Search

Abstract Flax (Linum usitatissimum) is a bast fiber plant known for its long fibers, making it an excellent source of pulp for paper production. In Ethiopia, flax is primarily cultivated for oil, with the residual straw utilized for papermaking. This study focuses on pulping flax straw using the Kraft process and investigates its chemical composition, proximate analysis, and morphological properties. The proximate analysis revealed an ash content of 4.13% and moisture content of 11%. Chemical composition analysis showed cellulose at 51.34%, hemicellulose at 25.20%, lignin at 14.12%, ash at 4.13%, and extractives at 5.21%. The morphological properties included a fiber length of 1.41 mm, diameter of 16.78 μm, lumen width of 9.45 μm, and cell wall thickness of 3.77 μm. Flax straw exhibited an acceptable Runkel ratio (0.8) and flexibility coefficient (56.32), placing it within the range of non-wood fibers. SEM analysis of the pulp’s morphology was conducted to assess fiber structure, including the presence of cracks. Pulp quality and length are directly linked to paper strength. Various pulping conditions were studied using a full-factorial design, with optimum conditions being 10% alkaline, 131.74°C, and 120 min of cooking time, yielding a pulp with a Kappa number of 10.45 and a yield of 40.56%. The resulting paper demonstrated standard tensile, tearing, and burst strengths, indicating that flax straw is a promising raw material for paper production.

Abstract Electrochemical analysis of glucose monitoring without painful blood collection provides a new noninvasive route for monitoring glucose levels. Thus, in this study, biobased cellulosic papers (methylated and phosphorylated one) based glucose monitoring sensor is developed. To achieve high hydrophilicity, microfibrillated cellulose (MFC) were functionalized using hexokinase mediated phosphorylation (–OH to – $$\text{SO}_{3}^{2-}$$ ). The instinctive increased surface charge density from 36.2 ± 3.4 to 118.4 ± 1.2 µmol/g and decrease contact angle (45°–22°) confirms the increased hydrophilicity of paper. Furthermore, functionalized phos-MFC paper increase the capillary flow of sweat, required low quantity (1 µl) of sweat for accurate analysis of glucose level. Additionally, chemically induced methyl groups (–CH3) make the sensor more barrier to other chemicals. In addition, a multilayer patch design combined with sensor miniaturization was used to lead to an increase in the efficiency of the sweat collection and sensing processes. Besides, this paper sensor integrated with artificial transdermal drug delivery unit (agarose gel as skin) for monitoring glucose levels in sweat. The patch monitoring system increase the accuracy of sensing with fluctuation in sweat vol. (1–4 µl), temperature (20–70 °C), and pH (4.0–7.0). In addition, temperature dependency artificial transdermal delivery (within agarose gel) of drug metformin agrees the measurement accuracy of sensor, called “switch system” without any error. As a result, the reported MFC paper based multi-patch disposable sensing system provides a novel closed-loop solution for the noninvasive sweat-based management of diabetes mellitus.

Abstract The pulp and paper industry generates vast quantities of paper sludge, posing significant environmental challenges due to its disposal in landfills or incineration. This study explores the potential of valorizing paper sludge by incorporating it into particleboard production. It aims to optimize sludge content and particle size to enhance board properties—a novel approach to waste management in the wood composites industry. Through systematic variation of sludge content (0–25%) and particle size ( 2 mm), we assessed the mechanical and physical properties such as internal bond strength (IB), modulus of rupture (MOR), modulus of elasticity (MOE), water absorption (WA), and thickness swelling (TS). The findings indicate that incorporating paper sludge at moderate levels (5–15%) with optimized particle sizes (

Abstract This work proposed an approach to multi-component non-metallic materials, namely regular polygonal paper honeycomb sandwich tubes filled with polyethylene (PE) foam, and focused on the influence of drop impact parameters and structural parameters on the deformation characteristics and energy absorption of the filled tubes. Axial drop impact tests were employed to exert drop impact loading on cross-sections of the specimens with a square drop weight. The results showed that the X-direction filled tube (X-DFT) had a higher crushing strength and yield strength than that of the Y-direction filled tube (Y-DFT). As the tubular cross-section edge number of the filled tube increased, the specific energy absorption (SEA) and specific total efficiency (STE) decreased. Under the same axial drop impact loading conditions, the SEA and STE of the X-DFT were superior to those of the Y-DFT. As the edge number of the tubular cross-section or the tubular length ratio increased, the SEA and STE of the filled honeycomb tube decreased significantly. While the impact energy increased, the SEA and STE of the filled tubes increased approximately linearly. This work investigated the influence of drop-impact and structural parameters on deformation characteristics and energy absorption. It is expected to provide supplementary documentation for the advancement of cushion protection technology and the optimization of product structure.

Abstract Nucleic acid amplification testing has great potential for point-of-need diagnostic testing with high detection sensitivity and specificity. Current sample preparation is limited by a tedious workflow requiring multiple steps, reagents and instrumentation, hampering nucleic acid testing at point of need. In this study, we present the use of mixed cellulose ester (MCE) paper for DNA binding by ionic interaction under molecular crowding conditions and fluid transport by wicking. The poly(ethylene) glycol-based (PEG) reagent simultaneously provides the high pH for alkaline lysis and crowding effects for ionic binding of the DNA under high salt conditions. In this study, we introduce Paper-based Abridged Solid-Phase Extraction with Alkaline Poly(ethylene) Glycol Lysis (PASAP). The anionic mixed cellulose ester (MCE) paper is used as solid phase and allows for fluid transport by wicking, eliminating the need for pipetting skills and the use of a magnet to retain beads. Following the release of DNA from the cells due to the lytic activity of the PASAP solution, the DNA binds to the anionic surface of the MCE paper, concentrating at the bottom while the sample matrix is transported towards the top by wicking. The paper was washed by dipping it in 40% isopropanol for 10 s. After air-drying for 30 s, the bottom section of the paper (3 mm × 4 mm) was snapped off using the cap of a PCR tube and immersed in the colourimetric loop-mediated isothermal amplification (cLAMP) solution for direct amplification and colourimetric detection. The total sample processing was completed in 15 min and ready for amplification. cLAMP enabled the detection of 102 CFU/mL of Escherichia coli (E. coli) from culture media and the detection of E. coli in milk

Abstract The paper industry is a major environmental polluter due to paper waste sludge (PWS), often disposed of in hazardous ways. The techniques are employed to disposing of PWS are posing significant environmental hazards and risks to well-being. This study aims to evaluate PWS as a potential replacement for commercial adsorbents like AC and ZEO in treating stabilized leachate. Contact angle analysis of PWS was 92.60°, reveals that PWS to be hydrophobic. Batch adsorption experiments were conducted with parameters set at 200 rpm stirring speed, 120 min contact time, and pH 7. Optimal conditions for COD and NH3–N removal were identified at 120 min contact time, 200 rpm stirring speed, pH 7, and 2.0 g PWS ratio. Removal percentages for COD and NH3–N were 62% and 52%, respectively. Based on the results of the isotherm and kinetic studies, it was observed that the Langmuir and Pseudo second order (PSO) model exhibited greater suitability compared to the Freundlich and Pseudo first order (PFO) model, as indicated by higher values of R-squared (R2). The R-squared of Langmuir for COD and NH3–N were 0.9949 and 0.9919 and for Freundlich model were 0.9855 and 0.9828 respectively. Whereas the R-squared of PFO for COD and NH3–N were 0.9875 and 0.8883 and for PSO were 0.9987 and 0.9909 respectively.

