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Aims The epidemiologic Study of Women's Health Across the Nation (SWAN) includes urinary incontinence (UI) questionnaire items. We introduced an independently self-administered paper towel test (PTT-ISA; invention disclosure #2021-347) to objectively demonstrate UI. Aims were to determine: (1) PTT-ISA compliance and (2) relationship to questionnaire results. Methods 276 community women were invited to complete both SWAN questionnaire and PTT-ISA. For PTT-ISA, a woman holds a trifold brown paper towel against her perineum while coughing hard three times. She checks the towel for wetness and compares it with pictorial showing wetted area gradations (dry towel through >6 ml/saturated). She then selects the best photo match for her towel. A newly conceptualized variable constructed as PTT-ISA plus questionnaire results was formed. Results Of 276 women, noncompliance with PTT-ISA was 2.2% (6 women). Four others (1.5%) were missing questionnaires. For the remaining 266 women, conceptual cohesiveness between questionnaire-only and PTT-ISA + questionnaire was demonstrated in 165 (62.0%). Lack of cohesiveness occurred in 101 (38.9%), including 41 women who said "no" to the questionnaire item indicative of stress UI and had leakage on PTT-ISA; leakage degree varied across the full pictorial spectrum from drops to saturated. Conclusion PTT-ISA demonstrates high compliance, with rate comparable to survey compliance. It is a novel measure for objective sign of urine loss when independently self-administered by community women outside of a clinic environment. Further research comparing PTT-ISA with clinician-observed cough test is warranted. As independently self-administered, PTT-ISA is simple, noninvasive, inexpensive, and an acceptable test that adds value to otherwise survey-dependent research.

Background Olanedine solution is a new antiseptic, and several cases of allergic contact dermatitis caused by the agent were reported in 2018; however, these cases were diagnosed based on positive results in 2-day closed patch testing of Olanedine solution "as is." Objectives To present another case of Olanedine-induced allergic contact dermatitis and to analyze the optimal patch-testing method for this condition. Methods A 34-year-old Japanese female patient and 25 healthy control subjects were patch tested using wet filter paper, which had been treated with 15 μL Olanedine solution, and dried filter paper, which had been treated with 15 μL Olanedine solution and then dried. Results The patient and all of the control subjects exhibited false-positive reactions due to irritation in the 2-day closed patch tests with wet filter paper containing Olanedine solution "as is." The tests with dried filter paper produced a positive reaction on day 7 in the patient, and negative reactions in all control subjects. Conclusions It is preferable to perform 2-day closed patch tests using filter paper with the test solution "as is," which had been dried before application in order to correctly diagnose antiseptic-induced allergic contact dermatitis.

Biologicals have transformed the management of severe disease phenotypes in asthma, atopic dermatitis, and chronic spontaneous urticaria. As a result, the number of approved biologicals for the treatment of atopic diseases is continuously increasing. Although atopic diseases are among the most common diseases in the reproductive age, investigations, and information on half-life, pharmacokinetics defining the neonatal Fc receptors (FcRn) and most important safety of biologicals in pregnancy are lacking. Given the complex sequence of immunological events that regulate conception, fetal development, and the intrauterine and postnatal maturation of the immune system, this information is of utmost importance. We conducted a systematic review on biologicals in pregnancy for indications of atopic diseases. Evidence in this field is scare and mainly reserved to reports on the usage of omalizumab. This lack of evidence demands the establishment of a multidisciplinary approach for the management of pregnant women who receive biologicals and multicenter registries for long-term follow-up, drug trial designs suitable for women in the reproductive age, and better experimental models that represent the human situation. Due to the very long half-life of biologicals, pre-conception counseling, and health care provider education is crucial to offer the best care for mother and fetus. This position paper integrates available data on safety of biologicals during pregnancy in atopic diseases via a systematic review with a detailed review on immunological considerations how inhibition of different pathways may impact pregnancy.

Perinatal depression can have enduring adverse effects on women and their children and families, incurring substantial ongoing economic and personal costs. A significant proportion of the cost of perinatal depression relates to adverse impacts on the child, most likely mediated through impairment to the mother-infant relationship. In recognition of this problem, Australia has invested in routine perinatal depression screening. Our previous research produced convergent findings suggesting that expected benefits for children have not yet been realised through perinatal depression screening. We question the potential of including a measure of personality in current perinatal depression screening for identifying maternal mental health problems and suboptimal mother-infant relationships. This paper reviews our previous research findings within the broader context of perinatal depression screening. We propose a position, that perinatal depression screening in Australia should be redesigned to more precisely detect vulnerable mother-infant relationships, parenting, maternal mental health, and infant psychosocial and psychological development. Practice change to appropriately target antenatal interventions may more efficiently improve both maternal and child outcomes, thereby contributing to greater efficiency and cost savings for the health system.

The World Association for Infant Mental Health (WAIMH) decided to compose a position paper on infants' rights in wartime, as there is still a general lack of attention paid to the impact of war-related traumas on infants' development and psychological health. Though there are numerous areas of violent conflicts around the globe, there have been few published studies that relate specifically to infants. Consequently, humanitarian aid programs tend to overlook infants' psychological needs and to pay more attention to those of older children. This position paper first reviews the studies identified through a literature search, about the impact of war-related traumas during pregnancy and postnatal periods, then describes the existing recommendations that have been added to the Children Rights Convention and their implications for infant mental health clinicians.

Anticholinergic medications are widely used in the treatment of overactive bladder (OAB), as well as for short-term treatment of bladder symptoms following a variety of urologic surgeries. Mounting evidence points to an association between anticholinergic medications and the increased risk of incident dementia. The Society for Urodynamics, Female Pelvic Medicine, and Urogenital Reconstruction (SUFU) thus convened a committee of subject experts to contextualize the current understanding of the cognitive risks of anticholinergic medications in the urologic patient population and to provide practical clinical guidance on this subject.Statements are based on an expert literature review and the committee's opinion. The document has been reviewed and approved by the SUFU board.Chronic use (gt;3 months) of OAB anticholinergic medications is likely associated with an increased risk of new-onset dementia. Short-term (lt;4 weeks) use of most OAB anticholinergic medications is likely safe in most individuals. Clinicians should consider potential cognitive risks in all patient populations when prescribing OAB anticholinergics for chronic use. Consideration should be given to progressing to advanced therapy (botulinum toxin or neuromodulation) earlier in the OAB treatment paradigm CONCLUSIONS: The current body of literature supports a likely small but significant increased risk of dementia with chronic exposure to OAB anticholinergic medications. Potential harms should be balanced against potential quality of life improvement with treatment.

