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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.

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.

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.

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.

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.

Paper is a perfect example of the circular economy as it remains the furthermost recycled product in Europe, creating significant environmental benefits and raw materials resources to the industry. Indeed, maintaining a consistent level of quality whilst limiting the environmental footprint of the product has become a major challenge for the industry. In this direction, paper is proving to be the promising feedstock for biorefinery and biomaterials. The future of paper recycling is slowly going beyond fibre recovery to address the needs of other industries because for the earth's environmental well-being various paper products need to be recycled and reused persistently. In this article, we outline the ambitious use of wastepaper (WP) for high-value applications such as; production of cellulose nanocrystals (CNC), composite reinforcement, high performance electrical components and biofuels.

The increasing presence of e-books (electronic books) has become a major focus in countries around the world. In the United States, e-books represented 28% of the total book sales for 2012. In Japan, the conversion from paper books to e-books is expected to accelerate by the prevalent use of smartphones and tablet PCs. It is therefore important to quantitatively evaluate the environmental load of paper books and e-books for a sustainable society. In this study, paper books are compared to e-books read on different electronic devices (e-ink tablets, tablets, cell phones, smartphones, laptop computers, desktop computers and portable music players) through a case study on a 224-page book. The study is based on key primary data such as use time and reading speed for each device and aims to minimize assumptions made in other studies. GHG emissions for paper books are 1.24 kg-CO2e/book, and are reduced to 1.11 kg-CO2e/book when the effect of paper recycling is taken into consideration. The results for e-books under average use-time conditions range from 0.25 to 0.91 kg-CO2e/book with the e-ink tablet having the lowest emissions. When the average use time of each e-book device is applied, the paper book has a higher impact than all the e-books. However, sensitivity analysis shows that the impact of paper books can be lower than that of e-books for larger screen devices such as tablets, laptops and desktops when the reuse of books is considered or the e-book reading device is hardly used during its life cycle.

Background A proportion of veterans experience post-traumatic stress disorder (PTSD). Research has shown reduced effectiveness of commonly offered psychotherapies in military personnel. Some research suggested the usefulness of art therapy for veterans with PTSD, but its mechanism of operation has been unclear. The current project aimed to establish participants’ perceptions of any impact of group art therapy and some of the perceived mechanisms of change. Method In a grounded theory design, single semi-structured interviews were conducted with nine veterans who had received group art therapy, two art therapists, and a veteran's wife. Interviews were transcribed and analysed. Findings Theorised categories included (a) art therapy group as “the family”, (b) “the gentle conductor”, (c) trust, (d) doing the work, (e) art therapy as "a communication tool", (f) "points of recognition", (g) "making things concrete", and (h) "not a cure". Limitations Shortcomings included a homogenous sample who all attended art therapy alongside other interventions, reliance on subjective and unmeasured symptom change, and researcher effects related to qualitative methodology. Conclusion The developed grounded theory is consistent with existing evidence and neuropsychological theory. Group art therapy may enable some veterans to prepare for verbal-only therapy, by offering a safe space in which to approach non-verbal traumatic and trauma-related contextual material in a controlled way. Artworks may provide a bridge to facilitate communication of experiences within subsequent verbal therapy and with loved-ones. It is suggested to replicate the project at different sites. Elements of the developed theory may be investigated further to establish its transferability.

Water plays several essential roles in paper manufacturing. It serves as a suspending medium and a swelling agent for the fibres, dispersing and forming them into a uniform sheet during the initial stage of the papermaking process. It also serves as the solvent for a variety of chemicals and additives to adjust product quality. Water reclamation has always been a momentous task in the pulp and paper (P&P) industry. The main driving forces for the adoption of process water and wastewater treatment technologies are environmental regulations, costs of wastewater discharge and the high cost of freshwater. Recent developments have made it possible to not only reduce water consumption and environmental impacts, but also to recover treated water and valuable compounds such as fibres, making water recycling technologies cost-efficient. Thus, the economic viability of these technologies has played an important role in their application. The technologies applied, the level of reduction in water consumption and the extent of water recycling are different for each mill, since the quality of whitewater and wastewater varies depending on the raw materials and products. The maintenance of the balance between partial equilibria of process variables such as water flowrates, pulp consistency, physiochemical, thermal and microbiological properties through water management is important for maintaining efficient water use and lowering the need for consumption of additional fresh water.

