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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.

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.

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.

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

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.

We report the first use of a paper-based device as a simple, low-cost and rapid detection platform for simultaneous determination of antioxidant activity and total phenolic content in food samples. Two antioxidant activity assays including 2,2'-azino-bis(3-ethylbenzthiazoline-6-sulphonate) radical cation (ABTS) assay and cupric reducing antioxidant capacity (CUPRAC) assay and one total phenolic content assay, Folin Ciocaltue reagent (FC) assay were simultaneously employed as a proof-of-concept. The device composed of a central sample zone connected to four pretreatment zones and consecutive detection zones to accommodate all three assays and a sample blank measurement. The analysis was achieved by dropping the samples onto the sample zone to flow to the pretreatment and detection zones containing the stored reagents for each antioxidant assay making the color change that was measured using imageJ software. Assay optimization including key reagent concentrations, reaction time, and surface modification were carried out to obtain sensitive and wide linear rage analyses. Various antioxidant standards were then evaluated to determine the analytical features of the method. The paper-based assays were successfully applied to detect antioxidant activity and total phenolic content in 10 beverage samples with similar gallic acid equivalent (GAE) values to those obtained from traditional assays at a 95% confidence interval. Moreover, the GAE values of the samples obtained from three assay analyses were well correlated to each other with relatively high Pearson's correlation coefficients. These results indicated that the assays gave accurate results and are suitable for simultaneous analysis of antioxidant activity and total phenolic content in real samples.

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

In this work, eugenol grafting onto cellulose is proposed as a strategy for developing a biodegradable active packaging material. Grafting reaction were performed according to Doehlert experimental design with temperature range fixed to 120–180 °C, time range 15–60 min and eugenol amount from 2 to 8 wt%. Reaction advances increases with three variables analyzed as expected, while paper mechanical properties decrease due to both grafting and secondary reactions (crosslinking and degradation). Also, color changes respect to virgin paper increases with the increment of the three variables although paper appearance is good for the most samples. Desirability function was used to determine optimal reaction conditions, looking for a trade-off between the paper properties (color and elongation at break) and reaction advance. The optimal conditions determined were 160 °C, 15 min and 2 wt% eugenol amount. Modified paper showed antioxidant activity and repellent and insecticide activity against Tribolium castaneum and Rhyzopertha dominica, making it a good material for active packaging applications. Fil: Muratore, Florencia. Universidad Nacional de Córdoba. Instituto de Investigación y Desarrollo en Ingeniería de Procesos y Química Aplicada. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación y Desarrollo en Ingeniería de Procesos y Química Aplicada; Argentina Fil: Martini, Raquel Evangelina. Universidad Nacional de Córdoba. Instituto de Investigación y Desarrollo en Ingeniería de Procesos y Química Aplicada. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto de Investigación y Desarrollo en Ingeniería de Procesos y Química Aplicada; Argentina Fil: Barbosa, Silvia Elena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Bahía Blanca. Planta Piloto de Ingeniería Química. Universidad Nacional del Sur. Planta Piloto de Ingeniería Química; Argentina

Although executive function disorders are among the most prevalent cognitive impairments a consensus on diagnostic criteria has yet to be reached. With a view to harmonizing these criteria, the present position paper (i) focuses on the main dysexecutive disorders, (ii) examines recent approaches in both the behavioral and cognitive domains, (iii) defines diagnostic boundaries for frontal syndrome, (iv) reports on the frequency and profile of the executive function disorders observed in the main brain diseases, and (v) proposes an operationalization of diagnostic criteria. Future work must define the executive processes involved in human adaptive behavior, characterize their impairment in brain diseases, and improve the management of these conditions (including remediation strategies and rehabilitation).

In a comparative approach toward treating real pulp and paper wastewater (PPWW), iron-based electro-chemical processes such as peroxi-coagulation (PC), electrocoagulation (EC), electro-Fenton (EF), and ultrasound-assisted PC, EC, and EF were investigated. Sono-peroxi-coagulation (SPC) process showed the best performance for treating the PPWW. The optimal results were achieved under reaction time 50 min, current density 140 mA, and pH = 2.0. Employing the SPC process for treating PPWW under optimal conditions, the best COD removal efficiency (81.7%) was achieved. Also, continuous pH adjustment of the solution, as compared to lack of adjustment, showed a significant influence on COD removal efficiency (more than 10%). The effect of pH on the SPC process and the kind of electro-chemical treatment process utilized, on biodegradability were investigated using BOD/COD ratio and average oxidation state (AOS). In comparison with other electro-chemical processes used in this study, the best biodegradability results were obtained for the SPC process in pH = 2, being 0.4 and 0.94 for BOD/COD ratio and AOS, respectively. SPC process compared to the sono EF process had superior COD removal efficiency and their difference in performance reached near 40%. The influence of sonication was obtained 11.3% and 9% for PC and EF processes respectively. In evaluating the toxicity, the best germination index of Raphanus sativus, irrigated by treated wastewater samples, was achieved 77.9% for the SPC process. The application of US for electrochemical process increased energy consumption and cost of process considerably. The sludge of SPC was also evaluated by Fourier transform infrared spectrum (FTIR), X-ray diffractometer (XRD) and field emission scanning electron microscope (FESEM).