Background Inpatient nursing documentation facilitates multi‐disciplinary team care and tracking of patient progress. In both high‐ and low‐ and middle‐income settings, it is largely paper‐based and may be used as a template for electronic medical records. However, there is limited evidence on how they have been developed. Objective To synthesise evidence on how paper‐based nursing records have been developed and implemented in inpatient settings to support documentation of nursing care. Design A scoping review guided by the Arksey and O'Malley framework and reported using PRISMA‐ScR guidelines. Eligibility criteria We included studies that described the process of designing paper‐based inpatient records and excluded those focussing on electronic records. Included studies were published in English up to October 2019. Sources of evidence PubMed, CINAHL, Web of Science and Cochrane supplemented by free‐text searches on Google Scholar and snowballing the reference sections of included papers. Results 12 studies met the eligibility criteria. We extracted data on study characteristics, the development process and outcomes related to documentation of inpatient care. Studies reviewed followed a process of problem identification, literature review, chart (re)design, piloting, implementation and evaluation but varied in their execution of each step. All studies except one reported a positive change in inpatient documentation or the adoption of charts amid various challenges. Conclusions The approaches used seemed to work for each of the studies but could be strengthened by following a systematic process. Human‐centred Design provides a clear process that prioritises the healthcare professional's needs and their context to deliver a usable product. Problems with the chart could be addressed during the design phase rather than during implementation, thereby promoting chart ownership and uptake since users are involved throughout the design. This will translate to better documentation of inpatient care thus facilitating better patient tracking, improved team communication and better patient outcomes. Relevance to clinical practice Paper‐based charts should be designed in a systematic and clear process that considers patient's and healthcare professional's needs contributing to improved uptake of charts and therefore better documentation.

It is well-established that food proteins, such as egg, soya, cow's milk and wheat, are detectable in breastmilk for many hours or days after ingestion. Exposure to these proteins is important to the process of developing tolerance but can also sometimes elicit IgE-mediated and non-IgE-mediated allergic symptoms in breastfed infants. Non-IgE-mediated allergy, outside of food protein-induced allergic proctocolitis and eosinophilic oesophagitis, is not well understood, leading to variations in the diagnosis and management thereof. A primary objective of the European Academy for Allergy and Clinical Immunology is to support breastfeeding in all infants, including those with food allergies. A Task Force was established, to explore the clinical spectrum of non-IgE-mediated allergies, and part of its objectives was to establish diagnosis and management of non-IgE-mediated allergies in breastfed infants. Eight questions were formulated using the Patient, Intervention, Comparison, Outcome (PICO) system and Scottish Intercollegiate Guideline Network (SIGN) criteria for data inclusion, and consensus was achieved on practice points through the Delphi method. This publication aims to provide a comprehensive overview on this topic with practice points for healthcare professionals.

The coronavirus disease 2019 (COVID‐19) pandemic is a case that can be used as a biochemistry learning resource in relation to the topic of viruses. Learning to use cases will be effective if students are assigned to produce reports, articles, or other scientific papers. Self‐assessment can be used to assess the competencies that have been learnt in the writing process. This study aims to analyze the scientific papers and self‐assessment of students using the COVID‐19 pandemic case. It includes qualitative research with scientific paper and self‐assessment questionnaire analyses. The research sample was chemistry education study program students (N = 57) following biochemistry course, out of a population of 87 students. The results show that the students have a good understanding of explaining COVID‐19. Self‐assessment analysis shows that 80% of the students responded positively to eight statements; those who gave positive responses to each questionnaire statement were able to produce scientific papers. Good self‐assessment is in line with the ability of students to compile good scientific papers.

Objective Understanding the impact different journal articles have in any academic field is important - particularly in emerging professions. A bibliometric analysis like this does not yet exist for paramedicine, despite the rapid increase in its primary literature. The objective of the present study was to identify and analyse the 100 top-cited articles about paramedicine. Methods We searched the Scopus database in August 2020 for studies relating to paramedicine. After screening titles and abstracts, we extracted the citation count, journal name, publication year, and country of origin. We manually assessed whether the study was clinical or not, noted the sex of the authors, the profession of first and last authors and the study design used. Results The median citation count for the top 100 papers in paramedicine was 58 (interquartile range 46-84 citations). The articles were published across 48 different journals, with Resuscitation and Prehospital Emergency Care being the two most frequent. The top-cited paramedic papers originated from 16 different countries and were written predominantly by medical doctors. Three quarters (73%) of the studies had a clinical focus, and a quarter (26%) were randomised controlled trials. Conclusions The evolution of paramedicine towards professionalism is backed up by the growth of its own body of knowledge. This analysis of the 100 most cited studies in paramedicine is the first of its kind and highlights that paramedicine articles have a high citation count and are published across numerous journals, but with a relative lack of contribution from paramedic practitioners and female researchers.

Machine learning, a branch of artificial intelligence, is increasingly used in health research, including nursing and maternal outcomes research. Machine learning algorithms are complex and involve statistics and terminology that are not common in health research. The purpose of this methods paper is to describe three machine learning algorithms in detail and provide an example of their use in maternal outcomes research. The three algorithms, classification and regression trees, least absolute shrinkage and selection operator, and random forest, may be used to understand risk groups, select variables for a model, and rank variables’ contribution to an outcome, respectively. While machine learning has plenty to contribute to health research, it also has some drawbacks, and these are discussed as well. In order to provide an example of the different algorithms’ function, they were used on a completed cross-sectional study examining the association of oxytocin total dose exposure with primary cesarean section. The results of the algorithms are compared to what was done or found using more traditional methods.

