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

Objective The purpose of this study was to develop a natural language processing (NLP) pipeline to identify incidental thyroid nodules (ITNs) meeting criteria for sonographic follow-up and to assess both adherence rates to white paper recommendations and downstream outcomes related to these incidental findings. Methods 21583 non-contrast chest CT reports from 2017 and 2018 were retrospectively evaluated to identify reports which included either an explicit recommendation for thyroid ultrasound, a description of a nodule ≥ 1.5 cm, or description of a nodule with suspicious features. Reports from 2018 were used to train an NLP algorithm called fastText for automated identification of such reports. Algorithm performance was then evaluated on the 2017 reports. Next, any patient from 2017 with a report meeting criteria for ultrasound follow-up was further evaluated with manual chart review to determine follow-up adherence rates and nodule-related outcomes. Results NLP identified reports with ITNs meeting criteria for sonographic follow-up with an accuracy of 96.5% (95% CI 96.2-96.7) and sensitivity of 92.1% (95% CI 89.8-94.3). In 10006 chest CTs from 2017, ITN follow-up ultrasound was indicated according to white paper criteria in 81 patients (0.8%), explicitly recommended in 46.9% (38/81) of patients, and obtained in less than half of patients in which it was appropriately recommended (17/35, 48.6%). Discussion NLP accurately identified chest CT reports meeting criteria for ITN ultrasound follow-up. Radiologist adherence to white paper guidelines and subsequent referrer adherence to radiologist recommendations showed room for improvement.

Laser-induced graphene (LIG) technology featuring low-cost, high-efficiency and scalability has presented great advantages in micro-supercapacitors (MSCs) fabrication. However, the limited capacitance of LIG based MSCs is still hindering their further development. Herein, we introduce joule heating as a critical in-situ treatment merged with the assembly of laser-induced graphene paper based MSCs (LIGP-MSCs) toward capacitive enhancement. By increasing heating-treatment temperature from ∼20 to 500 °C, the number of nanopores in LIGP continuously increases, attributed to the gradual decomposition of amorphous carbon components. The resulting joule-heated LIGP (J-LIGP) with improved specific surface area (160.97–533.49 m2/g) and pore volume (0.179–0.553 cm3/g) as well as superhydrophilic surface is highly suitable to be employed as J-LIGP-MSCs microelectrodes. By investigating process dependent performance, the J-LIGP-MSCs heated at 500 °C for 60 min delivers a significantly improved specific areal capacitance (CA) of 13.71 mF/cm2 at 10 mV/s, which is approximately six-fold higher than that of unheated LIGP-MSCs. By further exploring and optimizing the process efficiency, J-LIGP-MSCs with a CA of 12.61 mF/cm2 has been achieved by 550 °C heating for only 5 min. Along with superior mechanical flexibility, cyclability and structural modularity, the proposed in-situ joule heating treatment is finally proved to be a universal approach for consistently enhancing the CA of LIG based MSCs processed under various chemical modifications.

Antimicrobial stewardship programs (ASPs) have made immense strides in optimizing antibiotic, antifungal, and antiviral use in clinical settings. However, although ASPs are required institutionally by regulatory agencies in the United States and Canada, they are not mandated for transplant centers or programs specifically. Despite the fact that solid organ transplant recipients in particular are at increased risk of infections from multidrug-resistant organisms, due to host and donor factors and immunosuppressive therapy, there currently are little rigorous data regarding stewardship practices in solid organ transplant populations, and thus, no transplant-specific requirements currently exist. Further complicating matters, transplant patients have a wide range of variability regarding their susceptibility to infection, as factors such as surgery of transplant, intensity of immunosuppression, and presence of drains or catheters in situ may modify the risk of infection. As such, it is not feasible to have a “one-size-fits-all” style of stewardship for this patient population. The objective of this white paper is to identify opportunities, risk factors, and ASP strategies that should be assessed with solid organ transplant recipients to optimize antimicrobial use, while producing an overall improvement in patient outcomes. We hope it may serve as a springboard for development of future guidance and identification of research opportunities.

Mitigation of global warming, energy security and industrial competitiveness urge the energy-intensive pulp and paper industry (PPI) to transform energy use practices. This study investigates how the PPI has responded to the need for the energy transition in the 2000s. Finland and Sweden as forerunners of energy-efficient operation and decarbonization of the PPI are used as target countries. Understanding of changes in energy consumption is complemented using decomposition analysis (Logarithmic Mean Divisia Index Method) and the energy efficiency index approach. Analysis of companies’ investments in energy technologies is used for explaining changes in energy production. Evidence of significant development towards the more sustainable operation of the PPI was found. Energy consumption per produced unit has decreased, i.e., energy efficiency has improved. Fossil fuels have been partially replaced with bio-based alternatives. Thus, the CO2 intensity has decreased substantially. The generation of renewable electricity has increased in both countries. Examples of Finland and Sweden indicate that the PPI has great potential to contribute to CO2 emission reduction worldwide in the future as energy efficiency can be further improved, and the share of fossil fuels can be decreased increasing the use of biofuels and self-generated green electricity at least in kraft pulp mills.

