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Background Systemic lupus erythematous (SLE) is a systemic autoimmune/inflammatory condition. Approximately 15–20% of patients develop symptoms before their 18th birthday and are diagnosed with juvenile-onset SLE (JSLE). Gender distribution, clinical presentation, disease courses and outcomes vary significantly between JSLE patients and individuals with adult-onset SLE. This study aimed to identify age-specific clinical and/or serological patterns in JSLE patients enrolled to the UK JSLE Cohort Study. Methods Patient records were accessed and grouped based on age at disease-onset: pre-pubertal (≤7 years), peri-pubertal (8–13 years) and adolescent (14–18 years). The presence of American College of Rheumatology (ACR) classification criteria, laboratory results, disease activity [British Isles Lupus Assessment Group (BILAG) and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K) scores] and damage [Systemic Lupus International Collaborating Clinics (SLICC) damage index] were evaluated at diagnosis and last follow up. Results A total of 418 JSLE patients were included in this study: 43 (10.3%) with pre-pubertal disease onset; 240 (57.4%) with peri-pubertal onset and 135 (32.3%) were diagnosed during adolescence. At diagnosis, adolescent JSLE patients presented with a higher number of ACR criteria when compared with pre-pubertal and peri-pubertal patients [pBILAG2004 scores: 9(4–20] vs. 7(3–13] vs. 7(3–14], respectively, p = 0.015] with increased activity in the following BILAG domains: mucocutaneous ( p = 0.025), musculoskeletal ( p = 0.029), renal ( p = 0.027) and cardiorespiratory ( p = 0.001). Furthermore, adolescent JSLE patients were more frequently ANA-positive ( p = 0.034) and exhibited higher anti-dsDNA titres ( p = 0.001). Pre-pubertal individuals less frequently presented with leukopenia ( p = 0.002), thrombocytopenia ( p = 0.004) or low complement ( p = 0.002) when compared with other age groups. No differences were identified in disease activity (pBILAG2004 score), damage (SLICC damage index) and the number of ACR criteria fulfilled at last follow up. Conclusions Disease presentations and laboratory findings vary significantly between age groups within a national cohort of JSLE patients. Patients diagnosed during adolescence exhibit greater disease activity and “classic” autoantibody, immune cell and complement patterns when compared with younger patients. This supports the hypothesis that pathomechanisms may vary between patient age groups.

In paper-based microfluidics, the simplest devices are colorimetric, giving qualitative results. However, getting quantitative data can be quite a bit more difficult. Distance-based devices provide a user-friendly means of obtaining quantitative data without the need for any additional equipment, simply by using an included ruler or calibrated markings. This article details the development of a quantitative DNA detection device that utilizes the aggregation of polystyrene microspheres to affect the distance that microspheres wick through filter paper. The microspheres are conjugated to single-stranded DNA (ssDNA) oligomers that are partially complementary to a target strand and, in the presence of the target strand, form a three-strand complex, resulting in the formation of aggregates. The higher the concentration of the target strand, the larger the aggregate, and the shorter the distance wicked by the microspheres. This behavior was investigated across a wide range of target concentrations and under different incubation times to understand aggregate formation. The device was then used to successfully detect a target strand spiked in extracted plant DNA.

Digital informed consent may better inform individuals about health research and increase participation. In the United States and elsewhere, minorities and rural populations are underrepresented in health research and may benefit from well-designed electronic informed consent (eIC). Seven focus groups were conducted with 50 Caucasian, African American, and rural patients in the United States. Participants were asked their preferences for a paper versus electronic informed consent document. Participants found the e-version easier to use, more interesting, and better for understanding. Minority participants emphasized limited access, computer literacy, and trust barriers to eIC. Rural participants were concerned about accessibility, connectivity, privacy, and confidentiality. People see value in electronic consenting. Researchers should consider barriers to eIC among underrepresented populations before recruitment.

Objective The purpose of the present research is to establish measurement equivalence and test differences in reliability between computerized and pencil-and-paper-based tests of spatial cognition. Background Researchers have increasingly adopted computerized test formats, but few attempt to establish equivalence for computer-based and paper-based tests. The mixed results in the literature on the test mode effect, which occurs when performance differs as a function of test medium, highlight the need to test for, instead of assume, measurement equivalence. One domain that has been increasingly computerized and is thus in need of tests of measurement equivalence across test mode is spatial cognition. Method In the present study, 244 undergraduate students completed two measures of spatial ability (i.e., spatial visualization and cross-sectioning) in either computer- or paper-and-pencil-based format. Results Measurement equivalence was not supported across computer-based and paper-based formats for either spatial test. The results also indicated that test administration type affected the types of errors made on the spatial visualization task, which further highlights the conceptual differences between test mediums. Paper-based tests also demonstrated increased reliability when compared with computerized versions of the tests. Conclusion The results of the measurement equivalence tests caution against treating computer- and paper-based versions of spatial measures as equivalent. We encourage subsequent work to demonstrate test mode equivalence prior to the utilization of spatial measures because current evidence suggests they may not reliably capture the same construct. Application The assessment of test type differences may influence the medium in which spatial cognition tests are administered.

