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This work presents a unique approach to the design, fabrication, and characterization of paper-based origami robotic systems consisting of stackable pneumatic actuators. These paper-based actuators (PBAs) use materials with high elastic modulus-to-mass ratios, accordion-like structures, and direct coupling with pneumatic pressure for extension and bending. The study contributes to the scientific and engineering understanding of foldable components under applied pneumatic pressure by constructing stretchable and flexible structures with intrinsically nonstretchable materials. Experiments showed that a PBA possesses a power-to-mass ratio greater than 80 W/kg, which is more than four times that of human muscle. This work also illustrates the stackability and functionality of PBAs by two prototypes: a parallel manipulator and a legged locomotor. The manipulator consisting of an array of PBAs can bend in a specific direction with the corresponding actuator inflated. In addition, the stacked actuators in the manipulator can rotate in opposite directions to compensate for relative rotation at the ends of each actuator to work in parallel and manipulate the platform. The locomotor rotates the PBAs to apply and release contact between the feet and the ground. Furthermore, a numerical model developed in this work predicts the mechanical performance of these inflatable actuators as a function of dimensional specifications and folding patterns. Overall, we use stacked origami actuators to implement functionalities of manipulation, gripping, and locomotion as conventional robotic systems. Future origami robots made of paper-like materials may be suitable for single use in contaminated or unstructured environments or low-cost educational materials.

In recent decades, there has been a growing interest in the recycling of organic materials such as paper mill biosolids (PB) and biochar for use as soil amendments. However, the benefits of co-application of PB and biochar and its effects on soil phosphorus (P) availability remain unknown. An incubation study was conducted on two acidic soils to assess the effect of two PB types (2.5% w/w) co-applied with three rates (0%, 2.5%, and 5% w/w) of pine (Pinus strobus L.) biochar on soil P fractions. An unfertilized control and a mineral NP fertilizer were used as a reference. Soil P fractions were determined by Hedley procedure after 2 and 16 wk of incubation. Material fractionation indicated that the PB containing the highest total P and the lowest Al content had the highest proportion of labile P, whereas most P in the biochar was in a stable form. The incubation study revealed that the P-rich PB increased P availability in both soils to a level comparable to mineral fertilizer at the end of the incubation. The addition of biochar to PB, however, did not affect soil P availability, but the highest rate induced a conversion of P fixed to Al and Fe oxides towards recalcitrant forms, particularly in the sandy loam soil. We conclude that co-applying biochar and PB could be more beneficial than application biochar alone and soils amended with such a mixture would be expected to release part of their P slowly over a longer period of time.

The prevalence of diabetes has increased over the past years. Therefore, developing minimally invasive, user-friendly and cost-effective glucose biosensors is necessary especially in low-income and developing countries. Cellulose paper-based analytical devices have attracted the attention of many researchers due to affordability, not requiring trained personnel, and complex equipment. This paper describes a microfluidic paper-based analytical device for the detection of glucose in tear with the naked eye. The paper-based biosensor fabricated by laser CO2, and GOx/HRP enzymatic solution coupled with TMB was utilized as reagents. A sample volume of 10 µl was needed for the biosensor operation and the results were observable within 5 minutes. To evaluate the device performance, color intensity-based and distance-based results were analyzed by ImageJ and Tracker. Distance-based results showed a linear behavior in the range of 0.1–0.6 mM with an R2 = 0.967 and LOD of 0.2 mM. The results could be perceived by the naked eye without any need to further equipment or trained personnel in a relatively short time (3–5 minutes). Moreover, glucose concentration could be obtained non-invasively by tears collected by this µPAD.

Amending croplands with forest residues may help in restoring soil properties in fields subject to intensive land management. Despite their known benefits when applied separately, co-application of wood biochar with paper mill biosolids (PB) has seen little investigation under field conditions. A study was initiated in Québec, QC, Canada, to determine the effect of a single application of wood biochar with and without PB on the nitrogen (N) and phosphorus (P) availability of two pH-neutral to alkaline loamy soils. Biochar at 0, 10, and 20 Mg dry weight·ha−1 and PB at 30 Mg wet weight·ha−1 were applied before planting of corn (Zea mays L.) and soybean [Glycine max (L.) Merr.] in 2018. Residual effect of this co-application was determined under soybean and corn in the subsequent year. In both years, corn received supplemental N and P from mineral fertilizers according to local agronomic recommendations. Co-applying biochar and PB reduced soil NO3-N availability in the year of application and decreased corn yield by 1.0 Mg·ha−1 compared with biochar or PB applied alone, but these amendments did not affect soybean yields. In the following year, the previous biochar addition increased soybean yield by 0.6 Mg·ha−1 but had little effect on corn. For both years, biochar addition induced a large increase in soil Mehlich-3 P. This study revealed that wood biochar positively impacted P status of these soils but was not a source of N to crops even when co-applied with PB.