Palliative radiation therapy (pRT) is an effective tool for people with incurable cancer, in the treatment of many cancer-related symptoms such as pain, bleeding and dyspnea. As utilization rates for palliative radiation therapy increase, the demands on the healthcare system continue to grow. Radiation Therapists with advanced knowledge, skills and judgements began demonstrating their ability to practice autonomously in 2004, with the development of the Clinical Specialist Radiation Therapist (CSRT) role. Since this time, CSRTs with a specific focus in pRT (pCSRT) have been increasing in both numbers as well as their positive effects on the cancer care system. Integrating a pCSRT into the existing pRT system has resulted in increased access to and quality of pRT being delivered to palliative cancer patients. The benefits of the addition of pCSRTs to the cancer care system include increasing system capacity and increasing quality of care. This white paper provides information related to the improvements that can be realized in a RT program related to the care and treatment of its palliative patients by adding a pCSRT to the interprofessional healthcare team and suggest it as one of many strategies that can be undertaken to make improvements to access and quality of care.

Neonatal and infantile cholestasis (NIC) can represent the onset of a surgically correctable disease and of a genetic or metabolic disorder worthy of medical treatment. Timely recognition of NIC and identification of the underlying etiology are paramount to improve outcomes. Upon invitation by the Italian National Institute of Health (ISS), an expert working grouped was formed to formulate evidence-based positions on current knowledge about the diagnosis of NIC. A systematic literature search was conducted to collect evidence about epidemiology, etiology, clinical aspects and accuracy of available diagnostic tests in NIC. Evidence was scored using the GRADE system. All recommendations were approved by a panel of experts upon agreement of at least 75% of the members. The final document was approved by all the panel components. This position document summarizes the collected statements and defines the best-evidence diagnostic approach to cholestasis in the first year of life.

With the increased awareness of reusing solid wastes for higher sustainability and the concern of water pollution associated with phosphorus over-emission, there are strong interests in developing solid waste based adsorbents for purifying phosphorus-containing wastewater. As a rich calcium resource, paper mill sludge (i.e., a major solid waste from pulping industry) can be used as phosphorus removal adsorbent after calcination. Thus, in this work, a simple and clean thermally treating route has been proposed for preparing calcium-containing biochar from paper mill sludge. The effect of the physicochemical properties of paper mill sludge and its carbonization condition on phosphorus adsorption has been analyzed. Moreover, the influence of some key adsorption parameters, e.g., biochar dosage, initial pH of solution, co-existing anions, initial phosphorus concentration and contact time has also been investigated. The results showed that the phosphorus adsorption data could be fitted well with pseudo-second-order kinetic and Langmuir isothermal models. The calculated maximum adsorption capacity of the as-prepared optimal calcium-containing biochar could reach to 68.49 mg·g−1 at 25 °C. Combined with the characterization results, it can be reasonably inferred that the adsorption process was chemisorption-dominated. Lastly, the application of this spent adsorbent in agriculture field has also been discussed. In brief, this work provided a feasible strategy for converting paper mill solid waste to an environmental functional material (i.e., calcium-rich biochar) for remediation of eutrophic water.

Objective The objective of this study was to develop the first edition of a Chinese evidence-based position paper on the management of oral leukoplakia (OLK). Study Design The consultant group for drafting the position paper consisted of 31 oral medicine specialists and 2 evidence-based medicine specialists. English studies (searched in PubMed, EMBASE, and the Cochrane Library) and Chinese studies (searched in China National Knowledge Infrastructure and WanFang) published before January 2018 were used. The quality of the study was assessed using the Grading of Recommendations Assessment, Development, and Evaluation grid, and the strength of the recommendations was determined based on the results of 3 rounds of voting among the consultant group members using the Delphi method. Results Twenty-two evidence-based guidelines for clinical management and monitoring of OLK were established in this position paper. A clinical path diagram for oral health practitioners was constructed based on the recommendations. Conclusion Current evidence suggests that management and monitoring of patients with OLK should be performed by experienced clinicians to control the lesion and for early detection of malignant transformation. However, all recommendations are based on evidence of low or extremely low quality and may require further modification as new evidence is produced.

