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

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

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

This study's focus was to develop a potential pathway for recycling of the paper mill sludge compost (PMSC) in brick making. Composting reduces the paper mill sludge (PMS) moisture content considerably and shredding becomes easier. The addition of PMSC leads to an increase of porosities in bricks and makes them lighter, besides delivering energy to the firing process from burning organics. Lighter construction materials help minimize construction outlay by reducing labour and transportation costs and lesser expense on foundation construction. The variability in the experimental data and the brick properties were investigated for two types of soils, typical in the brick industry of India (alluvial and laterite soil), blended with PMSC in five mix ratios (0%, 5%, 10%, 15% and 20%). The samples of oven-dried bricks were fired at two different temperatures (850 and 900 °C) in an electrically operated muffle furnace representing typical conditions of a brick kiln. Various properties of bricks were analyzed which included linear shrinkage, bulk density, water absorption and compressive strength. Conclusions were drawn based on these properties. It was found that the addition of PMSC to the alluvial and laterite soil by up to 10% weight yield mechanical properties of fired bricks compliant with the relevant Indian and ASTM codes. Toxicity characteristic leaching procedure (TCLP) tests showed that PMSC incorporated fired bricks are safe to use in regular applications as non-load-bearing and infill walls. This study is timely in light of the European Green Deal putting focus on circular economy. Besides, it fulfills the objective of UN sustainable development goals (SDG). © 2021 Elsevier Ltd

Enzyme use has provided boost to the technoeconomics of many industrial processes. In this chapter, we summarize different cellulase-based industrial processes for preparation of paper, pulp, brewing products, and different foods. This review presents a brief chemistry and mechanism of cellulose degradation by the cellulase enzyme. Also, cellulase production abilities of many microbial species have been addressed in this chapter. Cellulase plays a major role in production of good-quality paper and pulp. It’s used to debark the biomass and to remove lignocellulosic part. This enzyme also has application in recycling of used paper by deinking and biobleaching. Cellulase enhances freeness and drainage ability of the fibers without compromising the brightness of the fibers. In brewing industry, cellulase in combination of other enzymes is used to extract the more sugar for better-quality alcohol production. Cellulases have a wide range of potential applications in food and beverage processing, production of fruit and vegetable juices, and improvement of methods for extraction, clarification, and stabilization.

A simple cellulosic (C6H10O5)n substance, paper has many applications in addition to its use in writing, painting, and packaging. Papers have long been used in analytical chemistry; however, recently, their use in the development of cheaper portable sensors and energy storage devices has been explored. These paper-based environmental sensing devices are providing faster and simpler contaminant detection, along with the removal of sample storage and transportation. In addition to chemical pollutant detectors, the paper-based sensors are also being developed for the gases and volatile compounds. Such paper-based sensors will be very useful in rapid detection of toxic gases during any emergency. . These easy and cheap paper-based devices will be very useful for the developing countries, where environmental pollution concentration is very high and the sophisticated analytical laboratories are not easily accessible. Along with the exponentially increasing in pollution level, our energy demands have also increased by the same pace. Modern-day electronic devices and electric vehicles need robust energy storage devices, and our conventional batteries are not efficient for it. Therefore the supercapacitor has emerged as a solution to this problem; it is a rechargeable, high energy density and quick-release energy storage device, and the use of paper in its development let it to be used in deformable electronic devices.

With the objective to obtain more sustainable production processes, the biorefinery network is integrated with traditional pulp and paper industries. A systematic framework with computer-aided tools consisting of synthesis, design and innovation stages has been applied to determine the biorefinery-integrated pulping process. An integrated network of succinic acid production and black liquor gasification for dimethyl ether (DME) production linked to an existing Soda pulping process is identified as the best option for increased profit, which also reduces pollutant emissions through integration of innovative CO2 capture and utilization (CCU) steps to form the biorefinery-integrated-Soda-pulping network (BIS). This paper aims at also designing a sustainable biorefinery-integrated-Kraft-pulping network (BIK). Three integration scenarios are considered for further study: (I) the production of gasification-based dimethyl ether (DME); (II) the coproduction of DME and succinic acid (SA); and (III) the co-production of DME and SA coupled with CCU. The best scenario is found to be Scenario II, which exhibits the best economic performance with 74% increase in profit compared to the conventional process. Scenario III achieves the highest energy efficiency at 39% and improved environmental performance, a 65% reduction of CO2 emission compared to the conventional process, with only 0.7% profit reduction. The BIK option shows improved performance in terms of economic and environmental improvements compared to the BIS network, confirming that the integrated biorefinery network can transform the conventional Kraft pulping process to a more sustainable process with increased profit.

