Search

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.

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 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%.

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.

Objective This study collected randomized controlled trials (RCTs) published in the social sciences in China and assessed their risk of bias and reporting quality. Study Design and Setting Three databases were systematically searched for publications from January 2000 to June 2020 for RCTs in the social sciences published by Chinese researchers. The risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool (CCRBT), and reporting quality was assessed using the Consolidated Standards of Reporting Trials for Social and Psychological Interventions (CONSORT-SPI). Results A total of 316 RCTs were identified, including 204 articles in English and 112 articles in Chinese. The most frequently researched interventions focused on education (33.9%), and the most frequently studied population were students (32.9%). Eighty-seven percent of RCTs had intermediate reporting quality. Twenty-four of the 43 CONSORT-SPI sub-items had a compliance rate of less than 50%. Most RCTs had an unclear risk of bias for blinding outcome assessors (84.5%), blinding participants and personnel (82.9%), allocation concealment (73.1%), and random sequence generation (68.0%). A low proportion of CONSORT-SPI items were reported and, high proportion of the papers had unclear risk of bias. Conclusion The quality and reporting of RCTs in the social sciences needs improvement in China, especially for reporting methods and results. Most studies had an unclear risk of bias as they lacked important methodological information.

The use of membranes in integrated water systems has garnered increasing attention in paper mills operating with virgin fibres, with documented closed water loops in industry. However, limited research exists on the performance of ultrafiltration (UF) in mills operating with 100% recycled fibres (RCF) and closed water systems, as these result in the introduction and accumulation of insoluble contaminants in the effluent. This study investigated the effect of transmembrane pressure (TMP) and feed organic load on the flux, types of fouling, and organic separation with UF membranes in a recycled paper mill using 100% RCF. The high feed organic load caused inevitable fouling, limiting the highest achievable flux. However, the TMP could be manipulated to improve on or exacerbate the process performance, within the range that was set as a result of the feed's characteristics. Low TMP (1.35 bar) generated the highest permeability and chemical oxygen demand removal, while higher TMPs produced higher fluxes and recoveries. The process was characterised by high initial fluxes, followed by cake formation, which dominated, and pore blockage. The excess cake formation induced cake filtration. This study shows the potential of UF membranes to be used as pre-treatment in filtering the process water in a recycled paper mill operating with 100% RCF, a critical step forward in implementing an integrated water system, and eventually closing the water loop.

L -dopa is a chiral drug that has been extensively used for the treatment of Parkinson’s disease. The concentration of L -dopa plays a vital role in the treatment, and this work emphasizes on designing a versatile platform for the quantitative and selective detection of L -dopa using reduced graphene quantum dot (rGQD). The platform is efficient in three different sensing methods, viz. fluorescence turn-on, filter paper-based sensing, and electronic measurements. The rGQD undergoes a dramatic fluorescence turn-on in the presence of L -dopa in aqueous media and artificial urine with a detection limit as low as 1.307 µM and 1.217 µM respectively. Experimental evidence revealed that the fluorescence enhancement is attributed to aggregation-induced emission mechanism. The system is also applicable for visual detection of L -dopa using filter paper strips treated with rGQD and develops bright fluorescence under ultra-violet irradiation. Apart from this, electrical sensors for L -dopa were also developed by preparing rGQD treated poly-vinyl alcohol films, and the increase in the current conduction with varying concentrations of L -dopa was observed. The films produce 2.5 order higher current conduction at 300 μM of L -dopa with a detection limit of about 13.136 µM. At the final stage, we have designed flexible electronic devices using these materials that develop 1.3 order higher current for L -dopa. The devices exhibit excellent air stability under varied relative humidity conditions as well as high bending stability for potential practical applications.

Background We use inkjet printing and film adhesion methods to economically develop paper-based electrowetting-on-dielectric (EWOD) mixing device. Because the periodic shrinking and stretching of droplet contact line induces surface capillary wave, the coalesced droplet on EWOD device vibrates to accelerate solute mixing on the merged spot. Methods An office inkjet printer fabricates pads of conducting silver nanoparticles to compose EWOD activation electrodes on a piece of glossy label paper, covered with one oil-coated dielectric film. Using the triggering relays of each pad, two droplets of thirty microliter individually loaded on the electrode ends are driven to coalesce. Alloy nanorod-catalyzed chemiluminescence assay can be performed on this mixing device. Findings When ac voltage of 100 Hz is applied on the electrode flakes, compared with solute transport efficiency in static condition, solute diffusivity is enhanced by 4 times using this mixing device. Linear relation (R2 = 0.99) between luminescence intensity acquired with smartphone camera and luminol concentration of aforementioned chemiluminescence assay is obtained, demonstrating reproducibility improvement for accurate determination.

Activating flux is made up of inorganic material mixed with a volatile medium. The objective of this study is to identify and review the literature in activating flux, and different type of welding techniques. For that purpose, a structured review method is adopted and the Scopus database is used as a primary source for the selection of papers. The papers were identified using the string term of “Activating flux” OR “Activated flux” in the title of papers. And a total of 238 papers were identified for the study. Besides the above few other papers were also reviewed and the materials used, the type of flux used, and the findings of different combinations were highlighted in the form of tables. The findings of the study provide a comprehensive understanding of the different type of welding techniques focusing on TIG welding, and the different combination of flux used and their impact was summarized.