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

Paper and pulp mills generate substantial quantities of cellulose-rich sludge materials that are disposed in landfills at a large scale. For sustainability purposes, sludge materials can be bioprocessed to produce renewable fuels and useful chemicals. The enzymatic hydrolysis of cellulose is the process bottleneck that affects the conversion economics directly by using zero-cost raw materials. In order to study and optimize the process, the characteristics of the sludge raw materials should be first evaluated. In this work, sludge samples were obtained from paper mills located at different locations in Wisconsin and Minnesota. Part of the sludge samples was washed (de-ashed) with hydrochloric acid while the other part remained unwashed. The samples were subjected to multiple spectroscopic analyses techniques to evaluate the morphological properties of cellulose fibers and to estimate the total structural carbohydrate content. The results showed that the de-ashing process changed some fiber characteristics and cellulose crystallinity structure in all sludge samples. Sludge sample A (obtained from Kraft pulp and recycled paper mill region) showed a high percentage of fiber, with crystalline cellulose, compared to the other two sludge samples suggesting that sludge A is a valuable source to make value-added products. Aspen Plus mass and energy calculations performed in view of the ‘zero’ cost and the reliable supply of sludge raw materials producing 2 mol H2/mol glucose. Moreover, the results showed that extracting crystalline cellulose from these sludge samples is more profitable than crystalline cellulose made from the other lignocellulosic feedstocks. The results reported here showed that the utilization of these sludge materials would be an economically attractive and promising alternative for the production of hydrogen.

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

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.

pH of fluids is an important indicator in biomedical and environmental studies. Conventional pH analysis techniques are often either instrumentation-intensive, expensive or qualitative in nature. Microfluidics based analytical devices have emerged as powerful alternative to overcome some of the existing limitations. These devices are characterized by low reagent and sample volumes, controlled flow, cost-effectiveness and portability. In this work, we report a microfluidic paper-based lab-on-a-chip pH sensing platform that incorporates passive fluid flow of samples. The colorimetric pH detection is integrated with mobile phone based image acquisition, followed by digital image processing and analysis for quantitative interpretation of data. The images are analyzed using image processing algorithms and color space. Regression analysis of data acquired from digital image analysis was used to evaluate the mathematical model for estimation of pH. The insights gained by this work would prove useful in development and deployment of portable and miniaturized sensors.

In society, there is widespread and growing acceptance of the value of cooperation between industry and universities being collaborative Research and Development (R&D) domain and industrial policy the fuel of knowledge-based economies. In this paper, different domains of cooperation between the University and Industry as well as their generated benefits for each partner are identified. These benefits have been assigned to each domain of cooperation, showing a large number of benefits associated to collaborative R&D. Leading us to make a statement - collaborative R&D is the key cooperation domain for sustainable long-term university-industry partnerships. Suggestions are given about how to continue this research study.

The transperineal approach is preferred to reduce prostate biopsy (PB)-related infections. Fluoroquinolones are suspended for prophylaxis of PB in the European Union; therefore, alternative antibiotics based on local resistance, or targeted prophylaxis, in conjunction with povidone-iodine rectal preparation are recommended for transrectal PB.

International audience; Magnetic resonance imaging (MRI) has become the reference imaging for the management of a large number of diseases. The number of MR examinations increases every year, simultaneously with the number of patients receiving a cardiac electronic implantable device (CEID). A CEID was considered an absolute contraindication for MRI for years. The progressive replacement of conventional pacemakers and defibrillators by MR-conditional CEIDs and recent data on the safety of MRI in patients with "MR-nonconditional" CEIDs have progressively increased the demand for MRI in patients with a CEID. However, some risks are associated with MRI in CEID carriers, even with "MR-conditional" devices because these devices are not "MR-safe". A specific programing of the device in "MR-mode" and monitoring patients during MRI remain mandatory for all patients with a CEID. A standardized patient workflow based on an institutional protocol should be established in each institution performing such examinations. This joint position paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) describes the effect and risks associated with MRI in CEID carriers. We propose recommendations for patient workflow and monitoring and CEID programming in MR-conditional, "MR-conditional nonguaranteed" and MR-nonconditional devices.

