Search

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.

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.

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.

Bisphenol A (BPA), a well-known endocrine disruptor, is used as a color developer in thermal paper. More recently, some emerging structural analogues have been introduced to replace BPA due to the strengthened regulations concerning thermal paper. Nevertheless, very limited data are available regarding their occurrence and potential health risks. Here, thirteen potentially toxic compounds were investigated in paper products (120 thermal papers and 81 nonthermal papers) collected in Beijing, China. The results indicated that the replacement of BPA by alternatives such as Bisphenol S (BPS), Bis(2-chloroethyl)ether-4,4″-dihydroxydiphenyl sulfone copolymer (D-90), 4-hydroxyphenyl 4-isoprooxyphenylsulfone (D-8), Bis(4-hydroxyphenyl)sulfonylphenyl (BPS-MAE) and Bis-(3-allyl-4-hydroxyphenyl) sulfone (TGSA) has been significantly advanced in several types of thermal paper (i.e., market weight stickers, train tickets, express labels, air boarding passes and lottery tickets). The mean value for the total analyte concentrations in thermal paper was 6.06 mg/g, and the highest level found was 26.0 mg/g. In addition, the frequent detection of these chemicals in nonthermal paper (>80%, n = 81) demonstrated that the contamination in thermal paper can be spread into other recycled paper, such as corrugated boxes, newspapers, food contact papers, etc. The estimated daily intake of BPA and its alternatives through the handling of thermal paper was 0.025 μg/kg bw/day for the general population. This is the first report on the occurrence of various new BPA alternatives in paper products from China, which will be helpful for further risk assessment and making responsible replacement decisions.

To evaluate the effect of brown-rot fungi Oligoporus placenta and earthworm Eisenia fetida on decomposition of paper mill sludge, the paper mill sludge was mixed with cow dung in 0, 25, 50, 75, and 100% proportions and changes in physicochemical quality of waste mixtures was carried out for 28 days. All waste mixtures were treated with: Setup-I (E. fetida), Setup-II (O. placenta) and, Setup-III (E. fetida + O. placenta). A decrease in total organic carbon, C/N ratio and cellulose but an increase in total kjeldhal nitrogen, total phosphorus, total potassium and pH was recorded. The paper mill sludge in 50–75% proportion in feedstock showed the better results and rate of mineralisation were in order: Setup-III > Setup-I > Setup-II. The proportion of CD has direct role in waste mineralisation. The microbial population (bacterial, fungal and actinomycetes) and earthworm biomass were also high in Setup-III, suggesting the influence of brown-rot fungi on paper mill sludge humification. Results indicate that fungal inoculate in vermicomposting was effective in decomposing cellulose-rich industrial sludge.

Both trade and production of graphic paper have decreased over the last three decades. While this general decrease can partially be attributed to increased prominence of information technology, the overall figure is devoid of context and thus of most of its meaning to global economy. In this study we aim to break this trend down across the geographical and temporal scope, across its supply-chain commodities and to find out what drives the global trade patterns. Econometric trade models focus on the trading countries and direct exports or imports but fail to consider the structural and the indirect trade relations. We take the approach of network analysis, where the emphasis is on the structure of trade and not on country-level descriptors. We focus on 1995–2017 period as within it this decrease can be observed and assess the entire graphic paper and pulp supply chain, consisting out of printing and writing paper, mechanical wood pulp, chemical wood pulp, semichemical wood pulp, pulp made from fiber other than wood, recovered paper and paperboard. We employ descriptive statistical and network analysis, grouping and role analysis, and end with an inferential logistic regression quadratic assignment procedure model. Results show that newsprint trade decline is mirrored in printing and writing paper and mechanical wood pulp. The trade network densities have remained generally stable throughout the observed period, but the topological proprieties of the individual product groups vary greatly. Although no stabile grouping of countries throughout the assessed period could be observed, role analysis shows that countries tend to trade within their continent, that European countries are at the core of the trade network, and that the structural shift of decline of the trade value is followed by increasing prominence of several Asian countries, such as China and Indonesia. The most important finding of the study is that internal trade effects such as reciprocity and transitivity are much more explanatory than classical effects used in trade models such as GDP per capita, geographical distance or forest endowment.

The present study demonstrates the vermistabilization of paper mill wastewater sludge (PMS) spiked with cow dung (CD) employing indigenous epigeic earthworm Perionyx excavatus Perrier. A total of six treatments were prepared along with a positive control (PC) and negative control (NC). Twenty earthworms were released into each treatment including PC and NC without earthworms. The different proportions viz., T1 (CD – 100%), T2 (PMS:CD – 1:3), T3 (PMS:CD – 1:2), T4 (PMS:CD – 1:1), T5 (PMS:CD – 3:1), T6 (PMS:CD – 2:1), PC (PMS – 100%) and NC (PMS – 100%) and changes in chemical parameters and microbial properties were recorded during the course of 60 days. Vermistabilization caused a significant decrease in the level of heavy metals: Cd (2.9–27.8%), Cu (0.22–42.3%), Pb (1.3–56.3%) and Cr (0.8–46.2%). The bioconcentration factor (BCFs) was also calculated and great amount of heavy metals accumulated in their body (mg kg−1) that ranged from 0.31 ± 0.003–0.45 ± 0.007 for Cd, 0.12 ± 0.005–0.24 ± 0.003 for Cu, 0.15 ± 0.005–0.31 ± 0.006 for Pb and 0.29 ± 0.007–0.56 ± 0.001 mg kg−1 for Cr, accumulation of heavy metals are in the order: Cr > Cd > Pb > Cu. The physicochemical parameters of earthworm treated substrate such as electrical conductivity, total nitrogen, total phosphorus and total potassium were significantly increased; whereas, pH, total organic carbon, C:N ratio (carbon: nitrogen) and C:P ratio (carbon: phosphorus) were reduced after 60 days of vermistabilization. The vermistabilized materials also had a higher population of bacteria (98.90 ± 0.30 CFU × 106 g−1), fungi (43.75 ± 0.55 CFU × 103 g−1) and actinomycetes (67.65 ± 0.45 CFU × 105 g−1) than initial mixtures. Moreover, several histopathological changes were observed in earthworm tissues viz., disintegration of cells, irregular surface of epidermis, cellular debris, irregular cellular compartmentation, and oval-shaped nucleus. Higher level of histopathological abnormalities was recorded in PC (PMS-100%) while none were detected in lower concentrations of PMS. Furthermore, the study concludes that the paper mill sludge in a mixture of cow dung (1:1 ratio) can be a useful proposition for utilizing this hazardous waste through the adoption of vermitechnology.