Gender disparities in scientific publications have been identified in oncological research. Oral research presentations at major conferences enhance visibility of presenters. The share of women presenting at such podia is unknown. We aim to identify gender‐based differences in contributions to presentations at two major oncological conferences. Abstracts presented at plenary sessions of the American Society of Clinical Oncology (ASCO) Annual Meetings and European Society for Medical Oncology (ESMO) Congresses were collected. Trend analyses were used to analyze female contribution over time. The association between presenter's sex, study outcome (positive/negative) and journals' impact factors (IFs) of subsequently published papers was assessed using Chi‐square and Mann–Whitney U tests. Of 166 consecutive abstracts presented at ASCO in 2011–2018 (n = 34) and ESMO in 2008–2018 (n = 132), 21% had female presenters, all originating from Northern America (n = 17) or Europe (n = 18). The distribution of presenter's sex was similar over time (p = 0.70). Of 2,425 contributing authors to these presented abstracts, 28% were women. The proportion of female abstract authors increased over time (p, What's new? Presenting one's research at a conference is a great way to get your name and ideas heard within the professional community. In this study, the authors investigated how often women served as presenters at plenary sessions of ASCO Annual Meetings and ESMO Congresses. Looking through 166 abstracts over a period of 8 years, they found that 21% had female presenters, while 28% of study authors were female. Lack of visibility for female researchers at conferences can slow their career progress, and greater representation should be encouraged.

Structural differences (congenital anomalies) in the makeup of the baby's heart, brain and other organs are found on antenatal ultrasound scans in up to 3% of pregnancies. These often have a genetic cause, arising because of changes in the chromosomes (which store our genetic material) or the DNA code that make up the genes. The more differences a baby has the more likely the risk of underlying genetic disease. If a structural difference is found, parents are usually offered a genetic test, which may be carried out on cells taken either from the placenta (chorionic villous sampling) or the fluid surrounding the baby (amniocentesis). At the moment, these cells are only tested for changes in the chromosomes and are only able to reveal the underlying cause in about 40% of unborn babies. Prenatal exome sequencing (ES) is a new genetic test, which, when combined with testing the DNA of both parents can find changes in the baby's genetic code. If a DNA change is found that can explain the structural changes seen on ultrasound, specific information about the underlying diagnosis can be given to the parents. Having this information can help parents make important decisions about their ongoing pregnancy, as well as help doctors to care for the mother and baby. Finding a genetic change can also help to understand how the condition has arisen and whether it might happen again in another pregnancy. It may also be possible to test for the genetic condition in future pregnancies. Although prenatal ES is an exciting new way to improve diagnosis rates for structural differences, it has some challenges. While the test is very detailed, it may not always find a genetic explanation and sometimes the results are difficult to interpret. For example, genetic changes can be found where their significance for the pregnancy is unclear. More recently, two studies have now shown that prenatal ES can find a genetic diagnosis in at least 10% of pregnancies with structural differences where standard chromosome testing has been negative. This paper reviews these studies, along with earlier evidence on ES and provides clinicians with guidance for future practice.

ACL injuries place the knee at risk for post-traumatic osteoarthritis (PTOA) despite surgical anterior cruciate ligament (ACL) reconstruction. One parameter thought to affect PTOA risk is the initial graft tension. This randomized controlled trial (RCT) was designed to compare outcomes between two graft tensioning protocols that bracket the range commonly used. At 7 years postsurgery, we determined that most outcomes between the two tension groups were not significantly different, that they were inferior to an uninjured matched control group, and that PTOA was progressing in both groups relative to controls. The trial database was also leveraged to gain insight into mechanisms of PTOA following ACL injury. We determined that the inflammatory response at the time of injury undermines one of the joint's lubricating mechanisms. We learned that patients continue to protect their surgical knee 5 years postinjury compared to controls during a jump-pivot activity. We also established that presurgical knee function and mental health were correlated with symptomatic PTOA at 7 years, that there were specific anatomical factors associated with poor outcomes, and that there were no changes in outcomes due to tunnel widening in patients receiving hamstring tendon autografts. We also validated a magnetic resonance imaging technique to noninvasively assess graft strength. In conclusion, the RCT determined that initial graft tensioning does not have a major influence on 7-year outcomes. Therefore, surgeons can reconstruct the ACL using a graft tensioning protocol that is within the window of the two graft tensioning techniques evaluated in this RCT.

Objective Although self-monitoring is an important part of eating disorder treatment, non-adherence is commonly observed among patients asked to maintain paper food records. This study aims to compare the efficacy and acceptability of electronic self-monitoring via Recovery Record to self-monitoring via traditional paper records, in an intensive outpatient (IOP) eating disorder treatment for adults. Method Ninety patients were recruited from an IOP eating disorder clinic and randomly assigned to the experimental or control condition. Those in the control condition received the standard treatment delivered by the IOP programme, including the use of paper records for self-monitoring. Those in the experimental condition received the same treatment but used Recovery Record for self-monitoring. Results The results did not demonstrate statistically significant group differences over time on eating disorder symptomatology, and there were no statistically significant group differences on acceptability or adherence. Conclusions Our pilot efficacy data do not support superiority of the app over paper records in an IOP setting, so proceeding to a larger efficacy trial is not warranted. Future studies should aim to determine whether the app is efficacious as an adjunct to less intensive treatment or to further explore adherence and acceptability outcomes in studies with larger sample sizes. Clinical trial registration ClinicalTrials.gov Identifier: NCT02484794.

BACKGROUND Computerized methods to analyze pain drawings (PDs) have been developed and may aid to measure the pain area more precisely. OBJECTIVE The aim of this study was to verify whether examiners can reproduce the patient's PDs with acceptable reliability. METHODS This was an intra-rater and inter-rater reliability study. The protocol consisted of 4 steps: (1) scanning of paper PDs; (2) sharing the digitalized PD images between examiners; (3) reproducing the PD images in the sketching application; and (4) calculating the pain area in pixels and percentages. We calculated intraclass correlation coefficients (ICCs; 2,1), the standard error of the measurement (SEM), and the smallest detectable difference (SDD). RESULTS Reliability was tested using 31 PDs from 17 patients in our database (11 female [64.7%], mean age: 53.23 ± 11.57 years). Intra-rater reliability varied from ICC (2,1) = 0.991 (95% confidence interval [CI] = 0.982 to 0.996; SEM = 3,432.45; SDD = 162.39 pixels; P

This Good Practice Paper was compiled according to the British Society for Haematology (BSH) process at http://www.b-s-h.org.uk/guidelines. The BSH produces Good Practice Papers to recommend good practice in areas where there is a limited evidence base but for which a degree of consensus or uniformity is likely to be beneficial to patient care. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) nomenclature was used to evaluate levels of evidence and to assess the strength of recommendations. The GRADE criteria can be found at http://www.gradeworkinggroup.org and is also detailed in Table 1.

