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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.

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.

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.

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.

Writing and presenting results is important for any research work. Publishing is not enough; it should be written clearly and consistently for others to read and cite. We present a review of different techniques, for improving the writing in research papers intended for publishing. These include how to write the title, whether to use active or passive voice, how long sentences should be, how to present the uncertainty, understanding the International System of Units (SI) writing conventions, how to assign authorship, how to effectively use references, how to present the work, and how to publish it in a journal. This paper is a summary of the main and most recent recommendations in the scientific field on how to write a research paper to increase its impact.

The following review paper thoroughly enables the readers to emulate the flexural behavior and impact test method for textile reinforced cementitious composites (TRCCs). The flexural parameters of ECCs corresponding to type of fiber material, fiber volume fraction, fiber volume length and strength parameters were discussed. For the textile reinforcement, the parameters like type of weaving pattern, mesh size, roving tex, fiber volume fraction and number of layers were discussed. Based on the tensile strength of textile fiber material, carbon, AR-glass, aramid and basalt fiber mesh were used for strengthening, repair works, plastering and reinforcement for thin elements. And also, the impact test performance on cementitious concrete composites is addressed as well as methods adopted for finding impact performance are discussed from the numerous literatures. This paper provides summary about the flexural and impact performance of textile fibers introduced into the concrete composites in different mesh sizes and fiber volume fractions. Generally, inclusion of textile fibers gives much more performance in tensile, toughness, flexural, energy absorption capacity and ductility in ECC composites. Many of the researchers have tried with different fiber materials for producing ECC and TRC composites separately, but only few of them used both have been discussed. Finally, from the literatures mostly artificial fibers are used for making textile reinforced composites.

Supercapacitors are favored by researchers because of their high power density, especially with the acceleration of people's life rhythm. However, their energy density, especially from the point of view of the whole energy storage device, is far lower than that of commercial batteries. In this work, a kind of customizable full paper-based supercapacitor device with excellent self-healing ability is fabricated by simple and low-cost screen printing, electropolymerization and dip coating methods. The resultant separator-free supercapacitor device exhibits both ultrahigh gravimetric and areal specific energy (power) densities of 39 Wh kg−1 (69 kW kg−1) and 692 μWh cm−2 (236 mW cm−2), achieving excellent supercapacitor performance. Notably, the addition of vitrimers endows the whole device with outstanding self-healing properties, which is helpful for enhancing the adaptability of the device to the environment. In addition, this kind of paper-based device also displays good photothermal and electromagnetic shielding performances. These striking features make paper matrix composites attractive in the fields of supercapacitors, medical photothermal treatment and electromagnetic shielding.

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.

In recent times, it has been witnessed that wireless systems based on IoT-based have developed rapidly in various sectors. The IoT (Internet of Things) is the network in which physical devices, equipment, sensors and other objects can communicate among themselves without human involvement. The WSN (Wireless Sensor Network) is a central component of the IoT, which has proliferated into several different applications in real-time. The IoT and WSNs now have various critical and non-critical applications impacting nearly every area of our everyday life. WSN nodes are usually small and battery-driven machines. Thus, the energy effective data aggregation techniques that increase the lifespan of the network are highly significant. Various approaches and algorithms for energy-efficient data aggregation in IoT-WSN systems were presented. This paper reviews the literature with specific attention to aspects of wireless networking for the preservation of energy and aggregation of data.

Objective This study collected randomized controlled trials (RCTs) published in the social sciences in China and assessed their risk of bias and reporting quality. Study Design and Setting Three databases were systematically searched for publications from January 2000 to June 2020 for RCTs in the social sciences published by Chinese researchers. The risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool (CCRBT), and reporting quality was assessed using the Consolidated Standards of Reporting Trials for Social and Psychological Interventions (CONSORT-SPI). Results A total of 316 RCTs were identified, including 204 articles in English and 112 articles in Chinese. The most frequently researched interventions focused on education (33.9%), and the most frequently studied population were students (32.9%). Eighty-seven percent of RCTs had intermediate reporting quality. Twenty-four of the 43 CONSORT-SPI sub-items had a compliance rate of less than 50%. Most RCTs had an unclear risk of bias for blinding outcome assessors (84.5%), blinding participants and personnel (82.9%), allocation concealment (73.1%), and random sequence generation (68.0%). A low proportion of CONSORT-SPI items were reported and, high proportion of the papers had unclear risk of bias. Conclusion The quality and reporting of RCTs in the social sciences needs improvement in China, especially for reporting methods and results. Most studies had an unclear risk of bias as they lacked important methodological information.