This work was supported by the research group "Ciencia y Cultura del Patrimonio"(HUM-1057) and the Ministerio de Economia y Competitividad in the framework of the I + D research project "Nuevas alternativas al conocimiento de los materiales y los procesos de conservacion y restauracion de obra grafica y patrimonio documental"(REF.MAT2014-58659-P). Funding for open access charge: Universidad de Granada/CBUA., This study offers a new tool to restorers to bleach paper documents: artificial light radiation (ALR). It is a controlled method that is an alternative to other highly aggressive procedures that have been applied to cellulose based media. Its main novelty is its intrinsic lighting characteristics which guarantee uniformity and avoid heating the paper. The results of testing this new tool were compared to those of bleaching with hydrogen peroxide (H2O2). Each of the two methods was applied to five different types of widely used paper: Arches and Somerset (brands serving for engraving and digital printing), Ingres (drawing), press-type (magazines and newspapers) and Bible-type (historical documents). Once characterised by physico-mechanical, chemical and optical parameters (grammage, thickness, specular gloss, optical properties, air permeance, tensile properties, determining the pH of both surface and aqueous extracts), the different papers were bleached by the two methods according to pre-established criteria. Finally, to determine the evolution and effects of the two treatments, the papers were subjected to accelerated ageing., Research group "Ciencia y Cultura del Patrimonio" HUM-1057, Spanish Government MAT2014-58659-P, Universidad de Granada/CBUA

The handling of cultural heritage objects has become a highly debated topic in the last decade. The work and outcomes described in this paper are aimed to provide objective data to assist in making appropriate decisions as to whether or not wearing gloves is appropriate in a given situation. The forensic fingermark development techniques of 1,2-indandione and single metal deposition II were used to investigate the efficacy of handwashing and glove use to improve the information available when deciding whether to use gloves when handling paper objects. It was found that fingermarks did not permeate through polymer glove types but could through cotton gloves. It was also shown that the amounts of observable fingermark residues were greater 5 min after handwashing than if handwashing had not occurred, undermining previous arguments for not wearing gloves if hands could be washed before object handling., Graphical abstract Image 1, Highlights • Fingermarks can be transferred onto paper even after washing hand. • Developed fingermark residues initially increase after handwashing. • Handwashing is not sufficient to prevent fingermark contamination of artifacts. • Fingermark residues can be transferred from surfaces to gloves to paper. • Some antibacterial gels can increase the amount of fingermark residue deposited.

Tissue paper is defined by its physical and mechanical properties, namely: high softness, low grammage, high bulk and high liquid absorption capacity. It is expected that the production of tissue paper will continue to grow, which increases the importance of better understanding the processes involved in its production as well as its optimization [1] . The experimental data presented in this article, are the physical-mechanical characterization of a group of 13 industrial base tissue papers, which were collected at the end of the tissue paper machine on Portuguese factories. These samples vary in grammage, composition and creping [2] , enabling a later evaluation of the crepe type [3] and its relationship with the final properties of the tissue paper.

Background: Proteins in the urine of women with preeclampsia (PE) bind Congo Red dye (urine congophilia). We sought to determine the diagnostic performance of a paper-based point-of-care test detecting urine congophilia for rapid triage and diagnosis of PE. Methods: Prospective cohort study conducted in 346 consecutive pregnant women evaluated for PE in the Labour and Delivery triage unit at our institution. The Congo Red Dot (CRD) Paper Test (index test) was performed on fresh urine samples. The CRD Paper Test results were compared to an expert adjudicated diagnosis in each case. The accuracy of the CRD Paper Test was also compared to urine and serum analytes (placental growth factor and soluble fms-like tyrosine kinase-1) previously proposed as diagnostic aids for PE. Findings: During the first triage visit, 32% (112/346) of women received a clinical diagnosis of PE. Yet, 63% (217/346) were admitted for in-patient diagnostic work-up or delivery. The CRD Paper Test was positive in 25% (86/346) of the cases. Adjudication confirmed PE in 28% (96/346) of all cases. The CRD Paper Test outperformed measured serum and urine markers (80·2% sensitivity, 89·2% specificity, 92·1% negative predictive value, 86·7% accuracy). The pre-test, positive and negative post-test probabilities were 27·7%, 74·0%, and 8·0%, respectively. Of women who were discharged undelivered, 38% (133/346) had at least one additional triage visit and the interval between the last negative and first positive CRD Paper Test was 12 (interquartile range, [5–34]) days. Interpretation: The CRD Paper Test is a simple, non-invasive, “sample-in/answer-out” point-of-care clinical tool for rapid identification of PE. Funding: Saving Lives at Birth Program and NICHD. Keywords: Preeclampsia, Cohort study, Congophilia, Misfolded proteins, Point-of-care

The progress in the fabrication of carbon-nanotube-based structures has made it possible to use Raman spectroscopy to measure the deformation states of carbon nanotubes and abutting materials. In this work, we investigate the effects of laser power and surrounding materials on the Raman shift of carbon-nanotube (CNT) papers for the laser intensity in a range of 0.071 to 1.415 kW/mm2 without action of mechanical loading. Two different configurations of the CNT papers are used in the Raman measurement; one uses a suspended CNT paper, and the other places a CNT paper on a glass or aluminum substrate. The experimental results reveal that there exist combinational effects of the laser power and abutting materials on the changes of the wavenumbers of the D, G and G′ bands of the CNT papers. We derive an analytical relation between the strain components, temperature and the change of the wavenumber of the Raman peak, which yields a proportional relationship between the change of the wavenumber of the Raman peak and the laser power. Such a relationship is supported by the experimental results.