Antimicrobial resistance (AMR) continues to threaten global health. Although global and national AMR action plans are in place, infection prevention and control is primarily discussed in the context of healthcare facilities with home and everyday life settings barely addressed.\ud \ud As seen with the recent global SARS-CoV-2 pandemic, everyday hygiene measures can play an important role in containing the threat from infectious microorganisms.\ud \ud This position paper has been developed following a meeting of global experts in London, 2019. It presents evidence that home and community settings are important for infection transmission and also the acquisition and spread of AMR. It also demonstrates that the targeted hygiene approach offers a framework for maximizing protection against colonization and infections, thereby reducing antibiotic prescribing and minimizing selection pressure for the development of antibiotic resistance. If combined with the provision of clean water and sanitation, targeted hygiene can reduce the circulation of resistant bacteria in homes and communities, regardless of a country's Human Development Index (overall social and economic development). Achieving a reduction of AMR strains in healthcare settings requires a mirrored reduction in the community.\ud \ud The authors call upon national and international policy makers, health agencies and healthcare professionals to further recognize the importance of targeted hygiene in the home and everyday life settings for preventing and controlling infection, in a unified quest to tackle AMR.

Unprinting of paper can reduce multiple life-cycle stages in the recycling of paper to yield significant environmental impact. Laser-unprinting has been demonstrated for uncoated paper but causes significant damage to coated paper. This work explores a scalable optical (non-laser) process for unprinting coated paper. Printed coated paper is exposed to pulsed broad-spectrum Intense Pulsed Light (IPL) from a xenon lamp and the toner is then removed by dabbing gently with an ethanol wipe. While black toner is easily unprinted, unprinting of colored prints (red, blue, green) is best realized by incorporating an initial overprint of black toner. An unprinting throughput on the order of mm2/s is achieved. Three distinct regimes of unprinting are identified based on the extent of toner removal and damage of the paper. The optical properties of the unprinted paper, characterized via UV–Visible spectrophotometry, are correlated to these regimes to understand the potential for in-situ optical process monitoring. Scanning Electron Micrography and Fourier-Transform Infrared Spectroscopy are performed to understand the underlying mechanisms that govern the occurrence of the different unprinting regimes. Further, the potential impact of the developed approach on recycling of paper is discussed in the context of the capabilities of current optical unprinting approaches and the potential elimination of life-cycle stages in conventional paper recycling.

The recycling of waste paper has been an effective way to achieve the environmental-friendly growth of papermaking industry. Focusing on the mixed-pulping process which has been generally employed, to ensure the required properties of the deinking pulp (DIP) and minimize the purchase cost of waste paper, an intelligent model scheduling the mixing ratio of waste paper was developed in the study. Primarily, driven by the field data of mixing ratio of waste paper and DIP properties, the prediction models of DIP properties were developed by SVM, GA-SVM, and BP-NN algorithms. Subsequently, based on the best prediction model, the scheduling model for the mixing ratio of waste paper was set up by NSGAII algorithm. The experimental results showed that, based on the obtained best BP-NN prediction model of DIP properties, the developed NSGAII scheduling model for the ratio of waste paper could achieve excellent scheduling results under the rigorous constraints and multi-objective. Compared with the previous study, the developed prediction and scheduling models in this study reduced the purchase cost of waste paper by 2.16%, and improved the acceptable proportion of DIP property from 56.07% to 100%.

Purpose Current trials on adjunctive treatment with antiseizure drugs often do not reveal results which are relevant for clinical practice. Method Therefore, an interdisciplinary group of German experts discussed a new framework for future antiseizure drug (ASD) trials in adults. This group included members of the executive board of the German Society of Epileptology, of the German institutes for health technology assessment (HTA), of patient organizations and of drug manufacturers. Agreement was reached by consensus decision making after intensive discussion of the findings of a narrative review of the current literature. Results The group jointly recommends that ASD trials in adults should be based on and include relevant patient groups, e.g. elderly patients and patients with relevant co-morbidities, should adopt a study duration of at least 12 months, should avoid placebo arms, should include active comparators of clinical relevance, may be designed as open label trials with blinded outcome measurements, should focus on patient relevant outcomes that reflect the impact of benefits and harms of treatments on daily living, such as seizure freedom and seizure severity as well as retention rate, functional outcomes and quality of life as compound measures, and should avoid arbitrary and non-sensitive primary endpoints such as dichotomized changes in seizure frequency. Conclusions This paper focused on improved head-to-head trials on adjunctive treatment with antiseizure drugs. The group welcomes any further work and discussion to enhance future studies which can be applied to the entire spectrum of potentially meaningful study populations and outcomes.

