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In Taiwan, the incidence and prevalence of psoriatic arthritis (PsA) have risen significantly in recent years. Moreover, data from the Taiwan National Health Insurance Research Database (NHIRD) show that more than 85% of PsA patients are treated with just non-steroidal anti-inflammatory drugs (NSAIDs) and/or conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). Taiwanese clinicians have also expressed concerns regarding uncertainties in the diagnosis of PsA and the delayed, interrupted, and/or tapered use of biologics, as well as differences in therapeutic preferences between and within dermatologists and rheumatologists. To address these issues, the Taiwan Rheumatology Association and the Taiwanese Association for Psoriasis and Skin Immunology jointly convened a committee of 28 clinicians from the fields of rheumatology, dermatology, orthopedics, and rehabilitation, to develop evidence-based consensus recommendations for the practical management of PsA in Taiwan. A total of six overarching principles and 13 recommendations were developed and approved, as well as a treatment algorithm with four separate tracks for axial PsA, peripheral PsA, enthesitis, and dactylitis. Psoriasis (PsO) management was not discussed here, as the Taiwanese Dermatological Association has recently published a comprehensive consensus statement on the management of PsO. Together, these recommendations provide an up-to-date, evidence-based framework for PsA care in Taiwan.

Background In recent times, the use of thermal papers has increased exponentially and the fingerprints on thermal papers are frequently encountered. Although fingerprint development on paper has been standardized, that on thermal paper is complicated. Thermal papers turn black on the application of heat which poses a problem in the visualization of fingerprints which makes it difficult to visualize. Main body One solution to this problem is to use heat or steam for the development of white fingerprints on darker backgrounds. Second solution might be to dissolve the chemicals present on the surface of the thermal papers using acetone. Many studies to develop fingerprints on thermal papers using iodine fuming, ninhydrin, 1,8-diazofluorene-9-one, and p-dimethylaminocinnamaldehyde have been performed. In the present review, an attempt has been made to summarize the problem posed to fingerprint development on thermal papers and the probable solutions attempted by different authors. Conclusion Although the development of fingerprints is difficult on thermal papers, it can be achieved either by subjecting the thermal paper to controlled heat or by removing the temperature-sensitive layer before treating it with other fingerprint development methods.

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

Introduction. The issue of environmental management and protection of the environment from pollution are of paramount importance. Today, there is a big problem associated with the accumulation of polymer waste, which catastrophically pollutes the planet. Most plastic waste is not recyclable, but can be decomposed in landfills for decades. As an alternative to plastic products, world experts suggest the use of paper, biodegradable (biopolymer), reusable packaging. Many countries are now working to develop and produce packaging from affordable and environmentally friendly and natural materials that can degrade in soil or compost. The purpose of this work is to determine the resistance of paper samples of different densities to microbiological contamination after treatment with bactericidal agent «ADALUX». Objects of research - samples of paper which are widely used in the industry, with a density of 80 g/cm2, 52 g/cm2, 50 g/cm2; liquid bactericidal drug «ADALUX» (hereinafter - the drug) - a disinfectant that does not contain chlorine compounds. Research methods and techniques. The paper samples were treated with a 0.1% solution of the drug in the form of an aerosol and stored at room temperature for a month and monitored. Raw paper samples were stored in the same conditions. The study of samples for microbiological contamination was performed for 7, 14 and 30 days on the following indicators: total microbial count (ТMC), bacteria of the Escherichia coli group (BЕCG), enterococci (EC), fungi and yeast-like microorganisms. The resistance of paper samples to microbiological contamination, or bactericidal properties of the paper treated with the drug, was determined by the following methods: contact (disk), agar filling, artificial contamination of the paper surface - test object - Escherichia coli B (hereinafter - E. coli В). By comparing the number of colonies that grew in the variants with treated and untreated paper samples, the resistance of the test paper samples to high bacterial contamination was determined. Results and discussion. On paper samples that were not treated with an antibacterial agent, growth of saprophytic bacteria (GSB) was observed during the storage period, mold and yeast-like fungi were also found, and a small number of bacteria belonging to the group of E. coli were found. Processing of paper samples with 0.1% solution «ADALUX» provided bactericidal and bacteriostatic properties of the paper. They especially manifested themselves on the day of treatment and after 7 days of storage. Bacteriological crops from the surface of the samples on the day the paper was treated with a bactericidal agent showed a complete absence of microorganisms on the surface of all the studied paper samples. After 7 days of storage, the contamination of the treated samples with saprophytic microorganisms was observed 1.6 - 2.9 times less than in untreated ones. After 14 and 30 days of paper storage, the bactericidal effect against TMC and BЕCG decreased, but the development of bacteria on the surface of the samples was slower than on untreated paper samples. Molds and yeast-like fungi were observed on both processed and untreated paper samples of various densities. Probably, the 0.1% solution «ADALUX» has a more pronounced bactericidal effect, but its fungicidal properties are much less. Microscopic studies of colonies grown on a selective medium for fungi showed a predominance of growth of yeast-like fungi and less mold. On all investigated paper samples (processed and unprocessed), stored for more than 14 days, colonies of microorganisms belonging to spore bacteria were identified. Morphological features and microscopy of the colonies of these microorganisms suggested that they belong to the spore bacteria of the genus Bacillus, tentatively of the species - Bacillus subtilis (hay bacillus), which are widespread in the environment. Due to the ability to form spores, these microorganisms easily tolerate adverse living conditions and continue to live on the surface of the paper. After processing paper samples with «ADALUX» disinfectant (0.1% solution), paper with a density of 80 g/cm2 had the most bactericidal properties, least of all with a density of 50 g/cm2. A study of the resistance of treated paper samples to artificial bacterial contamination with the Escherichia coli B test-object (at a concentration of ~ 103 - 106 cells/ml) showed that after 7 days of storage, there was no growth of the test object on paper samples with a density of 80 g/cm2 and growth retardation on paper samples with a density of 52 g/cm2. Studies of paper samples during storage for 30 days showed that all paper samples (processed and unprocessed) did not have resistance to artificial bacterial contamination upon contact with the test object, which resulted in fouling of paper samples with colonies of E. coli bacteria. Conclusions. Based on the results, it was found that the disinfectant «ADALUX» (chlorine-free) in a concentration of 0.1% has a bactericidal effect when processing paper samples for seven days and bacteriostatic effect (inhibition of bacterial growth) when stored for a month against saprophytic microorganisms and BЕCG, but not very effective against microscopic fungi. It is likely that paper products that have been treated with such a disinfectant, on the one hand, have bactericidal properties for some time, on the other hand, in case of impossibility of recycling after their direct use, as waste can decompose naturally without harming the environment., {"references":["Butko A.E.Ukrainian market for the disposal of polymer waste and key trends in its development. Young Scientist. 2015. № 2 (17). С 139 – 42.","The European Parliament has banned the production and sale of disposable plastic. URL: https://ukr.segodnya.ua/world/europe/evroparlament-zapretil-proizvodstvo-iprodazhu-odnorazovogo-plastika-1243502.html","Deynichenko G. V., Gorєlkov D. V., Dmitrevs'kiy D. V. Reference syllabus of lectures on the subject \"Packaging materials and equipment in the food industry\" [Electronic resource]. Electron. data. Kh .: KhDUHT, 2017.","Lutsenko L. І., Veseliy V. A., Sumakova N. V. Tests of disinfectants for disinfection of invasive elements of helminths in the environment. Veterinary medicine. 2010. Iss. 94. pp. 280-282.","Magiorakos A. P., Srinivasan А., Carey R. B. et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin. Microbiol. Infect. 2012. Vol. 18. P. 268–281.","About claim of the methodical pointing in relation to determination of sensitiveness of microorganisms to antibacterial preparations: order № 167. Operating from 05.04.2007. Kyiv. Ministry of Health Care of the Ukraine. 2007. 63 P.","Methodical recommendations on sanitary and microbiological control of household items and equipment of children's institutions. URL:https://zakon.rada.gov.ua/laws/show/v0024400-77#top","DSTU ISO 8199:2009 Water quality. General guidelines for counting microorganisms in culture (ISO 5667-1:1993, IDT)"]}