Adults with mild stroke face substantial challenges resuming valued roles in the community. The term "mild" provides false representation of the lived experience for many adults with mild stroke who may continue to experience persistent challenges and unmet needs. Rehabilitation practitioners can identify and consequently intervene to facilitate improved independence, participation, and quality of life by facilitating function and reducing the burden of lost abilities among adults with mild stroke. The Health and Wellness Task Force identified 2 important, and often interdependent, goals that frequently arise among adults living with mild stroke that must be addressed to facilitate improved community reintegration: (1) return to driving and (2) return to work. Adults with mild stroke may not be receiving adequate rehabilitative services to facilitate community reintegration for several reasons but primarily because current practice models are not designed to meet such needs of this specific population. Thus, the Health and Wellness Task Force convened to review current literature and practice trends to (1) identify opportunities based on the evidence of assessment and interventions, for return to driving and return to work; and (2) identify gaps in the literature that must be addressed to take advantage of the opportunities. Based on findings, the task force proposes a new interdisciplinary practice model for adults with mild stroke who are too often discharged from the hospital to the community without needed services to enable successful return to driving and work.

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.

Hydrophobic materials extracted from citrus wastes, both peel of mandarin fruits and leaf of mandarin trees were used to treat food-grade Kraft paper. The chemical compounds of the extracts were identified by gas chromatography–mass spectroscopy and infrared spectroscopy, and their antioxidant activities were determined using a free radical scavenger agent (2,2-diphenyl-1-picryl-hydrazyl-hydrate, DPPH). Water vapor permeability, air transmission rate, peroxide value, and microstructure of treated and original papers were also determined. The experimental results showed that: (i) most components of the peel or peel/leaf extracts were terpenes; (ii) free volume existed among cellulose macromolecule chains of the original paper, occupied by a part of extract materials, and another part of the extracts was formed a thin layer on the paper surfaces; and (iii) air and water barrier properties and antioxidant activity of the treated papers were improved, indicating that the extracts were efficient materials for food packaging applications.

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

Metastasis of oral squamous cell carcinoma (OSCC) to the cervical lymph nodes has a significant impact on prognosis. Accurate staging of the neck is important in order to deliver appropriate treatment for locoregional control of the disease and for prognosis. The management of the neck in early, low volume disease (clinically T1/T2 oral cavity tumours) has long been debated. The risk of occult nodal involvement in cT1/T2 OSCC is estimated around 20-30%. We describe the natural evolutionary history of OSCC and its patterns of spread and metastasis to the local lymphatic basins. We discuss most published literature and studies on management of the clinically negative neck (cN0). Particular focus is given to prospective randomized trials comparing the outcomes of upfront elective neck dissection against the observational stance, and we summarize the results of the sentinel node biopsy studies. The paper discusses the significance of the primary tumour histological characteristics and specifically the tumour's depth of invasion (DOI) and its impact on predicting nodal metastasis. The DOI has been incorporated in the TNM staging highlighting its significance in aiding the treatment decision making and this is reflected in world-wide oncological guidelines. The critical analysis of all available literature amalgamates the existing evidence in early OSCC and provides recommendations in the management of the clinically N0 neck.

This white paper recommends the standardization (content and presentation order) of several "key components" of the radiation therapy prescription to facilitate accurate communication between radiation therapy care providers. The rationale, other similar efforts, and detailed considerations are described. In brief, the Task Force recommends that the prescription's "elements" include: treatment site, method of delivery, dose per fraction, total number of fractions, total dose (eg, right breast, tangent photons, 267 cGy * 16 = 4272 cGy). A similar formalism is recommended for brachytherapy (eg, cervix, Ir-192 brachytherapy, 600cGy * 5 = 3000 cGy) and other modalities. The white paper also considers future directions for other items such as the simulation order, treatment planning objectives, prescription point or volume, treatment schedule, localization imaging, laboratory monitoring, concurrent chemotherapy, patient instructions for treatment, etc. The intent of this white paper is to facilitate accurate communication among providers to support safe practice as well as to guide vendors in product development that is consistent with this standard prescription.