Objectives Unlike the technological advances in cross-sectional imaging, the adoption of CR and DR has been relatively overlooked in terms of the additional radiographer skills and competences required for optimal practice. Furthermore, projection radiography is often referred to as basic, plain or other words suggesting simplicity or entry-level skill requirements. Radiographers’ professional identity is connected with the discourse expressed via the language used in daily practice and consequently, if the perception of projection radiography is regarded as simple practice not requiring much reflection or complex decision-making, apathy and carelessness may arise. The purpose of this narrative review was to raise projection radiography from its longstanding lowly place and re-position it as a specialist imaging field. Key findings Danish pre-registration radiography curricula contain little mention of projection radiography and a low proportion (n = 17/144; 11.8%) of Danish radiography students chose to focus on projection radiography within publicly available BSc. theses between 2016 and 2020 as compared to topics related to CT and MRI (n = 60/144; 41.7%). Conclusion By changing how we as the profession perceive the role and position of projection radiography, we can start to rebuild its lost prestige and demand a greater, more detailed and clinically relevant educational offering from academic partners. For this to commence, the language and terminology we use to describe ourselves and tasks undertaken must reflect the complexity of the profession. Implications for practice Regardless of imaging modality, every patient should be assured that a radiographer with expertise in acquiring images of diagnostic quality undertakes their examination. Reclaiming the prestige of projection radiography may lead students and radiographers to recognize projection radiography as a demanding specialist field for the benefit of the patients.

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

China has become the world largest paper and paperboard producer. However, pulp and paper industry has involved high resource consumption and severe pollution especially for water. This research has assessed the eco-efficiency of China's pulp and paper industry at the national level and provincial level. An overview regarding the cleaner production of China's pulp and paper industry was presented to reveal the measures for reducing environmental impact in the last two decades. Slacks-based measure was used to analyze the efficiency levels of 16 provinces' pulp and paper industries. To uncover the underlying causes of eco-efficiency performance, Malmquist–Luenberger index was calculated to discover the drivers of productivity growth of pulp and paper industries. Our results showed that the pollution treatment of China's pulp and paper industry has made progress in terms of water consumption and water pollution, although the absolute amount of pollution discharge is still large. Chemical oxygen demand emissions are still the first critical influencing factor of pulp and paper industry's inefficiency. Furthermore, efficiency progress was the dominating contribution of the industry's productivity growth between 2010 and 2013. The policies for adjusting the industrial structure of pulp and paper industry have resulted in the scale effects through eliminating backward production capacity and accelerating merger and acquisitions. Moreover, the productivity of pulp and paper industry was underestimated when the undesirable outputs were ignored. It indicates that the stricter environmental regulations have positive effects on paper companies to internalize environmental pressures in the production activities through environmental management. In the future, pulp and paper companies should further internalize the cost of pollution treatment through scale effects and technology improvement.

The main objective of this project was to assess an inkless method to collect reference (exemplar) fingerprints as a low-cost, portable, and hygienic technique; for temporary storage and as an alternative to the conventional black ink method. The tested inkless approach requires alcohol-based hand sanitizer gel as the medium and thermal paper as the substrate. The final quality and clarity of fingerprints were examined and compared between the two methods, especially on the basis of medium/substrate and biological sex effects. Two different evaluation systems of visual quality (clarity) were conducted to provide more reliable results: a quality score scheme (QS) and metrics from the FBI's Universal Latent Workstation (ULW). Fingerprints were obtained from 20 individuals (11 males and 9 females) between the ages of 20 and 40; a total of 240 impressions were evaluated. The results provide evidence that the inkless method produces identifiable fingerprints of equivalent quality to the standard ink method, although significantly better for males. The potential of the proposed technique as an alternative to the conventional ink method is proven and corroborated by the two independent systems of visual quality assessments.

Gastroparesis continues to represent a large unmet clinical need and a major opportunity for new drug development. This has led to increasing interest by federal funding agencies, regulatory bodies, and industry. This article summarizes the proceedings of the gastroparesis section of the “Drug Development Conference: Clinical Endpoints in Upper GI Disorders” organized by the American Gastroenterological Association in Washington, DC, on October 27–28, 2016. The presentation, diagnosis, and current therapeutic strategies are briefly reviewed, followed by a detailed discussion of the regulatory strategy, recommended endpoints, and future directions.

This study explores the relationship between interdisciplinarity and the citation impact of highly cited papers. In this paper, interdisciplinarity is investigated by comparing the dimensions of disciplinary diversity (variety, balance, and disparity) and the typical integration indicators (i.e., the Rao-Stirling index (RS) and the Leinster–Cobbold Diversity Index (LCDiv)) of all papers published in 2000 and indexed in Clarivate Analytics’ Web of Science. These papers are categorized into six percentile rank classes according to their citation rates, and the interdisciplinarity among these percentile rank classes is compared. Our results demonstrate that, whether control variables are considered or not, highly cited papers always exhibit higher variety and disparity, but they also exhibit lower balance. In terms of the integration interdisciplinarity indicators, the RS and LCDiv both have a positive effect on citation impact. From the perspective of effect size, our results suggest that the effect of variety on citation impact is most significant, followed by disparity and then balance. These results indicate that variety is likely the most important interdisciplinary factor for citation impact.