Causticizing process of pulp and paper mills, is highly energy intensive and environmentally unsafe. We report environmental friendly electro-electrodialysis (EED) process using in-house prepared cation exchange membranes (CEMs) for NaOH production from green liquor solution (GLS) of agro-based paper mills. Different composite CEMs with varied composition of sulfonated graphene oxide (SGO) incorporated sulfonated poly (ether ether ketone) (SPK) were synthesized. Best optimized CEM (SPK-3 with 3.0 wt% SGO loading) exhibited 1.75 mmol·g−1 cation exchange capacity, 32.01% water uptake, 11.41% swelling ratio, conductivity 0.037 S·cm−1, and 0.97 counter-ion transport number with high alkaline and thermo-mechanical stabilities. Industrial GLS was used for NaOH production by EED at 60 mA·cm−2current density. Optimized SPK-3 membrane produced 1.17 mol·L−1 of NaOH with 61.4% current efficiency (η), and 2.58 kW·h·kg−1 energy consumption (EC) during 4 h of EED process. Under similar operating conditions, pristine (SPK), and commercial CEM (FKB-PK-130), showed inferior performance. Longevity of SPK-3 CEM was assessed with industrial GLS for fifty cycles of EED experiments 4 h duration each. Reported results are promising for sustainable NaOH production from industrial GLS of pulp and paper mills, and provide a resourceful alternate for industrial waste.

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.

The use of membranes in integrated water systems has garnered increasing attention in paper mills operating with virgin fibres, with documented closed water loops in industry. However, limited research exists on the performance of ultrafiltration (UF) in mills operating with 100% recycled fibres (RCF) and closed water systems, as these result in the introduction and accumulation of insoluble contaminants in the effluent. This study investigated the effect of transmembrane pressure (TMP) and feed organic load on the flux, types of fouling, and organic separation with UF membranes in a recycled paper mill using 100% RCF. The high feed organic load caused inevitable fouling, limiting the highest achievable flux. However, the TMP could be manipulated to improve on or exacerbate the process performance, within the range that was set as a result of the feed's characteristics. Low TMP (1.35 bar) generated the highest permeability and chemical oxygen demand removal, while higher TMPs produced higher fluxes and recoveries. The process was characterised by high initial fluxes, followed by cake formation, which dominated, and pore blockage. The excess cake formation induced cake filtration. This study shows the potential of UF membranes to be used as pre-treatment in filtering the process water in a recycled paper mill operating with 100% RCF, a critical step forward in implementing an integrated water system, and eventually closing the water loop.

Background Brugada syndrome is a rare inherited arrhythmic syndrome with a coved type 1 ST-segment elevation on ECG and an increased risk of sudden death. Many studies have evaluated risk stratification performance based on ECG-derived parameters. However, since historical Brugada patient cohorts included mostly paper ECGs, most studies have been based on manual ECG parameter measurements. We hypothesized that it would be possible to run automated algorithm-based analysis of paper ECGs. We aimed: 1) to validate the digitization process for paper ECGs in Brugada patients; and 2) to quantify the acute class I antiarrhythmic drug effect on relevant ECG parameters in Brugada syndrome. Methods A total of 176 patients (30% female, 43 ± 13 years old) with induced type 1 Brugada syndrome ECG were included in the study. All of the patients had paper ECGs before and during class I antiarrhythmic drug challenge. Twenty patients also had a digital ECG, in whom printouts were used to validate the digitization process. Paper ECGs were scanned and then digitized using ECGScan software, version 3.4.0 (AMPS, LLC, New York, NY, USA) to obtain FDA HL7 XML format ECGs. Measurements were automatically performed using the Bravo (AMPS, LLC, New York, NY, USA) and Glasgow algorithms. Results ECG parameters obtained from digital and digitized ECGs were closely correlated (r = 0.96 ± 0.07, R2 = 0.93 ± 0.12). Class I antiarrhythmic drugs significantly increased the global QRS duration (from 113 ± 20 to 138 ± 23, p Conclusions Automated algorithm-based measurements of depolarization and repolarization parameters from digitized paper ECGs are reliable and could quantify the acute effects of class 1 antiarrhythmic drug challenge in Brugada patients. Our results support using computerized automated algorithm-based analyses from digitized paper ECGs to establish risk stratification decision trees in Brugada syndrome.