Resumen Introduccion La pandemia por COVID-19 ha conllevado la suspension de la actividad programada en la mayoria de las Unidades de Endoscopia de nuestro medio. El objetivo del presente documento es facilitar el reinicio de la actividad endoscopica electiva de forma eficiente y segura. Material y metodos Se formulo una serie de preguntas consideradas de relevancia clinica y logistica. Para la elaboracion de las respuestas, se realizo una busqueda bibliografica estructurada en las principales bases de datos y se revisaron las recomendaciones de las principales instituciones de Salud Publica y de endoscopia digestiva. Las recomendaciones finales se consensuaron por via telematica. Resultados Se han elaborado un total de 33 recomendaciones. Los principales aspectos que se discuten son: 1) la reevaluacion y priorizacion de la indicacion; 2) la restructuracion de espacios, agendas y del personal sanitario; 3) el cribado de la infeccion, y 4) las medidas de higiene y los equipos de proteccion individual. Conclusion La AEG y la SEED recomiendan reiniciar la actividad endoscopica de forma escalonada, segura, adaptada a los recursos locales y a la situacion epidemiologica de la infeccion por SARS-CoV-2.

The dissemination of emerging electronic devices increases considerably alongside with the Internet of Things (IoT) paradigm. Some key elements considered in these devices (e.g. rare-earth) are becoming critical materials and are associated with serious environmental concerns. Therefore, there is a major requirement for designing differently our electronic technologies at the early stages of the research process. Many reports present the promising properties of paper-based electronics as meant to address this challenge. Through technical and life cycle assessments, this article discusses the main design levers in terms of material and fabrication process choices for the eco-design of paper-electronics water quality sensors. Our results suggest conscientious choices of conductive nanomaterials and additive fabrication techniques.

Paper-based devices are always more gaining a relevant position in the field of sensors. The continuous demand for affordable, simple, sustainable, and portable devices, is making paper as the ideal basis towards the realization of analytical tools for the easy self-testing. In this work, we demonstrate, for the first time, the development of a disposable paper-based printed electroanalytical strip for reliable, rapid, and high-throughput detection of glutathione in blood. The detection is based on the thiol-disulfide exchange reaction, which produces a detectable compound easily oxidizable at a Prussian Blue/carbon black nanocomposite involving a favorable low-interference overpotential. This nanocomposite is mixed within a carbon-based conductive ink and successively screen-printed onto a wax-patterned filter paper. The employment of paper provides a reagent-free device, as a consequence of the reagents pre-loading within the testing area. After the experimental conditions have been optimized, glutathione has been detected up to 10 mM, with a detection limit of 60 μM, and a sensitivity of (0.102 ± 0.005) μA/mM. This sensor showed satisfactory repeatability (relative standard deviation equal to 10%, for detection of glutathione 1 mM), especially by considering the hand-made manufacturing process. The “real-world” applicability of this strip has been evaluated by quantifying blood glutathione at physiological levels and by recovery studies achieving satisfactory values.

Microbial fuel cell is a promising technology to harvest energy from wastewater, and effective anode catalysts are essential for its applications. In this study, zero-dimension nitrogen-doped carbon dots, as biocompatible efficient modifiers, were synthesized and decorated onto the carbon paper surface to prepare microbial fuel cell anode. The as-fabricated nitrogen-doped carbon dots decorated carbon paper anode was able to enhance electricity generation and efficient wastewater treatment. It was found that the as-fabricated electrode had a high hydrophilicity, which was favorable for the microbial immobilization. Compared with the carbon paper anode, the biofilm on the as-prepared anode was almost twice of thickness. After introducing nitrogen-doped carbon dots, the extracellular electron transfer process from the microorganisms to the anode was enhanced. The microbial fuel cell with the as-developed anode generated a remarkable power output of 0.32 mW, 1.1 times higher than that of the raw carbon paper anode with same measurement area. Moreover, 16 sRNA pyrosequencing analysis shows that the quantity of Pseudomonas on the electrode increased by ∼40%, which also promoted the electron transfer rate by excreting mediators like phenazines or phenazine derivatives. This work developed a new approach to design microbial fuel cell anode material and fabricate a high-efficiency and environmentally friendly anode for electricity generation from wastewater.

This study estimates efficiency in energy utilization at firm level and feasible energy saving target of the pulp and paper industry in India. For this analysis, data is extracted from prowess database for a panel of 67 major pulp and paper producing firms over the period of 2003–04 to 2013–14. We employed radial and non-radial variants of data envelopment analysis to assess the feasible energy saving target with the current level of output. Particularly, we employed slack-based method with variable returns to scale as a flexible and pragmatic approach to performance analysis. Results reveal no significant improvement in the energy efficiency level of the firms over the study period and show vast energy saving potential. Results of slack-based measure of energy efficiency show the feasible energy saving potential of 40%. Further, size of the firm, age and financial performance are important factors that influence energy efficiency. Therefore, this study recommends special attention to the paper industry while implementing energy efficiency programme. We also reviewed four major policies for industrial energy efficiency improvement initiated by Bureau of Energy Efficiency, India.