Objective Recently Doi et al. argued that risk ratios should be replaced with odds ratios in clinical research. We disagreed, and empirically documented the lack of portability of odds ratios, while Doi et al. defended their position. In this response we highlight important errors in their position. Study design and setting We counter Doi et al.’s arguments by further examining the correlations of odds ratios, and risk ratios, with baseline risks in 20,198 meta-analyses from the Cochrane Database of Systematic Reviews. Results Doi et al.’s claim that odds ratios are portable is invalid because 1) their reasoning is circular: they assume a model under which the odds ratio is constant and show that under such a model the odds ratio is portable; 2) the method they advocate to convert odds ratios to risk ratios is biased; 3) their empirical example is readily-refuted by counter-examples of meta-analyses in which the risk ratio is portable but the odds ratio isn't; and 4) they fail to consider the causal determinants of meta-analytic inclusion criteria: Doi et al. mistakenly claim that variation in odds ratios with different baseline risks in meta-analyses is due to collider bias. Empirical comparison between the correlations of odds ratios, and risk ratios, with baseline risks show that the portability of odds ratios and risk ratios varies across settings. Conclusion The suggestion to replace risk ratios with odds ratios is based on circular reasoning and a confusion of mathematical and empirical results. It is especially misleading for meta-analyses and clinical guidance. Neither the odds ratio nor the risk ratio is universally portable. To address this lack of portability, we reinforce our suggestion to report variation in effect measures conditioning on modifying factors such as baseline risk; understanding such variation is essential to patient-centered practice.

This study explored the relationship between syntactic complexity and rhetorical functions and the relationship between syntactic complexity and level of move/step realization in learner-generated research paper introductions. We created a corpus of 79 introductions written by undergraduate L2 students at intermediate to high-intermediate levels. We annotated the introductions for moves and steps, measured their syntactic complexity at the global, clausal, and phrasal levels, and rated their level of move/step realization across four levels (no, low, intermediate, and high). We conducted one-way MANOVA, one-way ANOVA, Pearson correlation, and stepwise multiple linear regression analyses. We found sentences realizing Reviewing items of previous research function to be significantly longer than other steps in Move1 and to contain significantly more clausal and phrasal complexity features. Sentences performing Claiming centrality function also demonstrated significantly more phrasal complexity features as measured by complex nominals per clause. We also found a higher level of phrasal complexity in introductions with a higher level of move/step realization, which can be attributed to introductions including Step1 and Step3, rather than containing all steps. Our findings imply that there is value in developing explicit instructions on how to use complex structures in performing rhetorical steps in research paper introductions. © 2021 Elsevier Ltd

Valorisation involves conversion of toxic compounds into value added products. The present study has tried to evaluate the potential of vermicomposting in management of different types of toxic paper mill wastes such as primary waste (VCP) and secondary waste (VCS) using Eisenia fetida for 60 days. The procedure was performed using sundried samples of paper mill wastes, cow dung and straw in different trial sets using different ratios. The study had revealed that the trial sets (VCP1 and VCS1) using ratio of paper mill waste: Cow dung: Straw (5:4:1) were effective in maintaining physiochemical parameters and different population attributes of earthworm. The present study had also demonstrated the enzymatic enrichment of vermicompost in terms of 19 enzymes such as α-Glucosidase, lipase, leucine aminopeptidase etc. in maintenance of C/N ratio of the compost. A significant reduction of heavy metals were noticed in vermicomposting of primary waste (VCP1) as Zn (40%) ​> ​Pb (36%) ​> ​Cr (28%) ​> ​Cu (25%) and secondary waste (VCS1) as Zn (44%) ​> ​Pb (41%) ​> ​Cu (19%) ​> ​Cr (13%). Such reduction of heavy metal was highly correlated with the reduction of C/N ratio of the vermicompost. The process of bioremediation was further manifested through the regular monitoring of bioaccumulation factor (BAF) among earthworm population in vermicomposting of primary waste (VCP1) as Zn (0.40) ​> ​Cu (0.23) ​> ​Cr (0.18) ​> ​Pb (0.11) and secondary waste (VCS1) as Zn (0.47) ​> ​Cu (0.25) ​> ​Cr (0.21) ​> ​Pb (0.14). Therefore, the study concludes that the ratio of paper mill waste, cow dung and straw (5:4:1) can be an efficient formulation in qualitative enrichment of different toxic organic paper mill wastes through vermicomposting.