The construction of a photoelectrochemical (PEC) strategy for multi-component detection represents a great challenge in the field of sensing. To address these challenges, herein we presented a hollow-channel paper-based PEC analytical platform based on chemiluminescence (CL) addressable strategies excited PEC strategy for multiplexed sensing application. Sandwich-structured CdS quantum dots (QDs)/reduced graphene oxide (RGO)/ZnO nanorods arrays (NRAs) heterostructure where CdS serves as visible light sensitizers, RGO acts as an electron relay between ZnO NRAs and CdS QDs, were simply assembled on the gold nanoparticles modified paper working photoelectrode (Au-PWE). The PEC performance of the CdS/RGO/ZnO can be greatly improved benefiting from the formation of type II band alignment between CdS QDs and ZnO NR as well as the super charge collection and shuttling property of RGO. Multiplexed CL emission could be achieved through controlling the CL co-reagents transport. By the virtue of CL addressable technique and the excellent PEC activity of CdS/RGO/ZnO, a highly sensitive, and selective multiple microRNAs (miRNAs) quantification method was achieved. Such a tailored strategy would break the bottleneck of the current PEC detection techniques in multiplex tracing, as well as serve as a novel concept for designing multi-channel PEC sensing method.

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.

Graphene-based papers have recently triggered considerable interests in developing the application as thermal interface materials (TIMs) for addressing the interfacial heat transfer issue, but their low through-plane thermal conductivity (κ⊥), resulting from the layer-by-layer stacked architecture, limits the direct use as TIMs. Although various hybrid graphene papers prepared by combining the graphene sheets and the thermally conductive insertions have been proposed to solve this problem, achieving a satisfactory κ⊥ higher than that of commercial TIMs (>5 W m−1 K−1) remains challenging. Here, a strategy aimed at the construction of heat pathways along the through-plane direction inside the graphene paper for achieving a high κ⊥ was demonstrated through the simultaneous filtration of graphene sheets with two different lateral sizes. The as-prepared graphene paper presented a hierarchical structure composed of loosely stacked horizontal layers formed by large graphene sheets, intercalated by a random arrangement of small graphene sheets. Due to the heat pathways formed by small graphene sheets along the through-plane direction, the hierarchically structured graphene paper exhibited an improved κ⊥ as high as 12.6 W m−1 K−1 after a common graphitization post-treatment. In the practical test, our proposed paper as an all-graphene TIM achieved an enhancement in cooling efficiency of ≈ 2.2 times compared to that of the state-of-the-art TIM, demonstrating its superior performance to meet the ever-increasing heat dissipation requirement.

Paper electronics have been fast developed in recent years due to their degradability and recyclability; however, most of them are barely equipped with logic functions, impeding them from becoming autonomous on-paper systems. To provide a working unit for logic implementations, a paper field-effect transistor (FET) with a clay-graphite channel that demonstrated negative differential resistance (NDR) is fabricated in this study. The device exhibited a p-type semiconductor characteristic with an optical bandgap of ∼1.97 eV according to photoluminescence analysis, resulting from considerable defective graphite mixed with clay in the channel. Considering that the NDR behavior is theoretically predicted to be tunable by the contact resistance, we fabricated FETs with different contact resistances and observed that the NDR behavior occurred in devices with relatively lower contact resistance. The NDR effect is also tunable by varying the gate voltage, which matches well with simulation results. The possible mechanism for the NDR behavior is the decrease in carrier drift velocity induced by band-to-band tunneling, associated with impurities-induced trapping states and gate-induced confined states. This work provides a promising and easy pathway to develop digital components using paper electronics in the near future.

Background In 2019, a randomized controlled trial (RCT) authored by Dr. Ismail was retracted due to concerns about data integrity. Since there are no policies in place to investigate other publications of authors of retracted studies, we investigated Dr. Ismail’s other trials. Methods We searched for RCTs authored by Dr. Ismail. We made pairwise comparisons of values in baseline and outcome tables between trials. We assessed whether the distributions of baseline characteristics were compatible with properly conducted randomization, using Monte Carlo simulations and the Kolmogorov-Smirnov test. We read the publications carefully for unusual features. Results Dr. Ismail was author in eight published and one unpublished trial. In three of his first author studies we found multiple identical values in the baseline and/or outcome tables from different trials. At least some of the trials were unlikely to have followed a proper randomization process. There were a number of other unusual features in the papers we reviewed. Conclusions It is probable that other trials published by Dr. Ismail contain questionable data. We call for a thorough investigation of the original trial data and related official documents. Our exercise suggests that the practice to assess research integrity should include all publications of authors with retracted fabricated articles.

Recently, triboelectric nanogenerator (TENG) has aroused considerable interest due to various advantages. Particularly, one benefit which sand out is that the triboelectric pair of TENG is very tolerant to the material composition. Thus, it is possible and significant to develop cost-effective TENG using commercial and inexpensive material. In this work, we present a paper TENG by repeated folding completely using commercially available commodity materials, such as paper, brush pen, Teflon tape, and conductive ink. Paper is used as functionally triboelectric pair and spring-like supporting structure. The stacked paper TENG is fabricated and large enhancement of output performance is observed. The generated electric outputs have been used to directly light-up commercial LEDs. The proposed TENG has demonstrated simplicity and cost-effective, which is suitable for flexible electronics.