Several eusocial wasps are prominent invaders to remote islands. The paper wasp Polistes chinensis antennalis is native to East Asia, was introduced to New Zealand in 1979 and has expanded its distribution there. This provides an excellent opportunity to examine the impacts of an initial bottleneck and subsequent expansion on genetic structure. We analysed and compared the genetic population structures of the native (Japan and South Korea) and invasive New Zealand populations. Although 94% of individuals had shared haplotypes detected across both populations, the remaining 6% had private haplotypes identified in only one of the three countries. The genetic variation at microsatellite loci was lower in New Zealand than in native countries, and the genetic structure in New Zealand was clearly distinct from that in its native range. Higher frequencies of diploid-male- and triploid-female-producing colonies were detected in New Zealand than in the native countries, showing the reduction in genetic variation via a genetic bottleneck. At least two independent introductions were suggested, and the putative source regions for New Zealand were assigned as Kanto (central island) and Kyushu (south island) in Japan. Serial founder events following the initial introduction were also indicated. The estimated dispersal distance between mother and daughter in New Zealand was twice that in Japan. Thus, the introduction history of P. chinensis antennalis in New Zealand is probably the result of at least two independent introductions, passing through a bottleneck during introduction, followed by population expansion from the point of introduction.

Background Global Doctors for Choice—a transnational network of physician advocates for reproductive health and rights—began exploring the phenomenon of conscience-based refusal of reproductive healthcare as a result of increasing reports of harms worldwide. The present White Paper examines the prevalence and impact of such refusal and reviews policy efforts to balance individual conscience, autonomy in reproductive decision making, safeguards for health, and professional medical integrity. Objectives and search strategy The White Paper draws on medical, public health, legal, ethical, and social science literature published between 1998 and 2013 in English, French, German, Italian, Portuguese, and Spanish. Estimates of prevalence are difficult to obtain, as there is no consensus about criteria for refuser status and no standardized definition of the practice, and the studies have sampling and other methodologic limitations. The White Paper reviews these data and offers logical frameworks to represent the possible health and health system consequences of conscience-based refusal to provide abortion; assisted reproductive technologies; contraception; treatment in cases of maternal health risk and inevitable pregnancy loss; and prenatal diagnosis. It concludes by categorizing legal, regulatory, and other policy responses to the practice. Conclusions Empirical evidence is essential for varied political actors as they respond with policies or regulations to the competing concerns at stake. Further research and training in diverse geopolitical settings are required. With dual commitments toward their own conscience and their obligations to patients’ health and rights, providers and professional medical/public health societies must lead attempts to respond to conscience-based refusal and to safeguard reproductive health, medical integrity, and women's lives.

The present clinical study aimed to investigate if there are differences in microbiological outcomes dependent on the subgingival biofilm collection method. Subgingival biofilm samples were collected from the four deepest pockets (>5 mm) of 17 patients with aggressive periodontitis (AgP) and 33 patients with chronic periodontitis (CP), first by paper point and thereafter by curette. Samples obtained with the same method were pooled together from each patient and forwarded for molecular microbiological analysis by a commercially available assay (IAI Pado Test 4.5) that estimates total bacterial load and levels of Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Aggregatibacter actinomycetemcomitans. Data analysis included frequency of detection, quantification and correlation of detection levels between the two sampling methods. P. gingivalis, T. forsythia and T. denticola were detected in >90% of the samples, and their detection levels exhibited a strong correlation between sampling methods. The detection consistency of A. actinomycetemcomitans was 56% between the two sampling methods. A. actinomycetemcomitans was more readily detected by paper point compared with curette collection with a stronger correlation between the two methods in AgP. Subgingival biofilm sampling by curette or paper point does not yield differences in the detection of the three 'red complex' species. However, A. actinomycetemcomitans was more consistently detected by means of paper point collection, which can be crucial in the decision to administer antibiotics as an adjunctive periodontal treatment.

Adverse effects of pulp and paper mill effluent on fish populations have been well documented in many countries over the last two decades. Some of the initial studies were at mills with conventional chlorine bleaching and no secondary effluent treatment. Following installation of secondary treatment, changes in bleaching technology to elemental chlorine-free bleaching, and other process changes, adverse effects on fish were reduced or eliminated at some mills. Because no two mills are exactly alike, it is difficult to predict adverse impacts of any given mill on fish populations. In 1994, a study of female white sucker (Catostomus commersoni) in the Androscoggin River, Maine, USA, showed induction of mixed function oxidase, reductions in gonad size and plasma estradiol, and an increase in plasma testosterone in fish downstream of discharges from three large bleached kraft pulp and paper mills, and host community municipal sewage treatment plants (STP). After all three mills switched to elemental chlorine-free bleaching in the late 1990s, studies from 2001 to 2003 found that the pattern of reproductive impacts on white sucker populations measured in 1994 was not repeated. In addition, population estimates of white sucker from 2002 to 2003 using mark–recapture techniques found that densities and biomass were well within the range of those of a reference population, and of those reported in the literature for unimpacted populations. Detailed studies immediately above and below each mill/sewage treatment plant showed no evidence of reproductive effects. However, a clear pattern of eutrophication was noted, which increased cumulatively downstream below each mill/STP. Environ. Toxicol. Chem. 2011;30:142–153. © 2010 SETAC

Although effluent treatment systems within pulp and paper mills remove many toxicants and improve wastewater quality, there is a need to understand and quantify the effectiveness of the treatment process. At a combined news and kraft pulp and paper mill in northwestern Ontario, Canada, fathead minnow (FHM) reproduction and physiology were examined before, during, and after a short-term (6-d) exposure to 10% (v/v) untreated kraft mill effluent (UTK), 25% (v/v) secondary treated kraft mill effluent (TK), and 100% (v/v) combined mill outfall (CMO). Although UTK exposure significantly decreased egg production, neither TK nor CMO caused any reproductive changes. The expression of six genes responsive to endocrine-disrupting compounds, stress, or metals was then examined in livers of these fish using real-time polymerase chain reaction. In female FHMs, none of the three effluents induced significant expression changes in any genes investigated. By contrast, in males there were significant increases in the mRNA levels of androgen receptor, estrogen receptor (ER) β, and cytochrome P4501A (CYP1A) upon UTK and TK exposure but no changes in ERα or vitellogenin (VTG) gene expression, whereas CMO exposure significantly increased the mRNA levels of ERα, VTG, and CYP1A. Together, these results suggest that kraft effluent before and after biological treatment contained compounds able to induce androgenic effects in FHMs, and that combination of kraft and newsmill effluents eliminated the androgenic compounds while inducing distinct and significant patterns of gene expression changes that were likely due to estrogenic compounds produced by the newsmill. Environ. Toxicol. Chem. 2010;29:430–439. © 2009 SETAC