Background Paper-analytical devices (PADs) have gained popularity as a simple and low-cost alternative for determining a wide range of analytes including proteins. Even though several colorimetric PADs methods for protein estimation are reported in literature, they lack justification for the chosen method and parameters therein. Aim Major aim of this work was to thoroughly evaluate the most commonly used colorimetric protein assays and recommend the most appropriate method for PADs platform. Method We performed following six colorimetric protein assays on PADs: biuret, lowry, bicinchoninic acid, bradford, bromocresol green, and tetrabromophenol blue. We obtained assay signal by analyzing images of the PADs and then assessed analytical figures of merit. Result Precision, accuracy, LOD, and LOQ of PADs protein assay methods ranged from 1.2 to 6.4%, 73.3–102.4%, 0.3–3.8 ​mg/mL, and 1.2–12.8 ​mg/mL, respectively. Out of six methods, we determined bromocresol green and tetrabromophenol blue as the best methods for serum and urine samples, respectively based on their optimized parameters and analytical figures of merit. The total average serum and urine protein in human samples were found to be 94.6 ​± ​16.2 ​mg/mL and 2.1 ​± ​1.5 ​mg/mL, respectively using PADs methods. The PADs result on human samples moderately correlated with the results from spectrophotometric determination (r2 ​> ​0.6). Conclusion Paper-based protein assays were easy to perform and were completed with thousand-fold less volume of samples/reagents without a spectrophotometer compared to conventional assay methods. After testing human samples, we found one protein assay method may not be appropriate for all types of samples., Highlights • Thorough evaluation of colorimetric protein assays on paper-analytical device. • Bromocresol green and tetrabromophenol blue methods were found to be best suited for serum and urine samples, respectively. • The selected methods are comparable with spectrophotometric assay protocols for human serum and urine samples.

Background and Aim: The development of dental treatments and the long-term maintenance of teeth increased the incidence of complications such as root fractures. Failure to detect root fractures may lead to progressive bone loss and unnecessary treatments. Therefore, an early diagnosis of this complication is important for both the patient and dentist. The role of radiographic examinations in the detection of such lesions is remarkable. The current study aimed at determining the diagnostic accuracy of digital radiography images printed on paper in vertical root fractures and comparing its efficacy with indirect digital radiography. Materials and Methods: The current in vitro study was conducted on 40 extracted human premolars that were fixed by using wax in the sheep mandibular bone. Imaging of the mounted teeth was performed horizontally at 0° and 15° using and X-ray machine (XGenus, De Götzen SRL, Varese, Italy) on the photostimulable storage phosphor (PSP) image plate. Then the teeth were extracted the teeth were extracted from the bony socket of the mandible. After creating a vertical root fracture and fastening the two-piece, the teeth were again fixed with wax in the mandible and indirect digital images were taken under the conditions similar to those of the initial ones All images were processed by Digora Optime (Soredex, Orion Corporation, Helsinki, Finland) and then transferred to Scanora 5.0 (Soredex Corp, Helsinki, Finland). The images were inverted into the desire sized using Scanora, and then all were printed on a silk paper (Fujifilm, São Paulo, Brazil) using a hp color laserjet 1600 printer, 2400 dpi. The images displayed on monitors and printed on papers were separately assessed by two radiologists and the data were analyzed by statistical tests, proportions, and Cochran formula. The agreement between the observers was determined by Kappa index (α=0.05). Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of vertical root fracture detection in images printed on paper were not significantly different from those of indirect digital radiographic images (P>0.05). Conclusion: There were no significant differences between the diagnostic accuracy of indirect digital images (PSP) displayed on monitors and paper printed images in the detection of vertical root fractures. Therefore, in order to detect the vertical root fractures, use of paper printed images can be considered as a complementary method, but not a specific diagnostic method.

Statement of Problem: The destruction of gingival tissue in the interradicular region of multi rooted teeth is called furcation involvement. The correct diagnosis of furcation lesions are the basis of a successful treatment. Purpose: compare the quality of printed images on desirable papers and indirect digital radiography (PSP) in diagnosis of furcation involvements. Materials and Method: Grade I and grade II furcation involvement were artificially created on 41 mandibular first and second molars and PSP radiography was prepared before and after induction of furcation involvement. Radiographs were printed on radiographic plates using Prima laser printer (Fuji, Japan) and on A4-sized papers (silk) using HP color laserjet 1600 printer. Two observers examined the radiographs and their observations were given to the statistics consultant for data analysis. Results: Positive and negative predictive value (PPV and NPV) of grade I, II (together) furcation involvement for PSP was measured as 96.1% and 84.4%, respectively, and for paper print were measured as 100% and 71.9%, respectively, in which there were no significant differences between the two in the PPV (Z=1.5, P ≥ 0.05) and NPV (Z=1.58, P ≥ 0.05). The sensitivities of the plate and paper print in diagnosis of grade I (Z=0, P>0.05) and grade I, II (Z=1.67, P>0.05) were not significant. Although, in grade II (Z=2.03, P ≤ 0.05), the plate sensitivity was significantly higher than paper print. The specificity of plate in comparison to paper print by considering the significant level of Z ≥ 1.96 did not show a significant difference (P ≥ 0.05). Conclusion: In general, it seems that in case of lack of access to radiography plates, the use of paper prints can be a justified and appropriate action, due to its relatively good sensitivity and specificity. However, if you have access to radiography plates, it is certainly preferable to use it. of fit indexes, and very good concurrent validity support utility of this scale for Iranian primary school children.

Institute of Cancer Research (ICR) mice have been widely used in various research fields including toxicology, oncology, pharmacology, and pharmaceutical product safety testing for decades. However, annual tendency of research papers involving ICR mice in various biomedical fields has not been previously analyzed. In this study, we examined the numbers of papers that used ICR mice as experimental animals in the social science, natural science, engineering, medicine-pharmacy, marine agriculture-fishery, and art-kinesiology fields by analyzing big data. Numbers of ICR mouse-used papers gradually increased from 1961 to 2014, but small decreases were observed in 2015 and 2016. The largest number of ICR-used papers were published in the medicine-pharmacy field, followed by natural science and art-kinesiology fields. There were no ICR mouse-used papers in other fields. Furthermore, ICR mice have been widely employed in cell biology studies within the natural science field as well as in biochemistry and pathology in the medicine-pharmacy field. Few ICR mouse-used papers were published in exercise biochemistry and exercise nutrition in the art-kinesiology field. Regardless in most fields, the total numbers of published papers involving ICR mice were higher in 2014 than in other years, although the numbers in some fields including dentistry, veterinary science, and dermatology were high in 2016. Taken together, the present study shows that various ICR stocks, including Korl:ICR mice, are widely employed as experimental animals in various biomedical research fields.