The purpose of this study is to investigate influence of calcination and cooling conditions on pozzolanic reactivity of waste paper sludge. Calcined paper sludge (CPS) is prepared by different temperatures of calcination, duration of calcination and cooling methods. Pozzolanic activity of CPS was investigated by using API (Assessed Pozzolanic Activity Index) and SAI (Strength Activity Index) in accordance with ASTM C618 -17 (KS L 5405) and consumption of Ca(OH)2 hydrate in mortars with CPS in detail, and compared to that of commercial fly ash (FA) and blast furnace slag (BFS) used in the concrete industry. Results revealed CPS produced from waste paper sludge had excellent pozzolanic activity compared with commercial pozzolanic admixtures such as FA or BFS. Their pozzolanic activity was most excellent in calcination temperature of 700 °C, calcination duration of 2 h and cooling method of water quenching. SAI (%) of mortar with CPS produced under optimal conditions was 96% at 28 days of age, and satisfied the quality of fly ash (Class F) as specified in ASTM C618 -17 (KS L 5405). There was linear relation between API (%) and SAI (%) of mortars with CPS, and the correlation coefficient was relatively good as 0.8 at 28 days of age. The API method is recommended as rapid and appropriate evaluation of the pozzolanic activity of the CPS.

When portability, low cost, and green energy requirements are considered, the search for an electricity generator harvesting environmental energy based on available cheap commercial materials and simple fabrication techniques becomes significantly important. In this study, the capability of ultrasoft and cuttable paper-based triboelectric nanogenerator (P-TENG) to harvest mechanical energy is demonstrated. The P-TENG maintains the excellent softness of tissue paper and has the characteristics of light weight (~ 87 g/m2), high electric conductivity (6 Ω/square), and low cost (~ $3.00/m2). More importantly, the P-TENG can be cut by the end-user to modify its size and shape and still function properly. The mechanical energies available during cleaning processes, the energy associated with the body's motion, sound energy, and wind energy can be directly harvested by using the P-TENG. The high portability of the P-TENG, the simple and scalable fabrication processes, low cost, and its ability to harvest mechanical energy make the P-TENG important for the development of green, portable, energy-harvesting devices.

The objective of this study was to determine the effect of electrical conductivity, pH and temperature which were kept constant during treatment via an advanced control strategy on chemical oxygen demand, color, turbidity and total suspended solids removal and energy consumption. Central Composite Design matrices were formed for aluminum and iron electrode systems separately with different combinations of 5 independent variables (electrical conductivity, pH, temperature, current intensity and electrolysis time). Obtained results revealed that aluminum electrode system was found to be more effective than iron electrode system under controlled conditions. Comparison of uncontrolled and controlled studies at optimum values of aluminum electrode system showed an increase by 31.67% in chemical oxygen demand removal and a decrease by 48.30% in energy consumption under controlled case. Results indicated that constant electrical conductivity, pH and temperature during electrocoagulation process of pulp and paper mill wastewater by means of a controller enhanced treatment efficiency.

Large-sized graphene sheets (LG) and doping strategy were employed to fabricate lightweight and flexible graphene paper with exceptional electromagnetic interference (EMI) shielding performance. Compared with the smaller sized ones, LG with fewer defects and more conjugated carbon domain size as well as better alignment result in higher electrical conductivity and strength of graphene paper. The iodine doping further improves the carrier density of LG by formation of triiodide ( I 3 − ) and pentaiodide ( I 5 − ) through charge transfer process without deteriorating the mechanical property, thus leading to superior EMI shielding effectiveness (SE). The EMI SE of iodine doped LG film with thickness of 12.5 μm is up to ∼52.2 dB at 8.2 GHz, which is much higher than that of undoped LG with the same thickness (∼47.0 dB). More important, the improvements in EMI SE is contributed to the SE absorption, while the SE reflection is almost unchanged. The mechanisms of improved EMI shielding performance as well as mechanical property were investigated and discussed. The present study provides a facile way to fully develop graphene in lightweight and flexible EMI shielding materials and devices.

The state-of-art is a mesophilic treatment of wastewater in paper mills without reuse due to the high water quality requirements. Thermophilic biological treatment could save a large amount of thermal energy, but the major obstacle of a reuse are the poor sludge settling properties under thermophile conditions, leading to insufficient water quality if conventional gravimetric phase separation is applied. MBR technology is a promising alternative which allows a recirculation of treated water for improving the water and energy footprint. So far, there is only limited experience with thermophilic MBR at the time. In this study, a thermophilic MBR with a submerged membrane (TSMBR) was operated to treat wastewater from a paper mill with a COD concentration of 25–30 g L −1 . The TSMBR was integrated into the operational process of the paper mill. Research questions were the influence of suspended solids, food to microorganism ratio (F/M ratio), cross-flow-aeration and filtration flux to the fouling of the membrane. Applying the critical flux concept, optimal operating conditions and costs for a future economic full-scale implementation could be derived. Key results are inter alia a sub-critical flux of below 10 L m −2 h −1 is recommended for long-time durability of the membrane for minimizing the irreversible fouling and the permeability decrease. A chemical cleaning does not change the critical flux, but improves the permeability of the membrane significantly. The TSMBR suffered from increasing fouling at a cross-flow-aeration of below 0.6 m 3 m −2 h −1 and a concentration of suspended solids of above 14 g L −1 . A stable process and cleaning could only be ensured by a F/M ratio of below 0.4 g COD g MLSS −1 d −1 . Higher values result in an increased cake layer formation and intensive foaming.

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.