Knowledge about the total waste generated by the production of consumer goods can help raise awareness among policy-makers, producers and consumers of the benefits of closing loops in a future circular economy, avoiding unnecessary production and production steps and associated generation of large amounts of waste. In strict life cycle assessment practice, information on waste outputs from intermediate industrial processes of material and energy transformation is translated into and declared as potential environmental impacts, which are often not reported in the final results. In this study, a procedure to extract available intermediate data and perform a systematic pre-consumer waste footprint analysis was developed. The pre-consumer waste footprint concept was tested to analyse 10 generic products, which provided some novel and interesting results for the different product categories and identified a number of challenges that need to be resolved in development of the waste footprint concept. These challenges include standardised data declaration on waste in life cycle assessment, with a separation into waste categories illustrating the implicit environmental and scale of significance of waste types and quantities (e.g. hazardous waste, inert waste, waste for recycling/incineration) and establishment of a common definition of waste throughout sectors and nations.

Background Until now, environmental sustainability issues are almost entirely unsolved for packaging materials. With the final aim of finding materials with a single recycling channel, cellulose fiber/poly(vinyl)alcohol composites were investigated. Methods After extrusion and injection molding, samples of composite with different cellulose fiber content (30%, 50% and 70% w/w) were tested. Results Tensile mechanical tests exhibited an improvement in composite stiffness when the reinforcement content was increased together with a decrease in composite elongation. Solubility tests performed at room temperature and 45°C showed different behavior depending on the water-resistant film applied on the composite (50% cellulose fiber content). In particular, the uncoated composite showed complete solubility after 2 hours, whereas at the same time point, no solubility occurred when a non-water-soluble varnish was used. Conclusions The proposed composites, named Poly-paper, appear to warrant further investigation as highly sustainable packaging.

In this study, carbon papers and aerogels were prepared from chitosan and graphene layers with aldehydic edge functional groups (G-CHO) able to form chemical bonds with chitosan and thus to form a crosslinked network. A high surface area graphite was edge functionalized with hydroxyl groups (G-OH) through the reaction with KOH. G-CHO, with 4.5 mmol/g of functional group, was prepared from G-OH by means of the Reimer-Tieman reaction. Characterization of the graphitic materials was performed with elemental analysis, titration, X-ray analysis, Raman spectroscopy and by estimating their Hansen solubility parameters. CS and G-CHO were mixed with mortar and pestle and carbon papers and aerogels were obtained from a stable acidic water suspension through casting and liophilization, respectively. Free standing and foldable carbon papers and monolithic aerogels based on a continuous covalent network between G-CHO and CS were prepared. G-CHO, which had about 22 stacked layers, was extensively exfoliated in the carbon paper, as confirmed by the absence of the 002 reflection of the graphitic crystallites in the XRD pattern. Carbon paper was found to be resistant to solvents and to be stable for pH ⩾ 7. Composites revealed electrical conductivity. The covalent network between the graphene layers and CS, suggested by the IR findings, accounts for these results. This work demonstrates the effectiveness of a continuous covalent network between chitosan and graphene layers edge functionalized with tailor made functional groups for the preparation of carbon papers and aerogels and paves the way for the scale up of such a type of composites.

The literature was reviewed with respect to deinking flotation methods with toner samples, specifically emphasizing the speciation of copy machine and laser printing, which produce an increasing quantity of paper that is difficult to recycle. Speciation here refers to the physical-chemical characteristics of the toner, which change because of the polymerization (fusion) and oxidation process, due to exposure to heat, light and oxygen (air) during the printing process. To simulate the deinking flotation, after the ideal disintegration process, samples of toner were prepared in order to provide free toner particles. Synthetic toner has iron content and the same physical-chemical features as free disintegrated printed toner particles. We report the toner ( I) and fibre ( Y) recovery and the brightness ( B) of laboratory filter pads formed of deinked product as deinking efficiencies. The application of oleic acid as the collector in the flotation stage gives a better flotation recovery in alkaline than in acidic conditions. The highest brightness ( BF = 93.66%) and flotation recoveries ( I = 90, Y = 92.82%) were achieved during testing at an oleic acid concentration of 3.38·10−6 mol l−1, which is the lowest dose used. This makes the use of oleic acid economical and environmentally friendly.

In this study, five typical municipal solid waste (MSW) components (tyres, cardboard, polyvinyl chloride (PVC), acrylic textile, toilet paper) were used as raw materials to prepare four kinds of MSW-based carbon materials (paperboard-based carbon materials (AC1); the tyres and paperboard-based carbon materials (AC2); the tyres, paperboard and PVC-based carbon materials (AC3); the tyres, paperboard, toilet paper, PVC and acrylic textile-based carbon materials (AC4)) by the KOH activation method. The characteristic results illustrate that the prepared carbon adsorbents exhibited a large pore volume, high surface area and sufficient oxygen functional groups. Furthermore, the application of AC1, AC2, AC3, AC4 on different heavy metal (Cu2+, Zn2+, Pb2+, Cr3+) removals was explored to investigate their adsorption properties. The effects of reaction time, pH, temperature and adsorbent dosage on the adsorption capability of heavy metals were investigated. Comparisons of heavy metal adsorption on carbon of different components were carried out. Among the four samples, AC1 exhibits the highest adsorption capacity for Cu2+; the highest adsorption capacities of Pb2+ and Zn2+ are obtained for AC2; that of Cr3+ are obtained for AC4. In addition, the carbon materials exhibit better adsorption capability of Cu2+ and Pb2+ than the other two kind of metal ions (Zn2+ and Cr3+).