The American Society of Hypertension is publishing a series of Position Papers in their official journals throughout the 2008 - 2009 years. The following Position Paper originally appeared: JASH. 2008;2(6):484–494. Hypertension complicates 5% to 7% of all pregnancies. A subset of preeclampsia, characterized by new-onset hypertension, proteinuria, and multisystem involvement, is responsible for substantial maternal and fetal morbidity and is a marker for future cardiac and metabolic disease. This American Society of Hypertension, Inc (ASH) position paper summarizes the clinical spectrum of hypertension in pregnancy, focusing on preeclampsia. Recent research breakthroughs relating to etiology are briefly reviewed. Topics include classification of the different forms of hypertension during pregnancy, status of the tests available to predict preeclampsia, and strategies to prevent preeclampsia and to manage this serious disease. The use of antihypertensive drugs in pregnancy, and the prevention and treatment of the convulsive phase of preeclampsia, eclampsia, with intravenous magnesium sulfate is also highlighted. Of special note, this guideline article, specifically requested, reviewed, and accepted by ASH, includes solicited review advice from the American College of Obstetricians and Gynecologists.

Background Malignant diseases but also cardiovascular and respiratory disorders and diabetes mellitus have been associated with work in pulp and paper production. The present cohort focuses on cardiovascular mortality in relation to various exposures in this industry. Methods The cohort, followed-up for mortality, includes 7,107 workers, 6,350 men and 757 women, from three major old mills in the middle of Sweden. Results Instead of a healthy-worker effect, a slightly increased risk for death in diseases of the circulatory system was found for male workers. Notably, work with sulfate digestion, steam and power generation and maintenance was associated with significantly increased risks. Cerebrovascular diseases showed non-significantly increased risks for maintenance and paper and paperboard production and manufacture. Conclusions The differences in risk among various parts of the production are striking although it is hard to pinpoint any specific exposures. Dust and small particles along with sulfur compounds might be suspected.

The Canadian environmental effects monitoring (EEM) program is a regulated, cyclical, industry-funded program designed to determine whether receiving water impacts exist when a mill is in compliance with its discharge limits. The results from three cycles of the fish monitoring program (1992 to 2004) are available from over 200 surveys of fish compared between sites located upstream and downstream of pulp and paper mill effluent outfalls. Previous meta-analyses have shown a national average response pattern across cycles characterized by an increase in endpoints measuring energy storage and growth and a decrease in a reproductive endpoint, consistent with a response of nutrient enrichment in combination with some form of metabolic disruption. Although the national average pattern of effects was temporally consistent, there was some variability in the magnitude of effects among cycles. Questions were raised as to whether the intercycle variability was due to changes in effluent quality or due, at least in part, to other factors. The present study compares responses over the first three cycles, and shows that the choice of sentinel species is likely to be a major contributing factor to the variability in observed effects. Subset analyses using studies from mills that used the same sentinel species across cycles reveal fairly uniform responses and little evidence of significant improvements in overall fish health from cycles one to three. However, a meta-analysis using 1991 data collected from 10 mills before the implementation of the EEM program and data from the same mills collected during cycles one to three of the program reveal significantly reduced effects on relative liver weight and potential improvements in other endpoints. Environ. Toxicol. Chem. 2010;29:440–452. © 2009 SETAC

Non

Aim The aim of this paper is to discuss the importance of ethical aspects when implementing eHealth services in healthcare. Background Challenges in healthcare today include a growing older population and, as a consequence, an increased need for healthcare services. One possible solution is the use of eHealth services. Design Discussion paper. Data sources Research literature published from 2000 - 2017 in CINAHL, PubMed and Scopus. Implications for nursing Implementing eHealth services in healthcare involves ethical challenges where different technologies can solve different problems in different ways. eHealth services should therefore be developed and implemented based on the patient's specific needs and conditions for use and in accordance with the healthcare professionals’ presumption to provide high quality care. Conclusion To preserve patients’ integrity, dignity and autonomy, healthcare professionals must include ethical aspects when implementing and using eHealth services in healthcare. Healthcare professionals have to take responsibility for the eHealth services introduced, explaining why and how they are implemented based on a person-centered approach. More knowledge is needed about ethical aspects when implementing eHealth services to improve the quality of care. This article is protected by copyright. All rights reserved.

The collection of subgingival plaque samples with paper points is time-consuming and accident-sensitive. However, the collection of saliva is simple and contains pathogens of all intraoral surfaces. The aim of this study is to investigate whether a sampling strategy with mouthrinse (mouthrinse sample [MSP]; test) leads to results comparable with standard sampling method (multiple site test from the deepest pocket of each quadrant [MT4]; control).In 50 patients with periodontitis, subgingival plaque was sampled from the deepest pocket of each quadrant by using paper points and by gaining saliva with saline mouthrinse. Analysis was performed using a commercially available polymerase chain reaction test for 11 periodontal pathogens.Detection frequency of Aggregatibacter actinomycetemcomitans (MT4/MSP: 42%/36%), Porphyromonas gingivalis (78%/66%), Tannerella forsythia (98%/84%), Treponema denticola (94%/74%), Parvimonas micra (86%/62%), Campylobacter rectus (90%/76%), Eubacterium nodatum (64%/30%), Prevotella intermedia (58%/54%), and Eikenella corrodens (90%/82%) was higher with MT4 than MSP. For Fusobacterium nucleatum (100%/100%), there was no difference between test and control. Only detection frequency of Capnocytophaga species (68%/74%) was higher with MSP than MT4. Differences were significant for P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum.There is no significant difference between MT4 and MSP for detection frequency of key pathogen A. actinomycetemcomitans. Key pathogens P. gingivalis, T. forsythia, T. denticola, P. micra, C. rectus, and E. nodatum show statistically higher detection frequencies with MT4.