Electrochemiluminescence (ECL) is a powerful technique with the advantages of high sensitivity and a wide dynamic range. However, most of previous strategies based on ECL could only detect one analyte so that it is inevitable to investigate the selectivity and influences of interferences. Herein ECL integrated with paper chromatography was showed to be a potential platform for separation and detection of two environmental hormones (bisphenol A, BPA, and dibutyl phthalate, DBP). In our approach, carbon conductive tape was attached to an ITO glass and then modified with multi-walled carbon nanotubes (MWCNTs) and CdSe quantum dot (CdSe QDs) to fabricate the working electrodes for ECL detection. The synthesis of CdSe QDs was optimized based on their photoluminescence spectra and the ECL intensities. The modified electrode was then coupled in the paper-based analytical devices consisting of the filter paper modified with chitosan. Based on their quenching effect on the ECL emission of CdSe QDs, excellent linear relationships could be obtained between decreased ECL intensities and both the concentrations of DBP and BPA. Besides, DBP and BPA could be separated based on their retention time by tilting the filter paper for 30° and then detected with ECL. This study suggested that paper-based analytical devices could be potentially applied for separation and detection of multiple targets due to their ease of fabrication and convenient operation.

Herein, Microfluidic Paper-based Analytical Devices (μPAD) strips, also called microstrips, have been fabricated using a fused-deposition modeling (FDM) based 3D printer. A polycaprolactone (PCL) filament on a chromatography paper was harnessed to create hydrophobic boundaries of a microchannel. A pair of screen-printed electrodes, with known separation, were integrated on the microchannel to measure the time taken for fluid automatically. A mini electronic sub-system, amenable to connect with an android smartphone, consists of an easily programmable microcontroller, Bluetooth module and voltage booster circuit. The pluggable-and-playable disposable microstrip was utilized to measure the viscosity of various biological samples with an accuracy of92% with respect to a benchtop viscometer. In particular, the protein denaturation of Bovine Serum Albumin (BSA) and Lysozyme, and viscosity variation of human saliva have been observed. With a competency to measure the viscosity between 0.5 cP to 10 cP, platform cost ofUS$ 8 and a cost-per-test of less than US$ 0.02, the present device has a strong potential to be employed as a personalized gadget for various viscosity dependent measurements.

Paper Spray (PS) is an ambient ionisation technique that is conceptually simple, economical, direct and versatile. In its simplest form, the procedure for operation relies on the application of an electric potential to a triangular-shaped paper substrate with the addition of an extraction/spray solvent to generate charge droplets, without requiring any pneumatic assistance. Despite its promise and rapidly growing popularity, there are some practical challenges associated with PS implementation with scope to enhance its performance further. One such challenge relates to only a small fraction of the Taylor cone expansion being sampled at the MS inlet. In this work we propose a new arrangement for PS, which retains the inherent advantages of this popular technique without introducing additional variables, by using an ambient ion focusing lens that is held at the same potential as the paper substrate. A thorough investigation, consisting of visual spray inspection, electric field simulations and analytical evaluation, including analysis of paracetamol from saliva, shows that ambient ion focusing can provide up to a 50% improvement in spray stability, 60% increase in signal intensity and a 30% improvement in detection limits for routine paper spray mass spectrometry analysis.

There is a need for an accurate end-of-life indicator for packaged food (meat, seafood, dairy food etc.) beyond a simple “best use by” date on the food package. In this work, we propose a low cost solution by repurposing the food’s barcode as a colorimetric sensor array to monitor food condition. A smart phone camera is used to read color information from the sensor barcode for quantitative estimate of the food aging and quality. The sensor is based on cross-reactive vapor sensitive dyes encapsulated in resin microbeads, which are impregnated onto a low cost paper substrate in a barcode pattern. The entire sensor platform is validated by accurately monitoring chicken aging and eventual spoilage under different temperature conditions. The proposed food diagnostics platform has the potential to reduce food waste and eliminate food-borne illness.

The present work demonstrates a miniaturized, easily fabricated, environment-friendly, and cost-effective Microfluidic Paper-based Microbial Fuel Cell (MPMFC) as a potential Energy Harvesting Device. The device consists of a microchannel with a reductant (Shewanella putrefaciens exoelectrogen bacterium with L.B Broth) and oxidant (aerated tap water) flowing over Carbon electrode (anode) and Silver electrode (cathode) using co-laminar flow with the self-capillary phenomenon. The electrochemical analysis like Polarization, Open Circuit Voltage (OCV) was evaluated using a potentiostat, and conductivity and sheet resistance were evaluated using a four-point probe instrument. Various bacterial studies, like growth curve study (Optical Density), volumetric concentrations, and incubation time, were carried out to find out the best suitable optimal bacterial conditions. Lastly, detailed element composition study and morphology of the surface of the electrode with biofouling was carried out using Energy Dispersive Spectroscopy (EDS) and Scanning Electron Microscopy (SEM) techniques, respectively. The portable MPMFC yields a maximum power density of 15.4 μW/cm2 (1340 nA/cm2) at 390 mV over 90 μL of culture. Also, An Internet of Things (IoT)/cloud-based hardware has been developed and integrated with MPMFC platform to observe the real-time device performance leading to its long-lasting potential to operate miniaturized microelectronics sensors and portable devices.