Diffuse reflectance ultraviolet-visible-near-infrared (UV-Vis-NIR) spectroscopy is applied as a means of differentiating various types of writing, office, and photocopy papers (collected from stationery shops in India) on the basis of reflectance and absorbance spectra that otherwise seem to be almost alike in different illumination conditions. In order to minimize bias, spectra from both sides of paper were obtained. In addition, three spectra from three different locations (from one side) were recorded covering the upper, middle, and bottom portions of the paper sample, and the mean average reflectivity of both the sides was calculated. A significant difference was observed in mean average reflectivity of Side A and Side B of the paper using Student's pair t-test. Three different approaches were used for discrimination: (1) qualitative features of the whole set of samples, (2) principal component analysis, and (3) a combination of both approaches. On the basis of the first approach, i.e., qualitative features, 96.49% discriminating power (DP) was observed, which shows highly significant results with the UV-Vis-NIR technique. In the second approach the discriminating power is further enhanced by incorporating the principal component analysis (PCA) statistical method, where this method describes each UV-Vis spectrum in a group through numerical loading values connected to the first few principal components. All components described 100% variance of the samples, but only the first three PCs are good enough to explain the variance (PC1 = 51.64%, PC2 = 47.52%, and PC3 = 0.54%) of the samples; i.e., the first three PCs described 99.70% of the data, whereas in the third approach, the four samples, C, G, K, and N, out of a total 19 samples, which were not differentiated using qualitative features (approach no. 1), were therefore subjected to PCA. The first two PCs described 99.37% of the spectral features. The discrimination was achieved by using a loading plot between PC1 and PC2. It is therefore concluded that maximum discrimination of writing, office, and photocopy paper could be achieved on the basis of the second approach. Hence, the present inexpensive analytical method can be appropriate for application to routine questioned document examination work in forensic laboratories because it provides nondestructive, quantitative, reliable, and repeatable results.

The present work introduces the study of the CO2 capture process by zeolites synthesized from paper sludge and scrap glass. Zeolites ZSM-5, analcime and wairakite were produced by means of two types of Structure Directing Agents (SDA): tetrapropilamonium (TPA) and ethanol. On the one hand, zeolite ZSM-5 was synthesized using TPA; on the other hand, analcime and wairakite were produced with ethanol. The temperature programmed desorption (TPD) technique was performed for determining the CO2 sorption capacity of these zeolites at two sorption temperatures: 50 and 100°C. CO2 sorption capacity of zeolite ZSM-5 synthesized at 50°C was 0.683 mmol/g representing 38.2% of the value measured for a zeolite ZSM-5 commercial. Zeolite analcime showed a higher CO2 sorption capacity (1.698 mmol/g) at 50°C and its regeneration temperature was relatively low. Zeolites synthesized in this study can be used in the purification of biogas and this will produce energy without increasing the atmospheric CO2 concentrations.

A pilot study assessed an electronic informed consent model within a randomized controlled trial (RCT). Participants who were recruited for the parent RCT project were randomly selected and randomized to either an electronic consent group ( n = 32) or a simplified paper-based consent group ( n = 30). Results from the electronic consent group reported significantly higher understanding of the purpose of the study, alternatives to participation, and who to contact if they had questions or concerns about the study. However, participants in the paper-based control group reported higher mean scores on some survey items. This research suggests that an electronic informed consent presentation may improve participant understanding for some aspects of a research study.

Surface-enhanced Raman spectroscopy (SERS) enables multiplex detection of analytes using simple, portable equipment consisting of a single excitation source and detector. Thus, in theory, SERS is ideally suited to replace fluorescence in assays that screen for numerous deoxyribonucleic acid (DNA) targets, but in practice, SERS-based assays have suffered from complexity and elaborate processing steps. Here, we report an assay in which a simple inkjetfabricated plasmonic paper device enables SERS-based detection of multiple DNA targets within a single polymerase chain reaction (PCR). In prior work, we demonstrated the principles of chromatographic separation and SERS-based detection on inkjet-fabricated plasmonic paper. The present work extends that capability for post-PCR gene sequence detection. In this design, hydrolysis DNA probes with 5′ Raman labels are utilized; if the target is present, the probe is hydrolyzed during PCR, freeing the reporter. After applying the PCR sample to a paper SERS device, an on-device chromatographic separation and concentration is conducted to discriminate between hydrolyzed and intact probes. SERS is then used to detect the reporter released by the hydrolyzed probes. This simple separation and detection on paper eliminates the need for complex sample processing steps. In this work, we simultaneously detect the methicillin-resistant Staphylococcus aureus genes mecA and femB to illustrate the concept. We envision that this approach could contribute to the development of multiplex DNA diagnostic tests enabling screening for several target sequences within a single reaction, which is necessary for cases in which sample volume and resources are limited.

Waste management in construction is critical for the sustainable treatment of building-related construction and demolition (C&D) waste materials, and recycling of these wastes has been considered as one of the best strategies in minimization of C&D debris. However, recycling of C&D materials may not always be a feasible strategy for every waste type and therefore recycling and other waste treatment strategies should be supported by robust decision-making models. With the aim of assessing the net carbon, energy, and water footprints of C&D recycling and other waste management alternatives, a comprehensive economic input–output-based hybrid life-cycle assessment model is developed by tracing all of the economy-wide supply-chain impacts of three waste management strategies: recycling, landfilling, and incineration. Analysis results showed that only the recycling of construction materials provided positive environmental footprint savings in terms of carbon, energy, and water footprints. Incineration is a better option as a secondary strategy after recycling for water and energy footprint categories, whereas landfilling is found to be as slightly better strategy when carbon footprint is considered as the main focus of comparison. In terms of construction materials’ environmental footprint, nonferrous metals are found to have a significant environmental footprint reduction potential if recycled.