Most anticancer molecules are administered in body-size-based dosing schedules, bringing up unsolved issues regarding pharmacokinetic data in heavy patients. The worldwide spread of obesity has not been matched by improved methods and strategies for tailored drug dosage in this population. The weight or body surface area (BSA)-based approaches may fail to fully reflect the complexity of the anthropometric features besides obesity in cancer patients suffering from sarcopenia. Likewise, there is a lack of pharmacokinetic data on obese patients for the majority of chemotherapeutic agents as well as for new target drugs and immunotherapy. Therefore, although the available findings point to the role of dose intensity in cancer treatment, and support full weight-based dosing, empirical dose capping often occurs in clinical practice in order to avoid toxicity. Thus a panel of experts of the Associazione Italiana Oncologia Medica (AIOM), Associazione Medici Diabetologi (AMD), Società Italiana Endocrinologia (SIE), and Società Italiana Farmacologia (SIF), provides here a consensus statement for appropriate cytotoxic chemotherapy and new biological cancer drug dosing in obese patients., Highlights • The worldwide spread of obesity is an emerging challenge also in cancer patients • Weight or BSA-based approaches do not adequately address the critical issue of optimal dosing for cancer drugs under obesity • Empirical dose capping is often employed in clinical practice to avoid toxicities among overweight and obese patients • There is a lack of clinical and pharmacokinetic studies in this population • Clinical practice recommendations should guide suitable dosing of cytotoxic and biological cancer drugs in obese patients

Endoscopic image-enhancement technologies provide opportunities to visualize normal and abnormal tissues within the gastrointestinal (GI) tract in a manner that complements conventional white light endoscopic imaging. The additional information that is obtained enables the endoscopist to better identify, delineate, and characterize lesions and can facilitate targeted biopsies or, in some cases, eliminate the need to send samples for histologic analysis. Some of these technologies have been available for more than a decade, but despite this fact, there is limited use of these technologies by endoscopists. Lack of formalized training in their use and a scarcity of guidelines on implementation of these technologies into clinical practice are contributing factors. In November 2014, the American Gastroenterological Association's Center for GI Innovation and Technology conducted a 2-day workshop to discuss endoscopic image-enhancement technologies. This article represents the third of 3 separate documents generated from the workshop and discusses the published literature pertaining to training and outlines a proposed framework for the implementation of endoscopic image-enhancement technologies in clinical practice. There was general agreement among participants in the workshop on several key considerations. Training and competency assessment for endoscopic image-enhancement technologies should incorporate competency-based education paradigms. To facilitate successful training, multiple different educational models that can cater to variations in learning styles need to be developed, including classroom-style and self-directed programs, in-person and web-based options, image and video atlases, and endoscopic simulator programs. To ensure safe and appropriate use of these technologies over time, refresher courses, skill maintenance programs, and options for competency reassessment should be established. Participants also generally agreed that although early adopters of novel endoscopic image-enhancement modalities can successfully implement these technologies by pursuing training and ensuring self-competency, widespread implementation is likely to require support from GI societies and buy-in from other key stakeholders including payors/purchasers and patients. Continued work by manufacturers and the GI societies in providing training programs and patient education, working with payors and purchasers, and creating environments and policies that motivate endoscopists to adopt new practices is essential in creating widespread implementation.

Highlights • In this position paper, we provide a collection of views on the role of AI in the COVID-19 pandemic, from the clinical needs to the design of AI-based systems, to the translation of the developed tools to the clinic. We highlight key factors in designing system solutions - per specific task; as well as design issues in managing the disease on the national level. We focus on three specific use-cases for which AI systems can be built: from the early disease detection, the management of the disease in a hospital setting, and building patient-specific predictive models that require the combination of imaging with additional clinical features. Infrastructure considerations and population modeling in two European countries will be described. This pandemic has made the practical and scientific challenges of making AI solutions very explicit. A discussion concludes this paper, with a list of challenges facing the community in the AI road ahead., In this position paper, we provide a collection of views on the role of AI in the COVID-19 pandemic, from clinical requirements to the design of AI-based systems, to the translation of the developed tools to the clinic. We highlight key factors in designing system solutions - per specific task; as well as design issues in managing the disease at the national level. We focus on three specific use-cases for which AI systems can be built: early disease detection, management in a hospital setting, and building patient-specific predictive models that require the combination of imaging with additional clinical data. Infrastructure considerations and population modeling in two European countries will be described. This pandemic has made the practical and scientific challenges of making AI solutions very explicit. A discussion concludes this paper, with a list of challenges facing the community in the AI road ahead.

The results of physico-chemical analysis of pulp and paper mill effluent sedimented sludge revealed the presence of heavy metals (mg l−1) Fe (67.53), Zn (13.90), Cu (2.15), Cr (2.30), Cd (0.255), Mn (11.0), Ni (3.30), and Pb (1.05) along with persistent chlorolignin. The major persistent organic pollutants detected by GC–MS were ethane, 1,1-diethoxy; tetradecanoic acid; furane 2,5-dimethyl; n-hexadecanoic acid; nonacosane, trimethylenebis-1,3-dioxolane; 1,3-dioxolane, 2-(phynylmethyl). Twelve representative native plants were noted based on their population number growing on pulp and paper sludge and evaluated for their phytoextraction potential of heavy metals. The result revealed that Triticum aestivum was found as root accumulator for all metals except Cu. Similarly, the Brassica campestris accumulated all metals maximum in root except Ni, Fe and Pb. While, Eclipta alba accumulated majority of metals in their shoot and leaves, But Solanum nigrum, Rumex dentatus accumulated metals in root and shoot both. Rananculus scleratus accumulated all the tested metals in their aerial parts except Cd and Pb. Cammelina benghalensis accumulated metals in root except Cd, Pd. Similarly the Phragmites cummunis and Ricinus cummunis accumulated majority of metals in their shoot and leaves. It was also noted that several evaluated plant showed bioconcentration factor (BCF) greater than one for accumulated metals i.e. Pb in T. aestivum (1.285), C. benghalensis (5.142), Cannabis sativa (3.466), P. cummunis (7.180), R. cummunis (66.80) was also noted. Furthermore, greater than one translocation factor (TF) for all these plants showed strong evidence for phytoextraction and in situ remediation potential of these plants. The overall order of phytoextraction potential of native wetland plants were C. sativa > P. cummunis > C. benghalensis > T. aestivum > B. campestris > E. alba.