Background Previous research has found that a “web-push” approach to data collection, which involves contacting people by mail to request an Internet survey response while withholding a paper response option until later in the contact process, consistently achieves lower response rates than a “paper-only” approach, whereby all respondents are contacted and requested to respond by mail. Method An experiment was designed, as part of the Millennium Cohort Family Study, to compare response rates, sample representativeness, and cost between a web-push and a paper-only approach; each approach comprised 3 stages of mail contacts. The invited sample (n = 4,935) consisted of spouses married to U.S. Service members, who had been serving in the military between 2 and 5 years as of October, 2011. Results The web-push methodology produced a significantly higher response rate, 32.8% compared to 27.8%. Each of the 3 stages of postal contact significantly contributed to response for both treatments with 87.1% of the web-push responses received over the Internet. The per-respondent cost of the paper-only treatment was almost 40% higher than the web-push treatment group. Analyses revealed no meaningfully significant differences between treatment groups in representation. Conclusion These results provide evidence that a web-push methodology is more effective and less expensive than a paper-only approach among young military spouses, perhaps due to their heavy reliance on the internet, and we suggest that this approach may be more effective with the general population as they become more uniformly internet savvy.

Intoduction: Sterile gauze is one of the medical devices that are often used to prevent infection. Several things, one of them is materials for packaging, can affect the sterility of gauze. Parchment paper is one of the packaging materials for sterilization. The study was done to analyze the sterility of gauze packed with parchment paper one layer and three layers on the growth of microorganism.Method: This study was an experimental study with a quasi-experimental design. Samples were 60 gauze packed with one layer parchment paper and 60 gauze packed with three layers of parchment paper. The sterility of sterile gauze tested at weeks 0, 2 and 4. Results: There was no significant difference in the sterility of gauze packed with 1 layer of parchment paper on the growth of microorganisms at 0, 2, 4 weeks (p = 0.126). No significant difference in the sterility of sterile gauze packed with 3 layers of parchment paper at 0, 2, 4 weeks (p = 0.675). There was a significant difference in the sterility of sterile gauze packed with parchment paper 1 layer and 3 layers on the growth of microorganisms (p = 0.002).Conclusion There is a significant difference of sterile gauze packed with parchment paper 1 layer and 3 layers against the growth of microorganisms. The sterility of the packaged sterile gauze with a layer of parchment paper is better than the three layers.

Clinical research relies on patients being willing to participate in research projects, and making this possible for patients with mental health problems can be a particular challenge. In the modern era, many countries have seen a movement to give a stronger voice to patients both in choices around their care and in how research is conducted. How to achieve effective patient and public involvement (PPI) and to make the patients real partners in this effort is itself a subject of research evaluation. This opinion piece—based on a keynote lecture given at the European General Practice Research Network 2017 autumn meeting in Dublin—describes both the reasons for expanding PPI, how it can usefully be achieved, and how this may relate to the particular context of mental health. There can be moral, methodological or policy reasons for PPI. The three commonest models of good practice in PPI are the ‘one off,’ the ‘fully embedded’ and the ‘outreach’ models. In research into common mental health problems in family practice, ‘outreach’ approaches that minimize commitment over time may work best. ‘Expert patients’ from mental health charities can sometimes play this role. PPI may be challenging and involve extra effort, but the gains for all may be considerable. Wonca Europe networks including EGPRN can extend this message and findings.

Paraquat is a highly toxic herbicide. Paraquat poisoning is often fatal and is an important public health threat in many places. The quick identification and timely initiation of treatment based on timely analysis of the paraquat concentration in urine/serum could improve the prognosis for patients. However, current paraquat concentration measurements are time-consuming and difficult to implement due to the expensive and bulky equipment required. To address these practical challenges, paper-based devices have emerged as alternative diagnostic tools for improving point-of-care testing. In this study, we demonstrate the successful use of a paper-based analytical device for the accurate detection of urine paraquat concentration. The developed paper-based analytical device employs colorimetric paraquat concentration measurements. The R2 value for the urine paraquat standard curve was 0.9989, with a dynamic range of 0&ndash, 100 ppm. The limit of detection was 3.01 ppm. Two other optical-based approaches, Spectrochip and NanoDrop, were used for comparison. The results suggest that the developed paper-based analytical device is comparable to other colorimetric measurements, as determined by Bland&ndash, Altman analysis. The device was clinically validated using urine from six paraquat-poisoned patients. The results prove that the developed paper-based analytical device is accurate, easy-to-use, and efficient for urine paraquat concentration measurement, and may enable physicians to improve clinical management.

Introduction: Scientific output of the Islamic Republic of Iran in Medical Sciences has been increased during recent years as reflected in Scopus database. Moreover, highly cited papers of researchers, institutions and countries can be used in order to study the citation impact and quality of scientific output. The current study investigates the quality of Medical Sciences’ scholarly output of Iran through analysis of its progress in publishing highly cited papers compared to the top 25 most productive countries in the world. Methods: To conduct this study, scientometric indicators were utilized. A total of 45065 papers published by Iranian Medical Science researchers during 2010-2014 and indexed in the Scopus were selected as the sample of the study. The contribution of Iranian researchers and institutions in top 1%, 10% and 25% highly cited papers in the world was studied. Results: Results of the study revealed that 0.35% of the country’s total output in Medical Sciences was among the top 1% most highly cited papers in the world during the time period of this study. This share is 4.9% and 17.39% based on top 10% and 25% citation threshold, respectively. Iran ranked 25th in top 1% as well as 24th in top 10% and 25% by share of highly cited papers, among most 25 productive countries in the world. Although the proportion of highly cited papers in the country’s total output was found to be relatively small compare to other leading countries, but Iran showed the highest growth rate in publication of highly cited papers over 5-year time span Conclusion: Beside the quantity Iran’s scholarly publication in Medical Sciences fields, the quality of these output show the increasing trend based on the share of highly cited papers.

The scientific publication landscape is changing quickly, with an enormous increase in options and models. Articles can be published in a complex variety of journals that differ in their presentation format (online-only or in-print), editorial organizations that maintain them (commercial and/or society-based), editorial handling (academic or professional editors), editorial board composition (academic or professional), payment options to cover editorial costs (open access or pay-to-read), indexation, visibility, branding, and other aspects. Additionally, online submissions of non-revised versions of manuscripts prior to seeking publication in a peer-reviewed journal (a practice known as pre-printing) are a growing trend in biological sciences. In this changing landscape, researchers in biochemistry and molecular biology must re-think their priorities in terms of scientific output dissemination. The evaluation processes and institutional funding for scientific publications should also be revised accordingly. This article presents the results of discussions within the Department of Biochemistry, University of Sao Paulo, on this subject.

Objective Methods to improve informed consent efficiency and effectiveness are needed for pragmatic clinical trials. We compared informed consent using a tablet computer to a paper approach to assess comprehension and satisfaction of patients and clinic staff for a future osteoporosis clinical trial. Methods Nine community-based practices identified and recruited patients to compare the informed consent processes (tablet vs. paper) in a mock osteoporosis clinical trial. The tablet informed consent included an animation summarizing the trial, complete informed consent document, and questions to assess and reinforce comprehension of the study. Participants were women age ≥55 years with ≥1 year of alendronate use. We surveyed participants to assess comprehension and satisfaction and office staff for satisfaction and perceived time demands. Results The nine practices enrolled 33 participants. There was not a significant difference in comprehension between the tablet vs. paper informed consent [mean (SD) tablet: 12.2 (1.0) vs. paper: 11.4 (1.7)]. Office staff preferred the tablet to the paper informed consent for identifying potential study participants (two-sided t-test p = 0.02) despite an increased perceived time spent to complete the tablet process [tablet: 28.3 min (SD 16.3) vs. paper: 19.0 min (SD 6.9); p = 0.08]. Conclusions Although, there were no significant differences in participant satisfaction and comprehension with the tablet informed consent compared to a paper informed consent, patients and office staff trended towards greater satisfaction with the tablet informed consent. Larger studies are needed to further evaluate the utility of electronic informed consent in pragmatic clinical trials.

