness-based approaches to managing transplant-ineligible patients.

The main objective of this project was to assess an inkless method to collect reference (exemplar) fingerprints as a low-cost, portable, and hygienic technique; for temporary storage and as an alternative to the conventional black ink method. The tested inkless approach requires alcohol-based hand sanitizer gel as the medium and thermal paper as the substrate. The final quality and clarity of fingerprints were examined and compared between the two methods, especially on the basis of medium/substrate and biological sex effects. Two different evaluation systems of visual quality (clarity) were conducted to provide more reliable results: a quality score scheme (QS) and metrics from the FBI's Universal Latent Workstation (ULW). Fingerprints were obtained from 20 individuals (11 males and 9 females) between the ages of 20 and 40; a total of 240 impressions were evaluated. The results provide evidence that the inkless method produces identifiable fingerprints of equivalent quality to the standard ink method, although significantly better for males. The potential of the proposed technique as an alternative to the conventional ink method is proven and corroborated by the two independent systems of visual quality assessments.

Paper Spray (PS) is an ambient ionisation technique that is conceptually simple, economical, direct and versatile. In its simplest form, the procedure for operation relies on the application of an electric potential to a triangular-shaped paper substrate with the addition of an extraction/spray solvent to generate charge droplets, without requiring any pneumatic assistance. Despite its promise and rapidly growing popularity, there are some practical challenges associated with PS implementation with scope to enhance its performance further. One such challenge relates to only a small fraction of the Taylor cone expansion being sampled at the MS inlet. In this work we propose a new arrangement for PS, which retains the inherent advantages of this popular technique without introducing additional variables, by using an ambient ion focusing lens that is held at the same potential as the paper substrate. A thorough investigation, consisting of visual spray inspection, electric field simulations and analytical evaluation, including analysis of paracetamol from saliva, shows that ambient ion focusing can provide up to a 50% improvement in spray stability, 60% increase in signal intensity and a 30% improvement in detection limits for routine paper spray mass spectrometry analysis.

Most anticancer molecules are administered in body-size-based dosing schedules, bringing up unsolved issues regarding pharmacokinetic data in heavy patients. The worldwide spread of obesity has not been matched by improved methods and strategies for tailored drug dosage in this population. The weight or body surface area (BSA)-based approaches may fail to fully reflect the complexity of the anthropometric features besides obesity in cancer patients suffering from sarcopenia. Likewise, there is a lack of pharmacokinetic data on obese patients for the majority of chemotherapeutic agents as well as for new target drugs and immunotherapy. Therefore, although the available findings point to the role of dose intensity in cancer treatment, and support full weight-based dosing, empirical dose capping often occurs in clinical practice in order to avoid toxicity. Thus a panel of experts of the Associazione Italiana Oncologia Medica (AIOM), Associazione Medici Diabetologi (AMD), Società Italiana Endocrinologia (SIE), and Società Italiana Farmacologia (SIF), provides here a consensus statement for appropriate cytotoxic chemotherapy and new biological cancer drug dosing in obese patients., Highlights • The worldwide spread of obesity is an emerging challenge also in cancer patients • Weight or BSA-based approaches do not adequately address the critical issue of optimal dosing for cancer drugs under obesity • Empirical dose capping is often employed in clinical practice to avoid toxicities among overweight and obese patients • There is a lack of clinical and pharmacokinetic studies in this population • Clinical practice recommendations should guide suitable dosing of cytotoxic and biological cancer drugs in obese patients

Low-cost, flexible and safe battery technology is the key to the widespread usage of wearable electronics, among which the aqueous Al ion battery with water-in-salt electrolyte is a promising candidate. In this work, a flexible aqueous Al ion battery is developed using cellulose paper as substrate. The water-in-salt electrolyte is stored inside the paper, while the electrodes are either printed or attached on the paper surface, leading to a lightweight and thin-film battery prototype. Currently, this battery can tolerate a charge and discharge rate as high as 4 A g−1 without losing its storage capacity. The charge voltage is around 2.2 V, while the discharge plateau of 1.6–1.8 V is among the highest in reported aqueous Al ion batteries, together with a high discharge specific capacity of ∼140 mA h g−1. However, due to the water electrolysis side reaction, the faradaic efficiency can only reach 85% with a cycle life of 250 due to the dry out of electrolyte. Benefited from using flexible materials and aqueous electrolyte, this paper-based Al ion battery can tolerate various deformations such as bending, rolling and even puncturing without losing its performance. When two single cells are connected in series, the battery pack can provide a charge voltage of 4.3 V and a discharge plateau as high as 3–3.6 V, which are very close to commercial Li ion batteries. Such a cheap, flexible and safe battery technology may be widely applied in low-cost and large-quantity applications, such as RFID tags, smart packages and wearable biosensors in the future.

Breastfeeding offers one of the most fundamental global health benefits for babies. Breastmilk is lifesaving, providing not only nutrition but immunologic benefits and as such is strongly supported by the World Health Organization and leading healthcare associations worldwide. When the COVID-19 pandemic started in 2020, the impact of the restrictions to prevent the spread of the disease created challenges and questions about provision of safe, quality care, including breastfeeding practices, in a new 'normal' environment. Mothers were temporarily separated from their babies where infection was present or suspected, parents were prevented from being present on neonatal units and vital breastfeeding support was prevented. This discussion paper provides an overview of essential areas of knowledge related to practice for neonatal nurses and midwives who care for breastfeeding mothers and babies, in the context of the COVID-19 pandemic and the latest global guidance. Three areas will be discussed; the protective benefits of breastfeeding, keeping breastfeeding mothers and babies together and supporting mothers to breastfeed their babies. Finally, care recommendations are presented to serve as a summary of key points for application to practice for neonatal nurses and midwives.