Coronavirus disease (COVID-19), caused by SARS-CoV-2, evolved into a global pandemic in 2020, and the outbreak has taken an enormous toll on individuals, families, communities and societies around the world. One practical and effective strategy is to implement rapid case identification based on a rapid testing to respond to this public health crisis. Currently, the available technologies used for rapid diagnostics include RT-PCR, RT-LAMP, ELISA and NGS. Still, due to their different limitations, they are not well suited for rapid diagnosis in a variety of locations. Paper-based devices are alternative approaches to achieve rapid diagnosis, which are cost-effective, highly selective, sensitive, portable, and easy-to-use. In addition to individual virus screening, wastewater-based epidemiology has been emerged to be an effective way for early warning of outbreak within the population, which tests genomic viral sequence to reflect information on the spread and distribution of the virus because SARS-CoV-2 can be shed into wastewater through the feces and urine from infected population. In this paper, we describe paper-based device as a low-cost and rapid sensor for testing of virus for both diagnosis and early warning of outbreak for wastewater-based epidemiology. Most importantly, the device has great potential for real-time detection in the field, without any advanced facilities and well-trained skilled personnel, and provides early warning or timely intervention of an outbreak of pandemic.

Background: In respect of the principle of autonomy and the right of self-determination, obtaining an informed consent of potential participants before their inclusion in a study is a fundamental ethical obligation. The variations in national laws, regulations, and cultures contribute to complex informed consent documents for patients participating in clinical trials. Currently, only few ethics committees seem willing to address the complexity and the length of these documents and to request investigators and sponsors to revise them in a way to make them understandable for potential participants. The purpose of this work is to focus on the written information in the informed consent documentation for drug development clinical trials and suggests (i) to distinguish between necessary and not essential information, (ii) to define the optimal format allowing the best legibility of those documents., SCOPUS: ar.j, info:eu-repo/semantics/published

Vermicomposting of paper mill sludge (PMS) with cowdung (CD) and green manure plants, Tephrosia purpurea (TEP) and Gliricidia sepium (GLS) in different combinations (21 days pre-decomposed) was carried out using Eisenia fetida (60 days). Results revealed that electrical conductivity, total Kjeldahl nitrogen, total phosphorus, total potassium and N NO3- levels were higher in vermicomposts generated from PMS + CD with TEP/GLS combination than in composts prepared without earthworms; while total organic carbon, C/N ratio, C/P ratio and organic matter content depicted significant reduction. C/N and C/P of final vermicompost ranged from 13.45 to 22.33 and 15.54 to 28.56 respectively. The total microbial population was significantly higher in CD + TEP/GLS vermicomposts (P

Objective. To investigate the number of authors and unique institutions per paper published in the American Journal of Pharmaceutical Education (AJPE) in 2015 through 2019, and to examine the number of authors and unique institutions for papers that were nominated for the Rufus A. Lyman Award in the same period. Methods. Articles published in AJPE from 2015 through 2019 were reviewed. Data collected for each article included article type, number of authors, and number of institutions. Results. Of the 811 articles published in AJPE during this period, the number of authors increased significantly from a mean (SD) of 3.5 (1.8) to 4.5 (2.2). The number of unique institutions also increased significantly from 1.7 (1.1) to 2.4 (1.8). Conclusion. There is a trend toward a greater number of authors and unique institutions for the publications in one pharmacy education journal. Explanations for this trend may include pressure to publish, increased research complexity, and expanded interprofessional collaboration.

Pulp and paper mill effluents (PPMEs) have been shown to increase gonad size, cause early maturation, and disrupt hormone functions in native and non-native Chilean fish. In this study, we assessed reproductive (plasma vitellogenin; VTG, gonad development) and metabolic (ethoxyresorufin-. O-deethylase activity; EROD) end points, relative liver size (LSI) and condition factor (K) of juvenile female and male rainbow trout exposed to effluents. Unlike previous studies, which have focus either on the specific effects of effluent on fish in laboratory exposures or biotic population statuses downstream of discharge sites, we simultaneously assessed the impacts of PPMES on trout using two approaches: (1) laboratory exposures of tertiary treated PPME produced from processing Eucalyptus globulus or Pinus radiata; and (2) in situ bioassay downstream of the combined discharge of the same pulp mill. Despite an increase in the average gonadosomatic index (GSI) in exposed fish, no statistical differences in gonad size between exposed and unexposed individuals was detected. However, both female and male fish exposed to effluents showed significantly higher concentrations of plasma VTG, so more in fish exposed to Eucalyptus-based effluent when compared to Pinus PPME. In addition, male fish showed intersex characteristics in all exposure assays (Eucaliptus and Pinus) and, despite the low concentration of effluent in the river (

Efficient and safe detection of Bacillus anthracis spores (BAS) is a challenging task especially in bio-terror scenarios where the agent is concealed. We provide a proof-of-concept for the identification of concealed BAS inside mail envelopes using short-wave infrared hyperspectral imaging (SWIR-HSI). The spores and two other benign materials are identified according to their typical absorption spectrum. The identification process is based on the removal of the envelope signal using a new automatic new algorithm. This method may serve as a fast screening tool prior to using classical bioanalytical techniques.