Following the American National Lung Screening Trial results in 2011 a consortium of French experts met to edit a statement. Recent results of other randomized trials gave the opportunity for our group to meet again in order to edit updated guidelines. After literature review, we provide here a new update on lung cancer screening in France. Notably, in accordance with all international guidelines, the experts renew their recommendation in favor of individual screening for lung cancer in France as per the conditions laid out in this document. In addition, the experts recommend the very rapid organization and funding of prospective studies, which, if conclusive, will enable the deployment of lung cancer screening organized at the national level.

Agro-wastes valorization focusses on production of high value-added products, such as cellulose nanofibers (CNF), and contributes to reduce the environmental impact of these residues. CNF have been used successfully as papermaking additives and some previsions maintain that this sector will become the most important, demanding CNF at a reasonable cost. Furthermore, the optimization of the production process of CNF from agricultural residues would contribute to the goals of a circular economy, the development of rural areas and the costs reduction by producing CNF of the minimum quality fit-for-use in recycled paper. In this study, CNF was produced from two agricultural residues; corn (C-CNF) and rape (R-CNF) stalk pulps, pretreated with bleaching, refining and TEMPO-mediated oxidation. Coagulant and cationic polyacrylamide (dual system) and chitosan were the retention systems. Results show the difficulty of predicting the effect of CNF based on their properties, as fibrillation degree or anionic charge, on the improvement of mechanical properties of recycled paper. That is proved by the low differences in tensile index (TI) improvement (∼15% by adding 0.5% C-CNF combined with dual system), obtained with CNF with very different properties. The expensive TEMPO pretreatment could be avoid by applying bleaching pretreatment to the corn pulp, increasing the TI up to 15% without affecting drainage and decoupling the simultaneous deterioration of drainage with TI improvement (drainage time decreased nearly 50% and 20% adding bleached R-CNF and C-CNF, respectively, combined with chitosan). Similar improvements on TI can be achieved by replacing the dual retention system by chitosan without addition of CNF, but the combination of CNF and chitosan allows achieving the highest TI values.

Question In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper? Design Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers. Intervention Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper. Outcome measures The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation. Results Compared with the control group, the experimental group: returned to work sooner (MD –18 days, 95% CI –33 to –3); required fewer physiotherapy sessions (MD –7.4, 95% CI –13.1 to –1.6), rehabilitation consultations (MD –1.9, 95% CI –3.6 to 0.3) and plastic surgery consultations (MD –3.6, 95% CI –6.3 to –0.9); and had better short-term recovery of functional ability and pinch strength. Conclusion In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments. Trial registration ACTRN12619000344190

The open-source release of self-replicating rapid prototypers (RepRaps) has created a rich opportunity for low-cost distributed digital fabrication of complex 3-D objects such as scientific equipment. For example, 3-D printable reactionware devices offer the opportunity to combine open hardware microfluidic handling with lab-on-a-chip reactionware to radically reduce costs and increase the number and complexity of microfluidic applications. To further drive down the cost while improving the performance of lab-on-a-chip paper-based microfluidic prototyping, this study reports on the development of a RepRap upgrade capable of converting a Prusa Mendel RepRap into a wax 3-D printer for paper-based microfluidic applications. An open-source hardware approach is used to demonstrate a 3-D printable upgrade for the 3-D printer, which combines a heated syringe pump with the RepRap/Arduino 3-D control. The bill of materials, designs, basic assembly, and use instructions are provided, along with a completely free and open-source software tool chain. The open-source hardware device described here accelerates the potential of the nascent field of electrochemical detection combined with paper-based microfluidics by dropping the marginal cost of prototyping to nearly zero while accelerating the turnover between paper-based microfluidic designs.

An integrated platform consisting of a microfluidic paper-based/PMMA (Polymethyl-Methacrylate) chip and a small battery-operated detection system is proposed for the concentration detection of sulfur dioxide (SO 2 ). In the proposed method, a small strip of filter paper is coated with acid-base indicator and then inserted into a PMMA microchip. The SO 2 sample is then injected into the reservoir of the chip; prompting a reaction with the acid-base indicator. The chip is transferred to the detection system, where the reaction-induced color change is captured by a CMOS (Complementary Metal-Oxide Semiconductor) camera. Finally, the CMOS image is transferred to a cell phone via a USB (Universal Serial Bus) connector and the SO 2 concentration is derived using self-written RGB color analysis software. The experimental results obtained for 10 control samples show that the correlation coefficient for the variation of the R(ed) signal intensity with the SO 2 concentration is equal to R 2 = 0.9971 in the low-concentration range (20 ∼ 600 ppm) and R 2 = 0.9920 in the high-concentration range (600 ∼ 5000 ppm). The real-world applicability of the proposed platform is demonstrated by measuring the SO 2 concentrations of fifteen commercial food samples. The concentration measurements deviate by no more than 4.29% from those obtained using a standard macroscale technique. Overall, the results presented in this study show that the proposed integrated microfluidic paper-based system provides a cheap, compact and reliable method for SO 2 concentration measurement purposes.

Pulp and paper production is a highly energy intensive process and improvement of energy efficiency in this process is considered as promising measures for reducing industrial greenhouse gases emissions (GHG). This study focuses the Pakistan's pulp and paper industry which consumes around 7% of the country's industrial energy and contributes to over 317,269 tonnes of CO 2 emissions. With rising demands for fuels and consequently as harp increase in CO 2 emissions due to the growth of the paper sector in Pakistan, this article aims to analyse the energy efficiency and carbon dioxide emissions reductions potential through the incorporation of cogeneration technologies. The cogeneration technologies studied are agas turbine, steam turbine and combined cycle and are evaluated from the energetic and economic point of view to propose a best suitable technology for each paper mill. The proposed cogeneration technologies are selected on the basis of high energy utilisation factor, as implepayback period of five years or less with least Annualised life cycle cost. The result shows that a theoretical energy saving potential equivalent to 16.9% of the actual thermal energy requirement of mills can be achieved through cogeneration which will lead to 14.3% reduction of the present carbon emissions levels in Pakistan's paper sector.

