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

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

Background The screening of biological hazards, chemical contaminants and allergens in food products is a major concern of food industry since they can cause serious illnesses and even lead to death. Therefore, there is a significant interest in developing low-cost, robust, and rapid detection methods for food safety and quality analysis. Conventional methods provide accurate analytical characteristics, but require well-equipped laboratories, trained personnel, costly reagents, and complicated sample preparation procedures prior to the detection in order to obtain reliable results. Hence, they are not always ideal for on-site food surveillance. Scope and approach This paper discusses the fundamentals of microfluidic paper-based analytical devices (μPADs) and reviews the recent progress in their usage for screening biological hazards, harmful chemical residues, and allergens in food products to systematically evaluate the strengths and weaknesses of this technology. It then covers future trends and useful strategies that could be employed in μPADs design and fabrication procedures to address the critical challenges in equipment-free food analysis. Key findings and conclusions μPADs offer promising avenues to revolutionize food safety and quality analysis with merits of equipment-free sample preparation and detection at low-cost. Despite the advancement in the microfluidic technology, the manufacturing of user-friendly sample-to-answer μPADs still requires intensive research studies to be employed for robust and sensitive food safety and quality analysis.

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

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

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

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

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

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

This study optimizes a novel surfactant-assisted green liquor dregs (GLD) pretreatment of paper mill sludge (PMS), both of which are wastes from the kraft pulping industry, using a combined Response Surface Methodology (RSM) design. Optimized conditions give a maximal reducing sugar release of 16.38 g/L. A substantial reduction in heavy metals aluminum, chromium, cobalt, arsenic, lead, and copper after pretreatment illustrates the enhancement of substrate digestibility by reducing toxic elements. Separate hydrolysis and fermentation (SHF) and simultaneous saccharification and fermentation (SSF) for hydrogen production are assessed. SSF produced a hydrogen yield of 3.72 mL/g, displaying a 36.26% increase from pretreated PMS compared to SHF. These findings provide insights into possible methods of reducing process duration, energy input, and costs incurred with waste disposal within the paper industry. Furthermore, improved hydrogen yield using an SSF process demonstrates the potential beneficiation of pulp and paper GLD and PMS wastes.

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

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

In 2015 the Spanish Society of Rheumatology (Sociedad Espanola de Reumatologia [SER]) published its position paper on biosimilar drugs. In this update, the SER, continues to manifest its unequivocal commitment to the sustainability of the health system of our country and is aligned with the measures that, without reducing quality of care, are aimed at ensuring its continuity. Since the publication of the previous position paper, the European Commission has authorized new biosimilar drugs, which provides an excellent opportunity to advance the efficiency of health care. In this new scenario of increased therapeutic offer of biologics, the SER considers it crucial to preserve the freedom of prescription of physicians who prescribe drugs based exclusively on the characteristics and individual circumstances of each patient, without forgetting the economic aspects there of.

Cellulose triacetate (CTA) forward osmosis (FO) membrane from Hydration Technology Innovation (HTI), USA was tested in a locally fabricated FO system to concentrate synthetic and pulp and paper mill wastewater. The industry is among the 17 most polluted industries with intensive water consumption and wastewater generation (MoEFCC, Government of India). The CTA membrane was studied with deionized water as feed solution and 1 M NaCl as draw solution, which resulted into water flux of 5.8 L/m2h and reverse salt flux of 0.2 g/L. A concentration stepping method was used to determine the critical draw concentration with lignin solution as the model feed. There was no deviation in flux between the baseline (deionized water feed) and the lignin solution up to 1.5 M NaCl, but a marginal deviation (8% and 21% respectively at 2 M and 3 M) was seen thereafter. The average water flux after 24 h FO study with synthetic wastewater as feed solution (draw solution 2 M NaCl) was 8 L/m2h, and 80% water recovery. Similar study with pulp and paper wastewater as feed solution (draw solution of 1.5 M NaCl) was 5.4 L/m2h was with 62% water recovery. Lignin and COD rejection in pulp and paper mill wastewater was 90% and 64% respectively. The preliminary results indicate that FO is promising for water and lignin recovery from waste streams.