Electronic learning (e-learning) is a broader approach to learning that brings new opportunities for learning and teaching in many fields of education far from the traditional classroom environment. Over the past decades, research in the field indicates a proliferation of e-learning contents and discrepancies that affect interoperability patterns in education for students and teachers; however, little has been done to assess the usability of e-learning systems. From a different perspective, this study aims to provide information on the numerous findings relating to the cumulative results of e-learning in education. This systematic review uses a full protocol with the aim of standardizing and specifying all the procedures adopted to collect and code 99 academic articles from 2010 to 2018 with keywords: education and e-learning. The text analysis as conducted using the qualitative software Leximancer to extract meaning from the large number of articles retrieved. The results highlight four dominant themes, namely education systems and learning issues that in turn promote student behaviours and the use of online learning tools. This research contributes towards providing research propositions that can be used in a cogent theoretical framework and, based on the analysis, we also propose a new definition of e-learning. info:eu-repo/semantics/acceptedVersion

Much literature exists for rock-paper-scissors (RPS) game. It is well known in a single habitat that spatial models are more stable than well-mixed population. However, the mechanism of spatial stabilization has been unclear. In the present article, we study multilayer model of RPS game in a patchy environment; respective patches are set as lattices. The predation probability of one of three species is assumed to be reduced as a parameter. Simulations on two-layer system reveal the opposite result to those on a single-habitat system. Namely, the well-mixed population becomes stable. In contrast, extinction occurs by random migration in spatially-explicit model, when the reduced predation probability is below a certain critical value. The extinction in spatial model is found to be caused by the collapse of a kind of swarm intelligence (SI). In RPS system, large swarms of each species are automatically protected from its predator. Such a self-organized protection is one of the simplest examples of SI. We also discuss some serious problems for random migration.

Our aim was to summarise current published evidence about the prognosis of various techniques of craniofacial distraction osteogenesis, particularly its indications, protocols, and complications. Published papers were acquired from online sources using the keywords "distraction osteogenesis", "Le Fort III", "monobloc", and "syndromic craniosynostosis" in combination with other keywords, such as "craniofacial deformity" and "midface". The search was confined to publications in English, and we followed the guidelines of the PRISMA statement. We found that deformity of the skull resulted mainly from Crouzon syndrome. Recently craniofacial distraction has been achieved by monobloc distraction osteogenesis using an external distraction device during childhood, while Le Fort III distraction osteogenesis was used in maturity. Craniofacial distraction was indicated primarily to correct increased intracranial pressure, exorbitism, and obstructive sleep apnoea in childhood, while midface hypoplasia was the main indication in maturity. Overall the most commonly reported complications were minor inflammatory reactions around the pins, and anticlockwise rotation when using external distraction systems. The mean amount of bony advancement was 12.3mm for an external device, 18.6mm for an internal device and 18.7mm when both external and internal devices were used. Treatment by craniofacial distraction must be validated by long-term studies as there adequate data are lacking, particularly about structural relapse and the assessment of function.

Autism affects children@?s learning and social development. Commonly used rehabilitative treatments are aimed at stimulating the social skills of children with autism. In this article, we present a prototype and a pilot study on an audio-augmented paper to support the therapy of children with autism spectrum disorder (ASD). The prototype supports audio recording with standard sheets of paper by using tangible tools that can be shared between the therapist and the child. The prototype is a tool for the therapist to engage the child in a storytelling activity. We use a progressive design method based on a dynamic process that merges concept generation, technology benchmarking and activity design into continuously enriching actions. The paper highlights the qualities and benefits of using tangible audio-augmented artefacts for therapy and educational intervention for children with ASD. The work describes three main qualities of our prototype: from building cooperation to attention control, flow control, and using the children@?s own voices to foster attention.

Training in surgical pathology specimen dissection and microscopic diagnosis is an integral part of pathology residency training, as surgical pathology is one of the defining activities of most pathologists. The Accreditation Council for Graduate Medical Education and the American Board of Pathology policies delineate guidelines and requirements for residency training. Both the ACGME and ABP require that residents are ready for “independent practice” upon completion of training (ACGME) and for board eligibility (ABP). This position paper, developed through a consensus process involving the Association of Pathology Chairs, including the Program Directors and Graduate Medical Education committee, expands on these guidelines and the importance of gross dissection as a part of training.

International language testing bodies are now moving rapidly towards using computers for many areas of English language assessment, despite the fact that research on comparability with paper-based assessment is still relatively limited in key areas. This study contributes to the debate by researching the comparability of a high-stakes EAP writing test (IELTS) in two delivery modes, paper-based (PB) and computer-based (CB). The study investigated 153 test takers’ performances and their cognitive processes on IELTS Academic Writing Task 2 in the two modes, and the possible effect of computer familiarity on their test scores. Many-Facet Rasch Measurement (MFRM) was used to examine the difference in test takers’ scores between the two modes, in relation to their overall and analytic scores. By means of questionnaires and interviews, we investigated the cognitive processes students employed under the two conditions of the test. A major contribution of our study is its use – for the first time in the computer-based writing assessment literature – of data from research into undergraudates’ cognitive processes within real-world academic settings as a comparison with test takers’ cognitive processes during academic writing under test conditions. In summary, this study offers important new insights into academic writing assessment in the computer mode.

Introduction Increasingly, over the past decade, there has been a global shift in healthcare away from fixed "fee for service" payment mechanisms towards value-based reimbursement models rewarding safety and quality patient outcomes. Curbing the burgeoning costs of healthcare while incentivising higher quality and safer patient care are key drivers of this approach. At face value, this is clearly a worthwhile endeavour. However, there is a lack of conclusive evidence to support the effectiveness of such schemes where they have been introduced internationally. For this reason, Australia has largely been an observer of the shift in payment modalities that are occurring in other countries such as the United States and the United Kingdom. Method This paper presents an overview of current Australian practice in pricing for safety and quality in Healthcare. Recommendations are provided to help infection control professionals prepare for the upcoming introduction of funding reforms aimed at reducing complications acquired in Australian public hospitals. Conclusion The implications for infection control professionals are wide-ranging. This will be a period of significant adjustment for the public health system in Australia.