During the early stages of the COVID-19 pandemic, EASL and ESCMID published a position paper to provide guidance for physicians involved in the care of patients with chronic liver disease. In the meantime, many countries and healthcare systems have been, or are still overwhelmed by the pandemic, significantly impacting on the care of this group of patients, whilst others have started to return towards their usual routine. In addition, many studies have been published focusing on how COVID-19 may affect the liver and how pre-existing liver diseases might influence the clinical course of COVID-19. While many aspects remain poorly understood, it has become increasingly evident that pre-existing liver diseases and liver injury during the course of the disease have to be kept in mind when caring for patients with COVID-19. Thus, this review should serve as an update on the previous position paper summarizing the evidence for liver disease involvement during COVID-19 and also provid, PNN was supported by the National Institute of Health Research (NIHR) Birmingham Biomedical Research Centre (BRC). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

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

According to a recent World Health Organization estimate, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which originated in China in 2019, has spread globally, infecting nearly 100 million people worldwide by January 2021. Patients with chronic liver diseases (CLD), particularly cirrhosis, hepatobiliary malignancies, candidates for liver transplantation, and immunosuppressed individuals after liver transplantation appear to be at increased risk of infections in general, which in turn translates into increased mortality. This is also the case for SARS-CoV-2 infection, where patients with cirrhosis, in particular, are at high risk of a severe COVID-19 course. Therefore, vaccination against various pathogens including SARS-CoV-2, administered as early as possible in patients with CLD, is an important protective measure. However, due to impaired immune responses in these patients, the immediate and long-term protective response through immunisation may be incomplete. The current SARS-CoV-2 pandemic has led to the exceptionally fast development of several vaccine candidates. A small number of these SARS-CoV-2 vaccine candidates have already undergone phase III, placebo-controlled, clinical trials in healthy individuals with proof of short-term safety, immunogenicity and efficacy. However, although regulatory agencies in the US and Europe have already approved some of these vaccines for clinical use, information on immunogenicity, duration of protection and long-term safety in patients with CLD, cirrhosis, hepatobiliary cancer and liver transplant recipients has yet to be generated. This review summarises the data on vaccine safety, immunogenicity, and efficacy in this patient population in general and discusses the implications of this knowledge on the introduction of the new SARS-CoV-2 vaccines.

Background: The cell-based quadrivalent influenza vaccine (QIVc) is now offered as an alternative to egg-based quadrivalent (QIVe) and adjuvanted trivalent (aTIV) influenza vaccines in the UK. While post-licensure studies show non-inferiority of cell-based vaccines, it is not known how its safety profile compares to other types of vaccines in real-world use. Methods: We conducted a retrospective cohort study using computerised medical records from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) sentinel network database. We used a self-controlled case series design and calculated the relative incidence (RI) of adverse events of interest (AEIs) over different risk periods. We then compared the RIs of AEIs within seven days of vaccination overall and between QIVc and QIVe in the 18-64 years age group, and between QIVc and aTIV in the ≥65 years age group. Findings: The majority of AEIs occurred within seven days of vaccination, and a seasonal effect was observed. Using QIVc as the reference group, QIVe showed similar incidence of AEIs whereas live attenuated influenza vaccine (LAIV) and aTIV had lower incidence of AEIs. In the stratified analyses, QIVe and aTIV were associated with a 16% lower incidence of AEIs in the seven days post-vaccination in both the 18-64 years and ≥65 years age groups. Interpretation: Routine sentinel network data allow comparisons of safety profiles of equally suitable seasonal influenza vaccines. The higher incidence of AEIs associated with QIVc suggest monitoring of several seasons would allow robust comparisons to be made.

Highlights • UASB was proposed for RPMW anaerobic treatement under mesophilic conditions. • Start-up up of the UASB reactor was completed in the 24 days. • 80,76 % COD and 90 % TS were removed at an OLR of 7,27 g COD/L d. • At optimal OLR of 8.31 g COD/L d was required to produce 62.51 L/d biogas. • For HRT 15.14 h, after reactor start-up 80.63 % of COD was removed. • The average biogas composition was 72.98 % CH4, 19.76 % CO2, 0.9 % O2., The anaerobic digestion (AD) has become an alternative source and an attractive treatment method. Up-flow Anaerobic Sludge Blanket (UASB) digester has been designed to treat the Recycled paper mill wastewater (RPMW) in Morocco. This paper provides a research on anaerobic digestion of RPMW using UASB technology. The UASB digester was designed following the characterization of wastewater and the feed rate, with the volume of 70 liters. The UASB reactor treating the RPMW was operated for 130 days with minimal overload problems. The experiments were carried out in the mesophilic temperature (37 °C) at different organic loading rates (OLR). A daily analysis was performed to ensure the efficiency of the digester. In this study, the AD experiment was performed in continuous mode with an effluent inlet flow rate equal to 1 L/h. Using the optimal OLR value 5.18 g COD/Ld and with an effluent 5,7 g COD/L, a biogas yield of 92 N mL/g COD removed (at normal temperature and pressure) was obtained during the RPMW anaerobic treatment. The reactor was operated at an optimal hydraulic retention time (HRT) of 15.14 h with a biogas production volume of the optimal value 62.5 L/d. These results indicate that RPMW can be effectively treated in a UASB reactor with the advantage of producing biogas. We tested our system with RPMW, to see the production capacity of the UASB system, which the objective is to develop the system for the industrial scale.