Over the last decade, the Low-Energy Nuclear Physics (LENP) and Nuclear Astrophysics (NAP) communities have increasingly organized themselves in order to take a coherent approach to resolving the challenges they face. As a result, there is a high level of optimism in view of the unprecedented opportunities for substantial progress. In preparation of the 2015 US Nuclear Science Long Range Plan (LRP), the two American Physical Society Division of Nuclear Physics town meetings on LENP and NAP were held jointly on August 21–23, 2014, at Texas A&M, College Station, in Texas. These meetings were co-organized to take advantage of the strong synergy between the two fields. The present White Paper attempts to communicate the sense of great anticipation and enthusiasm that came out of these meetings. A unanimously endorsed set of joint resolutions condensed from the individual recommendations of the two town meetings were agreed upon. The present LENP White Paper discusses the above and summarizes in detail for each of the sub-fields within low-energy nuclear physics, the major accomplishments since the last LRP, the compelling near-term and long-term scientific opportunities plus the resources needed to achieve these goals, along with the scientific impact on, and interdisciplinary connections to, other fields.

In the August of 2007, banks faced a freeze in funding liquidity from the asset-backed commercial paper (ABCP) market. We investigate how banks scrambled for liquidity in response to this freeze and its implications for the real economy. Commercial banks in the United States raised deposits and took advances from Federal Home Loan Banks (FHLBs). In contrast, foreign banks – with limited access to the deposit market and FHLB advances – lent less in the overnight interbank market and borrowed more from the Federal Reserve’s Term Auction Facility (TAF) auctions. Relative to banks in the United States, relative to before the ABCP freeze and relative to their non-US dollar lending (difference-in-differences), foreign banks with ABCP exposure charged higher interest rates on syndicated loan packages denominated in dollars. The results point to an important funding risk in global banking, manifesting as currency shortages for banks engaged in maturity transformation in foreign countries.

Exam paper generation is an indispensable part of teaching. Existing methods focus on the use of question extraction algorithms with labels for each question provided. Obviously, manual labeling is inefficient and cannot avoid label bias. Furthermore, the quality of the exam papers generated by the existing methods is not guaranteed. To address these problems, we propose a novel approach to generating exam papers based on prediction of exam performance. As such, we update the quality of the initially generated questions one by using dynamic programming, as well as in batches by using genetic algorithms. We performed the prediction task by using Deep Knowledge Tracing. Our approach considered the skill weight, difficulty, and distribution of exam scores. By comparisons, experimental results indicate that our approach performed better than the two baselines. Furthermore, it can generate exam papers with adaptive difficulties closely to the expected levels, and the related student exam scores will be guaranteed to be relatively reasonable distribution. In addition, our approach was evaluated in a real learning scenarios and shows advantages.

Establishing impact of a research paper is essential for academia, industry and research community alike. The attempts made in this direction are hitherto limited to some objective metrics, largely based on the citation count. The number of citations has always been used as a measure for ascertaining quality and popularity of research papers. Though, citations play an essential role in academic research, sometimes researchers may cite a paper to just point out its weaknesses and infirmities. A subjective look into the sentiments behind citations of a research paper aids in understanding the opinion of the peer research community for a paper. Objective measures such as citing author’s impact factor and the publication’s impact factor, may help to quantify the weightage of citations themselves and should also be included in the assessment of impact of a research paper. In this paper, we formulate a model that combines both the objective and subjective metrics and forms basis for an index to objectively convey the impact of a research paper.

Aim To describe the state of the professionalisation of midwifery in Belgium, and to formulate recommendations for advancing the midwifery profession. Methods A descriptive overview of maternity care in Belgium and the professionalisation of midwifery through an analysis of relevant policy and academic texts, underpinned by Greenwood’s sociological criteria for a profession: (1) own body of knowledge, (2) recognised authority, (3) broader community sanctions, (4) own code of ethics and (5) professional culture sustained by formal professional associations. From these insights, recommendations for advancing the midwifery profession in Belgium are formulated. Findings Current strengths of the professionalisation of midwifery in Belgium included unified midwifery education programmes, progress in midwifery research and overarching national documents for guiding midwifery education, practice and regulation. In contrast however challenges, such as the limited recognition of midwives’ roles by its clientele, limitations of midwives’ competencies and autonomy, lacking development of advanced roles in maternity care practice and a lack of unity of the organisation and its members, were also identified. Based on these, recommendations are made to strengthen Belgian midwifery. Conclusions Recommendations for advancing the midwifery profession in Belgium includes in particular increasing public awareness of midwives’ roles and competencies, implementing the full scope of midwifery practice and monitoring and advancing this practice. Thus, professional autonomy over both midwifery practice and working conditions should be enhanced. United midwifery organisations, together with women’s groups, other maternity care professionals and policy-makers as equal partners are key to bring about changes in the Belgian maternity care landscape.

In production, poor ergonomic environments not only lead to increased workloads and health hazards for employees but also tend to reduce efficiency and quality. Recently, the human-cyber-physical (HCP) system has been proposed and widely studies to meet human capabilities and limitations. However, most existing frameworks are still not adaptive enough to integrate humans into a smart production environment due to a lack of real-time individual human factors digitalization. This research proposes an HCP workstation model for comprehensive assembly resources digitalization and autonomous interaction by CPS enabling technologies. Based on this, an adaptive control system has been developed for proactive ergonomic risk mitigation. Computer vision is deployed for real-time individual ergonomic evaluation and a prototype has been set up for functional validation.