Abstract This viewpoint paper focuses on challenges for Swiss physiotherapy education institutes related to the transition towards evidence-based practice and the incorporation of advanced roles within the profession. To tackle such challenges, it is essential to establish structured pathways and competency frameworks and position physiotherapists as integral contributors to innovative healthcare.

Abstract Micro-credentials are an element of the European Skills Agenda 2020. This five-year plan aims to develop improved applied and broader work skills in response to system demands from employers, industry and communities. Within the labour market, employees increasingly want to obtain new skills-based qualifications in a relatively short period of time. Micro-credentials, as a form of lifelong learning, in the health care sector provide significant opportunities for upskilling the workforce in response to rapid changes in health care and service delivery. Moreover, micro-credentials have also been introduced in the context of undergraduate and postgraduate education within the process of accelerated digitalisation during the pandemic. However, despite its relevance, there is limited discussion about the implications and challenges of micro-credentials in the healthcare sciences. According to the findings that emerged from a review of policy documents and scientific papers, a reflective exercise has been conducted to debate the possibilities and challenges of emerging education based on micro-credentials within health care education and employment. Health care delivery is multidisciplinary and statutorily regulated to protect citizens. In such a complex sector, developing a micro-credential friendly ecosystem will require cooperation between various stakeholders if its potential is to be effectively realised.

High prevalence and low control rate of hypertension have brought a significant disease burden globally. In order to improve the level of hypertension prevention and treatment, remote healthcare and digital medicine have been rapidly developed and widely used worldwide. Currently, there are no relevant regulations in China for these technologies. In 2023, the Italian Society of Arterial Hypertension issued a position statement to guide the development, validation, and clinical use of remote medicine and digital healthcare. This article will interpret this position paper, focusing on the forms of application of telemedicine and digital healthcare in managing hypertension and its related cardiovascular diseases, key research evidence, existing advantages, as well as current opportunities and challenges. The aim is to guide general practitioners in China on how to utilize these technologies in managing hypertension and related cardiovascular conditions.

The Bündnis Junger Ärztinnen und Ärzte (BJÄ, Alliance of Young Physicians in Germany) has presented a position paper (PP) on Postgraduate Medical Education (PGME) against the background of an unfolding hospital reform in Germany, and they describe existing deficits of PGME in Germany. Based on this, demands were made of legislators, employers and medical associations which could result in a sweeping reformation of PGME. Hospital reforms can only be accomplished with well trained and motivated physicians. In this respect the BJÄ regards the reform of hospitals and the health-care system as a chance for a reform of PGME, which is long overdue. Legislative competence for PGME lies with the States of the Federal Republic of Germany and this warrants an adjustment of state medical association laws to accommodate the demands of the BJÄ. Generally PGME must be taken into consideration in all health-care legislation, in analogy to the meanwhile globally adopted principle of “Health in all Politics (HiAP)”. The BJÄ has made every endeavour to produce this PP. The responsible stakeholders and actors in the health-care system would be well-advised to take the position paper seriously with a dwindling physician work force in hospitals and serious quality deficits in PGME. Hence, the BJÄ must be comprehensively supported. They need congenial partners to define the scientific foundation of all their demands, to test their application under real life conditions in hospital and outpatient care, to pursue research on the impact on patient care and on the intended transformation of the health-care system. This might best be accomplished by partnering with a scientific as has been the case in many countries for decades.

Abstract Inquiry-based learning (IBL) is a type of problem-based learning. While IBL aims at reflecting the work of practicing researchers, only some students will pursue an academic career. We therefore designed a course that provides opportunities for IBL by applying participant observation to internship work experience inside and outside academia. Using this internship course as an example, we investigated, how master’s students in health science executed an IBL assignment regarding the application of participant observation and presentation of findings. In addition, the understanding of occupational fields provided through the IBL assignment was examined. To determine whether learning objectives were met, a document analysis of IBL assignments comprising presentation slides and field protocols was performed. Within content analysis, a category grid was used examining (a) suitability of chosen research objectives, (b) execution of field protocols, (c) sufficiency of reporting and (d) extent of reflection. 49 IBL assignments from the years 2020–2022 were included. Sides of IBL observations were: (a) organizations providing health care (n = 28); (b) administrations of health care (n = 8); and (c) research institutes (n = 13). Within students’ field protocols, the level of detail of descriptions differed. 30 assignments included reflection on the methods used and research experience. In about a third of IBL assignments, indication of observation type, theoretical background and data analysis was missing. Using participant observation of internship work-experience for IBL can serve as a teaching tool for students to develop methodological skills. For future courses, we developed a checklist to strengthen reporting, reflection and use of theory. As internships are often integrated in degree programs in health sciences similar courses could be implemented in different programs, given qualified methodological guidance.

Abstract Obesity is the one of the most important components of metabolic syndrome. Because obesity related hypertension accounts for two thirds of essential hypertension, managing obesity and metabolic syndrome is a crucial task in the management of hypertension. However, the current non-pharmacological therapies have limitations for achieving or maintaining ideal body weight. Recently, glucagon-like peptide-1 receptor agonists (GLP1-RAs) have demonstrated excellent weight control effects, accompanied by corresponding reductions in blood pressure. GLP1-RAs have shown cardiovascular and renal protective effects in cardiovascular outcome trials both in primary and secondary prevention. In this document, the Korean Society of Hypertension intends to remark the current clinical results of GLP1-RAs and recommend the government and health-policy makers to define obesity as a disease and to establish forward-looking policies for GLP1-RA treatment for obesity treatment, including active reimbursement policies.