Antibiotic resistance (AR) is becoming a worldwide threat due to the increasing occurrence of antibiotic-resistant pathogenic bacterial strains. There is a general consensus about the potential implications of the use of antibiotics in livestock on the onset of antibiotic resistant bacteria (ARB), mainly through meat consumption. However, the ever-increasing use of reclaimed wastewater (RWW) in agriculture may also contribute significantly to the non-accounted exposure to antibiotics, ARB, and antibiotic resistance genes (ARGs). This position paper aims at evaluating the current knowledge concerning the occurrence of antibiotics, ARBs, and ARGs in edible parts of different common crops irrigated with RWW. We will discuss which regulations on the use of RWW may contribute to the minimization of the prevalence of these contaminants in crops, and provide recommendations on how to minimize the impact of these practices., The authors would like to acknowledge the COST Action ES1403 NEREUS “New and emerging challenges and opportunities in wastewater reuse”, supported by COST (European Cooperation in Science and Technology, www.cost.eu) for enabling the collaboration among the authors of the paper.

Interest in water treatment by electrochemical methods has grown in recent years. Electrochemical oxidation has been applied particularly successfully to degrade different organic pollutants and disinfect drinking water. This study summarizes the effectiveness of the electrochemical oxidation technique in inactivating different primary biofilm forming paper mill bacteria as well as sulfide and organic material in pulp and paper mill wastewater in laboratory-scale batch experiments. Three different electrodes, boron-doped diamond (BDD), mixed metal oxide (MMO), and PbO2, were employed as anodes. The impact on inactivation efficiency of parameters such as current density and initial pH or chloride concentration of synthetic paper machine water was studied. The electrochemical behavior of the electrodes was investigated by cyclic voltammetry with MMO, BDD, and PbO2 electrodes in synthetic paper mill water as also with MMO and stainless steel electrodes with biocides. Some suggestions on the formation of different oxidants and oxidation mechanisms were also presented during the treatment. Aerobic paper mill bacteria species (Deinococcus geothermalis, Pseudoxanthomonas taiwanensis, and Meiothermus silvanus) were inactivated effectively (>2 log) at MMO electrodes by current density of 50 mA/cm2 and the time taken was 3 min. Increasing current density and initial chloride concentration of paper mill water increased the inactivation rate of D. geothermalis. The inactivation order of different bacteria species was M. silvanus > P. taiwanensis > D. geothermalis. It was observed that inactivation was mainly due to the electrochemically generated chlorine/hypochlorite from chloride present in the water and also residual disinfection by chlorine/hypochlorite occurred. In real paper mill effluent treatment, sulfide oxidation was effective with all the different initial concentrations (almost 100% reduction, current density 42.9 mA/cm2) and also anaerobic bacteria inactivation was observed (almost 90% reduction by chloride concentration of 164 mg/L and current density of 42.9 mA/cm2 in 5 min). Organic material removal was not as effective when comparing with other tested techniques, probably due to the relatively low treatment times. Cyclic voltammograms in synthetic paper mill water with stainless steel electrode showed that H2O2 could be degraded to radicals during the cathodic runs. This emphasizes strong potential of combined electrochemical treatment with this biocide in bacteria inactivation in paper mill environments. The results of the experiments showed that electrochemical oxidation could be used in paper mill waters for planktonic bacteria removal. Applying this technique together with some biocides can enhance the oxidation process, keeping the paper mill pipelines clean of slime formed by bacteria. Electrochemical oxidation is also a promising preliminary or tertiary treatment process in pulp and paper mill wastewater treatment, especially against refractory organic compounds which cannot be removed by biological processes.

In the present manuscript, novel effluent treatment processes for pulp and paper mill effluents are divided into two categories: a) those involving the use of chemical additives and b) those which are free of such chemicals. It is especially of high importance for pulp and paper industry to adopt the most efficient and cost-effective treatment methods. This paper critically reviews the recent studies on the treatment of pulp and paper mill effluents while providing suggestions for further studies on the application of various physic-chemical and biological methods for the treatment of such complex effluents containing a number of recalcitrant pollutants. Keywords: Pulp and paper industry, Industrial effluents, Chemical additives, Non-additive treatment processes

Biosensors are promising tools in several areas such as clinical diagnosis, food analyses, environment monitoring, and in other fields, where rapid and reliable analyses are needed. Today they are represented on the market worldwide by an increasing number of paper-based electrodes working in these areas. Paper-based electrodes for glucose monitoring have been commercially available for about 25 years. Apart from glucose monitoring by using paper-based electrodes, commercials tests are now available for metabolites, human chorionic gonadotrophin, C-reactive protein, troponin, myoglobin, human immunodeficiency virus, influenza A and B, streptococcus A, Helicobacter pylori, adenovirus and rotavirus, malaria, tuberculosis, hepatitis A/B/C, and cancer biomarkers measurements in human fluids. Other application points of these paper-based commercial tests are food, environment, and biothreat applications. Such tests are successfully applied in home, office, hospitals, and clinics. In this chapter, the commercial tests used for clinical, food, environmental, and biothreat analyses in global market are reviewed and the specific features of these tests are summarized.

Paper-based sensing platforms are one of the most powerful tools for point-of-care diagnostics. The ease of use while ensuring low production costs of such devices is the key for paper-based technologies to find their way to a successful commercialization. Thus, all steps in the analytical process chain from sample interface, sample preparation, signal amplification to signal transduction and data analysis have to be integrated in a single diagnostic platform. In this chapter, we provide a comprehensive and critical overview on recent developments towards integrated paper-based platforms in academia and industry. Herein, innovative solutions are discussed with respect to their sampling methods such as invasive and non-invasive approaches. We also address the requirements and challenges for the sampling and analysis of the different body fluids. Finally, we present our views about the future perspectives, challenges, and opportunities of the integrated paper-based devices.