Explaining the evolution of helping behaviour in the eusocial insects where non-reproductive ('worker') individuals help raise the offspring of other individuals ('queens'), remains one of the most perplexing phenomena in the natural world. Polistes paper wasps are popular study models, as workers retain the ability to reproduce: such totipotency is likely representative of the early stages of social evolution. Polistes is thought to have originated in the tropics, where seasonal constraints on reproductive options are weak and social groups are effectively perennial. Yet, most Polistes research has focused on non-tropical species, where seasonality causes family groups to disperse; cofoundresses forming new colonies the following spring are often unrelated, leading to the suggestion that direct fitness through nest inheritance is key in the evolution of helping behaviour. Here we present the first comprehensive genetic study of social structure across the perennial nesting cycle of a tropical Polistes - Polistes canadensis. Using both microsatellites and newly-developed single-nucleotide polymorphism (SNP) markers we show that adult cofoundresses are highly related, and that brood production is monopolised by a single female across the nesting cycle. Non-reproductive cofoundresses in tropical Polistes therefore have the potential to gain high indirect fitness benefits as helpers from the outset of group formation, and these benefits persist through the nesting cycle. Direct fitness may have been less important in the origin of Polistes sociality than previously suggested. These findings stress the importance of studying a range of species with diverse life-history and ecologies when considering the evolution of reproductive strategies.

Objectives: Immunoglobulin A dominates mucosal surfaces and is a biomarker of interest in populations with a high disease burden. The objectives of this work are to describe an ELISA for IgA and test the stability of storage on filter paper for human milk and saliva collection to be used in remote field locations. Methods: A two-site sandwich ELISA for IgA was developed. To test filter paper storage capabilities under field conditions, 248 matched whole and dried human milk filter paper samples and 251 matched whole and dried saliva samples were collected from northern Kenyan women. Whole samples were frozen in liquid nitrogen while dried samples were stored at ambient temperature for up to 8 weeks. Recovered dried IgA levels were compared to whole IgA levels and adjusted for time stored at ambient temperature. Results: The lower limit of quantification for this assay is 10.1 ng/ml. Linearity of dilution for human milk and saliva samples was excellent. High and low-control coefficient of variation values across plates were 9.1 (341.8 ng/ml) and 9.4% (132.5 ng/ml). IgA was detected in all whole and dried samples. There is a moderate concordance between dried and whole samples (R2 = 0.62). There is a small but significant effect of time stored, with a loss of ∼1 μg/ml per day (P = 0.0052). Conclusions: This IgA assay is a cost-effective alternative to commercial secretory IgA kits. Human milk and saliva can be stored on filter paper for up to 8 weeks. Am. J. Hum. Biol., 2011. © 2011 Wiley-Liss, Inc.

Aim: To investigate the repeatability of a short stress test of coughing and jumping (the expanded Paper Towel Test (PTT)) to quantify urine loss in stress incontinent adult women. Materials and Methods: In the laboratory, the reliability of two methods of measuring the size of the wet area, produced by a typical volume of water titrated onto paper towel was investigated and some absorbency properties of the brand of towel used were quanti¢ed. Thirty one women performed a provocative coughing and jumping test on consecutive days using a ‘‘perineal pad’’ of paper towel. The repeatability coe⁄cient was calculated. Results: The provocative test was repeatable to within 2.8 ml of urine loss, but with the exclusion of one anomalous result, the repeatability improved to lie within 1 ml. The coe⁄cient of variation (CV) for the between-method diierences (computer scanning and graph paper) was 1.27%. A volume of 1 ml of water produced a wet area of 25.7 cm 2 . The range of measurable areas corresponded to volumes of 0.005 ^ 8 ml. Standardization of method is required because the size of the wet area diiered by manufacturer of paper towel (P < 0.01, two products compared) and with time elapsed since titration (P < 0.01). Conclusions: The ‘‘expanded PTT’’ is a simple tool for quanti¢cation of urine loss (0.005 ^ 8 ml) in women to 72 years with stress incontinence. With a suggested modi¢cation, it should prove reliable for detection of between-visit diierences of 1 ml. The reliability of the test is dependent upon the use of standard protocol and paper towel with known volume ^area ratio. To improve clinical diagnosis, it can also be used with any brand of paper towel to con¢rm the sign of stress incontinence on exertion. Neurourol. Urodynam. 23:649 ^655, 2004. 2004 Wiley-Liss, Inc.

Pulp and paper mill effluents were examined for in vitro androgenicity using a recombinant yeast-based androgen receptor assay. Low levels of androgenic effects were detected in extracts of some effluents after activated sludge treatment. Yeast cell growth cell was inhibited in some samples, and this interfered with the androgenic response. Solid-phase fractionation revealed androgenicity after partial separation of components in the effluents. Comparison of levels in untreated effluent and in effluent treated in an aerated lagoon showed that this treatment had only a marginal effect on androgenicity. An assay of the fractions eluted with increasing concentrations of methanol showed that androgenic compounds were low to moderately lipophilic. In an attempt to identify these compounds, a number of wood-related compounds (guaiacol, vanillin, β-sitosterol, betulin, pinosylvin-O-methyl ether, and a wood extract enriched in lignans) were examined but were found not to be androgenic. Raw process water was not androgenic, but water from a highly humified lake and process water from the production of pulp from partly decayed wood had low androgenicity. It therefore can be plausibly suggested that the androgens originated in decaying wood. An assay of androgenicity in the bile of juvenile rainbow trout exposed to effluents for 3 weeks showed increased dose-dependent levels of androgens after enzymatic hydrolysis of hormone conjugates. © 2004 Wiley Periodicals, Inc. Environ Toxicol 19: 510–517, 2004.

We compared the use of serum and filter paper blood spots as specimen sources for the detection of measles- and rubella-specific IgM and IgG. We collected capillary blood into microtainer tubes and onto filter paper spots from 60 children and 60 healthy adults. The blood was collected from 12-15-month-old children approximately 3 weeks after primary vaccination with measles, mumps, rubella vaccine, and the sample-pairs were tested for measles-specific IgM and IgG antibodies by using a capture antibody EIA and an indirect EIA, respectively. We tested sample-pairs from a subset of participants for rubella- specific IgM and IgG antibodies by using commercially available capture IgM (Captia) and indirect IgG (Wampole) assays. The concordance of results from serum and filter paper blood spots was high for all assays: 98% for measles IgM, 93% for measles IgG, 94% for rubella IgM, and 93% for rubella IgG, and increased to between 96-100% for all four assays when indeterminate samples were excluded. The correlation coefficients for EIA signals were 0.99 and 0.77 for measles IgM and IgG, respectively, and 0.92 and 0.94 for rubella IgM and IgG, respectively. The cut-off values used for filter paper samples were the same as those used for serum samples for all tests except for the rubella IgM assay. The use of filter paper blood spots is a promising future option for the detection of measles- and rubella-specific antibodies.