The Indian education system has produced top-class global corporate leaders in recent decades. The combination of a solid educational foundation, work ethic, adaptability, technical and analytical skills, leadership abilities, networking, entrepreneurial spirit, and cultural values collectively contribute to the success of Indian students and professionals in the corporate world. On the contrary, India’s overall performance in Olympic sports has been modest compared to its population and potential. The education system of any country has a significant role in sporting success. To fully harness the potential of sports in schools, addressing these challenges and creating a supportive environment that values and promotes sporting abilities alongside academic excellence is essential. This will require concerted efforts from various stakeholders, including the schooling system, educational institutions, government, sports organizations, corporate sponsors, and the community. This white paper aims to systematically organize the available knowledge and debates around India’s sporting performance in the background of mainstream education culture. This paper also addresses the systemic devaluation, exclusion, disfranchisement, and stereotyping of sports and sportspersons in India. One key argument put forward in this paper is to extend absolute equivalence to Olympic sports disciplines (e.g., football) at par with general academic disciplines (e.g., mathematics) in terms of examinations and award of qualifications within the mainstream education system of India. And India must host the Olympics before 2047.

Abstract Software that employs screening prioritization through active learning (AL) has accelerated the screening process significantly by ranking an unordered set of records by their predicted relevance. However, failing to find a relevant paper might alter the findings of a systematic review, highlighting the importance of identifying elusive papers. The time to discovery (TD) measures how many records are needed to be screened to find a relevant paper, making it a helpful tool for detecting such papers. The main aim of this project was to investigate how the choice of the model and prior knowledge influence the TD values of the hard-to-find relevant papers and their rank orders. A simulation study was conducted, mimicking the screening process on a dataset containing titles, abstracts, and labels used for an already published systematic review. The results demonstrated that AL model choice, and mostly the choice of the feature extractor but not the choice of prior knowledge, significantly influenced the TD values and the rank order of the elusive relevant papers. Future research should examine the characteristics of elusive relevant papers to discover why they might take a long time to be found.

Abstract Background Academic paper writing holds significant importance in the education of medical students, and poses a clear challenge for those whose first language is not English. This study aims to investigate the effectiveness of employing large language models, particularly ChatGPT, in improving the English academic writing skills of these students. Methods A cohort of 25 third-year medical students from China was recruited. The study consisted of two stages. Firstly, the students were asked to write a mini paper. Secondly, the students were asked to revise the mini paper using ChatGPT within two weeks. The evaluation of the mini papers focused on three key dimensions, including structure, logic, and language. The evaluation method incorporated both manual scoring and AI scoring utilizing the ChatGPT-3.5 and ChatGPT-4 models. Additionally, we employed a questionnaire to gather feedback on students’ experience in using ChatGPT. Results After implementing ChatGPT for writing assistance, there was a notable increase in manual scoring by 4.23 points. Similarly, AI scoring based on the ChatGPT-3.5 model showed an increase of 4.82 points, while the ChatGPT-4 model showed an increase of 3.84 points. These results highlight the potential of large language models in supporting academic writing. Statistical analysis revealed no significant difference between manual scoring and ChatGPT-4 scoring, indicating the potential of ChatGPT-4 to assist teachers in the grading process. Feedback from the questionnaire indicated a generally positive response from students, with 92% acknowledging an improvement in the quality of their writing, 84% noting advancements in their language skills, and 76% recognizing the contribution of ChatGPT in supporting academic research. Conclusion The study highlighted the efficacy of large language models like ChatGPT in augmenting the English academic writing proficiency of non-native speakers in medical education. Furthermore, it illustrated the potential of these models to make a contribution to the educational evaluation process, particularly in environments where English is not the primary language.

Abstract Microfluidic paper-based analytical devices often are combined with scanners as detectors. In this work, different scanning options offered by scanners: resolution, scanning mode, exposure to radiation, colour restoration, and saving format were tested. Moreover, different attempts to mathematical data treatment based on intensities of three channels—Red, Green and Blue, were studied. All measurements presented in this article were conducted for a model dye—bromothymol blue and a model analyte—zinc(II) ion (complexed with xylenol orange in a paper matrix). The article summarizes the scanning options and possibilities of mathematical calculations. Nevertheless, it is suggested that the best option is to use the prior prepared calculation file to paste obtained intensities and compare all presented in this article (and the most frequently used) equations to process intensities and decide which one should be used in the particular analysis.

Introduction: Periodic review of Question papers is needed to ensure validity of student assessment. Blueprint is an effective tool to guide Paper setters. Objectives: To assess coverage and weightage of content areas in last 10 years (2012-2021) UG Community Medicine Question papers in West Bengal and to prepare a Blueprint of teaching and assessment in Theory Examination for the above subject. Method: Secondary data analysis was done on University Question papers (40 in number). For Blueprinting, inputs of 13 Faculty members were considered. The duration of the study was one year (Nov 2021-Oct 2022). Results: Overall, Basic and Disease Epidemiology were given maximum weightage (10.2%+23.8%= 34.0%) followed by Maternal and child health (MCH) (14.2%). Poor coverage and weightage was seen in Social & Behavioural sciences, Health planning and management, Geriatric health problems and Genetic diseases, which were allotted only 4.2% marks combined. There was cross-over of topics between two Papers (averaging 4.3% to Paper I and 8.4% to Paper II) in all the years with wide range across the period (2012 - 2021). The Blueprint suggested decrease in weightage of Epidemiology (28.4% vs 34.0%) and Health care delivery (5.0% vs 7.8%) whereas increase of weightage of 'Others' (24.2% vs 14.8%) compared to Question papers. Conclusion: There was inconsistency in coverage and weightage to different topics across the years. This review, along with the Blueprint prepared, would be helpful to improve teaching and assessment in the above subject.

This study assessed the progression of stroke using bibliometric methods. By March 31, 2024, highly cited papers on stroke were collected from the Web of Science Core Collection. Collaboration and keyword conjunction analyses, along with their visual representations, were conducted using VOSviewer. CiteSpace was employed to identify keywords and reference sources. A comprehensive review of 2,509 highly cited studies on stroke was conducted. Notably, the United States, China, and the United Kingdom have emerged as leading contributors to this research domain, with the New England Journal of Medicine having the highest number of publications. YUSUF S had the highest H-index among all authors. The key terms frequently encountered were “stroke,” “atrial fibrillation,” and “cardiovascular disease.” This study performed a detailed bibliometric review of stroke research over the past decade, shedding light on the participation of various countries, organizations, authors, journals, and articles in the field. These insights offer a broad snapshot of the global stroke research trends.

Introduction and purpose A pilonidal cyst also known as a pilondial sinus, is an inflammatory condition that occurs in the intergluteal region, which can lead to serious infections. It most commonly affects young men, with risk factors including the presence of hair in this area, excessive sweating, obesity, and poor hygiene. Symptoms include a lump, pain, and purulent discharge from openings in the skin. Diagnosis involves taking a medical history, a physical examination, and often an ultrasound. The aim of this paper is to present and compare the available methods for treating pilonidal cysts. Materials and methods Literature available in PubMed databases were reviewed using the following keywords: ‘’Pilonidal cyst’’, ‘’Hair cyst’’, ‘’Abscess’’, ‘’Treatment of pilonidal cyst’’,’’ Bascom II method’’,’’ Limberg flap’’,’’ Suchorski technique’’, ‘’V-Y or Z skin flap reconstruction’’,’’ the Karadakis’’ Results The available treatment methods can be divided into conservative and invasive approaches. Conservative methods include hair removal and improved hygiene. Among the surgical methods, there are traditional excision techniques and modern methods such as excision using the Bascom II method, Limberg flap, Suchorski technique, or V-Y or Z skin flap reconstruction. The Karadakis method, which involves shifting a skin flap, is particularly effective for obese patients. Conclusion Treatment of pilonidal cysts depends on the stage and symptoms. Abscesses require urgent surgical intervention, while asymptomatic cysts can be treated conservatively or surgically.