Objectives To describe the epidemiology of end stage renal disease (ESRD). Design Mixed-methods systematic review. Setting The countries of the Gulf Cooperation Council (GCC) which consist of Saudi Arabia, the United Arab Emirates, Kuwait, Qatar, Bahrain, and Oman. Participants Defined to have ESRD or patients on regular dialysis for a minimum dialysis period of at least three months. Since many outcomes were reviewed, studies that estimated the incidence and prevalence of ESRD as outcomes should not have defined the study population as ESRD population or patients on regular dialysis. Studies where the study population mainly comprised children or pregnant woman were excluded. Main outcome measures The trends of the incidence, prevalence, and mortality rate of ESRD; also, causes of mortality, primary causes and co-morbid conditions associated with ESRD. Results 44 studies included in this review show that the incidence of ESRD has increased while the prevalence and mortality rate of ESRD in the GCC has not been reported sufficiently. The leading primary causes of ESRD recorded in the countries of the GCC is diabetes with the most prevalent co-morbid conditions being Hypertension and Hepatitis C Virus infection; the most common cause of death was cardiovascular disease and sepsis. Conclusions This review highlights that the lack of national renal registries data is a critical issue in the countries of the GCC. The available data also do not provide an accurate and updated estimate for relevant outcomes. Additionally, considering the increasing burden of chronic kidney disease (CKD), these results stressed the needs and the importance of preventative strategies for leading causes of ESRD. Furthermore, more studies are needed to describe the epidemiology of ESRD and for assessing the overall quality of renal care.

The purpose of this study was to assess whether a computerized battery of neuropsychological tests could produce similar results as the conventional forms. Comparisons on 77 volunteer undergraduates were carried out with two neuropsychological tests: Line Orientation Test and Enhanced Cued Recall Test. Firstly, students were assigned randomly across the test medium (paper-and-pencil versus computerized). Secondly, the groups were given the same test in the other medium after a 30-day interval between tests. Results showed that the Enhanced Cued Recall Test–Computer-based did not correlate with the Enhanced Cued Recall Test-Paper-and-pencil results. Line Orientation Test–Computer-based scores, on the other hand, did correlate significantly with the Line Orientation Test–Paper-and-pencil version. In both tests, scores were higher on paper-and-pencil tests compared to computer-based tests. Total score difference between modalities was statistically significant for both Enhanced Cued Recall Tests and for the Line Orientation Test. In both computer-based tests, it took less time for participants to complete the tests.

Purpose. Using the Problem Oriented Screening Instrument for Teenagers (POSIT), the effect of mode of administration on (1) students' willingness to disclose sensitive information and (2) response rates was investigated. Design. A2 × 2 unequal N factorial analysis of variance (ANOVA) design was employed. Mode of administration (paper-and-pencil vs. Web-based) was crossed with grade level (middle vs. high school). Setting. The study was conducted in two middle and two high schools. Subjects. A total of 628 middle and high school students completed the survey. Measures. The POSIT is a self-report measure with 139 yes/no items that identifies stressors in 10 functional areas (e.g., Substance Use). Analysis. An unequal N 2 (mode) × 2 (grade level) factorial ANOVA was employed. Results. No statistically significant differences were found for self-reported risk across modes of administration. Students completing the Web-based version of the survey were four times more likely to skip an item. Conclusions. Effect of Mode on Reporting of Sensitive Information—Students completed the Web-based surveys in computer labs with other students. The intent of the Web-based survey was to increase perceived privacy but the environment likely negated any effect. Effect of Mode on Response Rates—The higher response rate for the paper-and-pencil survey was the opposite of what was expected and revealed that students were more likely to skip sensitive items on the Web survey. (Am J Health Promot 2011;25[5]:349-352.)

Purpose Since bacterial pollution is more troublesome than other nonbiologic air pollutants, the need to control airborne micro-organisms has led to renewed interest in filter media for air filtration in indoor environments. Although mechanical filtration of aerosols by HEPA systems is the most common method for particle removal, these filters characterized by high efficiency usually reveal a higher drop in pressure and noise and are very expensive. On this basis, we aimed to develop novel, very effective air filters for removal of airborne bacteria from confined environments. Methods Parallelepiped filters surrounded by a cardboard frame were manufactured by aligning strips of corrugated cardboard and were assessed in terms of airflow rate reduction. Cardboard filters were soaked in isopropanol or used untreated in in vitro experiments for assessment of their antibacterial effect against E. coli and in a testing chamber for assessment of airborne bacterial removal. The surface morphology of cardboard specimens was also investigated by Scanning Electron Microscopy (SEM). Results Cardboard filters determined a very low decrease in airflow rate. Although specimens showed no antimicrobial behavior, untreated filters showed a maximum of 77% abatement of the airborne bacteria and the alcohol treatment of filters further increased their effectiveness by 14% probably because of their more convoluted surface. Conclusions This work disclosed corrugated cardboard-based filters as promising tools for the air treatment of indoor environments because of their excellent microbial abatement properties. Moreover, cardboard is lightweight, inexpensive, and eco-friendly material, and corrugated cardboard-based air filters are very simple in shaping, mounting, and replacing existing ventilation systems.

This study examined the psychometric equivalence of paper-and-pencil and Internet formats of key questionnaires used in couple research. Self-report questionnaires assessing interpersonal constructs (relationship satisfaction, communication/conflict management, partner support, emotional intimacy) and intrapersonal constructs (individual traits, psychological symptoms, contextual influences) were administered to young adults in committed dating relationships. The same measures were administered twice via paper-and-pencil and/or Internet methods over a 2-week period. Method order was counterbalanced among participants, and temporal stability was controlled. Intrapersonal and interpersonal measures generally remained reliable when administered online and demonstrated quantitative and qualitative equivalence across methods. The implications of online administration of questionnaires are discussed, and specific recommendations are made for researchers who wish to transition to online data collection.