The thermal characteristics and kinetics of municipal solid waste (MSW) and paper mill sludge (PMS) and their blends were evaluated under pyrolysis condition with different additives, MgO and activated carbon (AC) which were the two common chemical reagents and different content (5% and 10%). The PMS was blended with MSW of 10%, 30%, 50%, 70% and 90%, which were named as 90M10P, 70M30P, 50M50P and 10M90P. The initial temperature, characteristic index, interaction and activation energy were studied in this paper. The initial temperature became higher with the increasing of PMS proportion and became lower when added the additives. The value of the comprehensive pyrolysis characteristic index of the blends indicated that 90M10P and70M30P were the suitable ratios for co-pyrolysis. There was significant interaction between MSW and PMS in high temperature. The average activated energy which calculated in the proportion of 90M10P showed that the MgO(5%) and AC(5%) were the preferable additives.

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.

This document seeks to respond to the questions raised by the Australian Human Rights Commission and World Economic Forum in their ‘Artificial Intelligence: governance and leadership’ White Paper consultation. It draws upon some of the research conducted at the Allens Hub to make suggestions about if and how systems involving some component of artificial intelligence or automation should be regulated. It also seeks to create further clarity regarding the potential structure and functions of the proposed Responsible Innovation Organisation. We note that our research does not relate to all the questions asked in the White Paper consultation, and so we only set out answers in relation to those matters where our research may be relevant. We are otherwise grateful for the opportunity to present our views and hope this submission will help the Australian Human Rights Commission and World Economic Forum in their consideration.

Objective Methods to improve informed consent efficiency and effectiveness are needed for pragmatic clinical trials. We compared informed consent using a tablet computer to a paper approach to assess comprehension and satisfaction of patients and clinic staff for a future osteoporosis clinical trial. Methods Nine community-based practices identified and recruited patients to compare the informed consent processes (tablet vs. paper) in a mock osteoporosis clinical trial. The tablet informed consent included an animation summarizing the trial, complete informed consent document, and questions to assess and reinforce comprehension of the study. Participants were women age ≥55 years with ≥1 year of alendronate use. We surveyed participants to assess comprehension and satisfaction and office staff for satisfaction and perceived time demands. Results The nine practices enrolled 33 participants. There was not a significant difference in comprehension between the tablet vs. paper informed consent [mean (SD) tablet: 12.2 (1.0) vs. paper: 11.4 (1.7)]. Office staff preferred the tablet to the paper informed consent for identifying potential study participants (two-sided t-test p = 0.02) despite an increased perceived time spent to complete the tablet process [tablet: 28.3 min (SD 16.3) vs. paper: 19.0 min (SD 6.9); p = 0.08]. Conclusions Although, there were no significant differences in participant satisfaction and comprehension with the tablet informed consent compared to a paper informed consent, patients and office staff trended towards greater satisfaction with the tablet informed consent. Larger studies are needed to further evaluate the utility of electronic informed consent in pragmatic clinical trials.

In this communication a prototype of paper-based analytical device designed for simultaneous determination of orthophosphate and calcium ions, which levels are significant for hyperphosphatemia diagnostics, is presented. The laboratory-on-paper structure for two analytes detection was wax-printed on the surface of filter paper. These two-analyte disposable paper strips are combined with two paired LED-based fluorescence detectors and simple voltmeter used as recorder of analytical signal, what makes the developed device miniature, extremely low-cost, portable and user-friendly. Thus the developed device allows usage outside of specialized clinical laboratory. Moreover, each paper strip is disposable and its utilization is easy and fast and, additionally, burnt strip tests ensure waste non-infectious. The presented LED&Paper-based analytical device provides low detection limits: 1.4 μmol L−1 and 7.4 μmol L−1 for orthophosphate and calcium ions, respectively. The practical utility of the developed device for calcemia/phosphatemia diagnostics is demonstrated using control serum standards and real human serum.

Electrical fire is the most frequently occurred fire accident, and fire sensors with self-cutting and ultrasensitive fire-alarm response capability are urgent to be designed and developed. Herein, conductive reduced graphene oxide paper (RGOP) with hierarchical structure is prepared by a facile evaporation-assisted self-assembly of graphene oxide (GO) dispersion and then reduction by hydrazine hydrate vapor. The oxidative decomposition of RGOP containing sodium chloride (RGOP-NaCl) is promoted by the addition of NaCl. When being exposed to flame, RGOP-NaCl strips are readily ruptured. Based on this distinctive self-cutting performance of RGOP-NaCl under fire attacking, a novel fire detection and alarm device is designed by establishing controlling and operation circuits. Under fire encountering, an ultrafast warning response (approximately 5.3 s) of RGOP-NaCl is triggered. Fire-alarm time of RGOP-NaCl is adjustable by varying the content of NaCl. Furthermore, this RGOP-NaCl has the function of fuse and can cut off the conductive circuit timely under fire attacking. This finding will provide a novel thought for the design of advanced fire-alarm sensor and will also expand the application of graphene paper.