Stochastic cellular automata for rock-paper-scissors games are related to Lotka-Volterra model. Simulations are usually performed by two methods local and global interactions. It is well known that the population dynamics with local interaction is stable, where all species coexist. In contrast, global interaction leads to extinction. So far, theories such as mean-field theory and pair approximation have been presented, but they never explained the stable dynamics in local simulation. In the present article, we apply effective medium approximation (EMA) which has been developed in Physics. The effective medium is determined in a self-consistent way. The EMA theory well predicts the stability of population dynamics. Moreover, it fairly explains the aggregation of each species observed in the stationary state.

Shared reading interactions with electronic books (ebooks) versus paper books were compared, using a randomized controlled crossover design. The ebooks were designed to encourage an interactive reading style by the adult reader and to highlight text-meaning correspondences for the child participants. Twenty-eight children from kindergarten classes situated in a low income community participated in the study, sharing books with an adult reader. Each child shared the same paper book three times in a single week and an ebook three times in a second week, with story and book presented in counterbalanced order. At the end of each week the childs learning with respect to story comprehension and emergent literacy was assessed by research personnel. All outcomes were significantly related to the childs letter knowledge. However, emergent literacy knowledge was greatest in the ebook condition compared to the print book condition, especially for those children with poor letter knowledge. Therefore, ebooks designed to facilitate supportive adult reading strategies may improve emergent literacy skills, especially in children with deficient skills at school entry.

Introduction Clinical trials require sufficient samples recruited within limited time and budget constraints. Trials with minors are additionally burdened by the requirement for youth assent and parental permission. This paper details the use of Facebook ads and traditional paper mailings to enroll 797 adolescent girls for a longitudinal, web-based, drug abuse prevention trial. Data on sample representativeness and retention are also provided. Methods Facebook ads appeared on the pages of females aged 13 or 14 years who reside in the U.S. Ads linked girls to a recruitment website. Girls who wanted more information submitted contact information and were mailed information packets to their homes containing, among other things, youth assent and parent permission forms. Returned forms were verified for accuracy and validity. Results The Facebook ad campaign reached 2,267,848 girls and had a unique click-through rate of 3.0%. The campaign cost $41,202.37 with an average cost of $51.70 per enrolled girl. Information packets were mailed to 1,873 girls. Approximately one-half of girls returned the forms, and 797 girls were enrolled. The Facebook campaign's success varied by ad type, month, and day of the week. Baseline data revealed comparability to national data on demographic and substance use variables. Conclusions Results suggest that Facebook ads provide a useful initial point of access to unparalleled numbers of adolescents. Clinical trials may benefit from a two-fold recruitment strategy that uses online ads to attract interested adolescents followed by traditional recruitment methods to communicate detailed information to adolescents and parents.

Paper has been an essential material in our daily life since ancient times. Its affordability, accessibility, adaptability, workability and its easiness of usage makes it an attractive structural material to develop many kind of technologies such as flexible electronics, and energy storage and harvesting devices. Additionally, the scientific community has increased its interest on waste heat as an environmentally friendly energy source to support the increasing energy demand. Therefore, in this paper we described two affordable and flexible thermoelectric nanogenerators (TEGs) developed on paper substrates by the usage of simple micromachining and microfabrication techniques. Moreover, they exhibit mechanical stability and adaptability (through folding and cutting techniques) for a diverse set of scenarios where vertical or horizontal schemes can be conveniently used depending on the final application. The first TEG device, implemented on standard paper, generated a power of 0.5 nW (ΔT=50 K). By changing the substrate to a tearless and extra-smooth polyester paper, the TEG performance was optimized achieving less internal resistance and a greater power of ~80 nW (ΔT=75 K), at the cost of more rigidity in the substrate. This power represented over three times higher power production than the standard paper–based TEG with same dimensions, number of thermoelectric pairs and temperature difference. Another interesting aspect of paper based TEG is due to its foldability, one can control the temperature difference by unfolding (larger separation between hot and cold ends) and folding (smaller separation). Finally, one of the underlying objectives of this work is to spread the availability of essential technologies to the broad population by inclusion of everyday materials and simple processes.

Background Once a proposed topic has been identified for a systematic review and has undergone a question formulation stage, a protocol must be developed that specifies the scope and research questions in detail and outlines the methodology for conducting the systematic review. Rationale Framework modifications are often needed to accommodate increased complexity. We describe and give examples of adaptations and alternatives to traditional analytic frameworks. Discussion This article identifies and describes elements of frameworks and how they can be adapted to inform the protocol and conduct of systematic reviews of complex interventions. Modifications may be needed to adapt the population, intervention, comparators, and outcomes normally used in protocol development to successfully describe complex interventions; in some instances, alternative frameworks may be better suited. Possible approaches to analytic frameworks for complex interventions that illustrate causal and associative linkages are outlined, including time elements, which systematic reviews of complex interventions may need to address. The need for and specifics of the accommodations vary with details of a specific systematic review. This in turn helps determine whether traditional frameworks are sufficient, can be refined, or if alternate frameworks must be adopted.

Isotope Ratio Mass Spectrometry (IRMS) has been shown to be a useful tool in the comparison of materials that are chemically identical either through man-made production processes or for materials that have been naturally produced. Paper therefore, is an ideal material for this type of measurement given that it is manufactured from a naturally produced product that can be difficult to discriminate based on physical feature comparison alone. To determine whether carbon isotopes are useful for discriminating document papers, 125 samples from Australia and New Zealand were collected over a 24-month period. When measured, a range of 8‰ was observed. A homogeneity study was undertaken to examine the range of values expected from paper sources including single sheets, single reams and multiple reams from the same brand. These results can also be used to suggest how best to sample from these different sources. After characterizing the natural variation of the material, a range of 1‰ was defined for use as a benchmark for discrimination. Utilizing this threshold, 68% of the 125 collected samples (when paired against each other) could be discriminated using the carbon isotope abundances alone. Additionally, correlation was observed when measured values were plotted against their production region of origin.