Toxicity of dye containing effluent of tannery, textile, dyes and pulp-paper industries was evaluated in an acute toxicity test using Daphnia magna. The 48-hour EC50 values were 4.33% and 19.5% for tannery effluents (Tn1 and Tn2). Textile effluents (Tx1—Tx7) had 48-hour EC50 values; >100%, >100%, 62.9%, 63.0%, 40.3%, >100% and >100%, respectively. Dye industries (D1—D7) had 48-hour EC50 values; 14.1%, 15.5%, 24.5%, 29.7%, 23.2%, >100% and >100%, respectively. Similarly pulp-paper effluents (P1—P5) showed acute toxicity as 100%, 77.87%, 46.44%, 69.55% and 82.84%, respectively. These results showed linear relationship with high degree of confidence (r2 ≥ 0.84—0.99) between immobility and test concentrations. Toxicity classification criteria showed that out of five effluents from pulp-paper mill, four were minor acutely toxic having 48-hour EC50 value in between >46%—100%. Out of seven textile effluents, four were not acutely toxic (48-hour EC50 value >100%) and three were minor acutely toxic (48-hour EC 50 value in the range of 40.3%—63.0%). Similarly, out of seven dye industrial effluents, two were not acutely toxic and five minor acutely toxic. One of the two tanneries was moderately acutely toxic and another one was minor acutely toxic. Classification based on toxic unit revealed that four out of five pulp-paper effluent, three out of seven textile effluents, five out of seven dye effluents and both the tannery effluents were toxic. Overall, 66.67% effluents were found toxic and 33.33% as non-toxic. In general, tannery and dyes effluents showed more toxicity than textile and paper mill effluents.

Background: Paper printers have been used to document radiological findings in some hospitals. It is critical to establish whether paper printers can achieve the same efficacy and quality as dry laser printers for full-field digital mammography (FFDM). Purpose: To compare the image quality and detection rate of dry laser printers and paper printers for FFDM. Material and Methods: Fifty-five cases (25 with single clustered microcalcifications and 30 controls) were selected by a radiologist not participating in the image review. All images were printed on film and paper by one experienced mammography technologist using the processing algorithm routinely used for our mammograms. Two radiologists evaluated hard copies from dry laser printers and paper printers for image quality and detectability of clustered microcalcifications. For the image quality comparisons, agreement between the reviewers was evaluated by means of kappa statistics. The significance of differences between both of the printers was determined using Wilcoxon's signed-rank test. The detection rate of two printing systems was evaluated using receiver operating characteristic (ROC) analysis. Results: From 110 scores (55 patients, two readers) per printer system, the following quality results were achieved for dry laser printer images: 70 (63.6%) were rated as good and 40 (36.4%) as moderate. By contrast, for the paper printer images, 25 scores (22.7%) were rated as good and 85 (77.3%) as moderate. Therefore, the image quality of the dry laser printer was superior to that achieved by the paper printer ( P=0.00). The average area-under-the-curve (Az) values for the dry laser printer and the paper printer were 0.991 and 0.805, respectively. The difference was 0.186. Results of ROC analysis showed significant difference in observer performance between the dry laser printer and paper printer ( P=0.0015). Conclusion: The performance of dry laser printers is superior to that of paper printers. Paper printers should not be used in FFDM.

Low vitamin D levels have been found in patients with autoimmune diseases, including type I diabetes, rheumatoid arthritis, multiple sclerosis and systemic lupus erythematosus. The main source of vitamin D is exposure to sunlight, but the same solar radiation is known to exacerbate lupus erythematosus. We investigated the prevalence of vitamin D insufficiency in patients with cutaneous lupus erythematosus (CLE). We designed a cross-sectional study including 55 patients with CLE to measure their serum 25-hydroxyvitamin D (25(OH)D) by chemiluminescence immunoassay and compare it with a control group consisting of 37 healthy sex and age-matched subjects recruited from the patients' relatives as well as healthcare workers. Correlations with clinical and demographic variables were determined. Approximately 95% of patients with CLE had less than 30 ng/ml of serum 25(OH)D, which is accepted as the lower limit for vitamin D adequacy. Mean serum vitamin D values were significantly lower than controls (p = 0.038) and were associated with higher levels of parathyroid hormone (p = 0.050). A history of CLE was a strong predictor of insufficiency of vitamin D (odds ratio 4.2; 95% confidence interval 1.0-17.4). The results suggest a role of CLE in the metabolism of the vitamin and provide guidance for future studies looking at a potential role for vitamin D in the prevention and treatment of CLE. Lupus (2010) 19, 810-814.

The authors examined whether paper-and-pencil and Web surveys administered in the school setting yield equivalent risk behavior prevalence estimates. Data were from a methods study conducted by the Centers for Disease Control and Prevention (CDC) in spring 2008. Intact classes of 9th- or 10th-grade students were assigned randomly to complete a survey via paper-and-pencil or Web. Data from 5,227 students were analyzed using logistic regression to identify associations of mode with reporting of 74 risk behaviors. Mode was associated with reporting of only 7 of the 74 risk behaviors. Results indicate prevalence estimates from paper-and-pencil and Web school-based surveys are generally equivalent.