Integrated processes have been proposed for high strength wastewaters such as pulp and paper wastewater. In this work, electrocoagulation (EC) followed by UV/oxidant system was studied for the removal of organic compounds from pulp and paper wastewater. EC process was optimized by Box–Behnken design. Under optimum conditions (natural pH, time = 33.7 min and current density = 5.55 mA/cm2), about 61% COD removal was achieved. The obtained effluent was remediated by UV/persulfate (PS) and UV/peroxymonosulfate (PMS). The results showed that UV/PS had the best performance in natural pH (pH of electrocoagulated effluent i.e. pH = 8.2) while UV/PMS required pH adjusting since pH = 4.0 provided the best efficiency. The scavenging effect was observed in overdosing oxidant in UV/PS while in UV/PMS, increase in PMS dosage increased the removal efficiency. The partial oxidation parameter showed that with increase of time, total oxidation was the predominant mechanism compared to partial oxidation. EC process was not effective in case of biodegradability improvement whereas EC along with UV/oxidant could significantly increase biodegradability (BOD5/COD ratio). In addition, the solar irradiation was tested as an alternative for UV source and the related results exhibited a negligible efficiency. Electrical energy consumption and current efficiency were also calculated.

Objective Most preventable adverse drug events and medication errors occur during medication ordering. Medication order entry and clinical decision support are available on paper or as computerized systems. In this post-hoc analysis we investigated frequency and clinical impact of blood glucose (BG) documentation- and user-related calculation errors as well as workflow deviations in diabetes management. We aimed to compare a paper-based protocol to a computerized medication management system combined with clinical workflow and decision support. Methods Seventy-nine hospitalized patients with type 2 diabetes mellitus were treated with an algorithm driven basal-bolus insulin regimen. BG measurements, which were the basis for insulin dose calculations, were manually entered either into the paper-based workflow protocol (PaperG: 37 patients) or into GlucoTab ® —a mobile tablet PC based system (CompG: 42 patients). We used BG values from the laboratory information system as a reference. A workflow simulator was used to determine user calculation errors as well as workflow deviations and to estimate the effect of errors on insulin doses. The clinical impact of insulin dosing errors and workflow deviations on hypo- and hyperglycemia was investigated. Results The BG documentation error rate was similar for PaperG (4.9%) and CompG group (4.0%). In PaperG group, 11.1% of manual insulin dose calculations were erroneous and the odds ratio (OR) of a hypoglycemic event following an insulin dosing error was 3.1 (95% CI: 1.4–6.8). The number of BG values influenced by insulin dosing errors was eightfold higher than in the CompG group. In the CompG group, workflow deviations occurred in 5.0% of the tasks which led to an increased likelihood of hyperglycemia, OR 2.2 (95% CI: 1.1–4.6). Discussion Manual insulin dose calculations were the major source of error and had a particularly strong influence on hypoglycemia. By using GlucoTab ® , user calculation errors were entirely excluded. The immediate availability and automated handling of BG values from medical devices directly at the point of care has a high potential to reduce errors. Computerized systems facilitate the safe use of more complex insulin dosing algorithms without compromising usability. In CompG group, missed or delayed tasks had a significant effect on hyperglycemia, while in PaperG group insufficient precision of documentation times limited analysis. The use of old BG measurements was clinically less relevant. Conclusion Insulin dosing errors and workflow deviations led to measurable changes in clinical outcome. Diabetes management systems including decision support should address nurses as well as physicians in a computerized way. Our analysis shows that such systems reduce the frequency of errors and therefore decrease the probability of hypo- and hyperglycemia.

This study focuses on the evaluation of the effects of incorporating a thin layer (‘paper’) of Graphene nanoplatelets (GnP) between the lamina on the processability and out-of-plane performance of glass fiber composites for EMI shielding applications. Various thicknesses of GnP paper (50, 120, and 240 µm) were embedded within layers of glass fabric for subsequent resin infusion. The out-of-plane failure surfaces were evaluated using a purpose-built fixture. In all experiments, the separation was observed within the graphene layers of the GnP paper rather than at composite/GnP interface. In comparison to pristine samples, decreases of 252%, 305%, and 386% respectively were recorded in the out-of-plane strength of embedded GnP papers. Numerical simulations were completed using a bilinear traction separation law based on the cohesive zone modeling approach. All composites were tested for electromagnetic interference (EMI) shielding properties. The EMI shielding was improved significantly by embedding GnP paper within glass fiber composites.

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.

At present the trends in paper and packaging industries are the personalization of products and the use of novel high-tech materials. Laser processes as non-contact and flexible techniques seem to be the obvious choice to address those developments. In this paper we present a basic understanding of the occurring mechanisms of laser based engraving of different paper and paperboard materials, using a picosecond laser source at 1064 nm. The influences on the beam-paper-interaction of grammage, the composition of the paper matrix, as well as the paper inherent cellulose fibers were investigated. Here the ablation threshold of commercially available paper was determined and a matrix ablation effect under the 1064 nm radiation observed. These results were characterized and qualified mainly by means of laser scanning microscope (LSM) micrographs in combination with color-space analytics.