This chapter highlights the importance of anaerobic digestion in pulp and paper mill waste (PPMW) treatment. Due to increasing environmental concerns and strict laws about the effluents from industries, it becomes imperative to use such a technology. PPMW contains a vast amount of organic contaminants that are recalcitrant. Postaerobic treatment, a considerable amount of sludge is generated, and to cope up with this, anaerobic digestion, which results in much-reduced sludge volumes, is one of the best methods. Anaerobic digestion of PPMW offers additional benefits through the generation of renewable value-added bioproducts such as biogas, biomethane, biohydrogen, and biofertilizer, along with the treatment of waste. The present chapter describes the importance of anaerobic treatment of PPMW for both sludge and wastewater and the simultaneous generation of value-added products. In the end, the various challenges associated with anaerobic treatment and their mitigation strategies are also discussed.

Current US health policy through the Office of the National Coordinator (ONC) of health information technology (Health IT) of the Department of Health and Human Services ( http://www.healthit.gov/ ) indicates that the standard practice for biomedical engineering (BME) roles in health care will include managing and dealing with comprehensive medical device interoperability with electronic health records. A recent workforce forecast from the US Department of Labor predicts that the United States will have a workforce of 25,000 biomedical engineers by 2022, and another 60,000 technicians and 100,000 related IT staff. This White Paper addresses the limited amount of appropriate curriculum and hands-on laboratory resources among the 87 US university-based BME programs to prepare the field to manage medical device interoperability and fully engage our current workforce for the transitions occurring today. We conclude that the field is not ready for this challenge, but some leading universities have begun this transition. We are ready to assist in this development.

The performance of an amine-based post-combustion CO2 capture and storage (CCS) process in an existing Kraft pulp mill and an existing pulp and board mill was assessed. The pulp and paper industry is an energy-intensive industry, with significant amounts of CO2 emitted onsite. The majority of this CO2 originates from the combustion of biomass, which renders it carbon neutral if the biomass used by the industry is grown and harvested in a sustainable manner. If the CO2 emissions from the pulp and paper industry were to be captured and permanently stored, then this could make the industry a potential carbon sink. In this evaluation, different configurations of capturing CO2 from the flue gases of the recovery boiler, the multi-fuel boiler and the lime kiln were assessed. For a stand-alone Kraft pulp mill, the excess steam available is sufficient to cover the demand from the CO2 capture plant. For an integrated pulp and board mill, there is less excess steam available for the CO2 capture plant and an auxiliary boiler may be required. The retrofit of a post-combustion CO2 capture plant into an existing pulp mill increases the steam demand by 1-8 GJ/air dried tonne (adt) pulp, depending on the volume of the flue gas treated. This translates to a reduction in the amount of electricity exported to the grid by 0.1-1.0 MWh/adt pulp for a stand-alone Kraft pulp mill, and by 0.1-0.5 MWh/adt pulp for an integrated pulp and board mill. The total potential for negative CO2 emissions amounts to just under 2.0 Mt CO2/a both for the market pulp mill and for the integrated pulp and board mill.

Purpose To analyze the 50 most-cited articles pertaining to “Bankart lesions,” also known as anteroinferior labral tears, by means of citation analysis as well as to provide analysis and summary of the origins and trends of research on Bankart lesions. Methods Scopus was used to query the literature on Bankart lesions. Included articles were related to Bankart lesions and the indications, risk factors, techniques, and outcomes of arthroscopic and open Bankart repair. The 50 most-cited articles were analyzed in the following areas: year of publication, citations in the most recent year, total citation count, contributing authors, institutions, countries, and journals, article classifications, and level of evidence. Results Years of publication ranged from 1938 to 2013. There were 608 total citations in the most recent year. Total citation count was 12,441. Regarding country, journal, and authorship, United States, R. A. Arciero, and Arthroscopy were the highest respective contributors. Rush University had the greatest number of publications. The most common article classification was clinical outcomes. Of 49 clinical articles, the most frequent Level of Evidence was IV. The majority of the top 50 Bankart literature consisted of case series and retrospective studies performed in the United States. Conclusions Our findings are consistent with the hypothesis that the 50 most-cited articles about Bankart lesions are predominantly U.S.-based, produced by academic orthopaedic groups, clinical outcomes articles, and of Level IV and V evidence. This list of articles should serve as a reference tool for any orthopaedist looking to review Bankart literature.

Paper mills yield large volumes of sludge materials which pose an environmental and economic challenge for disposal, despite the fact that they could be a valuable source for cellulose nanofibres (CNF) production. The aim of the study was to evaluate the production process and properties of CNF prepared by mechanical fibrillation of never-dried and dried paper mill sludge (PMS). Atomic force microscopy (AFM) showed that average diameters for both never-dried and dried paper sludge nanofibres (PSNF) were less than 50 nm. The never-dried and dried sludge nanofibres showed no statistical significant difference (p>0.05) in strength ∼92 MPa, and ∼85 MPa and modulus ∼11 GPa and ∼10 GPa. The study concludes that paper mill sludge can be used in a dried state for CNF production to reduce transportation and storage challenges posed on industrial scale.