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

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

Adding biochar to paper mill biosolids (PB) amendments may affect PB mineralization rate and nitrogen (N) availability. The objective of this 224-day incubation study was to evaluate the effect of amending two PB types varying in carbon (C)/N ratio (PB1, C/N = 24; and PB2, C/N = 13) with three rates (0%, 2%, and 5%) of pine (Pinus strobus L.) biochar produced at 700 °C on the dynamics of total C, total N, mineral N, N mineralization rate, and microbial biomass C (MBC) and N (MBN) in two agricultural soils (Kamouraska clay and St-Antoine sandy-loam). Two reference treatments were also included, namely, mineral fertilization and unamended soil. Total soil C concentration remained stable over the incubation period, whereas a decrease in total soil N was observed in both soils. In comparison with the unamended soil, the application of PB significantly increased total N, NH4-N, NO3-N, net mineralized N, applied N mineralization rate, and MBC in both soils. In comparison with the application of PB alone, biochar addition increased total C and MBC but decreased NH4-N, NO3-N, net N mineralization, and applied N mineralization rate in both soils. The co-application of biochar and PB1 resulted in the sequestration of mineral N released, which was more pronounced in the Kamouraska clay soil. The co-application of biochar and PB2 resulted in moderate release of mineral N. This study showed that the co-application of biochar and PB can benefit agricultural soils by improving NO3-N retention in agroecosystems while increasing organic matter and promoting microbial biomass.

Improvements in survival among cancer patients have revealed the clinical impact of cardiotoxicity on both cardiovascular and hematological and oncological outcomes, especially when it leads to the interruption of highly effective antitumor therapies. Atrial fibrillation is a common complication in patients with active cancer and its treatment poses a major challenge. These patients have an increased thromboembolic and hemorrhagic risk but standard stroke prediction scores have not been validated in this population. The aim of this expert consensus-based document is to provide a multidisciplinary and practical approach to the prevention and treatment of atrial fibrillation in patients with active cancer. This is a position paper of the Spanish Cardio-Oncology working group and the Spanish Thrombosis working group, drafted in collaboration with experts from the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology, and the Spanish Society of Hematology.

The development and production of new materials requires advanced analytical characterisation to explain the relation between the physico-chemical structure of the material and its properties. Highly integrated microelectronic structure analysis of surfaces with laser beams and X-ray fluorescence aided devices are found to be helpful for providing important information, including the interrelationships between physical, chemical, mechanical and durability characteristics of the new developed products. In most instances no single technique provides all the needed information and hence simultaneous application of several techniques becomes necessary. This study was aimed for hydration analysis, characterization and evaluation of a new novel non-Portland binder (NPB) with waste paper sludge ash (PSA) using FTIR and TG/DTA. The progressive formation of hydration products within the non-Portland binder was identified and their microstructural characteristics were analysed. The stable and non-expansive nature of secondary ettringite formation was also identified after a period of 365 days curing.

Thermal papers, commonly used for printed receipts or lottery tickets, are omnipresent in our everyday life. They are regarded as semi-porous substrates, and yet can be critical to analyze when looking for latent fingermarks due to their thermosensibility. The aim of this study was to investigate a development sequence that would better combine the adequate detection techniques in order to maximize the chances to develop latent fingermarks left on these substrates. Different methods of development have been compared on test substrates: black magnetic powder, Lumicyano™, thermal development, ninhydrin and 1,2-indanedione/ZnCl2. Whitening stages and thermal development have been focused on, tested and optimized. The results of these preliminary tests enabled the study of three development sequences. They have subsequently been compared to the one currently used in the Gendarmerie's laboratories and the best results have been provided during pseudo-operational comparative trials by one of these sequences, consisting in 6 stages.

Graphical abstract, Highlights • Detection of cytokine storm biomarkers with mobile biosensors. • Immunosensors are made solely of cellulose modified with antibody-decorated nanoparticles. • Turnaround time under 10 min. • Detection of biomarkers in respiratory samples allows monitoring local inflammation. • Compatible with decentralized health care schemes., Decentralizing COVID-19 care reduces contagions and affords a better use of hospital resources. We introduce biosensors aimed at detecting severe cases of COVID-19 in decentralized healthcare settings. They consist of a paper immunosensor interfaced with a smartphone. The immunosensors have been designed to generate intense colorimetric signals when the sample contains ultralow concentrations of IL-6, which has been proposed as a prognosis biomarker of COVID-19. This is achieved by combining a paper-based signal amplification mechanism with polymer-filled reservoirs for dispensing antibody-decorated nanoparticles and a bespoken app for color quantification. With this design we achieved a low limit of detection (LOD) of 10−3 pg mL-1 and semi-quantitative measurements in a wide dynamic range between 10−3 and 102 pg mL-1 in PBS. The assay time is under 10 min. The low LOD allowed us to dilute blood samples and detect IL-6 with an LOD of 1.3 pg mL-1 and a dynamic range up to 102 pg mL-1. Following this protocol, we were able to stratify COVID-19 patients according to different blood levels of IL-6. We also report on the detection of IL-6 in respiratory samples (bronchial aspirate, BAS) from COVID-19 patients. The test could be easily adapted to detect other cytokines such as TNF-α and IL-8 by changing the antibodies decorating the nanoparticles accordingly. The ability of detecting cytokines in blood and respiratory samples paves the way for monitoring local inflammation in the lungs as well as systemic inflammation levels in the body.