Objectives We assessed the proportion of primary health care (PHC) randomized controlled trial (RCT) protocols published in peer-reviewed journals that published results in subsequent papers in peer-reviewed journals; and whether this proportion changed over time. Study Design and Setting We searched (last update June 2019) for RCTs published in peer-reviewed journals reporting primary outcome results for 620 protocols that were published up to 2014 and were retrieved in PubMed. We recorded the absolute number and the proportion of protocols with published results per year; and estimated whether the proportion changed over time. Results Of the 620 published protocols, 525 (85%) disseminated their results through a published RCT by June 2019. The number of published protocols was increasing over time especially after 2001. However, the proportion of protocols per year with published results in subsequent papers was decreasing over time after 2002. Specifically, the proportion ranged from 86% to 96% for protocols published until 2010 while for those published from 2011 onward ranged from 76% to 86%. Mean time from protocol to results publication was 39 months (95% CI 37, 41). Conclusion Almost one-sixth of PHC trial protocols published in peer-reviewed journals did not publish their results in subsequent papers.

This paper reports the development and fabrication of a low-cost handheld point of care device that can quantify the concentration of biomarkers using a paper microfluidic assay. The commercially available light-to-digital converting sensor was used to achieve this objective. This RGB sensor was efficient in the digital values of the red, green, and blue components of the sample or object. It has an inbuilt white LED source, an array of photodiodes with color filters, an analog-to-digital converter module, and also an IR blocking filter. The sensor was interfaced with the Arduino UNO board, and the corresponding results were displayed on the serial monitor. This device was tested for manually prepared primary color samples and also for total protein. The colorimetric detection of protein was performed for 1 g dL-1 to 14 g dL-1 concentrations on a paper microfluidic device. The change in color intensity of the paper device with an increase in total protein concentration was monitored and calibrated the device for real sample analysis.

The thermal behavior of eucalyptus residues (ER), paper mill sludge (PMS) and their blends during combustion processes was investigated in this study. Blending ranging from 10 wt% to 90 wt% on dosage ratio were prepared to study their co-combustion behaviors and kinetics. The experiments were conducted in a differential thermogravimetric analyzer at different heating rates (10, 20 and 40 °C/min), at temperature ranging from 120 °C to 950 °C and in 80% nitrogen/20% oxygen atmosphere. The comprehensive characteristic index decreased with the increase of the PMS ratio. Adding ER to PMS may improve the combustion characteristics of PMS. The value of average activation energy obtained by Kissinger-Akahira-Sunose (KAS) and Starink methods did not gradually decline with the increasing proportion of PMS in the blends. The average activation energy reached the minimum number when the percentage of PMS was 10%, which was 159.30 kJ/mol by KAS and 160.36 kJ/mol by Starink, respectively.

Electro thermal papers have been widely applied in people's daily life. Compared to traditional metal alloy resistance heaters, three dimensional graphene/carbonized-PAN composite freestanding paper with lightweight, good flexibility and excellent electrothermal performance is presented. It retains intrinsic properties of graphene sheets in the bulk state, and exhibits fast electrothermal response under low operation voltage with robust mechanical property. The fastest specific heating rate could be up to 213 °C s−1 V−1, and the highest Ts is 235 °C at low driving voltage just of 1.75 V, which far surpasses those of previous carbon-based film heaters, commercial nichrome wire, and Kanthal wire. These outstanding properties together with the advantage of facile and large-scale fabrication, make the composite paper with great potential applications in flexible electronics.

Flexible perovskite solar cells (PSCs) on paper are promising biodegradable power sources for wearable and portable electronics, while fabrication of paper-based PSCs with high mechanical flexibility and efficiency is still challenging due to the limited optimization of paper-based PSCs. Herein, flexible PSCs were demonstrated using 25 μm cellophane paper substrates combined with TiO2/ultrathin Ag/TiO2 (OMO) electrodes, composing the typical structure of cellophane/OMO/C60 pyrrolidinetris-acid (CPTA)/CH3NH3PbI3/Spiro-OMeTAD/Au. PSCs on cellophane paper exhibited a high power conversion efficiency (PCE) of 13.00%. More interesting, the performance of paper-based PSCs showed minor degradation after bending with the radius in the range of 0.3–10 mm: they retained 97.6% of the initial PCE after bending with a radius of 0.3 mm and even preserved 95.8% of the initial PCE after bending with a radius of 1 mm for 1000 cycles. The ultraflexibility of PSCs was ascribed to the ultrathin substrates to relieve strain in bended devices and superior flexibility of OMO electrodes. The ultraflexible and efficient PSCs on paper are promising for application in self-powered paper-based electronics.

The all-in-one solar steam generation device renders a feasible technical support for freshwater supply in arid areas, where traditional large-scale desalination cannot be applied. In this work, we designed and assembled a paper-based integrated evaporation device (IED) for efficient solar steam generation, in which the self-hardening polyurethane foam was ingeniously fixed on the carbon nanotube (CNT) loaded filter paper connecting with four paper belts to perfectly integrate light absorption, water supply and thermal insulation into one device. Moreover, the effects of CNT concentration and illumination intensity on evaporation performance were experimentally investigated. The results showed that the maximum thermal conversion efficiency of the IED was as high as 88.1% at 1 kW m−2. Our research indicated that the IED as an easily-enlarged and all-in-one evaporation device was one of the ideal choices for applications in solar steam generation and provided a new resource for seawater desalination.