In April 2019, the U.K. released a white paper about Online Harms. The White Paper proposes to take Internet censorship to a new height, essentially unmatched by any other Western democracy. It’s a sign of how comprehensive censorship has moved beyond repressive regimes to become trendy even in leading republican democracies. To redress a wide range of anti-social online activity, the White Paper seeks to tightly circumscribe user-generated content — so tightly that only a small number Internet giants will be able to profitably publish user-generated content. Other Internet publishers will be pushed towards licensing professional content and cover those costs by charging subscriber fees to consumers. Thus, the White Paper will produce a reconfigured Internet 3.0 that will resemble the cable TV industry, not the current Internet we know and love. This essay addresses three main points. It first deconstructs the some of the “facts” the White Paper uses to justify its censorious ideas. Then it highlights some of the proposals’ worst policy aspects. The essay concludes by explaining how the White Paper will reshape the Internet and kill off most user-generated content.

Our society is facing serious environmental challenges related to climate change, pollution, diminishing resources, and biodiversity loss. Such problems are often ill-defined and are characterized by high uncertainty. Environmental decisions have strong impacts on society and demand clear and transparent trade-offs across values and priorities of stakeholder groups. This Feature Issue on Environmental Decisions includes papers focused on important environmental applications approached through various disciplinary backgrounds. The papers highlight advanced–often interdisciplinary–methodological approaches and include the perspectives of different stakeholders in the process of environmental decision-making. A wide range of methods are explored, ranging from a comprehensive review (for sustainable transport by Marleau Donais et al.) to an opinion paper proposing the use of Records of Engagement and Decision-making (RoED; by Cockerill et al.). Stakeholder engagement and preference elicitation required the development of new aggregation models for Multi-Criteria Decision Analysis (MCDA; by Reichert et al.). The integration of Cost-Benefit Analysis (CBA) with MCDA was found to be necessary in practice (by Liu et al.; Marleau Donais et al.). MCDA was extended to include the spatial dimension by integrating Geographic Information Systems (GIS; by Guay et al.; Schito et al.). The importance of considering the resilience of systems to better respond to and recover from unpredictable risks was emphasized (by Leyerer et al.; Mustajoki and Marttunen). These papers demonstrate the richness of approaches to environmental decision-making. Environmental issues offer ample exciting research opportunities to a broader scientific community. We encourage the readers of this Feature Issue—and of EJDP—to engage in environmental decision-making projects to support emerging societal needs.

The Essential Science Indicators (ESI) database is widely used to assess scientific outputs. The ESI database contains papers that entered the top 1% of sum citations in one discipline in the past ten years. Therefore, highly cited papers included in ESI database are of high quality in each field. This paper provides a bibliometric overview on the papers included in the ESI database in the field of operations research & management science. During the years of 2008–2017, there are 646 ESI highly cited papers in this area. Based on these 646 papers, we identify the most influential actors including journals, counties/regions, and institutes. The co-authorship relations among countries, institutes and authors characterize the collaboration status in the field of operations research and management science. The most cited papers are then presented. Finally, author keywords, keywords plus and words in title are analyzed, with hot research topics and future directions being provided.

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.

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

Context: According to the search reported in this paper, as of this writing (May 2015), a very large number of papers (more than 70,000) have been published in the area of Software Engineering (SE) since its inception in 1968. Citations are crucial in any research area to position the work and to build on the work of others. Identification and characterization of highly-cited papers are common and are regularly reported in various disciplines. Objective: The objective of this study is to identify the papers in the area of SE that have influenced others the most as measured by citation count. Studying highly-cited SE papers helps researchers to see the type of approaches and research methods presented and applied in such papers, so as to be able to learn from them to write higher quality papers which will likely receive high citations. Method: To achieve the above objective, we conducted a study, comprised of five research questions, to identify and classify the top-100 highly-cited SE papers in terms of two metrics: total number of citations and average annual number of citations. Results: By total number of citations, the top paper is "A metrics suite for object-oriented design", cited 1,817 times and published in 1994. By average annual number of citations, the top paper is "QoS-aware middleware for Web services composition", cited 154.2 times on average annually and published in 2004. Conclusion: It is concluded that it is important to identify the highly-cited SE papers and also to characterize the overall citation landscape in the SE field. We hope that this paper will encourage further discussions in the SE community towards further analysis and formal characterization of the highly-cited SE papers., Vahid Garousi was partially supported by several internal grants provided by the Hacettepe University. The authors would like to thank the anonymous reviewers for their insightful comments.