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

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

Edible oils form an integral component in the human diet as well as in the industrial preparations. Any adulteration in oil is concerning from nutritional as well as economical perspective. Although analytical techniques exist for detection of adulterants in oil, most of them require sophisticated instruments, and trained professionals. Microfluidic based lab-on-a-chip technologies have rapidly progressed over the recent years and offer promising alternatives in this regard. In this work, we report development of a paper-based microfluidic lab-on-a-chip for detection of palm oil contamination in sunflower oil. We use the paper-based microfluidic colorimetric detection approach that indicates the presence of adulteration in a visual manner. The data is analyzed using digitally acquired images along with ultraviolet–visible spectrophotometry. The paper-based microfluidic device is fabricated and tested for 10–50% (v/v) palm oil adulteration in sunflower oil. Further, we employ the device for free fatty acid content tests in oil samples. Visual signal acquired from the device is optimized by varying phenolphthalein proportions. The stability of visual colorimetric signal is examined over time and is found to remain steady over the trial period of six days considered in this work. The integration of the detection device with smartphone imaging can prove to be useful for onsite data collection. We believe the approach presented here can be extended to food quality monitoring portable platforms.

The waste of paper or the paper dump is a serious problem and its occurrence is widespread in various institutions. Wastepaper can be recycled to produce some important and usable products that are ecological and biodegradable. For example, it is used to extract new paper from the old by chemical decomposition. Other products such as paper plates, paper cups, paper spoons, tiles, toys, crafts, etc. can be formed from the slurry. This project also initiates a mould that makes cups and plates from the wastepaper management circuit. With learning institutions being the main consumers, most paper are usually eliminated after its use. The waste remains undeveloped and unused, although is a valuable resource. Studying the design of a manual, economical and efficient paper recycling machine, it can be surmised that the design uses the integration of the knowledge gained about the recycling technology that exists manually from the paper recycling machines used to form a cheap but effective paper recycling system. The advantages of the machine are not only of recycled paper, but also the advantages of the interaction of the manual drive system, which will also reduce the high cost. As the design is not 100% effective, the transmission, belt and chain transmission correspond to the estimated 90% efficiency using the 90% for the design. The power consumption for the design is 450 W and since an average user can produce 100 W constant, it takes 5 people to drive the machine.

Food safety is always one of the most important issues for human being. With the variety of food, it is required to develop rapid, low-cost and convenient detection techniques for food safety. As a representative, paper-based detection techniques have developed rapidly from simple test papers to various microfluidic paper-based devices. The paper-based analytical devices combining paper platform with a variety of advanced analytical methods have shown great application prospects for rapid testing of food safety. In this review, the surface functionalization and modification of paper are introduced. Then, the construction and development of various detection techniques are discussed, including colorimetric analysis, fluorescent analysis, electrochemical analysis, surface enhanced Raman spectroscopic analysis, and multimethods on paper-based platforms for the application in rapid detection for food safety. Finally, the prospects and future challenges of rapid detection techniques in food safety are also discussed.

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

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

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

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

Advancements in technology have led to the use of smartphones as biosensor detectors. However, it is difficult to obtain stable color information of colorimetric sensors using multiple smartphones owing to different light conditions and image correction operations. In this study, we attempted color detection of the colorimetric paper chip using smartphone-embedded light-emitting diode (LED) and simple transformation calculation. This method enables the acquisition of stable color information using different smartphones by reducing the influence of external light sources. Moreover, we studied characteristics such as convergence and distinction of detection result details by the manufacturers and smartphones. These findings suggested the necessity of classification criteria for the use of smartphones to achieve optimal detection. In addition, white and black references were used to set the standard for color correction of various light sources. Based on our results, we conclude that this approach presents the possibility of smartphone-based colorimetric detection in practical applications.