Abstract Anger suppression is important in our daily life, as its failure can sometimes lead to the breaking down of relationships in families. Thus, effective strategies to suppress or neutralise anger have been examined. This study shows that physical disposal of a piece of paper containing one’s written thoughts on the cause of a provocative event neutralises anger, while holding the paper did not. In this study, participants wrote brief opinions about social problems and received a handwritten, insulting comment consisting of low evaluations about their composition from a confederate. Then, the participants wrote the cause and their thoughts about the provocative event. Half of the participants (disposal group) disposed of the paper in the trash can (Experiment 1) or in the shredder (Experiment 2), while the other half (retention group) kept it in a file on the desk. All the participants showed an increased subjective rating of anger after receiving the insulting feedback. However, the subjective anger for the disposal group decreased as low as the baseline period, while that of the retention group was still higher than that in the baseline period in both experiments. We propose this method as a powerful and simple way to eliminate anger.

Introduction Buprenorphine is a highly effective treatment for opioid use disorder (OUD). However, provider observations and preliminary research suggest that the current standard maintenance dose may be insufficient for suppressing withdrawal and preventing cravings among people who use or have used fentanyl. Buprenorphine dosing guidelines were based on studies among people who use heroin and have not been formally re-evaluated since fentanyl became predominant in the unregulated drug supply. We aim to compare the effectiveness of a high (24 mg) vs standard (16 mg) maintenance daily dose of buprenorphine for improving retention in treatment, decreasing the use of non-prescribed opioids, preventing cravings and reducing opioid overdose risk in patients.Methods and analysis Adults who are initiating or continuing buprenorphine for moderate to severe OUD and have a recent history of fentanyl use (n=250) will be recruited at four outpatient substance use treatment clinics in Rhode Island. Patients continuing buprenorphine must be on doses of 16 mg or less and have ongoing fentanyl use to be eligible. Participants will be randomly assigned 1:1 to receive either a high (24 mg) or standard (16 mg) maintenance daily dose, each with usual care, and followed for 12 months to evaluate outcomes. Providers will determine the buprenorphine initiation strategy, with the requirement that participants reach the study maintenance dose within 7 days of randomisation. Providers may adjust the maintenance dose, if clinically needed, for participant safety. The primary study outcome is retention in buprenorphine treatment at 6 months postrandomisation, measured using clinical and statewide administrative data. Other outcomes include non-prescribed opioid use and opioid cravings (secondary), as well as non-fatal or fatal opioid overdose (exploratory).Ethics and dissemination This protocol was approved by the Brown Institutional Review Board (STUDY00000075). Results will be presented at conferences and published in peer-reviewed journals.Trial registration number NCT06316830.

Introduction Research has provided novel insights into how light stimulates circadian rhythms through specialised retinal ganglion cells to the suprachiasmatic nucleus. In addition, there has been a revolution in light-emitting diode (LED) technology, leading to tunable LED light sources and lighting systems, enabling 24-hour dynamic light scenarios with bright blue-enriched short wavelength light during the day and dim evening light, stimulating the circadian system. These dynamic LED lighting systems are now being implemented at hospitals without adequate understanding of how it may affect the health and well-being of patients and staff.Methods and analysis An optimised dynamic LED lighting scenario is investigated at a newly built psychiatric hospital in Copenhagen. In the 12 months baseline period, a standard lighting scenario with dynamic colour temperature and fixed light intensity is investigated. In the following 12-month intervention period, a new DEL scenario is investigated, having dynamic colour temperature as well as dynamic light intensity with a higher daytime and lower evening-time melanopic daylight equivalent illuminance. This setting is furthermore adjusted for geographical orientation to compensate for differences in sunlight access in wintertime. The study uses a quasiexperimental design comparing patients admitted in the two study periods. Prior to each of the study periods, daylight and the contribution from the LED-lighting scenarios was measured. Patient sociodemographic and mental health data will be retrieved retrospectively from electronic medical records and by questionnaires administered in the two periods, evaluating lighting, noise, sleep quality and quality of life. Primary outcome is the proportion of patients receiving pro re nata medications. Secondary outcomes are the length of stay, sleep onset latency, sleep quality and quality of life.Ethics and dissemination No ethical issues are expected. The results will be disseminated through peer-reviewed international journal, lectures, posters and interviews.Trial registration number NCT05868291.

Stigma is a widely experienced feature, and recognized as a major factor that facilitates the spread of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) epidemic. Unifying social work skills and knowledge with faith-based organizations and communities, can contribute to combating HIV/AIDS and relating stigma. Political actions, religious influence, societal engagement, social dynamics, and openness are major modalities combating stigma and assisting prevention efforts. The issue of HIV and AIDS is both problematic and dangerous to affected individuals along with social, economic, political, and spiritual grounds. The disease is spreading rapidly among younger generations around the world. It is a societal challenge to overcome HIV and AIDS and related stigma. There is a great need for courage, commitment, and leadership at all levels, particularly among religious leaders, using social influence to make a difference in the course of the epidemic. They are in a position of authority and able to use the trust of their respective communities to significantly influence the course of the scourge. They have the authoritative means for effective fighting of HIV and AIDS-related stigma. This article presented examples and modalities of combating HIV and AIDS-related stigma in the society by church leaders. They and their respective institutions possess strengths, credibility, and are well-grounded in communities. Spiritual leaders have opportunities to make a practical and real difference in battling HIV and AIDS-related stigma The challenges of stigma experienced by individuals affected by HIV and AIDS calls for faith communities to act as a strong force for transformation that results in healing, hope, and change to all HIV/AIDS-affected individuals and associated stigma. In understanding of issues related to HIV and AIDS stigma, engaging community members and church leaders can contribute to effective program planning and development resources that will address stigma. This paper can encourage social workers to examine how religious leadership structures are positioned to take responsibilities for reducing the effects of HIV and AIDS-related stigma utilizing religious, familial, individual, and community strengths. Finally, this article would inspire social workers to focus on the formation of support groups, and faith-based peer education as well as counseling and support services to ensure that HIV/AIDS-infected people living with associated stigma, especially young people, women, orphans, and other children, receive social, emotional, and spiritual services.