In this work, a granular activated carbon (GAC) was produced using primary paper mill sludge (PS) as raw material and ammonium lignosulfonate (AL) as binder agent. PS is a residue from the pulp and paper industry and AL is a by-product of the cellulose pulp manufacture and the proposed production scheme contributes for their valorisation together with important savings in GAC precursors. The produced GAC (named PSA-PA) and a commercially available GAC (GACN), used as reference material, were physically and chemically characterized. Then, these materials were tested in batch experiments for the adsorption of carbamazepine (CBZ), sulfamethoxazole (SMX), and paroxetine (PAR) from ultra-pure water and wastewater. Even though GACN and PSA-PA possess very similar specific surface areas (S) (629 and 671 m g, respectively), PSA-PA displayed lower maximum adsorption capacities (q) than GACN for the pharmaceuticals here studied (6 ± 1–44 ± 5 mg g and 49 ± 6–106 ± 40 mg g, respectively). This may be related to the comparatively higher incidence of mesopores in GACN, which might have positively influenced its adsorptive performance. Moreover, the highest hydrophobic character and degree of aromaticity of GACN could also have contributed to its adsorption capacity. On the other hand, the performance of both GACs was significantly affected by the matrix in the case of CBZ and SMX, with lower q in wastewater than in ultra-pure water. However, the adsorption of PAR was not affected by the matrix. Electrostatic interactions and pH effects might also have influenced the adsorption of the pharmaceutical compounds in wastewater., This work was funded by FEDER through Compete 2020 and by national funds through FCT by the research project PTDC/AAG-TEC/1762/2014. Vânia Calisto and Marta Otero also thank FCT for a postdoctoral grant (SFRH/BPD/78645/2011) and support by the FCT Investigator Program (IF/00314/2015), respectively. Thanks are also due for the financial support to CESAM (UID/AMB/50017-POCI-01-0145-FEDER-007638), to FCT/MEC through national funds, and the co-funding by the FEDER, within the PT2020 Partnership Agreement and Compete 2020

Paper and pulp industries consume huge amount of resources like wood and water every year and creates large amounts of solid wastes and waste water that have to be treated. Different forms of wastes are produced such as particle, solid, gas, and water during paper production. The developed wastes are usually not treated properly and waste water is mostly allowed to mix with water resources like river. So identification of some suitable methodologies to treat these wastes in an environmental-friendly way and to extract the energy from these wastes is the need of the day. This chapter focuses on the history of paper making, paper making methodologies, forms of waste generated along with their sources, and characteristics followed by the techniques for converting these wastes into useful energy. Incineration, gasification, pyrolysis, anaerobic digestion, and biodiesel production methodologies for converting paper mill wastes into energy are discussed and it is found that anaerobic digestion is a commonly used method for wastewater, whereas incineration is for solid wastes. The possibility of producing biofuels from these wastes was also found as feasible.

Publisher Summary Recovered paper, or waste paper, can come from a number of different sources, including internally at the paper mill. A number of different terms are used to indicate when in the life cycle of the paper that it is returned for recycling. Recovered paper collection is done in a number of different ways, depending on the type of paper being collected and the source of the paper. In general, preconsumer recycled paper is easier to collect as it tends to be concentrated in specific manufacturing locations and also tends to be much more homogeneous. These collections, often of the form of cuttings, trimmings and over issues, are typically baled and packaged directly at the collection site with little additional processing needed. Paper recycling is a key raw material for the papermaking process, representing a significant portion of the fiber used. However, because of the degradation of the fibers through the papermaking and recycling process, the limit to the amount of paper being recycled is slowly being approached. In addition, there are a number of grades of paper that are currently not recycled and will not be in the foreseeable future. This is particularly true for such personal care products such as toweling and tissue. Future improvements in recycling will need to deal mainly with the fiber quality issues.

The process of bioconversion of solid organic wastes through vermicomposting justifies the environmental message for sustainability such as reduce, recycle and reuse of wastes. In the present study, wastes derived from two different types of paper mill sludge (primary and secondary), was used for their bioconversion through the vermicomposting process using an indigenous species of earthworm (Perionyx excavatus). The maturity and stability stage of vermicompost production was assessed using FT-IR, GC-MS and TG analyses. During vermicomposting, different biochemical functional groups present in the wastes have shown differential chemical alteration and turnover as revealed by FT-IR spectroscopy. This study has also confirmed the trend of biodegradation of complex substances like lignin, cellulose, proteins etc. and thereby demonstrates the extent of mineralization. TG spectral analysis had revealed a mass loss of 80% and 71% in vermicompost produced from primary and secondary sludge respectively. GC-MS studies have also shown the presence of several humic acids like octadecanoic acid, heptadecanoic acid etc. in the decomposing substances demonstrating as an indicator of the maturity of products. This was further confirmed by the decrease of humification index which focuses the combined action of both earthworms and microbes in the degradation of organic wastes. The present study has highlighted the role of an indigenous earthworm in converting specific industrial wastes especially by recording the point of maturation using humic acids an indicator of the quality of decomposing of wastes following several instrumental applications.