Highlights • Evidence synthesis (including systematic reviews, scoping reviews, and more) involves many complementary areas of expertise: methods, information retrieval, statistics, and clinical knowledge. • Few individual peer reviewers have all the requisite knowledge to evaluate all aspects of evidence synthesis manuscripts. • Segmented peer review as proposed by Dinakaran et al offers a good solution to the challenges of rigorously peer reviewing evidence synthesis manuscripts.

In this position paper, we outline the essential features for an academic palliative care program. Our goal was to assist both academic palliative care faculty and their stakeholders (department chairmen, deans, and others) in building sustainable high-quality academic palliative care programs. We also provide the background that justifies such an effort. Palliative medicine provides coordinated, interdisciplinary care for a growing population of patients and their families with complex care needs as they face a life-threatening or serious condition. These programs have recently matured in the United States and have become

After the first successful pregnancy in a liver transplant recipient in 1978, much evidence has accumulated on the course, outcomes and management strategies of pregnancy following liver transplantation. Generally, liver transplantation restores sexual function and fertility as early as a few months after transplant. Considering that one third of all liver transplant recipients are women, that approximately one-third of them are of reproductive age (18–49 years), and that 15% of female liver transplant recipients are paediatric patients who have a >70% probability of reaching reproductive age, the issue of pregnancy after liver transplantation is rather relevant, and obstetricians, paediatricians, and transplant hepatologists ever more frequently encounter such patients. Pregnancy outcomes for both the mother and infant in liver transplant recipients are generally good, but there is an increased incidence of preterm delivery, hypertension/preeclampsia, foetal growth restriction, and gestational diabetes, which, by definition, render pregnancy in liver transplant recipients a high-risk one. In contrast, the risk of congenital anomalies and the live birth rate are comparable to those of the general population. Currently there are still no robust guidelines on the management of pregnancies after liver transplantation. The aim of this position paper is to review the available evidence on pregnancy in liver transplant recipients and to provide national Italian recommendations for clinicians caring for these patients.

Recent meta-analyses (Delgado et al., 2018; Kong et al., 2018; Clinton, 2019) show that reading comprehension on paper is better than on screen among (young) adults. Children's screen reading comprehension, however, is underexplored. This article presents an experiment measuring the effect of reading medium on younger (10-year old) readers' comprehension, carried out in Norway in 2015. In a within-subjects design, students (n = 1139) took two comparable versions of a reading comprehension test – one on paper, and another digitally, with test version and order of medium counterbalanced. Probabilistic test theory models (two-parameter logistic (2 PL) and partial credit models) were employed for both versions of the test, allowing direct comparisons of student achievement across media. Results showed that the students in average achieved lower scores on the digital test than on the paper version. Almost a third of the students performed better on the paper test than they did on the computer test, and the negative effect of screen reading was most pronounced among high-performing girls. Scrolling and/or misplaced digital reading habits may be salient factors behind this difference, which sheds further light on children's reading performance and how this may be affected by screen technologies. Implications of these findings for education and for reading assessment are discussed.

This work reviews the different analytical methods that have been proposed in the field of forensic dating of inks from different modern writing instruments. The reported works have been classified according to the writing instrument studied and the ink component analyzed in relation to aging. The study, done chronologically, shows the advances experienced in the ink dating field in the last decades.

In this paper, the Life Cycle Assessment (LCA) methodology is applied to Portuguese printing and writing paper in order to compare the environmental impact of the use of two kinds of fuels (heavy fuel oil and natural gas) in the pulp and paper production processes. The results of inventory analysis and impact assessment show that the pulp and paper production processes play an important role in almost all of the analysed parameters, which do not always result in an important contribution to the corresponding impact categories. The substitution of heavy fuel oil by natural gas in the pulp and paper production processes seems to be environmentally positive.

Background: Due to the aging of the population, cancer has become a health priority worldwide. While the number of elderly cancer patients is rapidly increasing, many barriers still exist to their effective management. Compared with their younger counterparts, the elderly are less likely to receive optimal medical, psychological and spiritual treatment provided in a culturally competent manner. Design: The scanty literature on cultural competence in elderly cancer patients has been reviewed. Additional material has been selected based on the authors' clinical research in medical oncology and psycho-oncology, and on their scholarly work in anthropology and bioethics. Results: The aging process is a synergistic product of biological, behavioral and social issues within a cultural context. Knowledge about how older people understand, perceive and experience their illness trajectory and make choices is essential to the planning and delivering of effective cancer care. Conclusion: This position paper of the SIOG Task Force on Cultural Competence in the Elderly creates awareness of the influence of culture in geriatric oncology. Negotiating cross-cultural issues in geriatric oncology helps managing possible conflicts between patients, families and physicians over differing health care values, beliefs, or practices. Possible areas of future scholarly investigation and clinical research are identified.

Several environmental contaminants have been found in paper mill effluent including substances with androgenic properties. The presence of androgenic substances in paper mill effluent was also indicated in the present study which demonstrated masculinized anal fins of female mosquitofish from the paper mill effluent contaminated Fenholloway River. In addition, when compared to the nearby Econfina River, which does not receive paper mill effluent, fewer females from the contaminated river were pregnant, they were smaller and their estradiol concentration exhibited greater variation. Males from the Fenholloway River and the Econfina River had similar sperm counts, but the testes were larger and greater variation in testosterone concentration was observed in male fish from the Fenholloway River. In males and females from the Fenholloway River, liver weights were increased and computer-aided behavior analysis demonstrated a reduction in their social behavior when compared to reference fish. We conclude that a number of sexual characteristics were affected in mosquitofish living in the paper mill contaminated Fenholloway River, with possible adverse effects on the reproduction of this population.