Brachytherapy is a type of radiation therapy, in which a radiation source is placed directly or close to a tumor. It is commonly used to treat skin cancer, and enables precise irradiation treatment of affected area (planning target volume – PTV) while minimizing exposure dose to surrounding healthy tissue (organs at risk – OARs). Recently, the use of 3D printing has begun revolutionizing brachytherapy, as it allows manufacturing of custom-designed applicators for unique shape of skin topography, tumor, and surrounding tissues. Outcome of the combination of 3D printing and brachytherapy has several advantages over traditional treatment planning methods. Some of the advantages are intuitive, whereas others can be concluded from a literature overview as follows: 1) Possibility of developing patient-specific applicators that precisely match the shape of tumor area; 2) Reduction of the time required for applicator production, especially when custom-made devices are needed; 3) Reduction of manufacturing costs; 4) Treatment procedures improvement; 5) Improvement of safety measures accelerated by the development of smart materials (e.g., polymer filaments with admixture of heavy elements); 6) Possibility of nearly instant adjustment into tumor treatment (applicators can be changed as the tumor is changing its shape); and 7) Applicators designed to securely fit to treatment area to hold radioactive source always in the same place for each fraction. Consequently, tumor-provided dose is accurate and leads to effective treatment. In this review paper, we investigated the current state-of-the-art of the application of 3D printing in brachytherapy. A number of existing reports were chosen and reviewed in terms of printing technology, materials used, treatment effectiveness, and fabrication protocols. Furthermore, the development of future directions that should be considered by collaborative teams bridging different fields of science, such as medicine, physics, chemistry, and material science were summarized. With the indicated topics, we hope to stimulate the innovative progress of 3D printing technology in brachytherapy.

Abstract Oil-immersed transformers are expensive equipment in the electrical system, and their failure would lead to widespread blackouts and catastrophic economic losses. In this work, an elaborate diagnostic approach is proposed to evaluate twenty-six different transformers in-service to determine their operative status as per the IEC 60599:2022 standard and CIGRE brochure. The approach integrates dissolved gas analysis (DGA), transformer oil integrity analysis, visual inspections, and two Back Propagation Neural Network (BPNN) algorithms to predict the loss of life (LOL) of the transformers through condition monitoring of the cellulose paper. The first BPNN algorithm proposed is based on forecasting the degree of polymerization (DP) using 2-Furaldehyde (2FAL) concentration measured from oil samples using DGA, and the second BPNN algorithm proposed is based on forecasting transformer LOL using the 2FAL and DP data obtained from the first BPNN algorithm. The first algorithm produced a correlation coefficient of 0.970 when the DP was predicted using the 2FAL measured in oil and the second algorithm produced a correlation coefficient of 0.999 when the LOL was predicted using the 2FAL and DP output data obtained from the first algorithm. The results show that the BPNN can be utilized to forecast the DP and LOL of transformers in-service. Lastly, the results are used for hazard analysis and lifespan prediction based on the health index (HI) for each transformer to predict the expected years of service.

The exponential increase in the number of submissions, further accelerated by generative AI, and the decline in the availability of experts are burdening the peer review process. This has led to high unethical desk rejection rates, a growing appeal for the publication of unreviewed preprints, and a worrying proliferation of predatory journals. The idea of monetarily compensating peer reviewers has been around for many years; maybe, it is time to take it seriously as one way to save the peer review process. Here, I argue that paying reviewers, when done in a fair and transparent way, is a viable solution. Like the case of professional language editors, part-time or full-time professional reviewers, managed by universities or for-profit companies, can be an integral part of modern peer review. Being a professional reviewer could be financially attractive to retired senior researchers and to researchers who enjoy evaluating papers but are not motivated to do so for free. Moreover, not all produced research needs to go through peer review, and thus persuading researchers to limit submissions to their most novel and useful research could also help bring submission volumes to manageable levels. Overall, this paper reckons that the problem is not the peer review process per se but rather its function within an academic ecosystem dominated by an unhealthy culture of ‘publish or perish’. Instead of reforming the peer review process, academia has to look for better science dissemination schemes that promote collaboration over competition, engagement over judgement, and research quality and sustainability over quantity.

The exponential increase in the number of submissions, further accelerated by generative AI, and the decline in the availability of experts are burdening the peer review process. This has led to high unethical desk rejection rates, a growing appeal for the publication of unreviewed preprints, and a worrying proliferation of predatory journals. The idea of monetarily compensating peer reviewers has been around for many years; maybe, it is time to take it seriously as one way to save the peer review process. Here, I argue that paying reviewers, when done in a fair and transparent way, is a viable solution. Like the case of professional language editors, part-time or full-time professional reviewers, managed by universities or for-profit companies, can be an integral part of modern peer review. Being a professional reviewer could be financially attractive to retired senior researchers and to researchers who enjoy evaluating papers but are not motivated to do so for free. Moreover, not all produced research needs to go through peer review, and thus persuading researchers to limit submissions to their most novel and useful research could also help bring submission volumes to manageable levels. Overall, this paper reckons that the problem is not the peer review process per se but rather its function within an academic ecosystem dominated by an unhealthy culture of ‘publish or perish’. Instead of reforming the peer review process, academia has to look for better science dissemination schemes that promote collaboration over competition, engagement over judgement, and research quality and sustainability over quantity.

BackgroundMeasurement-based care in behavioral health uses patient-reported outcome measures (PROMs) to screen for mental health symptoms and substance use and to assess symptom change over time. While PROMs are increasingly being integrated into electronic health record systems and administered electronically, paper-based PROMs continue to be used. It is unclear if it is feasible to administer a PROM on paper when the PROM was initially developed for electronic administration. ObjectiveThis study aimed to examine the feasibility of patient self-administration of a 2-part substance use screener—the Tobacco, Alcohol, Prescription medications, and other Substances (TAPS)—on paper. This screener was originally developed for electronic administration. It begins with a limited number of questions and branches to either skip or reflex to additional questions based on an individual’s responses. In this study, the TAPS was adapted for paper use due to barriers to electronic administration within an urgent care behavioral health clinic at an urban health safety net hospital. MethodsFrom August 2021 to March 2022, research staff collected deidentified paper TAPS responses and tracked TAPS completion rates and adherence to questionnaire instructions. A retrospective chart review was subsequently conducted to obtain demographic information for the patients who presented to the clinic between August 2021 and March 2022. Since the initial information collected from TAPS responses was deidentified, demographic information was not linked to the individual TAPS screeners that were tracked by research staff. ResultsA total of 507 new patients were seen in the clinic with a mean age of 38.7 (SD 16.6) years. In all, 258 (50.9%) patients were male. They were predominantly Black (n=212, 41.8%), White (n=152, 30%), and non-Hispanic or non-Latino (n=403, 79.5%). Most of the patients were publicly insured (n=411, 81.1%). Among these 507 patients, 313 (61.7%) completed the TAPS screener. Of these 313 patients, 76 (24.3%) adhered to the instructions and 237 (75.7%) did not follow the instructions correctly. Of the 237 respondents who did not follow the instructions correctly, 166 (70%) answered more questions and 71 (30%) answered fewer questions than required in TAPS part 2. Among the 237 patients who did not adhere to questionnaire instructions, 44 (18.6%) responded in a way that contradicted their response in part 1 of the screener and ultimately affected their overall TAPS score. ConclusionsIt was challenging for patients to adhere to questionnaire instructions when completing a substance use screener on paper that was originally developed for electronic use. When selecting PROMs for measurement-based care, it is important to consider the structure of the questionnaire and how the PROM will be administered to determine if additional support for PROM self-administration needs to be implemented.