The diagnosis of Alzheimer’s disease (AD) is frequently missed or delayed in clinical practice. To remedy this situation, we developed a screening, paper-based (P-ELISA) platform to detect β-amyloid peptide 1–42 (Aβ42) and provide rapid results using a small volume, easily accessible plasma sample instead of cerebrospinal fluid. The protocol outlined herein only requires 3 μL of sample per well and a short operating time (i.e., only 90 min). The detection limit of Aβ42 is 63.04 pg/mL in a buffer system. This P-ELISA-based approach can be used for early, preclinical stage AD screening, including screening for amnestic mild cognitive impairment (MCI) due to AD. It may also be used for treatment and stage monitoring purposes. The implementation of this approach may provide tremendous impact for an afflicted population and may well prompt additional and expanded efforts in both academic and commercial communities.

Tablet computers have emerged as increasingly useful tools in medical education, particularly for assessment. However, it is not fully established whether tablet computers influence the quality and/or quantity of feedback provided in high stakes assessments. It is also unclear how electronically-recorded feedback relates to student performance. Our primary aim was to determine whether differences existed in feedback depending on the tool used to record it. Methods We compared quantitative and qualitative feedback between paper-scoring sheets versus iPads™ across two consecutive years of a final year MBChB (UK medical degree) Objective Structured Clinical Examination. Quality of comments (using a validated five-point rating scale), number of examiner comments and number of words were compared across both methods of recording assessment performance using chi-squared analysis and independent t-test. We also explored relationships between student performance (checklist and global scoring) and feedback. Results Data from 190 students (2850 paper scored interactions) in 2015 and 193 (2895 iPad™ scored interactions) in 2016 were analysed. Overall, a greater number of comments were given with iPad™ compared to written (42% versus 20%; p < 0.001) but the quality of feedback did not differ significantly. For both written and electronic feedback, students with low global scores were more likely to receive comments (p < 0.001). Conclusion The use of iPads™ in high stakes assessment increases the quantity of feedback compared to traditional paper scoring sheets. The quantity and quality of feedback for poorer performing candidates (by global score) were also better with iPad™ feedback.

Somatotypic studies and their description of the human morphological configuration allow to appreciate impacts on eating habits and sedentary lifestyle. This study determined the somatotypic difference in Mapuche (NM) and non-Mapuche (NNM) children from Malleco, Chile. Through the ISAK protocol, 160 children with a mean age of 12.5 years, height 145.5 ± 3.5 cm and weight 43.7 ± 3 kg were evaluated, obtaining the following classifications: Group 12 years, Mapuche; mesoendomorphs. Non-Mapuche group 12 years; Endomesomorph. Group 13 years old, Mapuche; Mesoendomorphs. Non Mapuche group 13 years old; endomesomorph. The results indicate that for the age of 12 years, the NM presented lower values of endomorphy and higher values of mesomorphy (p≤0.01) than NNM. The 13-year-old NMs presented lower endomorphy and mesomorphy values (p≤0.01) than NNM. In conclusion, Mapuche schoolchildren present a mesomorphic predominance, however, NNM present a predominance of the endomorphic component.

Objective To investigate the effect of traditional paper operation methods and digital information systems on improving clinical work efficiency. Methodology A number of clinical controlled studies and questionnaire surveys were conducted to evaluate the operation of the hemodialysis information electronic management system, its impact on dialysis work efficiency and dialysis quality, and the satisfaction of doctors and patients, and achieved hemodialysis centers. Electronic information management can save costs and control operating expenses while liberating people and improving work efficiency. Results The information electronic management system helps improve the safety of hemodialysis treatment. With the use of electronic information management, the integrity of the records of hemodialysis medical records has been significantly improved, and the authenticity has been better guaranteed. The implementation rate of doctor’s orders reaches 100%, and medical errors are reduced, making it easier for traceability and quality control. Conclusion The use of digital information system in hemodialysis can improve the work quality and work efficiency of the hemodialysis room and improve the satisfaction of doctors and patients as a whole. Therefore, digital information systems have positive application value in hemodialysis.

Rapid assessment of burn depth is important for burn wound management. Superficial partial-thickness burn (SPTB) wounds heal without scars, but deep partial-thickness burn (DPTB) wounds require a longer healing time and have a higher risk of scar formation. We previously found that DPTB blister fluid displayed a higher angiogenin level than SPTB blister fluid by conventional ELISA. In this study, we developed a paper-based ELISA (P-ELISA) technique for rapid assessment of angiogenin concentration in burn blister fluid. We collected six samples of SPTB blister fluid, six samples of DPTB blister fluid, and seven normal healthy serum samples for analysis. We again chose ELISA to measure and compare angiogenin levels across all of our samples, but we developed a P-ELISA tool and compared sample results from that tool to the results from conventional ELISA. As with conventional ELISA, DPTB blister fluid displayed higher angiogenin levels than SPTB in P-ELISA. Furthermore, our P-ELISA results showed a moderate correlation with conventional ELISA results. This new diagnostic technique facilitates rapid and convenient assessment of burn depth by evaluating a key molecule in burn blister fluid. It presents a novel and easy-to-learn approach that may be suitable for clinically determining burn depth with diagnostic precision.

Background: There is a pressing need for effective education to help develop basic research and publication skills among clinicians in low and middle-income countries (LMIC). Learning from experience is important for achieving understanding of concepts and acquisition of skills rather than simply recall of facts. Methods: An innovative research and academic writing skills course was run for 21 participants from two universities in the Philippines. The experientially-based workshop encouraged development of skills and understanding through active involvement. Interaction with tutors and other participants was integral to the process. The novel workshop design linked various phases of the research process to relevant sections of an academic paper, thus integrating activities usually regarded as separate.This paper outlines the structure of the workshop and reports its evaluation through pre- and post-workshop surveys and post-workshop focus groups. Results: Participants appreciated the integrated format of the workshop and felt more confident in their ability to plan, conduct and write up research. Conclusion: Explicitly linking elements of an academic journal article to the components of developing a research project was successful in promoting learning and understanding of the research process and increased confidence in academic writing in this context and is likely transferable to similar contexts. Keywords: Research skills, Writing skills, Integrated workshop, Learning

Medical education research subjects are incredibly diverse and have changed over time. This work in particular aims to compare and analyze research trends in medical education through the words used in the titles of these research papers. Academic Medicine (the journal of the Association of American Medical Colleges), Medical Teacher (the journal of the Association of Medical Education in Europe), the Korean Journal of Medical Education (KJME), and Korean Medical Education Review (KMER) were selected and analyzed for the purposes of this research. From 2009 to 2018, Academic Medicine and Medical Teacher published approximately 10 to 20 times more papers than the KJME and KMER. Frequently used words in these titles include “medical,” “student,” “education,” and “learning.” The words “clinical” and “learning” were used relatively often (7.80% to 13.66%) in Korean journals and Medical Teacher, but Academic Medicine used these phrases relatively less often (6.47% and 4.41%, respectively). Concern with such various topics as problem-based learning, team-based learning, program evaluations, burnout, e-learning, and digital indicates that Medical Teacher seems to primarily deal with teaching and learning methodologies, and Academic Medicine handles all aspects of medical education. The KJME and KMER did not cover all subjects, as they publish smaller papers. However, it is anticipated that research on new subjects, such as artificial intelligence in medical education, will occur in the near future.