With the increasing interest in the health benefits arising from the consumption of dietary products rich in antioxidants, there exists a clear demand for easy-to-use and cost-effective tests that can be used for the identification of the antioxidant power of food products. Paper-based analytical devices constitute a remarkable platform for such expedient and low-cost assays with minimal external resources but efforts in this direction are still scarce. In this work we introduce a new paper-based device in the form of a sensor patch that enables the determination of antioxidant activity through analyte-driven on-paper formation of gold nanoparticles. The principle of detection capitalizes, for the first time, on the on-paper nucleation of gold ions to its respective nanoparticles, upon reduction by antioxidant compounds present in an aqueous sample. The ensuing chromatic transitions, induced on the paper surface, are used as an optical "signature" of the antioxidant strength of the solution. The response of the paper-based sensor was evaluated against a large variety of antioxidant species and the respective dose response curves were constructed. On the basis of these data, the contribution of each species according to its chemical structure was elucidated. For the analysis of real samples, a concentration-dependent colorimetric response was established against Gallic acid equivalents over a linear range of 10 μM-1.0 mM, with detection limits at the low and ultra-low μM levels (i.e.

International audience; Despite the increasingly high rate of implantation of pacemakers (PMs) and implantable cardioverter defibrillators (ICDs) in elderly patients, data supporting their clinical and cost-effectiveness in this age stratum are ambiguous and contradictory. We reviewed the data regarding the applicability, safety and effectiveness of conventional pacing, ICDs and cardiac resynchronization therapy (CRT) in elderly patients. Although periprocedural risk may be slightly higher in the elderly, the implantation procedure for PMs and ICDs is still relatively safe in this age group. In older patients with sinus node disease, the general consensus is that DDD pacing with the programming of an algorithm to minimize ventricular pacing is preferred. In very old patients presenting with intermittent or suspected atrioventricular block, VVI pacing may be appropriate. In terms of correcting potentially life-threatening arrhythmias, the effectiveness of ICD therapy is similar in older and younger individuals. However, the assumption of persistent ICD benefit in the elderly population is questionable, as any advantageous effect of the device on arrhythmic death may be attenuated by higher total non-arrhythmic mortality. While septuagenarians and octogenarians have higher annual all-cause mortality rates, ICD therapy may remain effective in selected patients at high risk of arrhythmic death and with minimum comorbidities despite advanced age. ICD implantation among the elderly, as a group, may not be cost-effective, but the procedure may reach cost-effectiveness in those expected to live more than 5-7years after implantation. Elderly patients usually experience significant functional improvement after CRT, similar to that observed in middle-aged patients. Management of CRT non-responders remains globally the same, while considering a less aggressive approach in terms of reinterventions (revision of left ventricular [LV] lead placement, addition of a right ventricular or LV lead, LV endocardial pacing configuration). Overall, physiological age, general status and comorbidities rather than chronological age per se should be the decisive factors in making a decision about device implantation selection for survival and well-being benefit in elderly patients.

The coronavirus disease 2019 (COVID-19) pandemic poses an enormous challenge to healthcare systems in affected communities. Older patients and those with pre-existing medical conditions have been identified as populations at risk of a severe disease course. It remains unclear at this point to what extent chronic liver diseases should be considered as risk factors, due to a shortage of appropriate studies. However, patients with advanced liver disease and those after liver transplantation represent vulnerable patient cohorts with an increased risk of infection and/or a severe course of COVID-19. In addition, the current pandemic requires unusual allocation of healthcare resources which may negatively impact the care of patients with chronic liver disease that continue to require medical attention. Thus, the challenge hepatologists are facing is to promote telemedicine in the outpatient setting, prioritise outpatient contacts, avoid nosocomial dissemination of the virus to patients and healthcare providers, and at the same time maintain standard care for patients who require immediate medical attention.

The timetable for placing a dental implant can be crucial in the reduction of resorption of the socket after an extraction. The association of immediate implantation with an implant that copies the anatomy of the extracted root seems to add benefits in limiting the hard and soft tissue changes that may occur. The purpose of this paper is to provide an overview of the historical development of all types of root analogue implants from their beginning to the present day. To our knowledge the first individualised ones were described in 1969. Later, the use of titanium instead of the polymers that were used to start with offered better bony integration, and showed that the selection of materials was a key factor in their success. Root analogue implants made from zirconia were also described when attempts were being made to improve aesthetics in the anterior regions. The more recent introduction of digital technology such as DICOM has allowed the fabrication of these implants in less time, and the combination with digital diagnostic options such as cone-beam computed tomography facilitated the fabrication of some types of implants before extraction that could be inserted immediately into the alveolar socket with optimal and safe 3-dimensional positioning. Currently digital planning allows the clinician to design the ideal implant and abutment, which reduces the need for tissue grafting in the surgical phase and gingival conditioning in the prosthetic phase.