Objective Communication in healthcare has influenced and been influenced by the COVID-19 pandemic. In this position paper, we share observations based on the latest available evidence and experiential knowledge that have emerged during the pandemic, with a specific focus on policy and practice. Methods This is a position paper that presents observations relating to policy and practice in communication in healthcare related to COVID-19. Results Through our critical observations as experts in the field of healthcare communication, we share our stance how healthcare communication has occured during the pandemic and suggest possible ways of improving policy and professional practice. We make recommendations for policy makers, healthcare providers, and communication experts while also highlighting areas that merit further investigation regarding healthcare communication in times of healthcare crises. Conclusion We have witnessed an upheaval of healthcare practice and the development of policy on-the-run. To ensure that policy and practice are evidence-based, person-centred, more inclusive and equitable, we advocate for critical reflection on this symbiotic relationship between COVID-19 and the central role of communication in healthcare. Practice implications This paper provides a summary of the key areas for development in communication in healthcare during COVID-19. It offers recommendations for improvement and a call to review policies and practice to build resilience and inclusive and equitable responsiveness in communication in healthcare.

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

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

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

Cancer-related cognitive decline (CRCD) may have particularly significant consequences for older adults, impacting their functional and physical abilities, level of independence, ability to make decisions, treatment adherence, overall quality of life, and ultimately survival. In honor of Dr. Hurria's work we explore and examine multiple types of screening, assessment and non-pharmacologic treatments for CRCD. We then suggest future research and clinical practice questions to holistically appreciate the complexity of older adults with cancer's experiences and fully integrate the team-based approach to best serve this population. (C) 2019 Elsevier Ltd. All rights reserved.

This document was prepared thanks to the collective expertappraisal, carried out by the Anses’expert group‘GECUCovid-19’(ANSES opinion 2020-SA-0037), chaired by Sophie Le Poder and whose members for the animal health component are cited in the authors.; International audience; In late December 2019, an outbreak of clustered cases of pneumonia associated with a novel coronavirus was reported by the Chinese authorities to the World Health Organization (WHO). Several initial confirmed cases were linked to a wetmarket selling live animals and seafood products in Wuhan(Hubei province), China (Huang et al.,2020). On 30 January 2020, the WHO declared the outbreak a Public Health Emergency of International Concern. On 11 February 2020, the causative pathogen was officially named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), responsible for Coronavirus Disease 2019 (COVID-19) (DuToit, 2020). Severe Acute Respiratory Syndrome Coronavirus 2 is mainly transmitted from person to person, by direct or indirect contact, through infectious microdroplets emitted wheninfected individuals spit, sneeze or cough (Bernard Stoecklin et al.,2020). The massive circulation of this new pandemiccoronavirus with a probable zoonotic origin raised questions on its ability to spillover to animal species and on the potential consequences of such events on both animals and humans. This public health concern came to the attention of animal health authorities given the close contacts between humans and domestic animals. Therefore, in France, the French Agency for Food, Environmental and Occupational Health and Safety (ANSES) established an Emergency Collective Expert Appraisal Group (Groupe d’Expertise Collective d’Urgence, GECU‘Covid-19’). The GECU ‘Covid-19’ urgently convened on 4 March 2020 and 8 April 2020 to conduct an evaluation of the potential role of domestic animals in the ongoing COVID-19 pandemic.