BackgroundThis study has two primary objectives. Firstly, it aims to measure the time savings achieved through the digitization of paper forms filled out by nurses in the inpatient care process. Secondly, it seeks to reveal the financial savings resulting from reduced paper consumption due to the digitalization. The Health Information Management System Society (HIMSS)—Electronic Medical Record Adaption Model (EMRAM), which makes stage-based (0–7) evaluations, serves as a tool to measure the rate of technology utilization in public hospitals in Turkey. The study is based on the HIMSS EMRAM criteria for 2018. Bahçelievler State Hospital, a public hospital in Turkey, was chosen as the research facility. In 2017, it was accredited as Stage 6 with HIMSS EMRAM. However, not all its wards have been digitalized. Initially, pilot selected wards were digitized. Therefore, digital and non-digital wards serve together. In this context, 4 wards were randomly selected and time, paper and toner savings before and after digitalization were measured.MethodA table was created in Microsoft Excel,listing the forms used by nurses in inpatient care and the time required to fill them out.The time spent for filling paper-based forms and digital-based forms was measured in randomly selected wards.ResultThe analysis showed that digital forms saved more time, paper and toner. For example, filling out the patient history form took 45 min when using paper, compared to 12 min in digital environment. Approximately 27% time savings are achieved only for the patient history form. The total time savings delivered by digitalization for 1,153 inpatients during the year were found as 117 care days, and the savings on total paper consumption was 41.289 pages. For 1,153 inpatients throughout the year, the total time savings from digitalization was 117 care days and the total paper consumption savings was 41,289 pages. In addition, in 4 wards with a total bed capacity of 25, annual paper savings of $1,705.86 and toner savings of $283,736 were achieved.DiscussionThis study reveals the benefits of digitalisation in hospitals for nurses. It saves the time that nurses allocate for filling out paper forms with digitalised forms. Thus, it is a good practice example in terms of using the time allocated for form filling for patient care.When we extend this study to Turkey in general, it can be considered that the time savings achieved by nurses by digitizing inpatient forms varies between 10.8% and 13%. The number of nurses working in public hospitals in Turkey is approximately 160,000. Assuming that 60% of the nurses work in the inpatient ward, it is understood that the annual savings achieved by digitizing the forms corresponds to a range of 398–559 nursing hours.

Objectives: This review aimed to determine the form, results, and barriers to exercise-based rehabilitation programs for severe COVID-19 survivors. Methods: Searching for the article was carried out from August to October 2021. We used the PubMed database as a search media with the keywords ([‘COVID-19’ OR ‘COVID 19’ OR ‘SARS CoV-2’ OR ‘post COVID-19’] AND [‘rehabilitation’]). Original articles and case reports published in the last 2 years (July 2019-2022), written in English, available in full text, and accessible in PDF or HTML format were included. Articles were excluded if they did not fit the research topic after reading the full text. Results: There were a total of 7461 articles found at the initial screening using keywords. In the next screening using the inclusion and exclusion criteria and after reading the whole article, we found 9 articles that matched the topic. Of these, 7 articles were original articles and 2 case reports. All of the articles explained the forms and outcomes of exercise-based rehabilitation in severe cases of COVID-19 survivors. However, no article explained the barriers to rehabilitation. Discussion: Exercise was generally given to increase exercise tolerance in severe COVID-19 survivors in both inpatient and outpatient cardiopulmonary rehabilitation programs. The form of exercise was aerobic, strength, or endurance training, and other forms of exercise such as balance training as well as breathing exercises. The type and intensity of exercises given were tailored to the patient’s needs. Research showed that exercise-based rehabilitation programs resulted in a positive impact on increasing the survivor’s quality of life, functional capability, and exercise tolerance. A previous study explained that barriers to rehabilitation in COVID-19 were related to the patient’s health condition, COVID-19 infectivity, and issues related to health services.

Abstract This article presents the results of an experiment designed to study the impact of temperature on the characteristic parameters of creeping discharges. The insulating interfaces consist of a thermally enhanced cellulose surface immersed in mineral oil, palm kernel oil methyl ester (PKOME) and castor oil methyl ester (COME). The study was carried out under a standard negative lightning impulse voltage (1.2/50 μs). The article also presents the complete algorithms for calculating the maximum extension of the discharges, the ionisation rate and the charge produced by them. The results of the study show that temperature favors the propagation of discharges and the ionisation rate. It was observed that liquids with a higher dielectric constant and high electrical conductivity were more exposed to the impact of temperature. The results show ionisation increments of 0.973%/°C, 1.093%/°C and 1.076%/°C in mineral oil (MO), COME and PKOME respectively. The maximum extension of the discharges shows a linear evolution with the applied voltage and temperature but a non-linear increment with the temperature. As for the charge produced, it shows a constant increment with temperature and voltage in each liquid. These values are (5.839%/°C, 1.977%/kV), (6.047%/°C, 2.082%/kV) and (6.177%/°C, 2.113%/kV) respectively in MO, COME and PKOME.

Introduction: Assessments direct students towards learning. There are three types of learning: cognitive, affective, and psychomotor. While all three are interlinked, the cognitive domain, which covers knowledge and intellectuality, is foundational and can be assessed through theory examinations. Theory exams are the best way to test the cognitive domain of a learner, while practical exams can assess the psychomotor and affective domains. Since the question paper is the most important tool in theory exams, it is essential that the question paper covers relevant topics and tests all levels of cognitive learning, which encompass knowledge, comprehension, application, analysis, synthesis, and evaluation. Aim: To assess the level of cognitive domains assessed and the weightage allocated to various topics in the undergraduate summative examination question paper of community medicine. Materials and Methods: A cross-sectional study was conducted at Department of Community Medicine, Pramukh Swami Medical College and Sri Krishna Hospital, Bhaikaka University, Karamsad, Anand, Gujarat, India in which the five-year question papers (2016-2020) from five Universities were analysed to assess the level of cognitive domains and the weightage assigned to various topics. Each question was categorised as recall, comprehension, or application based on the cognitive domain it assessed. Furthermore, each question was analysed to determine the topic it pertained to, and the marks allocated to that question were assigned to the corresponding topic. Results: The majority of marks in Universities 1, 2, 3, 4, and 5 were, respectively allocated as follows: 324 (80.62%), 459 (84.66%), 453 (75.5%), 895 (89.5%), and 379 (63.16%) for questions testing the recall ability of the learners. For questions assessing comprehension ability, the marks allotted were 20 (4.87%), 0, 81 (13.5%), 65 (6.5%), and 51 (8.15%). The fewest marks were assigned to questions testing application, synthesis, or evaluation abilities. Epidemiology had the highest weightage in all five Universities, with marks of 73 (18.25%), 75 (13.89%), 93 (15.5%), 141 (14.1%), and 83 (13.83%). Conclusion: The cognitive domains assessed in the subject across all five Universities were unsatisfactory. The weightage of marks allotted to topics varied, highlighting the need to develop a question paper plan that facilitates a systematic distribution based on different levels of cognitive domains and topics.