Objective: Preservation of parathyroid function is one of the primary tenets of endocrine surgery. For patients with thyroid disease, an inadvertently compromised parathyroid gland is routinely autotransplanted into the neck at the time of surgery. By contrast, for patients with parathyroid disease secondary to hyperplasia, the timing of auto-transplantation needs to be further considered in order to balance the risks between persistent disease and permanent hypocalcemia. Cryopreservation preserves cellular function and permits the storage of parathyroid tissue for potential re-implantation at a later date in patients who develop hypoparathyroidism. Methods: In this paper, we review the process of cryopreservation, with particular emphasis on the regulatory issues involved in establishing a local service, tissue processing, billing and reimbursements, outcome (functionality), and complications. Results: A detailed description of the technique as performed at our institution is described and illustrated. Conclusion: Cryopreservation affords surgical insurance against the disastrous sequelae of permanent hypoparathyroidism. Our techniques are easy to adopt with only a modest initial investment of time and money, particularly for institutions that already cryopreserve other tissue types. Abbreviations: PTH = parathyroid hormone; RMPI = Roswell Park Memorial Institute; RPMI-SSS = RPMI-serum substitute supplement

Purpose The comprehensive identification and delineation of organs at risk (OARs) are vital to the quality of radiation therapy treatment planning and the safety of treatment delivery. This guidance aims to improve the consistency of ontouring OARs in external beam radiation therapy treatment planning by providing a single standardized resource for information regarding specific OARs to be contoured for each disease site. The guidance is organized in table format as a quality assurance tool for practices and a training resource for residents and other radiation oncology students (see supplementary materials). Methods and Materials The Task Force formulated recommendations based on clinical practice and consensus. The draft manuscript was peer reviewed by 16 reviewers, the American Society for Radiation Oncology (ASTRO) legal counsel, and ASTRO's Multidisciplinary Quality Assurance Subcommittee and revised accordingly. The recommendations were posted on the ASTRO website for public comment in June 2018 for a 6-week period. The final document was approved by the ASTRO Board of Directors in August 2018. Results Standardization improves patient safety, efficiency, and accuracy in radiation oncology treatment. This consensus guidance represents an ASTRO quality initiative to provide recommendations for the standardization of normal tissue contouring that is performed during external beam treatment planning for each anatomic treatment site. Table 1 defines 2 sets of structures for anatomic sites: Those that are recommended in all adult definitive cases and may assist with organ selection for palliative cases, and those that should be considered on a case-by-case basis depending on the specific clinical scenario. Table 2 outlines some of the resources available to define the parameters of general OAR tissue delineation. Conclusions Using this paper in conjunction with resources that define tissue parameters and published dose constraints will enable practices to develop a consistent approach to normal tissue evaluation and dose documentation.

The performance of electrocoagulation (EC) using iron as sacrificial electrode was investigated at low current densities (0.6–1.9 mA/cm2) for treating a waste stream from a Kraft paper mill. A multi-level factorial design of experiments and response surface methodology (RSM) were applied to quantify the effects of current density and reaction time on the removal efficiency of color, COD, BOD5, tannin/lignin as well as on the enhancement of biodegradability index (BI). Increasing current density or reaction time significantly improve the treatment performance. An antagonistic effect of the two studied factors was identified, indicating that simultaneously increasing current density and reaction time does not yield added improvement in treatment performance. An RSM was developed to predict the optimum current density and reaction time within the experimental data range of this study. It was found that an optimized treatment combination exists at relatively low current density and reaction time. The optimum value for maximum pollutants removal was ∼1.5 mA/cm2 and ∼25 min. Under the optimum condition, the removals of tannin/lignin and color were >70 % and >95 %, and BI was increased to 0.41 BOD5/COD. Current density is the dominant factor for energy consumption and operating cost compared to reaction time and electrode consumption. This study demonstrated that EC can be operated at low current density to remove the bio-refractory organics effectively and increase the biodegradability index to the level suitable to biological treatment at low operating costs.

Objectives To estimate the internal consistency, test–retest reliability and comparability of paper and computer versions of the Finnish version of the Tampa Scale of Kinesiophobia (TSK-FIN) among patients with chronic pain. In addition, patients’ personal experiences of completing both versions of the TSK-FIN and preferences between these two methods of data collection were studied. Design Test–retest reliability study. Paper and computer versions of the TSK-FIN were completed twice on two consecutive days. Participants The sample comprised 94 consecutive patients with chronic musculoskeletal pain participating in a pain management or individual rehabilitation programme. The group rehabilitation design consisted of physical and functional exercises, evaluation of the social situation, psychological assessment of pain-related stress factors, and personal pain management training in order to regain overall function and mitigate the inconvenience of pain and fear-avoidance behaviour. Results The mean TSK-FIN score was 37.1 [standard deviation (SD) 8.1] for the computer version and 35.3 (SD 7.9) for the paper version. The mean difference between the two versions was 1.9 (95% confidence interval 0.8 to 2.9). Test–retest reliability was 0.89 for the paper version and 0.88 for the computer version. Internal consistency was considered to be good for both versions. The intraclass correlation coefficient for comparability was 0.77 (95% confidence interval 0.66 to 0.85), indicating substantial reliability between the two methods. Conclusion Both versions of the TSK-FIN demonstrated substantial intertest reliability, good test–retest reliability, good internal consistency and acceptable limits of agreement, suggesting their suitability for clinical use. However, subjects tended to score higher when using the computer version. As such, in an ideal situation, data should be collected in a similar manner throughout the course of rehabilitation or clinical research.