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

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

Enormous quantities of bagasse are being used as raw material in agro based large integrated pulp and paper mills. Anaerobic technology is an effective means of biodegradation of organic substance in wastewater and energy production of biogas that can be used as an alternative fuel. This study illustrates the effect of HRT on performance of lab scale hybrid upflow anaerobic sludge blanket (HUASB) reactor on treatment of pulp and paper mill bagasse wash water. The lab scale HUASB reactor was designed for an effective volume of 0.013 m3 with bio balls as packing media at the top of reactor and operated under mesophilic condition. After startup period, the reactor was operated with HRTs of 23.55, 15.98, 12.00, 10.03 and 7.97 h for the average influent COD concentrations of 2503.6 mg/L, 3918 mg/L, 5432 mg/L, 6608 mg/L and 7996 mg/L respectively. The results showed that the maximum COD removal efficiencies and TSS removal efficiencies were in the range of 68.60–92.19% and 89.56–94.66% respectively. The minimum and maximum biogas yield of 0.32 and 0.53 m3/kg CODa were obtained at influent concentration of 2503.6 mg/L and 7996 mg/L respectively.

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

Paper based assays are paving the way to automated, simplified, robust and cost-effective point of care testing (POCT). We propose a method for fabricating three dimensional (3D) microfluidic paper based analytical devices (μPADs) via combining thin adhesive films and paper folding, which avoids the use of cellulose powders and the complex folding sequence and simultaneously permits assays in several layers. To demonstrate the effectiveness of this approach, a 3DμPADs was designed to conduct more assays on a small footprint, allowing dual colorimetric and electrochemical detections. More importantly, we further developed a 3D platform for implementing automated and multiplexed ELISA in parallel, since ELISA, a routine and standard laboratory method, has rarely been used in practical analyses outside of the laboratory. In this configuration, complex and multistep diagnostic assays can be carried out with the addition of the sample and buffer in a simple fashion. Using Troponin I as model, the device showed a broad dynamic range of detection with a detection limit of 0.35 ng/mL. Thus, the developed platforms allow for various assays to be cost-effectively carried out on a single 3D device, showing great potential in an academic setting and point of care testing under resource-poor conditions.

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

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

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

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

The pulp and paper industry in contrast to other manufacturing industries consumes a large amount of energy and emits pollutants along with greenhouse gases. The waste generated from the pulp and paper industry causes severe harm to the aquatic life, disturbs the food chain, and also causes various health implications. In this review, we have highlighted some of the primary pollutants released from the industry and their health hazards. Strict action and implementation of the regulatory model is required in this industrial sector for environmental compliance. The environmental pollution caused by the pollutants poses a threat to aquatic life as well as to plants and human beings. The effect of pollutants on the environment has been assessed many times, but their mitigation still has a significant challenge. This review highlights some recent techniques to reduce pollutants from the pulp and paper industries. Among these techniques, microbial fuel cells, anaerobic digestion, bleaching technologies, cleaner production, and transformation pathways are the most used techniques. These will help in understanding the risk of pollutants released from the industry and the techniques will help in tackling these pollutants for a sustainable environment development.

Sample pretreatment is an important part in detection and analysis of samples, especially for those with low initial concentration. Preconcentration technology can improve the accuracy of analytical method and expand its application range. However, conventional sample preconcentration technology is often cumbersome, costly, time-consuming, and relies on expensive equipment. Paper-based microfluidic sample preconcentration technique has many advantages such as easy preparation, low cost and high efficiency, which can simplify operation and reduce detection cost. This paper focuses on the research and application progress of paper-based microfluidic sample preconcentration in recent years, including enrichment principle, selection of paper-based materials, design of device structure, and the application of this technology. Finally, the development trend of this technique was prospected.