Acidification and metal mobility may present challenges in soil receiving paper mill biosolids (PB). Co-applying biochar and PB could help prevent these issues, but its effect must be assessed. The objective of this 224 d incubation study was to evaluate the effect of amending two acidic soils, a clay and sandy loam, with two PB types varying in pH (PB1, pH = 7.80; and PB2, pH = 4.51) co-applied with three rates (0%, 2.5%, and 5% w/w) of pine (Pinus strobus L.) biochar on soil pH and macro- (P, K, Ca, and Mg) and micronutrients (Cu, Zn, Fe, and Mn). In both soils, co-applying biochar and PB significantly increased soil pH and extractable K concentration compared with PB-only application, whereas amending with PB significantly increased soil extractable P concentration compared with the unamended soil. In comparison with PB only, co-applying 5% biochar and PB decreased extractable Cu concentration in both soils and extractable Fe concentration in the sandy loam soil. This study showed that co-applying biochar and PB can be more beneficial to agricultural soils than application of PB alone by supplying nutrients and helping prevent metal toxicity by raising pH, especially in acidic sandy soils.

Purpose This study aimed to determine whether continual electronic patient-reported outcome (ePRO) measurements at home can capture the fluctuations in health-related quality of life (HRQOL) scores between visits. Methods We performed a randomized controlled trial to compare the scores obtained by standard practice (paper-based measurements in the hospital) to scores by continuous measurement of ePRO at home. Metastatic cancer patients were randomly assigned to either the paper-based ( n = 50) or the ePRO group ( n = 52). EQ-5D-5L and EORTC QLQ C-30 scores were obtained on 3 different chemotherapy days in the paper-based group. Meanwhile, scores were obtained on the chemotherapy day and on days 3, 7, 10, and 14 in the ePRO group during 2 cycles. The first hypothesis of our study was that both scores at the same time points would be equivalent despite different measurement frequency, place, or mode of measurement. The second hypothesis was that PRO score–adjusted time would be different between the groups. For equivalence, the endpoint was the mean EQ-5D-5L index value on the chemotherapy day before the outpatient treatment. Only if equivalence was shown, quality-adjusted life-days (QALDs) were considered using all the data. Results The adjusted mean difference in the EQ-5D-5L index was determined to be −0.013 (95% confidence interval [CI]: −0.049 to 0.022); the 95% CI did not exceed the equivalence margin. Similarly, the mean difference in global health status (2.28 [95% CI: −2.55 to 7.11]) also showed equivalence. However, the QALD by EQ-5D-5L was significantly lower in the ePRO group by 1.36 per 30 d (95% CI: −2.22 to −0.51; P = 0.0021). Conclusions Continual measurements of the HRQOL at home by ePRO may yield more detailed profiles of the HRQOL.

Paper mill effluent has been characterized as recalcitrant because of containing lignin and its derivatives. Since biofilm system exhibits a notable potential for the removal of recalcitrant contaminants, a sequencing batch biofilm reactor (SBBR) was employed to treat coagulated recycled paper mill effluent in this study. The results indicated that the SBBR removed 91.3 % of chemical oxygen demand (COD), whilst total suspended solid (TSS) and color removal reached 83.1 % and 71.0 %, respectively. The microbial analysis suggested that three typical heterotrophic phyla, Proteobacteria, Bacteroidetes and Acidobacteria are dominant bacteria and reflected the removal of recalcitrant contaminants. The COD removal rate of SBBR is evidently superior to conventional activated sludge process due to high sludge concentration as well as long sludge retention time (SRT). Whilst the problem of sludge bulking can be successfully avoided, the blockage of reactor caused by TSS accumulation and microbial growth deserve further investigation.

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

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

We present how harmful different wood extractives carried over to paper mill with unbleached softwood Kraft pulp are for the strength of packaging papers and boards. The investigations were done by simulating industrial papermaking conditions in laboratory-scale trials for handsheet production. It was found that fatty acids are the most relevant compounds in the carryover pitch extractives (CPEs), as they readily interfere in fiber–fiber bonding strength, control the properties of CPE micelles, and are furthermore the most abundant compounds. Addition of cationic starch improved strength and evened out the strength differences of handsheets with different CPE compounds. Oleic acid (unsaturated fatty acid) was an exception, as it was above average harmful for paper strength without cationic starch and also heavily impaired the functioning of cationic starch. As a whole, these findings demonstrate that fatty acids, especially unsaturated ones, are the most relevant CPE compounds contributing to the reduced efficiency of cationic starch and decreased strength of unbleached softwood Kraft paper. This makes the cleaning of process waters by precipitating CPEs on the pulp fibers harmful for paper strength.