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.

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.

L -dopa is a chiral drug that has been extensively used for the treatment of Parkinson’s disease. The concentration of L -dopa plays a vital role in the treatment, and this work emphasizes on designing a versatile platform for the quantitative and selective detection of L -dopa using reduced graphene quantum dot (rGQD). The platform is efficient in three different sensing methods, viz. fluorescence turn-on, filter paper-based sensing, and electronic measurements. The rGQD undergoes a dramatic fluorescence turn-on in the presence of L -dopa in aqueous media and artificial urine with a detection limit as low as 1.307 µM and 1.217 µM respectively. Experimental evidence revealed that the fluorescence enhancement is attributed to aggregation-induced emission mechanism. The system is also applicable for visual detection of L -dopa using filter paper strips treated with rGQD and develops bright fluorescence under ultra-violet irradiation. Apart from this, electrical sensors for L -dopa were also developed by preparing rGQD treated poly-vinyl alcohol films, and the increase in the current conduction with varying concentrations of L -dopa was observed. The films produce 2.5 order higher current conduction at 300 μM of L -dopa with a detection limit of about 13.136 µM. At the final stage, we have designed flexible electronic devices using these materials that develop 1.3 order higher current for L -dopa. The devices exhibit excellent air stability under varied relative humidity conditions as well as high bending stability for potential practical applications.

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.

nextGEN, a listserv and advocacy collective founded and maintained by graduate students across the international field of writing studies, 1 kairotically begun in response to controversial interactions on the WPA-Listserv in March 2018 (Laughner, 2019; “Where We Are,” 2020; Beare, 2021). Following the release of Vershawn Ashanti Young's 2019 CCCC Call for Papers, the backlash on WPA-L discussed, and in many ways perpetuated, the on-going racialized, linguistic discrimination within writing studies, writ large. As graduate students contributed to these conversations, this situation clearly illustrated their systemic dismissal from disciplinary conversations. In this white paper, we highlight four tactical strategies used by nextGEN since its inception to demonstrate the importance of coalitional literacies in digital advocacy spaces. Finally, we conclude by briefly looking forward to future challenges and possibilities for the next generation of nextGEN. Overall, we offer this argument as a “white paper” because it is our–the authors–understanding and situating of the systemic problems that defined the emergence and early work of nextGEN. 2 We offer readers a specific history, scholarly framework, and model for building and sustaining an international listserv and advocacy space for and by graduate students through coalitional literacies of digital safety and solidarity.

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.

Objectives To present the history and potential for development of evidence-based (EB) social work in China. Study design and setting The conception and methodology of EB social work is a potential strategy to support high quality development of social work in China. This article documents and analyzes the progress of EB social work in China. We focus on current research, reasons, challenges, and strategies. Results EB social work started late in China. The number of EB social work literature and systematic reviews has increased since 2004. The development of EB social work has been uneven nationally with few practitioners and decision makers involved. However, more and more social work researchers received training in evidence-based practice through national workshops and conferences. Conclusion EB social work faced various challenges, but there are now more opportunities for EB social work development in China. Researchers, practitioners, managers and decision makers are encouraged to work together to establish a thorough methodological system and use existing evidence as much as possible when carrying out social work programs and services.

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.

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).

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.