Abstract Energy storage devices (ESD) which are intended to power electronic devices, used in close contact of human skin, are desirable to be safe and non-toxic. In light of this requirement, Zn based energy storage devices seem to provide a viable pathway as they mostly employ aqueous based electrolytes which are safe and non-toxic in their functioning. Additionally, having a flexible ESD will play a crucial role as it will enable the ESD to conform to the varying shapes and sizes of wearable electronics which they energize. In this work, we have developed an inkjet-printed Zinc ion battery (IPZIB) with planar electrode configuration over bond paper substrate. Zn has been used as the negative electrode, MnO2 is used as the positive electrode with Poly(3,4-ethylenedioxythiophene) polystyrene sulfonate (PEDOT:PSS) as the active binder. Conducting tracks of reduced graphene oxide (rGO) are used to construct the current collector on the paper substrate. The fabricated IPZIB delivered a high discharge capacity of 300.14 mAh g−1 at a current density of 200 mA g−1. The energy density of the IPZIB is observed as 330.15 Wh kg−1 at a power density of 220 W kg−1 and retains an energy density of 94.36 Wh kg−1 at a high power density of 1650 W kg−1. Finally, we have demonstrated the capability of the IPZIB to power a LED at various bending and folding conditions which indicates its potential to be used in the next generation flexible and wearable electronic devices.

Abstract As the social organism, Polistes wasps build a communal nest using woody fibers with saliva for sustaining brood and adult population throughout the season. Limited information exists regarding the identification specific plant materials employed in wasp nest building. Thus, we firstly tested if the DNA metabarcoding approach utilizing rbcL and trnL molecular markers could identify the plant species quantitatively and qualitatively inform the mixed-origin woody samples. A threshold of 0.01 proportion of reads was applied for rbcL and trnL molecular markers, while this threshold for median proportion was 0.0025. In assessing taxa richness, the median proportion demonstrated superior performance, exhibiting higher taxa detection power, however, rbcL marker outperformed in quantitative analysis. Subsequently, we applied DNA metabarcoding to identify the plant materials from the nests of two Polistes species, P. mandarinus and P. rothneyi. The results showed that higher preference of Quercus and Robinia as the major nest building materials regardless of the surrounding plant communities, by two wasp species. Material diversity was higher for P. rothneyi than P. mandarinus, which may explain the abundance of this species possibly with heightened adaptive capacities in their nesting behavior. This study demonstrated that DNA metabarcoding could identify the complex nest-building plant materials of paper wasps and provide insights into their ecological interactions in the natural ecosystem.

N/a.

When deciding which submissions should be peer reviewed, eLife editors consider whether they will be able to find high-quality reviewers, and whether the reviews will be valuable to the scientific community.

N/a.

The objective of academic training is to prepare midwives as independent healthcare professionals to make a substantial contribution to the healthcare of women in their reproductive years as well as to the health of their children and families. This article therefore describes the professional and educational requirements derived from the legal midwifery competencies within the new midwifery act. Furthermore, it identifies the conditions that need to be established to enable midwives in Germany to practise to their full scope in compliance with statutory responsibilities. Educational science, academic efforts, policymaking and accompanying research should work in synergy. This in turn enables midwives to achieve the maximum scope of their skills, with the objective of promoting physiological pregnancies and births. Consequently, it can strengthen early parenthood in alignment with the national health objectives of “health around childbirth”.The academisation of the midwifery profession presents a profound opportunity for professional development in Germany. It is essential that midwives receive training based on the principles of educational science and care structures that are yet to be developed. This can enable them to perform within the wide range of their professional tasks to the highest standards, thereby ensuring the optimal care of their clients. Moreover, there is a chance to implement sustainable improvements in healthcare provision for women and their families during the reproductive phase and the period of parenthood in Germany.

The current situation in Germany is characterised by significant differences between the two types of higher education institutions offering bachelor's degree programmes in midwifery at both universities of applied sciences and universities. These differences are noticeable in admission procedures, resource allocation, content focus and competence assessment at the respective institutions, which in turn result in heterogeneous study experiences. This article highlights the challenges currently facing bachelor degree programmes and the academic qualification of midwives, and identifies future requirements for the development of degree programmes in theory and practice as well as theory-practice transfer, and assessment formats. Furthermore, this article covers the content-related and structural-organisational requirements to develop in-depth academic skills grounded in theory teaching, the facilitation of clinical placements at an academic level, the training of qualified practical instructors and the development of applicable competence-based assessment formats, especially for the state exam.The development of a standardised, high-quality academic education for midwives in Germany requires networking of the different academic sites/locations to exchange experiences in teaching/learning and assessment formats. Furthermore, it can facilitate the development of a standardised competence-oriented model and core curriculum as well as the definition of quality criteria and standards for study programmes of midwifery science. The Midwifery Science Committee (AHW) in the DACH Assoviation for Medical Education (GMA) offers an optimal platform for cooperation between the different universities. The existing challenges for the further professional development of midwives can only be overcome by collaboration and pooled expertise.