Effluents from paper mills are highly toxic and are a major source of aquatic pollution. In this study, we collected water and sediment samples to examine the microbial communities using denaturing gradient gel electrophoresis and identified bacterial taxa greatly affected by paper mill pollution using next-generation sequencing data. Our results indicated that bacterial communities in downstream sediments were similar to those in paper mill discharge sites, indicating obvious effects of pollution, while bacterial communities in downstream water samples showed similar profiles to those in upstream sites, both being quite different from the bacterial communities in paper mill discharge sites. This was possibly because of the short contact period. In addition, bacterial communities in the estuary were quite different from those in other water and sediment samples, which was owing to the special habitat type. Considering the storage of paper mill pollutants in sediment and the significant effect on shifts in bacterial communities, we selected Clostridia and Epsilonproteobacteria at the class level and Fusibacter and Desulfobulbus at the genus level as bacterial indicators of paper mill pollution. To monitor the remediation of polluted aquatic environments, we propose Sphingobacteria, Alphaproteobacteria, Actinobacteria, Subdivision3, Planctomycetacia and Verrucomicrobiae at the class level and Bacillus, Steroidobacter, Nocardioides, Terrimonas, Pirellula and Methylibium at the genus level.

Dried blood spot sampling technique has been a prevalent approach in therapeutic drug monitoring due to its numerous advantages over conventional blood or plasma sampling. But the effects of storage conditions, drying time in air and paper substrates on the stability and analysis sensitivity of therapeutic drugs are still lack. Herein we systematically investigated the effects of storage conditions and paper substrates on the appearance of dried blood spots and stability of different therapeutic drugs by using a facile paper spray mass spectrometry. The results demonstrated using silica coated paper SG81 favored to get an abundant signal due to the unique elution behavior of target compounds in dried blood spots relative to that with grade ET31 and grade 1 paper substrates. By examining the effects of light illumination and air on the stability of therapeutic drug, it reveals that both have a similar impact on the degradation of the tested drugs, whereas storing the samples in a zip-foiled bag could effectively suppress the degradation of the analytes in dried blood. The analysis sensitivity of different drugs in blood samples was also compared under different storage conditions. An improvement of 2–10-fold analysis sensitivity was obtained for these drugs when the DBS were stored in a zip-foiled bag relative to that exposure to air.

Sensitivity analysis (SA) has been used to evaluate the behavior and quality of environmental models by estimating the contributions of potential uncertainty sources to quantities of interest (QoI) in the model output. Although there is an increasing literature on applying SA in environmental modeling, a pragmatic and specific framework for spatially distributed environmental models (SD-EMs) is lacking and remains a challenge. This article reviews the SA literature for the purposes of providing a step-by-step pragmatic framework to guide SA, with an emphasis on addressing potential uncertainty sources related to spatial datasets and the consequent impact on model predictive uncertainty in SD-EMs. The framework includes: identifying potential uncertainty sources; selecting appropriate SA methods and QoI in prediction according to SA purposes and SD-EM properties; propagating perturbations of the selected potential uncertainty sources by considering the spatial structure; and verifying the SA measures based on post-processing. The proposed framework was applied to a SWAT (Soil and Water Assessment Tool) application to demonstrate the sensitivities of the selected QoI to spatial inputs, including both raster and vector datasets - for example, DEM and meteorological information - and SWAT (sub)model parameters. The framework should benefit SA users not only in environmental modeling areas but in other modeling domains such as those embraced by geographical information system communities.

The total emission control target of water pollutants (e.g., COD and NH 4 –N) for a certain industrial sector can be predicted and analysed using the popular technology-based bottom-up modelling. However, this methodology has obvious uncertainty regarding the attainment of mitigation targets. The primary uncertainty comes from macro-production, pollutant reduction roadmap, and technical parameters. This research takes the paper and pulp industry in China as an example, and builds 5 mitigation scenarios via different combinations of raw material structure, scale structure, procedure mitigation technology, and end-of-pipe treatment technology. Using the methodology of uncertainty analysis via Monte Carlo, random sampling was conducted over a hundred thousand times. According to key parameters, sensitive parameters that impact total emission control targets such as industrial output, technique structure, cleaner production technology, and end-of-pipe treatment technology are discussed in this article. It appears that scenario uncertainty has a larger influence on COD emission than NH 4 –N, hence it is recommended that a looser total emission control target for COD is necessary to increase its feasibility and availability while maintaining the status quo of NH 4 –N. Consequently, from uncertainty analysis, this research recognizes the sensitive products, techniques, and technologies affecting industrial water pollution.

Dyslexia is a type of Specific Learning Disability (SLD) that affects the educational development of a student, as it is the reason of difficulties not only in writing or reading but also in other disciplines like Mathematics. Research has proven that Information and Communication Technologies (ICT) can have a positive effect to the educational development of a dyslexic student. In this paper, twenty 6th-grade primary-school students were observed while using computers during exams - ten with Dyslexia and ten with no SLDs. All students were called to solve a digital test and a paper test that were including some basic mathematic operations. The researcher recorded and examined the differences between the results from the two tests. Descriptive and deductive statistical analysis showed that students had better results when examined via a computer compared to a traditional written examination.