Objective This study was designed to evaluate the results of paper-patch myringoplasty in patients with chronic perforations of the tympanic membrane of different sizes. Study design and setting A retrospective survey of paper-patch myringoplasties performed in a tertiary referral academic medical center on 77 patients with chronic perforations of the eardrum was carried out. Data consisted of the causes of the perforations, time the perforations had been present, their size, number of patch applications, duration of application, and number of successfully closed perforations. Results Closure rate was 63.2%, 43.5%, and 12.5% for small, medium, and large perforations, respectively. Small perforations needed the least number of repeated applications and the least time for closure. Conclusions and significance Paper patching is technically simple, time saving, safe to perform, cost effective, and suitable as an outpatient procedure and has a good success rate, It should be tried in perforations smaller than 5 mm before a patient is referred for surgery.

Introduction: Measuring patient-perceived outcomes following orthopaedic procedures have become an important component of clinical research and patient care. General and disease-specific outcomes measures have been developed and applied in orthopaedics to assess the patients’ perceived health status. Unfortunately, paper-based, self-administered instruments remain inefficient for collecting data because of: (a) missing data (b) respondent error, and (c) the costs to administer and enter data. Objective: To study the comparability of palm-top computer devices and paper–pencil self-administered questionnaires in the collection of health-related quality of life (HRQL) information from patients. Methods: The comparability of administering HRQL questionnaires using palm-top computer and traditional paper-based forms was tested in a sample of 96 patients with complaints of hip and/or knee pain. Each patient completed mailed versions of the Medical Outcomes Study (MOS), 36-item Health Survey (SF-36), and Western Ontario and McMasters University Arthritis Index (WOMAC) three weeks prior to presenting to clinic. At the clinic they were asked to complete the same outcomes measures using the palm-top computer or a paper-and-pencil version. Analysis: In the analysis, scale distributions, floor and ceiling effects, internal consistency and retest reliability of scales were compared across the two data collection methods. Because the baseline characteristics of the groups were not strictly comparable according to age, the data were analyzed for the entire sample and stratified according to age. Results: Few statistically significant differences were found for the means, variances and intra-class correlation coefficients between the methods of administration. While the scale distribution between the two methods was comparable, the internal consistency of the scales was dissimilar. Conclusions: Administration of HRQL questionnaires using portable palm-top computer devices has the potential advantage of decreased cost and convenience. These data lend some support for the comparability of palm-top computers and paper surveys for outcomes measures widely used in the field of orthopaedic surgery. The present study identified the lack of reliability across modes of administration that requires further study in a randomized comparability trial. These mode effects are important for orthopaedic surgeons to appreciate before implementing innovative data-capture technologies in their practices.

Background The aim of the present study was to investigate cancer risk among women working in the Norwegian pulp and paper industry. The cohort included a total of 4,247 workers employed for at least one year between 1920 and 1993 (108,095 person-years), 85% of them as paper or administration workers. Methods The follow-up period for cancer was from 1953–1993. No data of exposure measurements were available. The analyses were based on comparisons of standard incidence ratios. The expected numbers of cancer cases were calculated using the five-year age-specific incidence rates for the entire female population. Results During the follow-up period, 380 new cases of cancer were observed vs. 322 expected (SIR = 1.2, 95% CI = 1.07–1.30). An excess risk of ovarian cancer was found (SIR = 1.5, 95% CI = 1.07–2.09). The SIR was highest among those younger than 55 years, and mostly among those working in paper departments. Short-term workers showed increased risk of lung and bladder cancer. Conclusions Based on results from the present study, the increased risk of ovarian cancer is difficult to interpret, since existing knowledge of its etiology is limited. However, these women might have been exposed to various work-related agents such as talc, microbes, and different types of paper dust. Am. J. Ind. Med. 36:108–113, 1999. © 1999 Wiley-Liss, Inc.

Background Numerous studies have indicated an increased risk of lung cancer in pulp and paper industry workers. In a 1990 survey, standardized mortality ratio (SMR) was found to be 122 (95% CI:96–153) for lung cancer in Polish male workers in the pulp and paper industry, and 166 (95% CI:95–270) among workers engaged in paper production. Methods A nested case-control design within a cohort of pulp and paper workers was applied. Seventy-nine lung cancer cases and 237 “healthy” controls were selected from the cohort of 10,460 workers employed during the years 1968–1990, and observed until the end of 1995. Based on personnel files, occupational exposure was reconstructed by experts. Using a questionnaire, data on smoking habits were collected. ORs unadjusted and adjusted for smoking were calculated applying the model of conditional logistic regression. Results Occupational exposure to inorganic dusts (kaolin, lime, cement, brick, grindstone) adjusted for smoking was a significant lung cancer risk factor, with a 4.0-fold risk (95% CI:1.3–12.6), and a dose-response by cumulative dose index. Among organic dusts only wood dust increased albeit insignificantly the risk for those exposed (adjusted for smoking OR = 2.1, 95% CI:0.9–4.9), but without dose-response relationship. Conclusions Exposure to occupational dust with relatively low content of silica, but at high concentrations may be considered as a factor increasing lung cancer risk. However, the observation made in this study should be viewed with caution as it was based on a small number of cases, and further evidence is needed to confirm or refute the authors' hypothesis. Am. J. Ind. Med. 39:547–556, 2001. © 2001 Wiley-Liss, Inc.