Paper-based analytical devices (PADs) are simple, convenient, and portable devices that can detect selected substances and quickly display results. PADs are being adopted at increasing rates for use in an expanding array of fields including biochemistry, drug test assaying, and environmental analysis. Compared with traditional analytical methodology, PADs provide several advantages including the following: (1) the capacity for easy mass production; (2) portability; (3) low cost; and (4) small sample volume requirements. These features position PADs as significantly useful tools in rural areas and developing countries, where sophisticated laboratories are limited. In addition to these advantages, PADs offer great potential for integration with the Internet and new artificial intelligence technology. Integrating what may be called “lab-on-a-paper” technology with the Internet of Things offers new opportunities for individuals, in the lab, in the field, and even at home, to carry out advanced examinations and analyses of a variety of things including point-of-care health diagnostics, health status, and environmental quality. In this way, PADs can significantly improve quality of life for a great number of people.

Wireless chemical sensors are increasingly finding use as analytical devices in healthcare diagnostics, wearable sensing (sweat analysis) and in the rapidly emerging area of the Sensor Internet of Things (SIoT). In such wireless scenarios, the application of fluorescence-based sensors is lagging behind other types of transduction mechanisms. In this work a new low-cost and highly portable wireless fluorimeter for optical chemical fluorescence intensity measurements is presented (bill-of-materials approximately €20). The fluorimeter is programmed and communicates wirelessly with mobile devices or personal computers by radio-frequency identification (RFID) or near-field communication (NFC). This novel mobile analytical system is highly adaptable for use with different fluorescent sensor chemistries and analytes. The fluorimeter has been evaluated in the laboratory in two sets of proof-of-concept experiments: firstly fluorimetry in solution, where the fluorescence intensities of fluorescein were recorded, and secondly chloride sensing via a paper-immobilised quinine sulphate fluorescent indicator. The latter represents the first demonstration of wireless (radio-frequency) fluorescence-based chloride sensing. Satisfactory analytical performance was achieved in the entire range of sweat chloride concentrations. The wireless fluorimeter system presented here could make a significant contribution to several emerging areas of mobile chemical sensor research, including wearable sensors for healthcare and sport, mobile point-of-sample diagnostics as well as more generally for the Sensor Internet of Things.

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

This study focused on preparation of microfibers from bamboo culms using steam explosion with and without chemical treatments, and utilization of the isolated fibers in formation of bamboo paper fabricated with nanofibrillated cellulose (NFC). Compared with those obtained from the steam explosion alone (S), the bamboo microfibers isolated using the steam explosion followed by bleaching process (S/A) exhibited a significantly reduced fiber width of 7.5 μm and a markedly increased cellulose content of 97.85%. The S/A fiber showed an increased decomposition temperature, corresponding with lower contents of hemicellulose and lignin than those of the S fiber. The S/A microfibers were subsequently proceeded to paper formation. Physical and mechanical properties of the paper with an introduction of different NFC concentrations (0–50 wt%) were investigated. The linear relationship between the density, porosity and mechanical properties of the paper and NFC contents was observed. The more the NFC content, the greater the density and the lower the porosity the paper exhibited. At 50 wt% NFC, the paper density increased to 0.64 g cm−3, and the paper porosity decreased to 57.0% whereas the paper without NFC showed a density of 0.39 g cm−3 and porosity of 73.6%. Tensile strength and strain of the paper composed with 50 wt% NFC were 10-fold and 3-fold, respectively, greater than those of the paper without NFC. The addition of NFC could manifest paper mechanical properties and porosity within the paper structure, which would be useful for scaffold and membrane applications. Keywords: Bamboo, Mechanical properties, Paper, Nanofibrillated cellulose, Steam explosion, Microfibers, Nanofibers

The use of fibre-based materials as substrates in printed electronics has been increasing, mainly due to its attractive characteristics, such as low-cost or wide availability. Additionally, paper enables recycling and it shows attractive features, such as high thermal stability, when compared to traditional polymer-based substrates (Tobjörk and Österbacka, 2011 [1]). Nevertheless, one of the drawbacks of using paper substrates is that the surface usually is very rough, typically, showing roughness values above 10 μm2. In most cases, printing structures that need to be highly uniform, without disruptions, require additional coating. Inkjet printing provides sharp detail reproduction and strict lines on printed structures. Sintering is required for drying the ink. Thermal sintering is the traditionally used method, but requires long periods of time and promotes the ageing of the paper due to a long exposure at high temperature. When printing conductive structures on paper alternative photonic sintering methods such as IR-sintering show some attractive characteristics. IR-sintering is compatible with roll-to-roll fabrication, providing low-cost, fast and localized sintering, which makes it suitable for fibre-based substrates (Tobjörk et al., 2012 [3]). This work has been carried out to study and compare the efficiency of thermal and IR sintering of conductive structures on different paper and polymer substrates. All substrates were printed using silver based ink, which was applied on the substrate surface by inkjet. Resistivity values of the printed structures were used to compare the performance on the substrates. IR-sintering showed the best results in terms of achieved conductivity of the printed lines when using short sintering time of no more than 10 min. The conductivity values of the inkjet-printed silver lines on Lumi silk substrate reached about 40% of the bulk silver value after IR-sintering, whereas with thermal-sintering this value only reached about 20% of the bulk silver value. IR-sintering improves the sintering process, increasing the conductivity of the printed structures and at the same time reducing significantly the sintering time. In the case of Lumi silk substrate, high conductivity was observed after only two minutes of sintering time when IR-oven was used. Both techniques can be used in a roll-to-roll mass manufacturing process, enabling the fabrication in large scale of flexible electronic devices, on paper substrates, without the need for extra steps, such as coatings.