The cellulose and paper industry produces large volumes of wastewater which are difficult to treat due to large concentrations of Humic acid (HA). In subsurface water, HA can react with active chlorine to produce carcinogenic compounds causing different ecological problem and danger to human health. The main objective of the present study is to investigate the influence of electrocoagulation (EC) process parameters using aluminum (Al) electrodes to remove HA from synthetic solution, and then studies the efficiency of the coupling of electrocoagulation and the adsorption on active carbon (GAC). It has been observed from the experimental results that the best removal of HA by EC was obtained with the following optimum conditions: initial pH of 4, current density of 1.388 mA cm−2, Na2SO4 concentration of 150 mg L-1 and EC time of 10 min. These operating conditions allow a removal percentage up to 93% with 0.033 KWh m-3 of power consumption by EC and the same removal ratio was achieved for a treatment time of only 2 min by combining adsorption onto GAC with EC with a decrease of power consumption (0.007 kW h m-3). Accordingly, our results displayed prominently that combination of electrocoagulation with adsorption on GAC notably reduces the treatment duration without inducing a strong increase of cost. The current study extends our investigation of these promising processes to wastewater applications, employing samples of cellulose and paper industrial wastewater. The results suggest that combining adsorption onto GAC with EC could greatly improve the economics of treatment of wastewaters generated in cellulose and paper industry by extending efficiency through reduced treatment time and cost. HA was completely removed from Tunisian industrial wastewater with a very low energy consumption (0.0183 KW h m-3) and treatment cost of 0.233 TND.

This study assessed validity, reliability, and feasibility of a filter paper blood spot insulin-like growth factor 1 (IGF-1) assay for retinopathy of prematurity (ROP) research. Blood samples were collected from 45 healthy children. Half of each sample was spun to obtain serum; half was applied to filter cards and stored for varying times and at different temperatures. IGF-1 assays were performed using a commercially available kit. Intraclass correlation between blood spot and serum IGF-1 values was high (0.97) for validity, and the mean differences were low for test-retest reliability. Time (up to 25 days) and temperature (4° C to 37° C) had no significant effect on sample stability. Feasibility was further assessed in a second cohort study of 74 premature infants being screened for ROP. A total of 817 filter card samples were successfully collected and transported to a central lab, where IGF-1 assays were successfully performed.

The effective performance of electrocoagulation (EC) technique in the treatment of paper mill wastewater has been investigated using different combination of aluminum (Al) and iron (Fe) electrodes. The influence of pH, temperature and current density on removal performance was explored. The optimum working pH was found to be in the range 5–7, allowing paper mill wastewater to be treated directly without pH adjustment. In addition, it is found that an increase in the current enhanced the speed of the treatment significantly. However, simultaneous increase of electrode and energy consumption was observed. The optimum current density allowing the quickest treatment with a low cost was found to be 70 mA cm− 2. Therefore, a current density of 70 mA cm− 2 was selected as an optimum that allows fast and low cost treatment. Also temperature has negative effect on the removal efficiency.

With first cases noted towards the end of 2019 in China, COVID-19 infection was rapidly become a devastating pandemic. Even if most patients present with a mild to moderate form of the disease, the estimated prevalence of COVID-19-related severe acute respiratory failure (ARF) is 15-20% and 2-12% needed intubation and mechanical ventilation. In addition to mechanical ventilation some other techniques of respiratory support could be used in some forms of COVID-19 related ARF. This position paper of the Respiratory Support and Chronic Care Group of the French Society of Respiratory Diseases is intended to help respiratory clinicians involved in care of COVID-19 pandemic in the rational use of non-invasive techniques such as oxygen therapy, CPAP, non-invasive ventilation and high flow oxygen therapy in managing patients outside intensive care unit (ICU). The aims are: (1) to focus both on the place of each technique and in describing practical tips (types of devices and circuit assemblies) aimed to limit the risk of caregivers when using those techniques at high risk spreading of viral particles; (2) to propose a step-by-step strategy to manage ARF outside ICU.