Aim A discussion of the concepts of leadership and emotional intelligence in nursing and midwifery education and practice. Background The need for emotionally intelligent leadership in the health professions is acknowledged internationally throughout the nursing and midwifery literature. The concepts of emotional intelligence and emotional-social intelligence have emerged as important factors for effective leadership in the healthcare professions and require further exploration and discussion. This paper will explore these concepts and discuss their importance in the healthcare setting with reference to current practices in the UK, Ireland and internationally. Design Discussion paper. Data sources A search of published evidence from 1990–2015 using key words (as outlined below) was undertaken from which relevant sources were selected to build an informed discussion. Implications for nursing/midwifery Fostering emotionally intelligent leadership in nursing and midwifery supports the provision of high quality and compassionate care. Globally, leadership has important implications for all stakeholders in the healthcare professions with responsibility for maintaining high standards of care. This includes all grades of nurses and midwives, students entering the professions, managerial staff, academics and policy makers. Conclusion This paper discusses the conceptual models of leadership and emotional intelligence and demonstrates an important link between the two. Further robust studies are required for ongoing evaluation of the different models of emotional intelligence and their link with effective leadership behaviour in the healthcare field internationally. This is of particular significance for professional undergraduate education to promote ongoing compassionate, safe and high quality standards of care.

Introduction The cohort of students enrolled in the discipline-specific bioscience paper reflects a structural diversity in that it includes students of multiple ethnicities, varied age groups, differing scholastic and life experiences. These divergent identities of students are known to influence academic performance. The purpose of this retrospective quantitative study was to determine the ability of a set of variables such as age, gender, ethnicity, level of prior education, the place from which prior education was obtained, work experience and prior academic achievement to predict academic performance in the discipline-specific bioscience paper. Method The sample for this study was a purposive sample of all oral health students who had enrolled in the paper at the Auckland University of Technology from 2011 to 2014. The desensitised empirical data of 116 students from the University's database were subject to multivariable regression analysis. Pearson's correlation coefficients were calculated. Results Prior academic achievement was a statistically significant predictor variable (P < 0.001) for the academic performance in the discipline-specific bioscience paper and was also positively correlated (r = 0.641, P < 0.001) to the grades in the discipline-specific bioscience paper. Conclusion Prior academic achievement was the only variable that was demonstrated to be correlated to and predictive of the academic performance in the discipline-specific bioscience paper.

Computer-assisted data collection offers advantages over traditional paper and pencil measures; however, little guidance is available regarding the logistics of conducting computer-assisted data collection with adolescents in group settings. To address this gap, we draw on our experiences conducting a multi-site longitudinal study of adolescent development. Structured questionnaires programmed on laptop computers using Audio Computer Assisted Self-Interviewing (ACASI) were administered to groups of adolescents in community-based and afterschool programs. Although implementing ACASI required additional work before entering the field, we benefited from reduced data processing time, high data quality, and high levels of youth motivation. Preliminary findings from an ethnically diverse sample of 265 youth indicate favorable perceptions of using ACASI. Using our experiences as a case study, we provide recommendations on selecting an appropriate data collection device (including hardware and software), preparing and testing the ACASI, conducting data collection in the field, and managing data.

Process and office workers at a Swedish paper mill (n + 274) and dairy workers (n + 45) were investigated with questionnaires regarding skin symptoms. In the second part of the study, subjects reporting skin symptoms and a random sample of subjects without symptoms were examined and investigated with patch testing. Pruritus and skin irritation probably related to exposure to dust were found. The results do not indicate an increased prevalence of contact allergy. In two cases, positive patch test reactions to paper size (rosin) and a slimicide, mercaptobenzothiazole (MBT), were noted. © 1993 Wiley-Liss, Inc.

With 'fake news' virulently disseminated on the internet, we should all be on the lookout for misleading or false information. In nursing, the doctrine of evidence-based practice depends on the quality of evidence, and research findings or theoretical argument should not be accepted uncritically, just because they appear in trusted journals. I raise this following an embarrassing hoax in the field of gender studies (Boghossian & Lindsay, 2017). This article is protected by copyright. All rights reserved.

A nonatopic female secretary developed hand dermatitis after I year of full-time work with telefax paper. Her dermatitis improved on sick leave and vacation and relapsed at work. Patch testing showed allergic reactions to several fragrances, balsam of Peru, colophony and neomycin. In 3 patch test sessions, her own telefax papers gave a doubtful reaction which persisted for 4 days, but it could not be determined whether the reactions were allergic or irritant. The colophony content of the telefax paper was about 1%, and it was possible that colophony in the telefax paper was responsible for the weak patch lest reactions. Accordingly, the contact dermatitis would have been allergic. The patient has now been relocated, does not handle telefax paper, and is symptomless. We concluded that our patient had an occupational hand contact dermatitis induced by telefax paper and possibly caused by coin phony allergy.

An over 2 x fold increase in para-aminoazobenzene allergy was observed in patients with allergic contact dermatitis during the years 1990-1991. Presuming that an increase in colour-printed newspapers might be a new unrecognized source of clinical allergy to azo dyes, patch tests were performed in 32 patients with an established p-aminoazobenzene allergy using a series of important azo dyes used in offset printing ink (Pigment Yellow 12, Pigment Yellow 13, Pigment Red 53, Pigment Red 57), as well as with dye-containing inks and specimens of colour-printed newspaper containing these azo dyes. In 25 out of the 32 patients (78%), positive patch tests were seen to textile azo dyes, in particular to Disperse Orange 3 (24 patients). In none of the 32 patients were reactions observed to the azo dyes used in printing ink, to the inks used or to the colour-printed paper specimens, indicating that these products were apparently not a cause of contact dermatitis in our group of patients with azo dye sensitization.

Oral health education and promotion are the connecting mechanisms among prevention, policy development and program implementation, maintenance and evaluation. Given the preventive procedures available today, all focus populations of women and children should have access to accurate information about such procedures as well as access to the procedures themselves. Furthermore, appropriate methodologies need to be utilized for community oral health education and these methods differ from those commonly used for individual education. In the context of maternal and child health there are unprecedented opportunities for new accomplishments in oral health. The health education model most appropriate for these groups is the public health model, an approach designed to empower as well as inform, and one that fosters shared decision making among community members and health professionals. Dental professionals have the responsibility to address this challenge, and to help correct the health information inequities that prevail, especially among the traditionally informationally disenfranchised subfocus populations discussed in this paper.

To explore how model building adapts to changing environments, we had participants play "rock-paper-scissors" against a computer that played a frequency bias or a player-dependent bias and then switched. Participants demonstrated their use of prior experience in how quickly they recognized and exploited changes in the computer's play strategy; in general, the more similar the strategies, the more efficient the updating. These findings inform our understanding of previously reported updating impairments in right-brain damaged patients.