Traditional industry sectors, like paper making industry, tend to stay within well-known technology rather than going forward towards promising, but still quite new technical solutions and applications. This study analyses the feasibility of the laser cutting in large-scale industrial paper making processes. Aim was to reveal development and process related challenges and improvement potential in paper making processes by utilizing laser technology. This study has been carried out, because there still seems to be only few large-scale industrial laser processing applications in paper converting processes worldwide, even in the beginning of 2010's. Because of this, the small-scale use of lasers in paper material manufacturing industry is related to a shortage of well-known and widely available published research articles and published measurement data (e.g. actual achieved cut speeds with high quality cut edges, set-up times and so on). It was concluded that laser cutting has strong potential in industrial applications for paper making industries. This potential includes quality improvements and a competitive advantage for paper machine manufacturers and industry. The innovations have also added potential, when developing new paper products. An example of these kinds of products are ones with printed intelligence, which could be a new business opportunity for the paper industries all around the world.

In modern times, increasing divorce ratio should be addressed properly by the agencies concerned. There are numerous studies that found that dyadic coping plays a vital role in marital satisfaction as a significant predictor of marital quality. However, previous research overlooked the function of dyadic coping from both dimensions of marital quality: positive and negative marital quality. Factors that hinder marital satisfaction do not simply mean that they cause marital dissatisfaction. Thus, this conceptual paper aims to discuss the function of dyadic coping to marital quality from both domains.

This study explores science communication on Twitter by investigating a sample of tweets referring to academic papers in five different scientific fields. The specifications of science communicators on Twitter, the characteristics of those who initiate actions (by tweeting), the extent and quality of reactions (retweeting), individual and group interactions, and the distribution of tweets across types of engagement in the process of science communication (i.e., dissemination, consultation, and evaluation) were explored. A broad array of actors is involved in the communication of science on Twitter, with individual citizens and individual researchers playing an important role. In principle, this is promising for creating direct interaction, which can be difficult through more traditional mass media. The vast majority of communication activities regarding academic papers is undigested dissemination with almost no sign of debate, contestation, or collective reflection. Another general finding of this study is that bot accounts play a major role in the science communication landscape on Twitter.

Summary Introduction The term variations of sex development subsumes a large number of congenital conditions including chromosomal mosaics and variations of chromosomal, gonadal, and phenotypic sex. A situation of this nature may cause severe distress to both, parents and affected persons. One of the reasons for this is the binary form of gender classification in the society. In the past, because of a fear of possible stigmatization and an inability to cope with complex situations, it has been medical policy and practice for newborns to undergo early, mostly ‘feminizing’ elective surgery with the aim of achieving an outer genital appearance that is unambiguously male or female. Protests by advocacy groups for the most part as well as the results of outcome studies have shown that the development of affected persons may be very different to what has been expected and often does not result in the intended clear female or male gender identity as had been intended. It, therefore, seemed a matter of urgency to implement this new awareness as well as the ethical and personal human rights perspectives in the recommendations for the medical and psychosocial management of diverse sex development (DSD) in the future. Study design In 2012, an interdisciplinary group of German academics engaged in the field of DSD decided to work on a consensus paper for this topic. It involved the participation of all faculties and non-scientific groups dealing with DSD, in particular advocacy and service-user groups. In a structured consensus, process recommendations were developed based on scientific literature as well as personal experiences of clinicians and affected individuals. Results Finally, 37 recommendations were agreed on. The strength of consensus is reflected in the degree of agreement as expressed in percentages. Conclusion The introduction of the consensus paper reflects on the emerging paradigm shift and the necessity for a more open view of gender within society. The paper is intended to aid the performance of appropriate diagnostics in DSD-affected newborns and especially to help parents and affected persons cope with the biological and social consequences of DSD. With regard to medical or surgical therapy, it gives information about the most recent treatment trends.

In a paper introduction presentation of scientific papers, the presenter needs to understand the contents of a paper, summarizes them by slides and explains them to the audiences, such as participants the paper introduction activity, and discuss the contents with participants. However, if the presenter does not have enough skills for reading the contents deeply or for creating understandable slides, participants are not able to get the importance of the paper precisely and do not have fruitful discussion. For such situation, participants give questions to understand the paper. Therefore, questions regarding to the contents from other participants implicitly suggest problems with the presenter’s understanding of the paper and creating the slides. Therefore, it is valuable for the presenter to reflect on their skills that are used to prepare the paper introduction presentation based on the questions asked by other participants. This research proposes a reflection support environment for promoting the active and sufficient reflection using the questions asked by other participants. Our environment prepares an interface that records the activities involved in preparing the presentation, such as understanding papers and creating slides. Our environment also provides an interface with which the presenter can compare the recorded activities and the participants’ questions. By comparing the questions with their understanding of papers and created slides, the presenter is encouraged to recognize the insufficient points of their reading and presentation methods.