Background: Developing countries are facing a rise in noncommunicable diseases (NCD), which is a cause for concern. The World Health Organization has recommended a stepwise approach for NCD risk factor surveillance. Screening for risk factors in remote populations is difficult due to lack of resources and technical expertise, including standardized laboratory facilities. The collection of samples on filter paper for the assessment of risk factors circumvents the need for blood processing, storage, and shipment at ultralow temperatures. Method: Samples were collected on 3-mm Whatman filter paper from one industry (National Thermal Power Corporation) located in the periphery of Delhi as part of a surveillance carried out in industries from different parts of India. Total cholesterol was measured in serum and dried blood by the cholesterol oxidase/p-aminophenazone method and triglycerides by the glycerophosphate oxidase–peroxidase/aminophenazone method. Values obtained by the two methods were compared using Pearson correlation, and Bland–Altman plots were prepared to assess bias. Results: The correlation coefficient “ r” was 0.78 for cholesterol and 0.94 for triglycerides between dried blood spots and serum. Bland–Altman plots suggest that differences in values obtained by the two methods were within two standard deviations for most of the samples. Conclusions: Blood samples dried on filter paper can be a successful option for population screening in remote areas, provided preanalytical variations arising due to the method of blood spot preparation and storage are well controlled.

The psychometric properties of two paper-and-pencil versions of the Children’s Attributional Style Interview (i.e., CASI-I and CASI-II) were evaluated in a sample of 166 third and fourth graders and a sample of 245 sixth and seventh graders. The results demonstrated strong internal consistency reliability, convergent validity, and a factor structure that was consistent with theory in both samples. Furthermore, analyses demonstrated adequate evidence of the reliability and validity of several dimensional subscale scores and the composite measures of attributional style for both positive and negative events. These results suggest the utility of the CASI in research testing specific attributional predictions of cognitive theories of depression with the dimensional subscale scores. They further add to the literature by demonstrating item-level factor analytic support for a children’s attributional style measure and the feasibility of administration sizes larger than previously tested, which add to the utility of the CASI in large-scale research designs.

Greenhouse gas (GHG) emissions have been established for recycling of paper waste with focus on a material recovery facility (MRF). The MRF upgrades the paper and cardboard waste before it is delivered to other industries where new paper or board products are produced. The accounting showed that the GHG contributions from the upstream activities and operational activities, with global warming factors (GWFs) of respectively 1 to 29 and 3 to 9 kg CO2-eq. tonne— 1 paper waste, were small in comparison wih the downstream activities. The GHG contributions from the downstream reprocessing of the paper waste ranged from approximately 490 to 1460 kg CO2-eq. tonne —1 of paper waste. The system may be expanded to include crediting of avoided virgin paper production which would result in GHG contributions from —1270 to 390 kg CO2-eq. tonne— 1 paper waste. It may also be assumed that the wood not used for virgin paper production instead is used for production of energy that in turn is assumed to substitute for fossil fuel energy. This would result in GHG contributions from —1850 to —4400 kg CO2-eq. tonne— 1 of paper waste. These system expansions reveal very large GHG savings, suggesting that the indirect upstream and operational GHG contributions are negligible in comparison with the indirect downstream emissions. However, the data for reprocessing of paper waste and the data for virgin paper production are highly variable. These differences are mainly related to different energy sources for the mills, both in regards to energy form (heat or electricity) and fuel (biomass or fossil fuels).

Atacicept, a recombinant fusion protein containing the extracellular, ligand-binding portion of the transmembrane activator and calcium modulator and cyclophilin-ligand interactor receptor, and the Fc portion of human immunoglobulin (Ig) G, is designed to block the activity of B-lymphocyte stimulator and a proliferation-inducing ligand, and may have utility as a treatment for B-cell-mediated diseases, such as systemic lupus erythematosus (SLE). This Phase Ib study investigated the safety, tolerability, pharmacokinetics (PK) and pharmacodynamics of intravenous (i.v.) atacicept in patients with mild-to-moderate SLE. Patients (n = 24) were randomised (5:1) to receive atacicept (single dose: 3, 9 or 18 mg/kg; or multiple dose: 2 x 9 mg/kg) or matching placebo. Patients were followed for 6 weeks after dosing (9 weeks in the 2 x 9 mg/kg cohort). Local tolerability of atacicept was comparable with that of placebo, with only mild injection-site reactions reported with atacicept. Atacicept i.v. was generally well tolerated, both systemically and locally, in patients with mild-to-moderate SLE. Atacicept displayed non-linear PK, which was predictable across doses and between single and repeat doses. The biological activity of atacicept was demonstrated by its marked effect in reducing B-cells and Ig levels in patients with SLE. This supports the utility of this therapeutic approach in the treatment of autoimmune diseases, such as SLE.

A five-stage sequential extraction procedure was used to determine the distribution of 11 metals (Cd, Cr, Cu, Mo, Pb, Zn, As, Co, V, Ni, Ba), and sulphur (S) in bottom ash and in fly ash from a fluidized bed co-combustion (i.e. wood and peat) boiler of Stora Enso Oyj Oulu Mill at Oulu, Northern Finland, into the following fractions: (1) water-soluble fraction (H2O); (2) exchangeable fraction (CH3COOH); (3) easily reduced fraction (NH2OH—HCl); (4) oxidizable fraction (H2O2 + CH3COONH 4); and (5) residual fraction (HF + HNO3 + HCl). Although metals were extractable in all fractions, the highest concentrations of most of the metals occurred in the residual fraction. From the environmental point of view, this fraction is the non-mobile fraction and is potentially the least harmful. The Ca concentrations of 29.3 g kg—1 (dry weight) in bottom ash and of 68.5 g kg— 1 (dry weight) in fly ash were correspondingly approximately 18 and 43 times higher than the average value of 1.6 g kg— 1 (dry weight) in arable land in Central Finland. The ashes were strongly alkaline pH (∼ 12) and had a liming effects of 9.3% (bottom ash) and 13% (fly ash) expressed as Ca equivalents (dry weight). The elevated Ca concentrations indicate that the ashes are potential agents for soil remediation and for improving soil fertility. The pH and liming effect values indicate that the ashes also have a pH buffering capacity. From the environmental point of view, it is notable that the heavy metal concentrations in both types of ash were lower than the Finnish criteria for ash utilization.