Hematopoietic stem cell transplantation (HSCT) patients can suffer from various musculoskeletal problems resulting in long-term functional incapacity. Physical therapy (PT), as a part of the healthcare team, has been historically advocated for regaining functional capacity and improving quality of life post-HSCT. Because of the nature of this condition and the burden of post-transplant complications, this patient group requires a unique approach toward their rehabilitation that takes into account their complex musculoskeletal presentation ranging from fascia, muscle, tendons, bones, and ligaments. However, to our knowledge there is no universal standardized PT protocol or pathway to help guide rehab specialists to achieve optimal gains for this patient group, and anecdotal evidence suggests that these patients do not always receive the PT care they require. Hence, in collaboration with the Transplant Complications Working Party of the European Society for Blood and Marrow Transplantation, the Survivorship Special Interest Group of the American Society of Blood and Marrow Transplantation, and the Quality of Life Committee of the Eastern Mediterranean Blood and Marrow Transplantation, herein the Physical Therapy Association for Graft Versus Host Disease provides a brief review on role of PT in mitigating musculoskeletal complications in HSCT patients and makes evidence-based recommendations for incorporation of PT into routine HSCT care. ispartof: Biol Blood Marrow Transplant vol:25 issue:6 pages:e191-e198 ispartof: location:United States status: published

Pulp and paper industry is one of the high priority sectors that generates large amount of solid (sludge) and liquid (paper mill effluent) wastes. Making use of this huge quantity of paper mill sludge (PMS) in an environment friendly manner is challenging and cost involving. Similarly the present wastewater treatment strategies based on physical and chemical methods encounter certain serious setbacks including secondary pollution generation with expensive mode of abatement processes. The present study aims at a “waste treats waste” strategy for the bioremediation of paper mill effluent in fluidized bed reactor (FBR) using another waste of the same industry, PMS as immobilizing matrix for Planococcus sp. TRC1, a wastewater bacterial isolate. This study simultaneously explores this isolate for the yellowish orange pigment it produces (2.3 ± 0.2 mg/gm of dry bacterial biomass) and characterizes it as a member of the pharmacologically important carotenoid pigment family via UV-Vis spectrophotometry, TLC, FT-IR and 13C NMR. The antioxidant potential of this pigment was studied by DPPH assay (IC50 = 33 ± 0.4 μg/ml) and H2O2 assay (IC50 = 147.4 ± 2.2 μg/ml). In FBR, the PMS immobilized bacteria showed removal of phenol, lignin, colour and COD from the effluent by 96%, 74%, 81% and 85% respectively after 60hr of treatment. The experimental data on immobilization fitted well with pseudo second-order (R2 = 0.955) and Freundlich adsorption isotherm (R2 = 0.996) models. The alterations in PMS before and after bacterial immobilization, as revealed by SEM and FT-IR, depicted the success of PMS as immobilization matrix. Phytotoxicity (90% seed germination) and mutagenicity studies confirmed that the treated effluent was substantially less toxic than its raw state. This study highlights a novel utilization possibility of PMS in an eco-friendly and economic way as immobilization matrix for Planococcus sp.TRC1 for paper pulp mill effluent treatment along with production of carotenoid pigment from this potential bacterial isolate as value added product.

Pulp and paper mill industry is already known as an extensive water user and hence produces large volume of wastewater. Phytoremediation has merits to offer due to its environmentally friendly, relatively low cost and easy maintenance. This work focused on the performance of a continuous pilot subsurface flow (SSF) system of constructed wetlands in removing chemical oxygen demand (COD) representing organic carbon, colour and suspended solids from recycled pulp and paper mill under 5-day hydraulic retention time (HRT) for 95 days. In this study, there were two tanks based on the SSF system; one tank planted with Malaysian native bulrush (Scirpus grossus) and another tank without plants acting as a control. It was found that the SSF system with S. grossus was much better compared to the SSF control. Throughout the 95-day exposure, the planted SSF system have achieved removals of 66.1, 55.8 and 87.2% for COD, colour and suspended solid (SS), respectively. However, the control SSF system without plants has lower performance for all the three parameters (62.4% COD, 44.4% colour and 84.8% SS), giving evidence that constructed wetlands is an efficient technology to phytoremediate COD, colour and SS from recycled pulp and paper effluent.

Flexible sensing devices have drawn tremendous attention in the past decades due to their potential applications in future hand-held, potable consumer, and wearable electronics. Here, we firstly developed an ultrasensitive wireless potentiometric aptasensor based on flexible freestanding graphene paper for kanamycin detection. Flexible graphene paper made from a simple vacuum filtration method was used as a biocompatible platform for effective immobilization of aptamer. A nuclease-assisted amplification strategy was introduced into this potentiometric biosensing system in order to significantly improve the detection sensitivity through a classic catalytic recycling reaction of target induced by the nuclease (DNase I). As expected, an ultra-low detection limit of 30.0 fg/mL for kanamycin was achieved. Furthermore, the developed potentiometric enzymatic aptasensor exhibits high selectivity, favorable flexibility, excellent stability and reproducibility, which holds great promising for its routine sensing application.

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

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