Rationale and Objectives We sought to determine (1) whether United States Medical Licensing Examination (USMLE) scores predict academic productivity in neuroradiology fellows as measured by publications and citations, and (2) what factors predict such productivity. Materials and Methods We reviewed the USMLE scores, gender, medical school location attended, publication record before and during fellowship, fellowship evaluation ratings and subsequent practice site (private vs academic) of neuroradiology fellows from 2004 to 2014 to determine relationships with publications and citations after fellowship. Spearman's correlation and Poisson regression analyses were performed to assess the association between these factors and quantity of publications and citations per year after fellowship. Results USMLE scores and fellowship evaluation scores correlated inversely with radiology publications and citations. There were strong correlations between publication records before or during fellowship and after fellowship. Fellows from international medical schools, with PhD degrees, and those fellows proceeding to academic practice had more publications before or during and after neuroradiology fellowship. Conclusions The best predictors of whether a graduating neuroradiology fellow will publish and have high citation rates is prior publication record, a PhD degree, and staying in academics. USMLE scores and evaluations during the fellowship were inversely correlated with publication measures of academic productivity.

Objective To investigate whether the use of the think-aloud method with propositional analysis could be helpful in the design of a Clinical Decision Support System (CDSS) providing guideline recommendations about long-term follow-up of childhood cancer survivors. Materials and methods The think-aloud method was used to gain insight into healthcare professionals’ information processing while reviewing a paper-based guideline. A total of 13 healthcare professionals (6 physicians and 7 physician assistants) prepared 2 fictitious patient consults using the paper-based guideline. Propositional analysis was used to analyze verbal protocols of the think-aloud sessions. A prototype CDSS was developed and a usability study was performed, again with the think-aloud method. Results The analysis revealed that the paper-based guideline did not support healthcare practitioners in finding patient-specific recommendations. An information processing model for retrieving recommendations was developed and used as input for the design of a CDSS prototype user interface. Usability analysis of the prototype CDSS showed that the navigational structure of the system fitted well with healthcare practitioners’ daily practices. Conclusions The think-aloud method combined with propositional analysis of healthcare practitioners’ verbal utterances while they processed a paper-based guideline was useful in the design of a usable CDSS providing patient-specific guideline recommendations.

Rock-paper-scissors games metaphorically model cyclic dominance in ecology and microbiology. In a static environment, these models are characterized by fixation probabilities obeying two different "laws" in large and small well-mixed populations. Here, we investigate the evolution of these three-species models subject to a randomly switching carrying capacity modeling the endless change between states of resources scarcity and abundance. Focusing mainly on the zero-sum rock-paper-scissors game, equivalent to the cyclic Lotka-Volterra model, we study how the ${\it coupling}$ of demographic and environmental noise influences the fixation properties. More specifically, we investigate which species is the most likely to prevail in a population of fluctuating size and how the outcome depends on the environmental variability. We show that demographic noise coupled with environmental randomness "levels the field" of cyclic competition by balancing the effect of selection. In particular, we show that fast switching effectively reduces the selection intensity proportionally to the variance of the carrying capacity. We determine the conditions under which new fixation scenarios arise, where the most likely species to prevail changes with the rate of switching and the variance of the carrying capacity. Random switching has a limited effect on the mean fixation time that scales linearly with the average population size. Hence, environmental randomness makes the cyclic competition more egalitarian, but does not prolong the species coexistence. We also show how the fixation probabilities of close-to-zero-sum rock-paper-scissors games can be obtained from those of the zero-sum model by rescaling the selection intensity., 31 pages, 15 figures: Main text (18 pages, 9 figures) followed by Supplementary Material (13 pages, 6 figures). Supplementary Information and resources available at https://doi.org/10.6084/m9.figshare.8858273.v1

Objective Bleeding data in contraceptive trials are often collected using daily diaries, but data quality may vary due to compliance and recall bias. Text messaging is a widespread and promising modality for data collection. Study design This trial randomized participants 1:1 to use text messages or paper diaries to report on bleeding experienced during the 90 days after intrauterine device (IUD) insertion. Participants chose either the copper T380A or the 52-mg levonorgestrel IUD. Our primary outcome was number of days of reported bleeding data. We hypothesized that data gathered with daily text messages would have fewer missing values than paper diaries. Intention to treat analyses used the rank-sum test to compare medians. Results Two hundred thirty women enrolled, and randomization yielded groups similar in baseline characteristics. Twenty percent of participants provided no bleeding data; of these, 77% were assigned to paper diaries. With 90 days of reporting, approximately 20% in each group provided complete bleeding data. The text group reported a median of 82 days [interquartile range (IQR) 40–89] and the paper group reported a median of 36 days (IQR 0–88) (p≤.001). The number of responses received decreased gradually over the 90-day period but was always higher in the text group. Women who had attained higher levels of education did well regardless of data collection modality, while response rates of text messages were greater among those with a high school education or less (p Conclusions Participants reporting bleeding via text messages provided more complete data than women using paper diaries. Implications Depending on resources and population of interest, text messages may be a useful modality to improve data collection for patient-reported outcomes.

This paper captures the perceptions of both a new academic and his students on the use of the one-minute paper (OMP). Much of the originality of this paper derives from the multi-layered qualitative approach which provides a deeper insight into the direct and indirect mechanism through which the OMP is perceived to work. This paper argues that, more than the prevailing literature suggests, in order to increase the benefits of using the OMP then considerable investment in time is required. The findings show that the academic’s cost in terms of time is greatest when asking ‘lecturer effectiveness’ type questions, but the benefits derived are potentially longer term than standard ‘lecture content’ based question. Students value the use of the OMP, principally because it demonstrates respect for them; this helps to create an atmosphere of trust, which can encourage engagement and an active approach to student learning. The research informs a discussion on how practical implementation techniques can be used to maximise the benefits and limit the costs.