Background: The toes play an important stabilizing role in weightbearing activities. However, the factors that influence toe plantarflexion strength are poorly understood, and there are no validated measures for assessing toe weakness in the clinical setting. Therefore, the objectives of this study were to determine whether plantarflexion strength of the toes differs according to age and gender and to evaluate the validity of a clinical screening test for assessing toe plantarflexor weakness (the paper grip test). Methods: Plantarflexion strength of the hallux and lesser toes was measured in 40 young participants (20 men and 20 women, mean age 20.8 ± 2.2 years) and 40 older participants (20 men and 20 women, mean age 74.6 ± 5.7 years) using a pressure platform in conjunction with clinical assessment using the paper grip test. Results: Older participants exhibited 32% less plantarflexion strength of the hallux and 27% less plantarflexion strength of the lesser toes compared to younger participants, and women exhibited 42% less hallux plantarflexor strength than men. Gender did not influence lesser toe plantarflexor strength. Participants who failed the paper grip test exhibited significantly reduced plantarflexion strength for both the hallux and lesser toes. The sensitivity and specificity of the paper grip test of the hallux to predict plantarflexor strength less than 2.6 kg was 80% and 79%, respectively, and the sensitivity and specificity of the paper grip test of the lesser toes to predict plantarflexor strength less than 2.2 kg was 75% and 74%, respectively. Conclusions: These findings indicate that aging is associated with reduced plantarflexion strength of the toes. The paper grip test may be a useful screening tool to detect toe weakness in the clinical setting.

Cage-cleaning is necessary for a hygienic environment, but since rats communicate using scent, they might suffer if their cages are cleaned too frequently. Male rats (Sprague–Dawley and Wistar) were kept for five months across four animal units. Their cages were cleaned twice-weekly, weekly, or every two weeks, and contained either aspen woodchips or absorbent paper bedding. Aggression, injuries and general health, weight gain, chromodacryorrhoea (a stress-related Harderian gland secretion), handleability, and lung pathology were monitored, as was in-cage ammonia. Cleaning frequency had no clear impact on rat welfare, although frequent cleaning decreased ammonia concentrations and handleability, and non-aggressive skirmishing was highest in weekly cleaned rats. Surprisingly, bedding type did not affect ammonia, but all ammonia readings were unexpectedly low. However, rats kept on aspen had greater sneezing rates and lung pathology than those on paper bedding, but also had higher body weights. The results raise concerns about aspen bedding, which is relatively inert compared with other wood beddings, but nevertheless more harmful than paper. Animal unit significantly affected eight of the 11 variables tested, having interactive effects on five of them. The study also demonstrates the interactive effects of different animal units, casting doubt on the feasibility of standardization. We explored multiple variables of interest, so all findings require confirmation through further work. Nevertheless, cage-cleaning rates seem to affect socially housed male rats little, while bedding type has important effects on rat health.

The work presented in this paper details the design and performance characteristics of a new hyperspectral visible imaging technique. Rather than using optical filters or a dispersing element, this design implements Fourier transform spectroscopy to achieve spectral discrimination. One potentially powerful application of this new technology is the nondestructive analysis and authentication of written and printed documents. Document samples were prepared using red, blue, and black inks. The samples were later altered using a different ink of the same color. While the alterations are undetectable to the naked eye, the alterations involving the blue and black inks were easily detected when the spectrally resolved images were viewed. Analysis of the sample using the red inks was unsuccessful. A 2004 series $20 bill was imaged to demonstrate the application to document authentication. The results argue that counterfeit detection and quality control during printing are plausible applications of Fourier transform hyperspectral visible imaging. All of the images were subjected to fuzzy c-means cluster analysis in an effort to objectively analyze and automate image analysis. Our results show that cluster analysis can distinguish image features that have remarkably similar visible transmission spectra.

Measurement of illicit drugs on paper currency is of interest for evidentiary purposes in legal cases involving the drug trade. Current methods, primarily based on mass spectrometry, are destructive and prevent re-analysis of the evidence. This article details a method based on Raman microspectroscopy that is able to collect spectra from individual crystals on the surface of paper currency. Mixtures of isoxsuprine and norephedrine, which are non-pharmacologically active drug surrogates, as well as lidocaine and benzocaine, common excipients in street drugs, were doped in small quantities onto US currency. Significant fluorescence interference resulted from the underlying dollar bill. This work presents two methods for reducing the fluorescence background, photobleaching and background subtraction, which both worked well. Finally, a method for determining the percent composition of individual components in heterogeneous mixtures was developed by systematically sampling the surface of the dollar bill. Results were accurate within a few percent, although the method was quite time consuming.