That AI will have a major impact on society is no longer in question. Current debate turns instead on how far this impact will be positive or negative, for whom, in which ways, in which places, and on what timescale. In order to frame these questions in a more substantive way, in this prolegomena we introduce what we consider the four core opportunities for society offered by the use of AI, four associated risks which could emerge from its overuse or misuse, and the opportunity costs associated with its under use. We then offer a high-level view of the emerging advantages for organisations of taking an ethical approach to developing and deploying AI. Finally, we introduce a set of five principles which should guide the development and deployment of AI technologies. The development of laws, policies and best practices for seizing the opportunities and minimizing the risks posed by AI technologies would benefit from building on ethical frameworks such as the one offered here.

The potential of social media to disseminate, aggregate, channel and democratize social accountability processes has encouraged a variety of organizations to actively promote and champion such initiatives. These initiatives typically envision a three step social accountability process where, for example, the publication of previously-private financial information about the inappropriate wealth accumulation activities of politicians and their business allies (step #1), combined with social media dissemination and discussion of these activities (step #2), can result in an accountability conversation that spills out of the medium and that sometimes results in positive social change (step #3). The current study examines Twitter reactions to the International Consortium of Investigative Journalist’s (ICIJ) publication of the Panama Papers. The analysis illustrates that there was a Twitter reaction: furthermore, that there were different styles of response and that certain styles were more likely to elicit an audience reaction, especially if the tweeter was a journalist or organization. While the provided analysis focuses on step #2 within the social accountability process, the results imply that publicly-interested accounting academics qua activists can facilitate social accountability by helping to make previously-private financial information public and by cultivating sympathetic individuals within the traditional media as well as within organizations that are active on social media.

The JK Paper industry located at Rayagada discharges biologically untreated effluent more than the permissible limit prescribed by Pollution Control Board, Odisha in to the environment. The industry is seriously polluting the surrounding aquatic and terrestrial environment. No detailed intensive study was carried out by previous workers on this industry earlier. The present study aims at finding out the impact of effluent on the flora at the contaminated site. The chemically treated effluent (TE) contained significant amount of mercury and cadmium. The TE has high BOD, COD, dissolved solids and suspended solids when compared to normal river water at the site of discharge. The TE deteriorated the natural water bodies changing the physico-chemical properties of natural river water. After meeting the river water the TE was diluted after 1 km distance from the meeting point of the river. Crop plants collected from the contaminated site showed higher level of residual Hg and Cd and significant depletion in pigment was observed. Plants collected from both the sides of the treated effluent canal showed significant amount residue mercury and cadmium in the plant leaves. The plants exposed to the TE, showed variation in chlorophyll and Phaeophytin pigment content when compared to their respective control values in all terrestrial plants collected from the contaminated site. In some plant leaves little increment in the pigment level was noted but the values were not significant. The changes observed in the plant pigment might be due to heavy metal accumulation. The presence of residual Hg and Cd in crop plants and plant leaves grazed by grazing animals after absorption, accumulation and enrichment may lead to a possible biological magnification, warrants attention. Proper biological treatment, treatment of effluent by modern methods and removal of heavy metals from the effluent before discharge by the industry is suggested.

Sewer networks play a pivotal role in our everyday lives by transporting the stormwater and urban sewage away from the urban areas. In this regard, Sewer Overflow (SO) has been considered as a detrimental threat to our environment and health, which results from the wastewater discharge into the environment. In order to grapple with such deleterious phenomenon, numerous studies have been conducted; however, there has not been any review paper that provides the researchers undertaking research in this area with the following inclusive picture: (1) detailed-scientometric analysis of the research undertaken hitherto, (2) the types of methodologies used in the previous studies, (3) the aspects of environment impacted by the SO occurrence, and (4) the gaps existing in the relative literature together with the potential future works to be undertaken. Based on the comprehensive review undertaken, it is observed that simulation and artificial intelligence-based methods have been the most popular approaches. In addition, it has come to the attention that the detrimental impacts associated with the SO are fourfold as follows: air, quality of water, soil, and business and structure. Among these, the majority of the studies' focus have been tilted towards the impact of SO on the quality of ground water. The outcomes of this state-of-the-art review provides the researchers and environmental engineers with inclusive hindsight in dealing with such serious issue, which in turn, this culminates in a significant improvement in our environment as well as humans’ well-beings.

This White Paper summarises currently available empirical data about attitudes and opinions of citizens and state actors regarding cybersecurity. The data emerges from reports of EU projects, Eurobarometer surveys, policy documents of state actors and additional scientific papers. It describes what these stakeholders generally think, what they feel, and what they do about cyber threats and security (counter)measures. For citizens’ perspectives, three social spheres of particular interest are examined: 1) health, 2) business, 3) police and national security.

International audience; Planning is motivated by acting. Most of the existing work on automated planning underestimates the reasoning and deliberation needed for acting; it is instead biased towards path-finding methods in a compactly specified state-transition system. Researchers in this AI field have developed many planners, but very few actors. We believe this is one of the main causes of the relatively low deployment of automated planning applications. In this paper, we advocate a change in focus to actors as the primary topic of investigation. Actors are not mere plan executors: they may use planning and other deliberation tools, before and during acting. This change in focus entails two interconnected principles: a hierarchical structure to integrate the actor's deliberation functions, and continual online planning and reasoning throughout the acting process. In the paper, we discuss open problems and research directions toward that objective in knowledge representations, model acquisition and verification, synthesis and refinement, monitoring, goal reasoning, and integration.