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Paper-based colorimetric biosensors combine the use of paper with colorimetric signal detection. However, they usually demonstrate lower sensitivities because a signal amplification procedure has not been used. Stopping the reaction of colorimetric signal generation is often used in lab-based assays in order to amplify and stabilize the colorimetric signal for detection. In this study, the generation of a stopped colorimetric signal was examined for accurate and enhanced signal detection in paper-based biosensors. The colorimetric reaction in biosensors is usually based on the interaction between the enzyme horseradish peroxidase (HRP) and a selected chromogenic substrate. The two most commonly used HRP substrates, 3, 3&rsquo, 5, 5&rsquo, tetramethylbenzidine (TMB) and 2&rsquo, azinobis (3-ethylbenzothiazoline-6-sulfonic-acid) (ABTS), were compared in terms of their ability to generate a stopped colorimetric signal on membrane. The stopped colorimetric signal was visible for TMB but not for ABTS. Moreover, the generation of stopped colorimetric signal was dependent on the presence of polyvinylidene-difluoride (PVDF) membrane as the separation layer. With PVDF the colorimetric signal (color intensity) was higher (TMB: 126 &plusmn, 6 and ABTS: 121 &plusmn, 9) in comparison to without PVDF (TMB: 110 &plusmn, 2 and ABTS: 102 &plusmn, 4). The TMB stopped colorimetric signal demonstrated a more stable signal detection with lower standard deviation values. To conclude, a stopped colorimetric signal can be generated in paper-based biosensors for enhanced and accurate signal detection.

The study and documentation of occlusal-articulation relationships has a high diagnostic significance in patients with bruxism and bruxomania. The study aims on the basis of registration of occlusal contacts via articulating paper and the T-Scan system to evaluate the advantages and disadvantages of both methods in occlusal diagnosis of patients with bruxism and bruxomania. Material and Methods: 40 patients with bruxism and / or bruxomania (29 women and 11 men) aged between 21 and 77 years from October 2010 to February 2014 was conducted computerized occlusal analysis using the systems T-Scan II (in 12 patients), T-Scan III (in 28 patients) and the software T-Scan III. All patients were subjected to registration of occlusal relationships in centric occlusion (CO) with articulating paper Bausch PROGRESS 100 µ and Bausch® Arti-Fol® 8 µ. Results and Discussion: In 90.0% of patients it is established unevenly distributed, irregular in size and intensity occlusal contacts. Essential factor for preventing the spontaneous bilateral closure with balanced forces is the presence of interceptive contacts and sliding occurring in the first frame of the occlusion time until the maximum intercuspation - MIP. Conclusion: Registration with articulating paper visualizes cumulative picture of the contacts in CO and interceptive contacts without being able to distinguish them in size and time of onset. Computerized occlusal analysis objectively and quantitatively determines interceptive contacts and distinguishes them from contacts in MIP and gives real meaning to the terms "strong" and "light contacts".

Background Monitoring and managing data returns in multi-centre randomised controlled trials is an important aspect of trial management. Maintaining consistently high data return rates has various benefits for trials, including enhancing oversight, improving reliability of central monitoring techniques and helping prepare for database lock and trial analyses. Despite this, there is little evidence to support best practice, and current standard methods may not be optimal. Methods We report novel methods from the Trial of Imaging and Schedule in Seminoma Testis (TRISST), a UK-based, multi-centre, phase III trial using paper Case Report Forms to collect data over a 6-year follow-up period for 669 patients. Using an automated database report which summarises the data return rate overall and per centre, we developed a Microsoft Excel-based tool to allow observation of per-centre trends in data return rate over time. The tool allowed us to distinguish between forms that can and cannot be completed retrospectively, to inform understanding of issues at individual centres. We reviewed these statistics at regular trials unit team meetings. We notified centres whose data return rate appeared to be falling, even if they had not yet crossed the pre-defined acceptability threshold of an 80% data return rate. We developed a set method for agreeing targets for gradual improvement with centres having persistent data return problems. We formalised a detailed escalation policy to manage centres who failed to meet agreed targets. We conducted a post-hoc, descriptive analysis of the effectiveness of the new processes. Results The new processes were used from April 2015 to September 2016. By May 2016, data return rates were higher than they had been at any time previously, and there were no centres with return rates below 80%, which had never been the case before. In total, 10 centres out of 35 were contacted regarding falling data return rates. Six out of these 10 showed improved rates within 6–8 weeks, and the remainder within 4 months. Conclusions Our results constitute preliminary effectiveness evidence for novel methods in monitoring and managing data return rates in randomised controlled trials. We encourage other researchers to work on generating better evidence-based methods in this area, whether through more robust evaluation of our methods or of others.

Purpose. There is no gold-standard health literacy measure. The Single Item Literacy Screener (SILS) and Subjective Literacy Screener (SLS) ask people to self-report ability to understand health information. They were developed in older adults, before common use of electronic health information. This study explored whether the SILS and SLS related to objective literacy, numeracy, and comprehension among young adults, and whether specifying “online” or “paper-based” wording affected these relationships. Methods. Eligible individuals (18–35 years of age, English-speaking, US residents) from an online survey company were randomized to 1) original measures; 2) measures adding “paper-based” to describe health information/forms; or 3) measures adding “online” to describe health information/forms. We examined how each measure related to e-Health Literacy (eHEALS), subjective numeracy (SNS), objective numeracy (ONS), and comprehension of a short passage. Results. A total of 848/1342 respondents correctly answered attention-checks and were analyzed. The validated SILS related to comprehension ( P = 0.003), eHEALS ( P = 0.04), and ONS ( P < 0.001) but not SNS ( P = 0.44). When adding “paper-based,” SILS related to eHEALS ( P < 0.001) and ONS ( P = 0.003) but did not relate to comprehension ( P = 0.25) or SNS ( P = 0.35). When adding “online,” SILS related to comprehension ( P < 0.001), eHEALS ( P < 0.001), ONS ( P = 0.005), and SNS ( P = 0.03). The validated SLS related to comprehension ( P < 0.001), eHEALS ( P < 0.001), ONS ( P < 0.001), and SNS ( P < 0.001). When adding “paper-based,” the SLS only related to eHEALS ( P =

The chemical graft copolymerization reaction of acrylonitrile (AN) and methyl methacrylate (MMA) binary mixture onto paper sheet was performed. The effect of initiator concentration, monomer concentration and temperature on the reaction rate was studied. The reaction rate equation of the graft copolymerization reaction is found to be RP = K2 [Initiator]0.795[Monomer]2.007. The apparent activation energy (Ea) of the copolymerization reaction is found to be 75.01 kJ/mol. The infrared characteristic absorption bands for cellulosic paper structure and the paper gr-AN-MMA are investigated. Tensile break load, porosity and burst strength were measured for the grafted and pure paper sheet. It was found that the mechanical properties are improved by grafting copolymerization. The chemical resistance of the graft product against a strong acid a strong alkali, polar and nonpolar solvents was investigated. It was found that the resistance to these chemicals is enhanced by grafting.

Background Propensity scores are widely used to deal with confounding bias in medical research. An incorrectly specified propensity score model may lead to residual confounding bias; therefore it is essential to use diagnostics to assess propensity scores in a propensity score analysis. The current use of propensity score diagnostics in the medical literature is unknown. The objectives of this study are to (1) assess the use of propensity score diagnostics in medical studies published in high-ranking journals, and (2) assess whether the use of propensity score diagnostics differs between studies (a) in different research areas and (b) using different propensity score methods. Methods A PubMed search identified studies published in high-impact journals between Jan 1st 2014 and Dec 31st 2016 using propensity scores to answer an applied medical question. From each study we extracted information regarding how propensity scores were assessed and which propensity score method was used. Research area was defined using the journal categories from the Journal Citations Report. Results A total of 894 papers were included in the review. Of these, 187 (20.9%) failed to report whether the propensity score had been assessed. Commonly reported diagnostics were p-values from hypothesis tests (36.6%) and the standardised mean difference (34.6%). Statistical tests provided marginally stronger evidence for a difference in diagnostic use between studies in different research areas (p = 0.033) than studies using different propensity score methods (p = 0.061). Conclusions The use of diagnostics in the propensity score medical literature is far from optimal, with different diagnostics preferred in different areas of medicine. The propensity score literature may improve with focused efforts to change practice in areas where suboptimal practice is most common.