Natural and synthetic alkaloids are widely used for several applications, ranging from clinical purposes to criminal activities. Presumptive color tests are considered a leading tool to reveal on-scene substance identification via rapid chemical reactions that result in visual color changes. Colorimetric tests are popular due to their inherent simplicity, low cost, promptitude and portability; however, in many cases the results of such tests may not be predictable, partly because of the interference from similar species. In this proof-of-concept study, we present a paper-based microfluidic optoelectronic tongue - the so-called μOPTO - comprised of 6 indicators in lieu of one specific test and capable of discriminating 8 different alkaloid drugs (i.e. scopolamine, atropine, cocaine, morphine, ephedrine, caffeine, dipyrone and alprazolam) used for recreational, criminal and medical purposes. The wax printing method was employed to fabricate the microfluidic analytical device with six circular spots for reagent accommodation connected to a centered spot to enable simultaneous reactions with one sample injection. Digital images were obtained using an ordinary flatbed scanner, and the RGB information from before and after sample exposure was extracted using appropriate software. The color changes related to each spot were used to build differential maps with a unique fingerprint for each drug. The chemometric tools (i.e. PCA and HCA) showed suitable discrimination of all studied alkaloids in different quantities. To demonstrate a practical application, different alcoholic beverages spiked with scopolamine - a famous substance that causes drug abuse - were analyzed using the optoelectronic tongue. The results showed that small quantities of the drug were identified in different beverages, demonstrating that our device has the potential to be used in situ to prevent ingestion of contaminated samples.

Herein, we developed a novel, cheap, fast and simple portable sensing platform based on the photoluminescence (PL) quenching effect of paper-incorporated bovine serum albumin protein stabilized gold nanoclusters (BSA-AuNCs) when interacting with Cu ions (Cu2+) from real water samples. First, we demonstrated the sensibility and specificity of the BSA-AuNCs-based sensor for the detection of Cu2+ in solution via PL quenching effect, using a portable fluorescence spectrometer, under 502 nm LED excitation. The limit of detection (LOD) was found to be as low as 0.83 µM. For improved portability and accessibility, the sensing performance of BSA-AuNCs was successfully combined with the unique properties of Whatman paper substrates in order to develop a portable and ready-to-use sensor for the detection of Cu2+ from real water samples. The obtained BSA-AuNCs incorporated paper-based sensing substrate was successfully used for naked-eye detection of Cu2+ levels from water, under UV light, based on the visual detection of PL quenching. We obtained a LOD of 5 µM which was confirmed even for 14 days aged paper sensing substrates. The as-prepared BSA-AuNCs-paper-based sensor was validated for the detection of Cu2+ in different real water samples through the visual examination of the PL quenching on the paper substrates under UV light illumination and relevantly dangerous levels for humans or subaquatic organisms were successfully identified. The newly prepared BSA-AuNCs-incorporated paper-based sensing platform is easy-to-use and presents great promise in the fast, selective, qualitative and semi-quantitative naked-eye detection of Cu2+ in real water samples.

Thermal papers are replacing the conventional form of printing and are being extensively used across the globe. This study encompasses a non-destructive approach to examine thermal papers by using ATR-FTIR spectroscopy and Video Spectral Comparator (VSC), where the former technique helps in characterizing and discriminating different samples and the latter helps in deciphering the faded prints on thermal paper. The qualitative analysis of the spectroscopic data based on peak to peak comparison and quantitative analysis using chemometrics has been done to obtain high discriminating power. Multivariate analysis using HCA gave a discriminating power of 83.82% and PCA showed a variance of 95.64%. The strength of the study is portrayed through the decipherment of artificially and naturally faded thermal papers using VSC and analyzing the effect of different storing conditions on their rate of fading.

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.

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.

The benefits of many breakthroughs in biotechnology, health, and medicine have often been restricted by the high cost and the limited availability of tests and application devices. There is a need for low-cost bioassays for biotechnological applications and health diagnostics. To facilitate quality health care to resource-limited regions, the point-of-care devices needs to be affordable, sensitive, user-friendly, rapid, and robust. Paper is an ideal ingredient to develop disposable bioassay devices. Bioactive papers can be used to develop paper-based analytical devices for clinical diagnosis, assessing organ dysfunction, and detecting infectious diseases and microorganisms. Bioactive papers can also be used as antibacterial papers in healthcare and food packaging. At present the paper diagnostics is a multibillion-dollar market. Considering the product range and applications in health sector the market potential of bioactive papers is very high. Synchronized scientific and industrial research is needed to develop high quality and consistent commercial products from laboratory proof of concept.