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

The use of continuous intravenous regular human insulin (RHI) infusion is often necessary to achieve glycemic control in critically ill patients. Because insulin is a high-risk medication owing to the potential for severe hypoglycemia, it is imperative that insulin infusion algorithms are designed to be safe, effective, and instructionally clear. The safety and efficacy of our intravenous RHI infusion algorithm protocol has been previously established (Nutrition 2008;24:536-45); however, the protocol violations by nursing personnel were not examined. The objective of this study was to assess nursing adherence to our RHI infusion algorithm.Continuous RHI infusion algorithm violations were retrospectively evaluated in adult patients admitted to a trauma intensive care unit who received concurrent continuous enteral and/or parenteral nutrition therapy and our algorithm for at least 3 d. Blood glucose (BG) monitoring was done every 1 to 2 h with the target BG at 70 to 149 mg/dL (3.9 to 8.3 mmol/L). Nursing adherence to the RHI infusion protocol was evaluated for each patient by comparing the adjustments in insulin infusion rates documented by the nursing personnel with the prescribed adjustments per our graduated continuous intravenous RHI infusion algorithm.A total of 4150 BG measurements necessitating the determination of the appropriate RHI dosage rate by nursing personnel in 40 patients occurred during the observational period. The target BG was achieved for a mean of 20 h/d and none of the patients had an episode of severe hypoglycemia (BG40 mg/dL or 2.2 mmol/L). The overall rate of algorithm violations was 12.1%. The algorithm violations accounted for a single episode of mild to moderate hypoglycemia (BG 40 to 60 mg/dL or 2.2 to 3.3 mmol/L) in 4 patients and 65 total episodes of hyperglycemia (BG ≥150 mg/dL or 8.3 mmol/L) in 18 patients.An adherence rate of nearly 90% is indicative of excellent nursing adherence compared with other published paper-based algorithms that examined protocol adherence. These data, combined with our previously published glycemic control data, indicate that this RHI infusion algorithm is an effective one for hyperglycemic trauma patients receiving continuous enteral and/or parenteral nutritional therapy.

This research attempted to find the optimum condition for color and total COD reduction in wastewater from the pulp and paper mill industry by using electrocoagulation techniques in batch and continuous modes. Six pieces of iron plates constructed in parallel configurations were used as electrodes. The effect of key parameters including the type of polyelectrolyte, current density, initial pH of the wastewater, and the circulating flow rate of wastewater in the reactor were investigated. The results indicated that the polyelectrolyte had no effect on pollutant removal. At optimum conditions, greater than 97% of color and 77% of total COD were effectively removed with a total operating cost of approximately 0.29 USD/m 3 wastewater. First order rate kinetics best explained the reduction of color and total COD concentration, the model fitting the actual data very well. For the continuous mode, the treatment process reached the steady state condition within 2.15 h and the efficiency of color and total COD reduction was greater than 91% and 77%, respectively. The properties of wastewater including color, total COD, BOD 5 , TSS, TDS, pH and iron ions content were in the range of the acceptable values of current Thai Government standards.

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) adversely affects the quality of life, producing significant morbidity in afflicted patients. Strategies for the treatment of patients with, or at risk of, BRONJ were set forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper on Bisphosphonate-Related Osteonecrosis of the Jaws (Position Paper) and approved by the Board of Trustees in September 2006. 1 The Position Paper was developed by a Task Force appointed by the Board and composed of clinicians with extensive experience in caring for these patients and basic science researchers. The knowledge base and experience in addressing BRONJ has expanded, necessitating modifications and refinements to the original Position Paper. The Task Force was reconvened in August 2008 to review the 2006 recommendations, appraise the current published data, and revise the Position Paper and recommendations, where indicated. This update contains revisions to the diagnosis and staging and management strategies and highlights the status of basic science research. AAOMS considers it vitally important that this information be disseminated to other dental and medical specialties.

A cost-effective assay for antioxidant using simple cotton thread combining paper based device with mobile phone detection has been investigated. Standard and sample solutions flow along a bunch of cotton thread treated with sodium hydroxide via microfluidic behaviors without external pumping. The analyte solution reacts with the reagents that have been immobilized on the paper strip fixed at the end of the cotton bunch. The developed platforms were used for the assays of total phenolic content and antioxidant capacity by employing Folin-Ciocalteu and 2, 2-diphenyl-1-picryhydrazyl (DPPH) respectively. Simple detection can be made by employing a mobile phone camera (iPhone 4S) with Image J or Photoshop for image processing and evaluation. Gallic acid was used as a reference standard in this work, as its polyphenol structures can be found in many plants. The total phenolic content is expressed as gallic acid equivalents (GAE) (mg/g material). Inhibition capacity is calculated by the equation: % I = [(Io - Is)/ Io] × 100, where Is is the relative magenta intensity (CMYK mode) of sample, and Io the relative magenta intensity of DPPH•. IC50 inhibition can be estimated from the graph and can be used for the antioxidant capacity consideration. Applications to the assay green tea samples were demonstrated. The total phenolic contents in the green tea samples were found to be 48-105mg/g, with %RSD of less than 10 for that of higher 50 GAE mg/g and IC50 values of the samples studied were 25-50mg/L. The results obtained by the developed methods agree with that of the standard methods.