Background Citation analysis is a commonly used method for appraising the impact of academic publications within a particular field of study. A gap exists in the citation analysis literature with regard to the topic of direct anterior approach (DAA) hip arthroplasty. The purpose of this study is to identify the 50 most frequently cited publications related to this topic. Methods The Clarivate Analytics Web of Knowledge database was utilized to search for publications relating to DAA hip arthroplasty. The top 50 most cited articles that met inclusion criteria were recorded and reviewed for various metrics. Results The top 50 publications were cited a total of 3521 times, with an average of 86.3 total citations per year between 1980 and 2019. 47 of the 50 articles identified had been published since the year 2000. Cohort designs were the most common study type. Conclusions This analysis provides insight into factors that characterize highly cited articles on the specific topic of DAA hip arthroplasty. These factors include higher levels of evidence, recent publication, and origin in the United States. Citations of DAA hip arthroplasty papers appear to be on the rise. The curation and analysis of this set of 50 articles will provide orthopaedic surgery clinicians, researchers, and residency program directors a guide for quickly isolating influential articles on the topic of DAA hip arthroplasty. This may serve as a quick reference for clinical decision-making, foundation for further research, and curriculum on DAA hip arthroplasty.

Background One of the most important part of tissue engineering (TE) is a matrix called scaffold. A good scaffold integrates with the host tissue and support the growth and differentiation of the cells. Collagen is the most abundant protein in the ECM and has been considered to be a group of proteins with a characteristic molecular structure—fibrillar structure, which contributes to the extracellular scaffolding. Objective In this research we study the biocompatibility and attachment of collagen scaffold by measuring the level of availability of mesenchymal stem cell (MSC) cluster from stromal vascular fraction (SVF). Method This study was experimental invitro on MSC culture derived from SVF, with post-test control group design. Biocompatibility was measured by viability of MSC from SVF with marker Propidium Iodine through flowcytometry and electron microscope was used to assess the population density of MSC from SVF by measuring the number of cluster cells seen. Result Oxidize cellulose has the greatest value of MSC cluster with average number of 2003 cell cluster. This result was significant with p, Highlights • Biocompatibility and attachment of collagen scaffold. • Measuring the level of availability of mesenchymal stem cell (MSC) cluster from stromal vascular fraction (SVF). • Experimental in vitro study on MSC culture derived from SVF. • Biocompatibility was measured by viability of MSC from SVF with marker Propidium Iodine through flowcytometry. • Electron microscope was used to assess the population density of MSC from SVF.

Water appears to play several essential roles during manufacture of paper. The quality of fresh water entering a paper machine system can affect both process efficiency and paper quality, contributing to, or being responsible for, various problems. About 85% of the water used in the pulp and paper industry is used for processing, ultimately producing large volumes of contaminated wastewater. All processing cycles in paper production are connected directly or indirectly by water loops. The objectives of the water circuit system are to offer the required volume rate and quality of water for each consumer and to treat and/or bleed out water containing detrimental substances. Water circuits with loop designs and circuit closure are presented in this chapter.

Zeolite nanostructures were used as hosts for dyes normally used in some bioassays (pH and protein), and applied on microfluidic paper-based analytical devices (PADs). The obtained dye nanomaterials were characterized by several techniques (structural (FTIR and XRD), surface (SEM/EDX), textural (N2 adsorption) analyses and dye loading determination by TGA analysis), to confirm the stability of both host and guest. After their deposition on the papers surface, the color change was studied by analyzing the RGB values, taking into account the lifetime and the results stability of the PADs. These results confirmed that both the lifetime and the color change of the modified devices were stable over one week. It was also demonstrated that the choice of the paper for the PAD as well as the zeolite nanostructures properties influences the colorimetric response. This strategy by encapsulating dyes into zeolites solve current challenges in colorimetric sensors in where long-term stability of the colorimetric results is an issue. The results obtained were promising for the studied assays, and the strategy could also be extended to other bioassays., A.R.B. thanks for the ERASMUS+ program to her grant. This work has been developed under the scope of the projects: BioTecNorte (NORTE-01-0145-FEDER-000004), AIProcMat@N2020 (NORTE-01-0145-FEDER-000006), projects supported by Norte Portugal Regional Operational Programme (NORTE 2020), under the Portugal 2020 Partnership Agreement, through the European Regional Development Fund (ERDF). This work also has been funded by ERDF through COMPETE2020–Programa Operacional Competitividade e Internacionalização (POCI), Project POCI-01-0145-FEDER-006984, Associate Laboratory LSRE-LCM and by national funds through FCT, Fundacão para a Ciência e a Tecnologia for project PTDC/AAGTEC/5269/2014 and Centre of Chemistry (UID/QUI/00686/2013 and UID/QUI/0686/2016). The support from the Oslofjordfondet project, «Touchsensor for enklere og raskere urinprøvetaking og analyse (no. 234972)» and NSFC project no. 61650410655 is also acknowledged., info:eu-repo/semantics/publishedVersion