Background The Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW) is a prevalent face-to-face interview method for measuring quality of life by integrating respondent-generated dimensions. To apply this method in clinical trials, a paper-administered alternative would be of interest. Therefore, our study aimed to analyze the agreement between the SEIQoL-DW and a paper questionnaire version (SEIQoL-PF/G). Methods In a crossover design, both measures were completed in a random sequence. 104 patients at a heart surgery hospital in Germany were randomly assigned to receive either the SEIQoL-DW or the SEIQoL-PF/G as the first measurement in the sequence. Patients were approached on their earliest stable day after surgery. The average time between both measurements was 1 day (mean 1.3; SD 0.8). Agreement regarding the indices, ratings, and weightings of nominated life areas (cues) was explored using Bland-Altman plots with 95% limits of agreement (LoA). Agreement of the SEIQoL indices was defined as acceptable if the LoA did not exceed a threshold of 10 scale points. Data from n = 99 patients were included in the agreement analysis. Results Both measures led to similarly nominated cues. The most frequently nominated cues were “physical health” and “family”. In the Bland-Altman plot, the indices showed a mean of differences of 2 points (95% CI, − 1 to 6). The upper LoA showed a difference of 36 points (95% CI, 30 to 42), and the lower LoA showed a difference of − 31 points (95% CI, − 37 to − 26). Thus, the LoAs and confidence intervals exceeded the predefined threshold. The Bland-Altman plots for the cue levels and cue weights showed similar results. The SEIQoL-PF/G version showed a tendency for equal weighting of cues, while the weighting procedure of the SEIQoL-DW led to greater variability. Conclusions For cardiac surgery patients, use of the current version of the SEIQoL-PF/G as a substitute for the SEIQoL-DW is not recommended. The current questionnaire weighting method seems to be unable to distinguish weighting for different cues. Therefore, the further design of a weighting method without interviewer support as a paper-administered measure of individual quality of life is desirable.

This position paper is the result of a collaborative approach of several European Specialty Accreditation Boards (ESABs) and, has been stimulated by their current experience in accreditation regarding roles and responsibilities assumed by sponsors of accredited continuing medical education (CME). The suggestions made in this paper aim to preserve the fundamental principle in CME accreditation that the physician in charge of the programme has sole responsibility for the selection of topics, speakers, content and format, as well as mode of presentation, and that sponsors will under no circumstances interfere with this principle. This is considered as a responsibility of an individual physician (or physicians), which cannot be delegated, even in part, to third parties. This responsibility has been extended to include all communication before and after the event. The paper also identifies undecided issues, about which ESABs are committed to elaborate proposals in the future.

Introduction: The current study aimed to investigate the effectiveness of Iranian scientific outputs on common cancers published in PubMed database during 2011-2015. Methods: In this applied, descriptive-analytical study, a scientometrics analysis was used. The study was conducted on all research papers which were written by Iranian scholars on stomach, colon, breast, prostate, and lung cancers and were indexed in PubMed database during 2011-2015. Data were extracted using Altmetrics Bookmarklet tool and analyzed by excel software. Results: According to the findings, the number of articles published by Iranian scholars on stomach, colon, breast, prostate, and lung cancers in 2011 was 25, 40, 88, 20 and 15, respectively. The number of articles on the same subjects in 2015 was 52, 93,256,44, and 32, in that order; however, a small percentage of the research papers were assigned a digital object identifier or had altmetrics scores. Mendeley had the highest proportion among other social networks to represent Iranian scholars’ outputs. Conclusion: Although the rate of scientific publications of Iranian scholars on common cancers has totally increased, they were heterogeneous in terms of quality and Altmetrics score. Therefore, it is recommended that the researchers select journals that assign a digital object identifier to their articles and publish their scientific papers in social media as well.

There is growing recognition of the potential value of human induced pluripotent stem cells (hiPSC) for understanding disease and identifying drugs targets. This has been reflected in the establishment of multiple large-scale hiPSC initiatives worldwide. Representatives of these met recently at a workshop supported by the Welcome Trust in the UK and in a focus session at the 2014 ISSCR annual meeting in Vancouver. The purpose was to discuss strategies for making thousands of hiPSC lines widely available with as few restrictions as possible while retaining financial viability and donor privacy. The outcome of these discussions is described here.

Some considerations on the writing of scientific papers

About paper Level of knowledge about smoking and its relation with oral cavity

Se expone que durante la revisión de informes finales de trabajos de terminación de residencia, se detectan numerosas deficiencias relacionadas con la Metodología de la Investigación, la Bioestadística y otros aspectos de interés; tal situación es multifactorial. Un tutorial que aborde adecuadamente estos temas puede favorecer la calidad de los medios digitalizados, de los cuales opina el autor de este documento.It is stated that during the review of final reports of the residency degree papers, many deficiencies related to the Research Methodology, Biostatistics and other aspects of interest are detected; such a situation is multifactorial. A tutorial to properly address these issues may benefit the quality of the digital media, about which the author of this document writes.

El tipo de materia orgánica presente en el agua residual influye sobre el grado y la complejidad del tratamiento biológico, por lo que el análisis del fraccionamiento de la materia orgánica puede brindar información complementaria para la optimización de los procesos. En esta investigación, se identificaron las fracciones de materia orgánica: biodegradable particulada, biodegradable soluble, no biodegradable particulada y no biodegradable soluble, en el agua residual de una industria papelera y en los efluentes de las unidades que componen la planta de tratamiento de agua residual (clarificador primario, laguna aireada facultativa y laguna de sedimentación). Los resultados mostraron que la fracción no biodegradable representó el 69% de la DQO total del afluente, mientras que la fracción biodegradable significó el 31%. La clarificación primaria desempeñó un papel fundamental en la tratabilidad biológica del agua residual, al reducir significativamente la fracción no biodegradable. La laguna aireada facultativa disminuyó, representativamente, la fracción biodegradable soluble de 44% a 12%, mientras que la laguna de sedimentación desarrolló un efecto de pulimiento sobre el efluente, alterando, principalmente, la fracción particulada. La disminución de la materia orgánica no biodegradable soluble fue especialmente obtenida como resultado de su adsorción sobre la biomasa en la laguna aireada facultativa; la fracción de este tipo de materia orgánica fue adquiriendo mayor protagonismo en el agua residual, a medida que avanzó el grado de tratamiento, incrementado su valor desde 19%, en el afluente, hasta 45%, en el efluente de la laguna de sedimentación.Slowly biodegradable organic matter represents the bulk of organic matter content of pulp and paper mill wastewater which can influence the performance of treatment systems. The organic matter fractionation is a useful tool that generates information for optimize treatment processes of wastewater. Organic matter fractionation study was carried out. Biodegradable soluble, biodegradable particulate, non- biodegradable soluble and non-biodegradable particulate fractions were identifies in effluents of primary clarifier, facultative aerated pond and sedimentation pond. Results of this study show that organic matter non-biodegradable/ total organic matter ratios of the influent were 69% while biodegradable fraction was 31%. Primary clarifi�er removed significantly the non-biodegradable fraction it was key for biological treatment. The biodegradable soluble fraction was mostly removed in facultative aerated pond (44% to 12%). The effluent was polished in the sedimentation pond, mainly particulate organic matter fraction. Only a small percentage of non-biodegradable organic matter was adsorbed by facultative aerated pond biomass, the fraction of this organic matter accounted for 19% in the influent and increased to 45% in the effluent.