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

The development of renewable energy sources minimizes the burning of fossil fuels for clean and green environment. Electrochemical energy storage/conversion device pays a way towards sustainable development that concludes an emerging field in the trends of the research community. Prominently, the functional materials with suitable structure and property determine the performance and durability of the devices. In recent times, graphene with its tremendous properties play a major role in electrochemical energy device applications. Meanwhile, the graphene-based electrodes were fabricated by various coating techniques on existing electrodes that utilized for energy device fabrication. Apart from these, it is also fabricated in a paper like a form (self-supported or free-standing) with its remarkable high conductivity, flexibility, robustness and electrochemical behavior which have been nominated for fabrication of flexible energy devices. Paper-like electrodes become an emerging field to fabricate a light-weight and flexible electronic devices for future prospects. Thus, we have summarized a synthetic strategy of graphene paper and its properties that potentially focused on flexible device fabrication in both the energy storage and conversion system. Hence, this review boosts up the forthcoming researchers to enhance the device performance with interrelating free-standing graphene and other host material.

In most cases, three-dimensional paper-based microfluidic analytical devices (3D-μPADs) were fabricated manually by stacking or folding methods. For the first time, digital light processing stereolithography (DLP-SLA) 3D printing technology was adopted to automatically make 3D-μPADs. In the fabrication process, a printing pause was set between two layers to allow paper to be placed in the resin tank. The resin on the fresh paper spontaneously bonded to the former cured paper layer during curing, thus realizing the automatic bonding and alignment between different layers of paper and avoiding the human participation and errors as in stacking and folding methods. There was a gap between two vertical aligned flow paths, therefore the liquid did not flow spontaneously from the upper layer to the lower layer. Most of the fluid flow in 3D-μPADs was spontaneous or manually activated, which was not conducive to complex assays that require different regents to be delivered sequentially. Herein, we used an electric field or airflow to trigger the fluid flow and demonstrated the flow controllability by a proof-of-concept colorimetric assay. The limits of detection of glucose and albumin were 0.8 mM and 3.5 μM, respectively, which were sufficient for clinical requirements. Given the characteristic of flow controllability, we believe that the proposed 3D-μPADs have great potential to make paper-based complex assays automated and programmable.

Chemical Looping Combustion (CLC) CO2 capture technology can be used to recover energy from municipal solid waste (MSW). In this study, techno-economic analysis of CLC of waste paper, PVC and their blends for electricity and heat generation was carried out. The process includes the chemical looping combustion section, carbon capture section and lastly, electricity generation section, and this was simulated using Chemcad software. Four scenarios were evaluated; IG-CLC (In-situ Gasification Chemical Looping Combustion) with electricity production only, and with combined heat and power (CHP), Chemical Looping Oxygen Uncoupling (CLOU) with electricity production and with combined heat and power (CHP). Based on a net capacity of 150 MW, the effect of waste paper, PVC and its blends on its net efficiency and LCOE was investigated for all four scenarios.

The ACR Incidental Findings Committee (IFC) presents recommendations for managing adnexal masses incidentally detected on CT and MRI. These recommendations represent an update of those provided in our previous JACR 2013 white paper. The Adnexal Subcommittee, which included six radiologists with subspecialty expertise in abdominal imaging or ultrasound and one gynecologist, developed this algorithm. The recommendations draw from published evidence and expert opinion and were finalized by iterative consensus. Algorithm branches successively categorize adnexal masses based on patient characteristics (eg, pre- versus postmenopausal) and imaging features. They terminate with a management recommendation. The algorithm addresses most, but not all, pathologies and clinical scenarios. Our goal is to improve quality of care by providing guidance on how to manage incidentally detected adnexal masses.

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

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

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

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

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

This review paper encompasses the inclusive approach of lime sludge valorization in construction materials. Research studies based on cement and aggregate replacement by lime sludge concludes that 10–30% lime sludge is gainfully utilized in sustainable concrete and mortar. Additional prospect for lime sludge application in construction material is the production of cement and ceramics. Significant use of lime sludge in combination with supplementary cementitious materials such as silica fume, nanosilica and fly ash is recommended for the production of cement components and ceramics. The recommendations are also suggested in accordance with the outcome of the study.

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

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

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