Background Eye movement desensitization and reprocessing (EMDR) therapy has been shown to be efficacious for PTSD in adults and children in quantitative research, and its effectiveness has been demonstrated in qualitative studies. Limited research, however, has investigated EMDR from the perspective of clients. Therefore, this systematic review aims to locate and assess the qualitative empirical research about clients’ experiences of EMDR. Data sources Adhering to a pre-defined protocol, the title, abstracts and keywords of 2489 papers retrieved using keyword searches related to EMDR from 5 electronic academic databases (ASSIA, ERIC, PsycINFO, SCOPUS and Web of Science) were screened. Twenty-seven full-text articles were assessed for eligibility. Five qualitative papers met the inclusion criteria and proceeded to quality assessment and data analysis. Data synthesis Thematic synthesis was applied to the findings of the primary research studies to generate over-arching concepts regarding what clients say about their experiences of EMDR. Results Four super-ordinate themes (and 16 sub-themes) were identified in the data: EMDR changes a person, necessary conditions for EMDR to effect change, EMDR method as agent of change and EMDR therapist as agent of change. Conclusion EMDR is talked about in a transformative manner. There are conditions, which need to be present for EMDR to work, and connections exist between the EMDR method and therapist as agents of change. For practitioners, a pluralistic approach, incorporating the EMDR method could be used to carry out tasks in therapy to achieve therapeutic goals based on the client's requirements. In research, the paucity of qualitative studies could be addressed by engaging counselling psychologists, as scientific enquirers and artistic therapists, to expand research into clients’ experiences of EMDR to improve therapeutic practice and treatment programmes. Areas suggested for further qualitative experiential research include adverse effects, tolerability and withdrawal from therapy; EMDR for specific populations, such as combat veterans where the quantitative evidence is equivocal; and EMDR therapy practised in inpatient settings.

Objective To design an endometrial cancer (EC) alternative payment (ECAP) model focused on surgical management of EC, as well as identify drivers of cost in order to develop opportunities for cost-savings while maintaining quality of care. Methods National practice patterns and reimbursements were compared between private payers (MarketScan data, years 2009–13) and public payers (Medicare, year 2014) of EC patients who underwent hysterectomy. An episode of care for EC included the hysterectomy, stratified by surgical approach (laparotomy versus robotic versus laparoscopy), and in- and outpatient reimbursements from 30days preoperatively to 60days postoperatively. Reimbursements were categorized into cost centers. A decision model informed modifiable components influencing overall reimbursements for EC surgical care. Variations in length of stay (LOS), emergency department (ED visits), and readmissions were analyzed to create an optimal care model. Results A total of MarketScan (n=29,558) and Medicare (n=377) patients were included. Mean total reimbursement for an episode of care was $19,183 (SD $10,844) for Medicare and $30,839 (SD $19,911) for MarketScan. Mean reimbursements were greatest for abdominal cases in Medicare ($25,553; SD $11,870) and MarketScan ($35,357; SD $21,670), followed by robotic and laparoscopic. Among MarketScan patients, 7.6% of women were readmitted within 60days after surgery and 11.7% had an evaluation in the ED. The median reimbursement per patient for readmission was $14,474 (IQR $8584 to $26,149), and for ED visit was $6327 (IQR $1369 to $29,153). In an optimized care model, increasing the rate of minimally invasive surgery by 5% while reducing LOS by 10% and ED visits/readmissions by 10%, lowered the average case reimbursement by $903 (2.9%) for MarketScan and $1243 (5.9%) for Medicare. Conclusion An ECAP model demonstrates that reimbursements vary by public versus commercial payers in the U.S. for the surgical management of endometrial cancer patients, and that opportunities for cost savings exist. Nominal increases in the rate of minimally invasive surgery and reduction in the rate of ED visits/readmissions and length of stay can result in substantial savings for endometrial cancer care.

Pediatric empyema can be managed with a variety of modalities, and the evidence for an ideal management strategy is limited. Early or simple effusions can be treated with antibiotics alone or with drainage when respiratory distress occurs. Once fibrinopurulent empyema has developed, therapy may involve either chest tube placement with instillation of fibrinolytics or video-assisted thoracoscopic surgery with pleural decortication. In late or fibrotic empyema, an assumption persists that the fibrotic peel must be managed by decortication that can be done either thoracoscopically or through a minithoracotomy incision. This position paper is coauthored by the New Technology Committee of the American Pediatric Surgery Association. The goal is to discuss the ongoing controversies and summarize, in an evidence-based manner, the various treatment options and to suggest a reasonable therapeutic algorithm for the care of children with empyema.

We examined the utility of dried blood on filter paper for the source of cytokine messenger RNA (mRNA). Total RNA was isolated from the dried blood of mice infected with Plasmodium yoelii, and cDNA was amplified by reverse transcription-polymerase chain reaction (RT-PCR). As a reference, we extracted total RNA from peripheral blood collected at the same time as the preparation for dried blood. There was no difference in cytokine mRNA expression between the two sources; the dried blood on filter paper and the peripheral blood. Th1 cells, Th2 cells, and monocytes/macrophages derived cytokine mRNAs in the dried blood from infected mice were detected, and the increase of some of the cytokines mRNAs after infection was also observed. These results suggested that the dried blood on filter paper is satisfactory RNA source for immunological examination in field-based studies.