Objectives The Chilean health system mandates providers to ensure assistance under a guaranteed system, the Explicit Guarantees in Healthcare (EGH) program. The Health Ministry has developed clinical practice guidelines (CPGs), but independent assessment of their quality is lacking. Study Design and Setting We assessed all CPGs of the EGH program using Appraisal of Guidelines for Research & Evaluation II (AGREE II) tool for appraising quality, validity period, and last update. Results Eighty-six CPGs were published between 2005 and 2016. Only 15 (17.4%) were updated. The overall mean raw score was 4.18 (±0.98). The scaled scores for each domain were: Scope and objectives 79.7%, Stakeholder involvement 46.2%, Rigor of development 36.3%, Clarity of presentation 82.8%, Applicability 23.5%, and Editorial independence 39.2%. The highest items were: overall objectives described, population described, options for management clearly presented, and key recommendations easily identifiable. The worst evaluated items were: views and preferences of the target population, strengths and limitations of the body of evidence, methods for formulating the recommendations, external review by experts, and description of facilitators and barriers to application. Conclusion Most Chilean CPGs included in the EGH program are outdated and show items that should be improved, mainly through a more rigorous methodology, the inclusion of patients in its development, and appropriate consideration of its applicability.

Background and Objective High-quality clinical practice guidelines (CPGs) are needed to guide practitioners, policy makers, and other stakeholders to provide optimal health care. This study aims to appraise the CPGs developed in the Philippines using the AGREE II instrument. Methods Ninety-one CPGs were appraised independently by two health-care professionals. CPGs were considered acceptable if they garnered an overall mean score of at least 75.0% for all 6 domains and a domain score of at least 75.0% for rigor of development. A mean score of Results Overall mean scores of the CPGs ranged from 8.4% to 79.2%, with a mean of 43.9% (standard deviation = 13.4%). In general, CPGs scored better for the domains of clarity of presentation, scope and purpose, and stakeholder involvement. Lowest scores were obtained for the domains of rigor of development, applicability, and editorial independence. Only 1 (1.1%) CPG qualified as acceptable. Conclusion AGREE II is a practical and useful guide in appraising the quality of CPGs. Strengthening technical capacity in various medical fields is essential to improve the quality of CPGs. Rigor of development, applicability issues, and editorial independence should be emphasized in CPG capacity-building activities.

Integration of functional structures onto foldable, stretchable and disposable paper substrates is a growing field in low cost electronics. Herein this paper, we present a laser printing technology to directly convert fibrous paper to molybdenum carbide-graphene composite with exceptional conductivity (

Electrocoagulation (EC) process was used for the treatment of recycled fiber based paper mill wastewater. The present study deals with the economical solution of EC process by using perforated electrodes and vary different process parameters like electrode distance (ED), current density (CD), conductivity and pH. Further, study on sludge generated during EC process was also performed. EC process shows maximum reduction of COD 95%, Color 67% and TDS value of the treated sample was found 1340 mg/L. The result was achieved at operating condition pH=7.15, CD= 20 mA/cm2, ED= 2 cm and conductivity= 3.15 mS/cm. The results suggest that 20 min of electrolysis time was enough for maximum reduction of organic load. This is considered as an optimum condition of the process. At this operating condition cell voltage utilization was 1.1 V with energy consumption of 2.3 kWh/kg of anode dissolution and cost of operation to treat 1 L effluent was found 65 INR (0.83€) approximate. Proximate analysis of sludge shows moisture contents, volatile matter, ash and fixed carbon were 9.86%, 48.32%, 16.32% and 25.50% respectively. While calorific value of sludge was 2435.45 Kcal/Kg. Sludge compaction shows sludge volume index (SVI) and dryness of sludge were 56.67 mL/g and 9% respectively. The settling study of sludge was carried out for treated effluent at different pH and filterability of sludge was checked at optimum pH. Further analytical study of sludge was also performed by Fourier Transform Infrared Spectroscopy (FTIR), Energy Dispersive X-Ray Spectroscopy (EDX) and X-Ray Diffraction (XRD) analysis.

Objective To compare estimated treatment effects of physical therapy (PT) between patient-reported outcome measures (PROMs) and outcomes measured in other ways. Study Design and Setting We selected randomized trials of PT with both a PROM and a non-PROM included in Cochrane systematic reviews (CSRs). Two reviewers independently extracted data and risk-of-bias assessments. Our primary outcome was the ratio of odds ratios (RORs), used to quantify how effect varies between PROMs and non-PROMs; an ROR > 1 indicates larger effect when assessed by using PROMs. We used REML-methods to estimate associations of trial characteristics with effects and between-trial heterogeneity. Results From 90 relevant CSRs, 205 PT trials were included. The summary ROR across all the comparisons was not statistically significant (ROR, 0.88 [95% CI: 0.70–1.12]; P = 0.30); however, the heterogeneity was substantial (I2 = 88.1%). When stratifying non-PROMs further into clearly objective non-PROMs (e.g., biomarkers) and other non-PROMs (e.g., aerobic capacity), the PROMs appeared more favorable than did clearly objective non-PROMs (ROR, 1.92 [95% CI: 0.99–3.72]; P = 0.05). Conclusion Estimated treatment effects based on PROMs are generally comparable with treatment effects measured in other ways. However, in our study, PROMs indicate a more favorable treatment effect compared with treatment effects based on clearly objective outcomes.