The study sought to examine the complexities involved in the implementation of public–private partnerships in the transport sector using the experience of Intercity STC Coaches Limited and private partners in Ghana. The study seeks to contribute to the literature on public–private partnership by examining the implementation challenges associated with the partnership between a public and private transport entities. An exploratory qualitative design through semi-structured interviews and document reviews is adopted for the study. The paper uses the complexity of joint action as the theoretical framework. The study contends that the presence of a challenge, the threat of a challenge or the quest to realize an untapped opportunity offers the basis for a PPP to kick-start. Despite the ideals, there are challenges which impede the effective operationalization of partnerships. These are discussed with clear policy suggestions to address them.

Paper based humidity sensors are low-cost, flexible, and biodegradable. However, the previously reported paper based humidity sensors exhibit poor repeatability, low sensitivity, high drift, and slow response. Here, we reported a new strategy to monolithically fabricate humidity sensor based on porous paper (PPHS) using robust and precise screen and gravure printings. PPHS is highly sensitive, with the maximum 1480% change at 1 kHz and the maximum 411.4% change at 10 kHz in capacitance, respectively. PPHS is highly repeatable (a 1.05% standard derivation in sensitivity for 3 continuous runs) and is stable and insensitive to a mild temperature change (15-30 °C). PPHS rapidly responds (0.8 s) and recovers (0.78 s). PPHS is also highly foldable and twistable. The high repeatability, high sensitivity, quick response/recovery, high foldability/twistability, and good stability of PPHS could be attributable to the combined effects of the high specific surface area of porous paper and the robust and precise printings. By comparison, PPHS is more sensitive than the previously reported paper-based humidity sensors and several humidity sensors fabricated using different substrates, materials, and printings. Due to these unique features, PPHS shows great potential applications in the humidity sensing, the breath detection, the proximity detection, and non-touch switch.

A microfluidic paper-based analytical device (PAD) with both pre-concentration and parallel operation functions is of great promise for sensitive and high throughput detection. In this paper, a fast and multiplexed PAD was designed based on wax-screen-printing with glass fiber paper substrate and validated by image-based colorimetry. Driven by the same DC power supply, parallel electrokinetic stacking with the PAD of 8 channels can be completed within 2 minutes, and each channel can be loaded with different samples. Enrichment factor of 2 orders of magnitude was demonstrated with RSD below 2.5% between the chips and the channels of a chip. Reproducible and multiplexed stacking operations of this PAD provide a solid foundation for online calibration and sample detection on the same chip at the same time. Applications of this PAD was demonstrated by online colorimetric detection of food pigments from beverages and offline MS/MS detection of amino acids from a serum sample. Besides high-throughput and sensitive point-of-care test detection, this PAD method could also find applications for efficient pre-separation and pre-concentration of complex samples.

We report the use of a laser-based fabrication process in the creation of paper-based flow-through filters that when combined with a traditional lateral flow immunoassay provide an alternative pathway for the detection of a pre-determined analyte over a wide concentration range. The laser-patterned approach was used to create polymeric structures that alter the porosity of the paper to produce porous flow-through filters, with controllable levels of porosity. When located on the top of the front end of a lateral flow immunoassay the flow-through filters were shown to block particles (of known sizes of 200 nm, 500 nm, 1000 nm and 3000 nm) that exceed the effective pore size of the filter while allowing smaller particles to flow through onto a lateral flow immunoassay. The analyte detection is based on the use of a size-exclusive filter that retains a complex (∼3 μm in size) formed by the binding of the target analyte with two antibodies each of which is tagged with different-sized labels (40 nm Au-nanoparticles and 3 μm latex beads), and which is larger than the effective pore size of the filter. This method was tested for the detection of C-reactive protein in a broad concentration range from 10 ng/ml to 100,000 ng/ml with a limit-of-detection found at 13 ng/ml and unlike other reported methods used for analyte detection, with this technique we are able to counter the Hook effect which is a limiting factor in many lateral flow immunoassays.