Objectives This document provides an English translation of the Israeli Joint Commission’s national guidelines for triaging severely ill patients during the coronavirus disease 2019 (COVID-19) pandemic. Methods Four subcommittees of medical, legal, ethical-social, and religious experts developed the general principles and practical medical criteria for triaging scarce life-saving resources. Results The guidelines provide an overview of general principles as well as pragmatic medical criteria and a practical triage protocol to be followed should the healthcare system be overwhelmed due to COVID-19. Issues covered include triggers for activating the guidelines, guiding ethical, legal, and religious principles, equity in access, fair distribution, transparency, consistency, palliation, medical policy prioritization, problem-solving mechanisms, and public trust. Conclusions The Israeli consensus document and pragmatic medical triage protocol offer a societal and medical roadmap for allocating scarce resources during the COVID-19 pandemic or other disasters.

In recent years we have seen an exponential growth in scientific research aimed at characterising the structure and composition of the microbiota, which colonises various organs and systems. These investigations were supported by the development of very recent microbiological analysis techniques, most of which include molecular methods. In more recent times, however, scientific research has focused more on the study and characterization of relationships between the microbiota and systemic diseases. The purpose of this review is to present the scientific evidence, published from April 2019 to March 2020, on the relationships between oral microbiota and systemic pathologies.

Background: Computer-based examination (CBE) has become increasingly popular as a testing modality in underand postgraduate health sciences education. Since 2013, Prince Sultan military college of health sciences (PSMCHS) has utilized CBE to conduct the preparatory year examination in first year assessments with multiple choice questions, column matching, and the modified essay question paper. Aims: To evaluate the test anxiety levels among students during computer-based and traditional paper-and-pen examination. Settings and Design: The descriptive survey based study was conducted in PSMCHS. Methods and Material: A sample of 199 male and female students of the preparatory year of allied health sciences was selected by random sampling technique. Test anxiety was quantified by using Westside anxiety scale. Statistical analysis: Descriptive statistics were used to analyze data. Mean anxiety scores were compared by unpaired t-test. Results: Of 199 students, 109 (54.8%) and 89 (45.2%) were males and females. A statistically significant decrease in mean anxiety score on WTA scales was observed in students administered with computer-based examination when compared with pen-and-paper based examination (2.48 vs. 3.90; P

The ESPAD (European School Survey Project on Alcohol and Other Drugs) study is carried out in a changing number of European countries every four years since 1995. In 1995, 22 countries participated in the survey and 34 in 2015. Poland participated in all six ESPAD editions. The aim of ESPAD is to target the use of psychoactive substances by schoolchildren, and recently also risk behaviours from the areas of new technologies and gambling. The results are intended to provide data for designing and evaluating policy towards psychoactive substances and what is broadly understood as prevention addressed to youth. The studied population are 15-16 year-old students (at the time of the study). Random-clustered sampling is applied, where clusters are school classes. The recommended sample size is 2400 students, which ensures separate representativity for boys and girls. The study has been realised using a classroom self-administrated questionnaire. Great attention was paid to providing students a sense of security and anonymity. Despite the efforts to ensure full comparability of ESPAD results both between countries and over time, this comparability is still limited.

Leticia Delgado-Herrera,1 Benjamin Banderas,2 Oluwafunke Ojo,2 Ritesh Kothari,3 Bernhardt Zeiher1 1Astellas Pharma Global Development, Inc., Northbrook, IL, 2Adelphi Values LLC, Boston, MA, 3ACCESS Medical LLC, Chicago, IL, USA Background: Subjects with diarrhea-predominant irritable bowel syndrome (IBS-D) experience abdominal cramping, bloating, pressure, and pain. Due to an absence of clinical biomarkers for IBS-D severity, evaluation of clinical therapy benefits depends on valid and reliable symptom assessments. A patient-reported outcome (PRO) instrument has been developed, comprising of two questionnaires – the IBS-D Daily Symptom Diary and IBS-D Symptom Event Log – suitable for clinical trials and real-world settings. This program aimed to support instrument conversion from pen-and-paper to electronic format.Materials and methods: Digital technology (Android/iOS) and a traditional mode of administration study in the target population were used to migrate or convert the validated PRO IBS-D pen-and-paper measure to an electronic format. Equivalence interviews, conducted in three waves, each had three parts: 1) conceptual equivalence testing between formats, 2) electronic-version report-history cognitive debriefing, and 3) electronic version usability evaluation. After each interview wave, preliminary analyses were conducted and modifications made to the electronic version, before the next wave. Final revisions were based on a full analysis of equivalence interviews. The final analysis evaluated subjects’ ability to read, understand, and provide meaningful responses to the instruments across both formats. Responses were classified according to conceptual equivalence between formats and mobile-format usability assessed with a questionnaire and open-ended probes.Results: Equivalence interviews (n=25) demonstrated conceptual equivalence between formats. Mobile-application cognitive debriefing showed some subjects experienced difficulty with font/screen visibility and understanding or reading some report-history charts and summary screens. To address difficulties, minor revisions/modifications were made and landscape orientation and zoom-in/zoom-out features incorporated.Conclusion: This study indicates that the two administration modes are conceptually equivalent. Since both formats are conceptually equivalent, both are psychometrically reliable, as established in the pen-and-paper version. Subjects found both mobile applications (Android/iOS) offered many advantages over the paper version, such as real-time assessment of their experience. Keywords: irritable bowel syndrome diarrhea-predominant, IBS-D, symptoms, mobile ­application, patient-reported outcomes, conceptual equivalence

Background Web-surveys are increasingly used in population studies. Yet, web-surveys targeting older individuals are still uncommon for various reasons. However, with younger cohorts approaching older age, the potentials for web-surveys among older people might be improved. In this study, we investigated response patterns in a web-survey targeting older adults and the potential importance of offering a paper-questionnaire as an alternative to the web-questionnaire. Methods We analyzed data from three waves of a retirement study, in which a web-push methodology was used and a paper questionnaire was offered as an alternative to the web questionnaire in the last reminder. We mapped the response patterns, compared web- and paper respondents and compared different key outcomes resulting from the sample with and without the paper respondents, both at baseline and after two follow-ups. Results Paper-respondents, that is, those that did not answer until they got a paper questionnaire with the last reminder, were more likely to be female, retired, single, and to report a lower level of education, higher levels of depression and lower self-reported health, compared to web-respondents. The association between retirement status and depression was only present among web-respondents. The differences between web and paper respondents were stronger in the longitudinal sample (after two follow-ups) than at baseline. Conclusions We conclude that a web-survey might be a feasible and good alternative in surveys targeting people in the retirement age range. However, without offering a paper-questionnaire, a small but important group will likely be missing with potential biased estimates as the result.