During the COVID-19 pandemic, some goods suddenly became scarce due to panic purchases and stockpiling. The decision to hoard is influenced by higher-order beliefs. If an agent believes that other agents think that a good will become scarce, she concludes that these other agents will hoard, and thus tries to preempt them by hoarding herself. To capture such behaviour, we construct a model with a global game. Agents receive noisy information about some variable that influences supply or demand. They then form higher-order beliefs, and possibly panic and hoard the product. We analyze determinants of such panics. Endogenizing prices and quantities, we show that producers with market power set prices strategically to induce panics and thus boost demand. Absent market power, strong competition leads to low prices and thus little overproduction, also causing panics. We also consider firms who need the scarce good as an intermediate product in their production chain, and show that a regulator would require such firms to stockpile the product, thus increasing resilience.

In this study, the effects of ambient illuminance and light source on participants’ reading performance and visual fatigue during a long reading task were investigated using three electronic paper displays. Reading on electronic paper displays was also compared with reading on paper. In Experiment 1, 100 participants performed a reading task where the display area for the text was equated for the displays. The results indicated that participants’ visual performance and visual fatigue did not differ significantly among different electronic paper displays, ambient illuminance conditions, or light sources. In Experiment 2, another 60 participants performed the same reading task where the full screen of each electronic paper display was used to present the text. The results showed that reading speed differed significantly across different electronic paper displays and ambient illuminance levels. The reading speed was slower for displays with smaller screens and increased as the ambient illuminance increased. Changes in the critical flicker fusion frequency significantly differed across ambient illuminance levels. Implications of the results for the use of electronic paper displays are discussed.

Tax Software has become the predominant format used to prepare and file taxes in the U.S. Compared to filing paper returns, tax software significantly changes the reporting environment. For example, tax software uses tax position indicators that update a taxpayer's tax position (i.e. whether they will receive a refund or owe additional tax) in real time as they enter their tax information. This study uses an experiment to investigate how tax compliance decisions made when using tax software with a tax position indicator differ from those made when using paper forms. In addition, we investigate the extent to which taxpayer attitudes (personal norms) impact taxpayer compliance decisions in these two environments (paper v. software). We find that taxpayers using software with a tax position indicator report more (less) cash revenue depending on their “tax due” (“refund”) position, which has both beneficial and negative effects on tax compliance. In addition, we find that taxpayers are strongly influenced by their personal norms in their reporting decisions.

Quality papers are essential for scientific dissemination as well as to instigate new researches in the field. This corollary also applies to atomic spectrometry, which has experienced amazing developments in concepts, instruments, and applications. This article highlights the main characteristics expected in a quality paper overall and particularly in atomic spectrometry. The aim is to bring guidelines for research students, newcomers in the field, and practicing chemists.

Rigorous and transparent critical appraisal is a core component of high quality systematic reviews. Well-conducted quasi-experiments have been empirically shown to estimate credible, unbiased treatment quantities. Conversely, when inappropriately designed or executed, these estimates are likely to be biased. This paper draws on recent advances in risk of bias assessment. It presents an approach to evaluating the internal validity of credible quasi-experiments. These are non-randomised studies using design-based approaches to control for unobservable sources of confounding such as difference studies, instrumental variables, interrupted time series, natural experiments and regression discontinuity designs. Our review suggests that existing risk of bias tools provide, to different degrees, incomplete transparent criteria to assess the validity of credible quasi-experiments. We argue that a tool is needed to assess risk of bias consistently across credible quasi-experiments. Drawing on existing tools, in particular Cochrane’s new tool for non-randomized studies of interventions (Sterne et al., 2014), we discuss domains of bias and suggest directions for evaluation questions.

The need to increase the recovery rates of recyclables from households, reducing at the same time the collection costs, has favored the spreading of commingled collection systems. This study presents a thorough analysis of the quality of a secondary source of recovered paper of a Spanish newsprint mill, imported from the United Kingdom, where these systems are widely practiced. The results show that the quality of recovered paper from commingled systems is very far from the quality obtained with selective systems: the unusable material content vary from 1% to 29% (11.9% on average) compared to less than 1%. Larger materials recovery facilities (MRF), less oversaturated and with advanced sorting techniques, have demonstrated to be able to render better qualities, the unusable material content varying from 0.3% to 16.6% (8.1% on average). However, the quality is still far from contamination levels typically found with selective systems, especially in terms of non-paper components. This fact limits significantly the use of this recovered paper for graphic paper production where the major potential for an extended use of recovered paper in papermaking lies. Furthermore, there is a discussion on the cost efficiency of these systems and how the legislation and private or public initiatives are affecting the spreading of these systems, especially in the United States and the United Kingdom.