The objective of this work was to compare the performance of two laboratory-scale, mesophilic systems aiming at the anaerobic digestion of the organic fraction of municipal solid wastes (OFMSW). The first system consisted of two coupled reactors packed with OFMSW (PBR1.1-PBR1.2) and the second system consisted of an upflow anaerobic sludge bed reactor (UASB) coupled to a packed reactor (UASB2.1-PBR2.2). For the start-up phase, both reactors PBR 1.1 and the UASB 2.1 (also called leading reactors) were inoculated with a mixture of non-anaerobic inocula and worked with leachate and effluent full recirculation, respectively. Once a full methanogenic regime was achieved in the leading reactors, their effluents were fed to the fresh-packed reactors PBR1.2 and PBR2.2, respectively. The leading PBR 1.1 reached its full methanogenic regime after 118 days ( Tm, time to achieve methanogenesis) whereas the other leading UASB 2.1 reactor reached its full methanogenesis regime after only 34 days. After coupling the leading reactors to the corresponding packed reactors, it was found that both coupled anaerobic systems showed similar performances regarding the degradation of the OFMSW. Removal efficiencies of volatile solids and cellulose and the methane pseudo-yield were 85.95%, 80.88% and 0.109 NL CH4 g-1 VSfed in the PBR-PBR system; and 88.75%, 82.61% and 0.115 NL CH4 g-1 VSfed in the UASB-PBR system [NL, normalized litre (273oK, 1 ata basis)]. Yet, the second system UASB-PBR system showed a faster overall start-up.

Reading from a visual display terminal (VDT) has increased enormously with widespread computer use. Whether such reading affects higher cognitive processes requires study so the effect of display medium (LCD screen vs paper) and luminance contrast (1:3, 1:7, 1:11) on concept-formation performance and EEG responses was investigated. 96 men and 24 women participated in two concept-formation tasks (rule learning vs attribute and rule learning). Concept-formation performance and EEG responses were similar for stimuli displayed on paper or LCD screen. The concern that the screen may be detrimental to conception-formation performance was not confirmed; however, luminance contrast significantly affected time to complete a concept-formation task and EEG response. The middle contrast (1:7) had the smallest mean EEG power, so this contrast might be appropriate for cognitive performance. Participants' performance was significantly faster and EEG power lower for the rule-learning task than for an attribute and rule-learning task.

A dynamic model has been developed for reused and recycled packaging material flows. It allows a rigorous description of the flows and stocks during the transition to new targets imposed by legislation, product demand variations or even by variations in consumer discard behaviour. Given the annual reuse and recycle frequency and packaging lifetime, the model determines all packaging flows (e.g., consumption and reuse) and variables through which environmental policy is formulated, such as recycling, waste and reuse rates and it identifies the minimum number of variables to be surveyed for complete packaging flow monitoring. Simulation of the transition to the new flow conditions is given for flows of packaging materials in Greece, based on 1995-1998 field inventory and statistical data.

According to the new regulations on junk mail management to be adopted in France, both producers and distributors must participate in the recycling process. This case study was carried out in 2000 in four sectors in the Département of Charente in the south west of France. This report presents the quantities of junk mail in residual waste and in separate collections. The conclusion is that the new regulations may reduce overall domestic waste production by 2–4%, with the impact on separately collected paper being some 20%.

The application of low-temperature pyrolysis mass spectrometry to the identification of some commercial and synthetic polymers using a direct insertion probe and electron ionization has been studied. The polymers were analyzed directly in the solid probe of a mass spectrometer within the ion source at 70 eV electron impact. The quadrupole mass spectrometer, equipped with gas chromatogram software and a library of low molecular weight compounds, was used to characterize the polymers by measuring the chemical structure of the repeat units and the end groups and to examine the thermal degradation pathways. The polymers investigated show different degradation pathways. Investigation of sequences and determination of the composition of co-polymers were studied. Total ion pyrogram and spectrum subtractions were used to separate and measure spectra of pyrolysis steps at distinctly different temperatures.

Understanding the changes that occur when dyes are absorbed onto paper is crucial for the design of new inkjet dyes. This problem is particularly difficult for black dyes that have complex chromophores, and as a result, spectroscopic information on electronic and structural changes can be of importance. Surface-enhanced resonance Raman scattering (SERRS) and electronic structure calculations were used to probe in situ changes in the chromophore in black di-azo dyes printed onto paper. The data indicate that the low-energy chromophore is due mainly to the hydrazone group and the high-energy chromophore to both the azo and hydrazone groups. A comparison of SERRS from the dyes adsorbed onto silver particles in suspension and from the dyes on paper demonstrated a broadening of the chromophore into the red for both dyes and evidence of a structural change in one dye.

Recent advances in handheld computer hardware and software may provide alternatives to paper-based data collection methods. The authors compared data collected with paper forms to data collected with handheld computer-based forms in a field observation study of alcohol purchase attempts at 47 community festivals in a large metropolitan area. Agreement between data collected with paper forms and data collected with handheld computers was greater than 95%. Computer-based forms handled branching patterns better and yielded data that were immediately available for analyses. Paper forms handled written comments better. Handheld computers are a feasible alternative to paper forms for field data collection.

Ewapower Ltd in Pietarsaari, Finland produces pellets from paper and plastic waste for burning. During 1998 and 1999, several measurements were made to determine the dust, particle, microbe and endotoxin concentrations, and also the noise level in the hall where the waste is received and pre-crushed. The noise level exceeded the Finnish recommended level of 85 dBA. The dust and the particle concentrations were low, but the microbe concentrations, especially in the summer and in the autumn, were at a level which may be harmful to health. The total concentration of microbes (both dead and alive) was high - approximately 4.8 million particles m-3. The concentrations of endotoxins was high in summer and in autumn, from 340 to 1000 ng m-3 and exceeded recommended values. In the winter, the concentration of the endotoxin was lower, ranging between 4.7 and 33 ng m-3.

Artefacts in dental radiographs are not uncommon findings. In some cases, however, such film faults might lead to difficult or even wrong diagnoses. In this brief report, the authors present a case where a small piece of paper cast a foreign body-like image onto a panoral radiograph. The importance of proper techniques and film handling when taking radiographs cannot be over-emphasised.