Engineering has been playing an important role in serving and advancing healthcare. The term “Healthcare Engineering” has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of “Healthcare Engineering” remains ambiguous. The purpose of this position paper is to present a definition of Healthcare Engineering as an academic discipline, an area of research, a field of specialty, and a profession. Healthcare Engineering is defined in terms of what it is, who performs it, where it is performed, and how it is performed, including its purpose, scope, topics, synergy, education/training, contributions, and prospects. Published version

Introduction: After the era of paper health record, in 2002 standard questionnaires for chronic patients were collected and registered by a hospital nurse. Since then, our electronic health record has been evolving. Nowadays the same electronic health record (eHR) is shared by the whole public health system that attends 2 million people, nursing homes included. The next step forward comes with the creation of standard questionnaires within an “Integral Program Manager”, this meaning that relevant information of the patient will be registered and analyzed giving identical recommendations in any setting (primary care, specialist or hospital) in a given clinical change. This will lead to “message reconciliation” in the system avoiding contradictions and helping educate and empower the patients for self-control. The creation of the personal health record and the new technologies (smartphones) will enable patients to fill the questionnaires by themselves. Description of practice change implemented: Change of paper based fragmented health record to an electronic and integrative one. Aim: Same electronic health record, questionnaires and recommendations in different settings Target population: All patients, but specially: - Pluripathological patients - Home-dependent patients - Nursing home residents - End of life patients Timeline: *Until 1996: health record on paper. *1996-2000: some reports are digitalized and the copy is carried by the patient. *2000-2009: basic electronic health record, different for primary care *Since 2002: assessment questionnaires for heart failure and COPD by phone by a case management nurse *2009-2012: health care based on an electronic health record, but different for hospital and primary care. Beginning of a electronic prescription tool (same for all) *Since 2012: creation of personal health records for patients *2012-2018: integrative electronic health record accessible for all healthcare workers, old paper reports are digitalized, warnings (allergies e.g.), same prescription tool (“Presbide”). *Since 2018: beginning of electronic application forms including those for pluripathological patients. Beginning of the “Integral Program Manager” to suggest recommendations according to clinical changes registered in the application forms. Highlights: -Creation of the electronic health record. -Computer integration: only one electronic health record -Healthcare integration: same questionnaires for all pluripathological patients (generic and specific disease related application forms). Information collected in any setting (call center, primary care physician or hospital) and creation of recommendations accordingly (by the “Integral Program Manager”) leading to remote treatment adjustment, face-to-face assessment in primary care or direct hospital admission. Sustainability: The unification of theelectronic health record reduces maintenance costs and those related to the lack of coordination. Transferability: Transferable for all health services with compatible information systems. Conclusions: Integrative electronic health record and healthcare process with the same questionnaires and recommendations are desirable for a coordinated health care, especially for multipathological patients. Discussion: The new technologies should allow patients to choose the easiest way to fill in control questionnaires by themselves. Lessons learned: This process is not easy because apart from the technical difficulties requires important habit changes, but is the only way to achieve our goals.

Background Neurological injuries remain the leading cause of death in comatose patients resuscitated from out-of-hospital cardiac arrest (OHCA). Adequate blood pressure is of paramount importance to optimize cerebral perfusion and to minimize secondary brain injury. Markers measuring global cerebral ischemia caused by cardiac arrest and consecutive resuscitation and reflecting the metabolic variations after successful resuscitation are needed to assist a more individualized post-resuscitation care. Currently, no technique is available for bedside evaluation of global cerebral energy state, and until now blood pressure targets have been based on limited clinical evidence. Recent experimental and clinical studies indicate that it might be possible to evaluate cerebral oxidative metabolism from measuring the lactate-to-pyruvate (LP) ratio of the draining venous blood. In this study, jugular bulb microdialysis and immediate bedside biochemical analysis are introduced as new diagnostic tools to evaluate the effect of higher mean arterial blood pressure on global cerebral metabolism and the degree of cellular damage after OHCA. Methods/design This is a single-center, randomized, double-blinded, superiority trial. Sixty unconscious patients with sustained return of spontaneous circulation after OHCA will be randomly assigned in a one-to-one fashion to low (63 mm Hg) or high (77 mm Hg) mean arterial blood pressure target. The primary end-point will be a difference in mean LP ratio within 48 h between blood pressure groups. Secondary end-points are (1) association between LP ratio and all-cause intensive care unit (ICU) mortality and (2) association between LP ratio and survival to hospital discharge with poor neurological function. Discussion Markers measuring cerebral ischemia caused by cardiac arrest and consecutive resuscitation and reflecting the metabolic changes after successful resuscitation are urgently needed to enable a more personalized post-resuscitation care and prognostication. Jugular bulb microdialysis may provide a reliable global estimate of cerebral metabolic state and can be implemented as an entirely new and less invasive diagnostic tool for ICU patients after OHCA and has implications for early prognosis and treatment. Trial registration ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT03095742). Registered March 30, 2017. Electronic supplementary material The online version of this article (10.1186/s13063-019-3397-1) contains supplementary material, which is available to authorized users.

Background and purpose : The methodological aspects, as well as the quantity of papers published in a scientific journal are important factors regarding its periodic evaluation. The study was conducted by Mazandaran Thalassemia Research Center, Sari Iran.Materials and methods : This descriptive study was conducted on all issues published to the date. A questionnaire consisted of 48 items was prepared according to authors instruction of the journal and educational workshops and the reference booklet. Validity of the questionnaire was achieved through expert consultations and reliability by test –re test method.Four hundred and seven papers were evaluated in 2 groups. The 1st group (n=43) consisted papers published in volumes 1-12, from 1992-1995. The second group n=364 was divided in two subgroups, each consisted of 182 articles, according to dates of publications.Descriptive statistics was used to show the data.Results : Papers in the 1st group were mainly case reports, translations and nonsystematic reviews. Original researches were exceptional. In second group, however, descriptive, clinical trials and experimental designs were mainly.Used by researchers. The time gap between the research and issue date in 3 periods were 1±1.6, 1.34±1.5 and 1.22±1.3 years respectively. The number of references of each article was significantly more in the recent period (P

Department of Emergency Medicine, Sapienza University, Post Graduate School in Emergency-Urgency Medicine, Sant’Andrea Hospital, Rome, Italy University of North Dakota School of Medicine and Biomedical Sciences Grand Forks, ND, USA Department of Medicine, University of Padova, Italy Department of Emergency Medicine, Cleveland Clinic, Cleveland, OH, USA Department of Nephrology, Dialysis and Dietology, SM della Misericordia Hospital, Rovigo, Italy Cardiovascular Department, San Filippo Neri Hospital, Rome, Italy Department of Nephrology Dialysis and Transplantation, International Renal Research Institute (IRRIV), San Bortolo Hospital, Vicenza, Italy GREAT: Global Research in Acute Conditions Team Network

The paper-and-pencil digit-comparison task for assessing negative priming (NP) was introduced, using a referent-size-selection procedure that was demonstrated to enhance the effect. NP is indicated by slower responses to recently ignored items, and proposed within the clinical-experimental framework as a major cognitive index of active suppression of distracting information, critical to executive functioning. The digit-comparison task requires circling digits of a list with digit-asterisk pairs (a baseline measure for digit-selection), and the larger of two digits in each pair of the unrelated (with different digits in successive digit-pairs) and related lists (in which the smaller digit subsequently became a target). A total of 56 students (18-38 years) participated in two experiments that explored practice effects across lists and demonstrated reliable NP, i.e., slowing to complete the related list relative to the unrelated list, (F(2, 44) = 52.42, P < 0.0001). A 3rd experiment examined age-related effects. In the paper-and-pencil digit-comparison task, NP was reliable for the younger (N = 8, 18-24 years) and middle-aged adults (N = 8, 31-54 years), but absent for the older group (N = 8, 68-77 years). NP was also reduced with aging in a computer-implemented digit-comparison task, and preserved in a task typically used to test location-specific NP, accounting for the dissociation between identity- and spatial-based suppression of distractors (Rao R(3, 12) = 16.02, P < 0.0002). Since the paper-and-pencil digit-comparison task can be administered easily, it can be useful for neuropsychologists seeking practical measures of NP that do not require cumbersome technical equipment.