Introduction Paediatric concussion is a common injury. Approximately 30% of youth with concussion will experience persisting postconcussion symptoms (PPCS) extending at least 1 month following injury. Recently, studies have shown the benefit of early, active, targeted therapeutic strategies. However, these are primarily prescribed from the specialty setting. Early access to concussion specialty care has been shown to improve recovery times for those at risk for persisting symptoms, but there are disparities in which youth are able to access such care. Mobile health (mHealth) technology has the potential to improve access to concussion specialists. This trial will evaluate the feasibility of a mHealth remote patient monitoring (RPM)-based care handoff model to facilitate access to specialty care, and the effectiveness of the handoff model in reducing the incidence of PPCS.Methods and analysis This study is a non-randomised type I, hybrid implementation-effectiveness trial. Youth with concussion ages 13–18 will be enrolled from the emergency department of a large paediatric healthcare network. Patients deemed a moderate-to-high risk for PPCS using the predicting and preventing postconcussive problems in paediatrics (5P) stratification tool will be registered for a web-based chat platform that uses RPM to collect information on symptoms and activity. Those patients with escalating or plateauing symptoms will be contacted for a specialty visit using data collected from RPM to guide management. The primary effectiveness outcome will be the incidence of PPCS, defined as at least three concussion-related symptoms above baseline at 28 days following injury. Secondary effectiveness outcomes will include the number of days until return to preinjury symptom score, clearance for full activity and return to school without accommodations. The primary implementation outcome will be fidelity, defined as the per cent of patients meeting specialty care referral criteria who are ultimately seen in concussion specialty care. Secondary implementation outcomes will include patient-defined and clinician-defined appropriateness and acceptability.Ethics and dissemination This study was approved by the Institutional Review Board of the Children’s Hospital of Philadelphia (IRB 22-019755). Study findings will be published in peer-reviewed journals and disseminated at national and international meetings.Trial registration number NCT05741411.

Introduction While research into adolescent mental health has developed a considerable understanding of environmental and psychosocial risk factors, equivalent biological evidence is lacking and is not representative of economic, social and ethnic diversity in the adolescent population. It is important to understand the possible barriers and facilitators to conduct this research. This will then allow us to improve our understanding of how biology interacts with environmental and psychosocial risk factors during adolescence. The objective of this scoping review is to identify and understand the needs, barriers and facilitators related to the collection of biological data in adolescent mental health research.Methods and analysis Reviewers will conduct a systematic search of PubMed, Medline, Scopus, Cochrane, ERIC, EMBASE, ProQuest, EBSCO Global Health electronic databases, relevant publications and reference lists to identify studies published in the English language at any time. This scoping review will identify published studies exploring mental health/psychopathology outcomes, with biological measures, in participants between the ages of 11 and 18 and examine the reported methodology used for data collection. Data will be summarised in tabular form with narrative synthesis and will use the methodology of Levac et al, supplemented by subsequent recommendations from the Joanna Briggs Institute Scoping Review Methodology.Ethics and dissemination Ethical approval is not required for this scoping review. The scoping review will be conducted with input from patient and public involvement, specifically including young people involved in our study (‘Co-producing a framework of guiding principles for Engaging representative and diverse cohorts of young peopLE in Biological ReseArch in menTal hEalth’—www.celebrateproject.co.uk) Youth Expert Working Group. Dissemination will include publication in peer-reviewed journals, academic presentations and on the project website.

Objectives To map the current use of paper-based and/or screen-based media for health education aimed at older people.Design A scoping review was reported following the Preferred Reporting Items of Systematic Reviews and Meta-analyses for Scoping Reviews checklist.Data sources The search was carried out in seven databases (Scopus, Web of Science, Embase, Medline, CINAHL, ACM Guide to Computing Literature, PsycINFO), with studies available from 2012 to the date of the search in 2022, in English, Portuguese, Italian or Spanish. In addition, Google Scholar was searched to check the grey literature. The terms used in the search strategy were older adults, health education, paper and screen-based media, preferences, intervention and other related terms.Eligibility criteria Studies included were those that carried out health education interventions for older individuals using paper and/or screen-based media and that described barriers and/or facilitators to using these media.Data extraction and synthesis The selection of studies was carried out by two reviewers. A data extraction form was developed with the aim of extracting and recording the main information from the studies. Data were analysed descriptively using Bardin’s content analysis.Results The review included 21 studies that carried out health education interventions with different purposes, the main ones being promotion of physical activity, hypertension prevention and psychological health. All 21 interventions involved screen-based media on computers, tablets, smartphones and laptops, while only 4 involved paper-based media such as booklets, brochures, diaries, flyers and drawings. This appears to reflect a transition from paper to screen-based media for health education for the older population, in research if not in practice. However, analysis of facilitators and barriers to using both media revealed 10 design factors that could improve or reduce their use, and complementarity in their application to each media type. For example, screen-based media could have multimedia content, additional functionality and interactivity through good interaction design, but have low accessibility and require additional learning due to complex interface design. Conversely, paper-based media had static content and low functionality but high accessibility and availability and a low learning cost.Conclusions We recommend having improved screen-based media design, continued use of paper-based media and the possible combination of both media through the new augmented paper technology.Registration number Open Science Framework (DOI: 10.17605/OSF.IO/GKEAH).

Objective Since the emergence of COVID-19, university education has drastically transformed into digital-based learning (DBL). Online education has been well recognised as a promising mode of teaching; however, only a limited number of studies have reported the students’ preferred format for academic learning.Design Cross-sectional.Setting The study was conducted in a university setting in Japan. A Google Forms online questionnaire was distributed to the participants between April and May 2022.Participants A total of 939 undergraduate medical, nursing and pharmaceutical students in the pre-clinical grade were recruited, and 344 were included in the final analysis.Primary and secondary outcome The questionnaire assessed students’ format preferences between paper-based learning (PBL) and DBL as it pertained to academic performance and eyestrain. In terms of academic performance, comprehension, memory retention and absorption (concentration) were assessed. We also explored the association between students’ daily time spent using DBL and their digital preference by the Cochran-Armitage trend test and logistic regression analysis.Results A total of 344 (191 medical, 73 nursing and 80 pharmaceutical) university students completed the questionnaire (response rate 36.6%). An even distribution was observed in the preferred learning format for comprehension: PBL (32.0%), both formats equivalent (32.8%) and DBL (35.2%; digital preference). Only few students preferred DBL for memory retention (6.1%), absorption (6.7%) and eyestrain (1.2%). Although a positive association was observed between daily time spent using DBL and digital preference for comprehension, there was no association for memory retention, absorption and eyestrain.Conclusion Among university students, DBL was just as preferred as PBL for comprehension; however, only a few students reported that DBL was better in terms of memory retention, absorption and eyestrain. A learning environment where students can study using PBL should be continued.

Zabihollah Yousefi1, Reza-Ali Mohmadpour 2, Ebrahim Zarei3, Mansour Barafrashtehpour 4 1 PhD, Department of Environmental Health Engineering, School of Health and Health Sciences Research Center, Mazandaran University of Medical Sciences, Sari, Iran 2 PhD, Professor, Department of Statistics, School of Health, Mazandaran University of Medical Sciences, Sari, Iran 3 Lecturer, Department of Analytical Chemistry, University of Mazandaran, Sari, Iran 4 MSc, Department of Environmental Health Engineering, Student Research Committee, School of Health, Mazandaran University of Medical Sciences, Sari, Iran In the article published in volume 23, issue Suppl 2, 2014, the first author’s name was incorrect. It should have been Zabihollah Yousefi, which is now corrected.