Paper cultural relics such as double-sided printed newspapers and periodicals represent modern cultural heritage. Severe damage such as embrittlement, decay, and dreg generally occur to paper; hence, it urgently needs conservation and restoration. Therefore, herein, a new reinforcement method for the fragile double-sided printed paper cultural relics is proposed with cotton mesh and adhesive PVA217 as reinforcement materials. Using a computer measured and controlled folding endurance tester, a pendulum tensile strength tester, pH meter, pulp viscosimeter, and other instruments, the physical properties of newspaper samples before and after aging were evaluated. In addition, the mechanical properties, chromatic aberration and surface morphology of simulated samples before and after the cotton mesh reinforcement and Japanese washi paper reinforcement were assessed. The experimental results indicate that this new reinforcement method could effectively improve the physical strength, chromatic aberration and durability of the simulated samples. Widespread applications of this cotton mesh reinforcement method for the reinforcement and protection of the red revolutionary cultural relics such as double-sided printed newspaper and periodicals during the Republic of China era are foreseeable.

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

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

Aβ42 is one of the most extensively studied blood and Cerebrospinal fluid (CSF) biomarkers for the diagnosis of symptomatic and prodromal Alzheimer’s disease (AD). Because of the heterogeneity and transient nature of Aβ42 oligomers (Aβ42Os), the development of technologies for dynamically detecting changes in the blood or CSF levels of Aβ42 monomers (Aβ42Ms) and Aβ42Os is essential for the accurate diagnosis of AD. The currently commonly used Aβ42 ELISA test kits usually mis-detected the elevated Aβ42Os, leading to incomplete analysis and underestimation of soluble Aβ42, resulting in a comprised performance in AD diagnosis. Herein, we developed a dual-target lateral flow immunoassay (dLFI) using anti-Aβ42 monoclonal antibodies 1F12 and 2C6 for the rapid and point-of-care detection of Aβ42Ms and Aβ42Os in blood samples within 30 min for AD diagnosis. By naked eye observation, the visual detection limit of Aβ42Ms or/and Aβ42Os in dLFI was 154 pg/mL. The test results for dLFI were similar to those observed in the enzyme-linked immunosorbent assay (ELISA). Therefore, this paper-based dLFI provides a practical and rapid method for the on-site detection of two biomarkers in blood or CSF samples without the need for additional expertise or equipment. Graphical Abstract

Parenteral and enteral nutrition support are key components of care for various medical and physiological conditions in infants, children, and adults. Nutrition support practices have advanced over time, driven by the goals of safe and sufficient delivery of needed nutrients and improved patient outcomes. These advances have been, and continue to be, dependent on research and development studies. Such studies address aspects of enteral and parenteral nutrition support: formulations, delivery devices, health outcomes, cost-effectiveness, and related metabolism. The studies are supported by public funding from the government and by private funding from foundations and from the nutrition support industry. To build public trust in nutrition support research findings, it is important to underscore ethical research conduct and reporting of results for all studies, including those with industry sponsors. In 2019, American Society for Parenteral and Enteral Nutrition's (ASPEN's) Board of Directors established a task force to ensure integrity in nutrition support research that is done as collaborative partnerships between the public (government and individuals) and private groups (foundations, academia, and industry). In this ASPEN Position Paper, the Task Force presents principles of ethical research to guide administrators, researchers, and funders. The Task Force identifies ways to curtail bias and to minimize actual or perceived conflict of interests, as related to funding sources and research conduct. Notably, this paper includes a Position Statement to describe the Task Force's guidance on Public-Private Partnerships for research and funding. This paper has been approved by the ASPEN Board of Directors.

Although crucial in improving health outcomes in the preterm infants, parenteral nutrition (PN) is not without risk, especially if handled improperly. A growing body of evidence suggests that components of PN admixtures, including lipid injectable emulsions (ILEs), are susceptible to degradation, including oxidation when exposed to light (ie, photo-oxidation), resulting in the production of reactive oxygen species. Infants, especially those born preterm, are considered more susceptible to consequences of oxidative stress than children and adults. Oxidative stress is associated with bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and intestinal failure-associated liver disease. The American Society for Parenteral and Enteral Nutrition (ASPEN) assembled a working group to provide recommendations on clinical practice surrounding photoprotection of PN.This Position Paper reviews the scientific literature on the formation of quantifiable peroxides and other degradation products when PN admixtures and ILEs are exposed to light and reports adverse clinical outcomes in premature infants exposed to PN. Recommendations for photoprotection of PN admixtures and ILEs are provided, as well as the challenges in achieving complete photoprotection with the equipment, supplies, and materials currently available in the US. ASPEN and the authors understand that the full implementation of complete photoprotection may not currently be feasible given current product availability; recommendations provided in this paper serve to represent the goal to which to strive as well as to highlight the importance of product availability to achieve these practices. This paper has been approved by the ASPEN Board of Directors.

The study attempted to assess the water quality around paper mill effluents discharge areas. Several physicochemical parameters and the Canadian Council of Ministers of the Environment (CCME) Water Quality Index (WQI) were considered to determine the pollution level of surface and groundwater in the selected paper mills areas located in Saidpur, Gobindaganj, and Dupchanchia Upazilas of Bangladesh. Physicochemical characterization of the surface water around the paper mills areas showed that the concentration of EC, TSS, BOD5, COD, phenols, NO3−-N, and K+were exceeded the surface water standard, whereas the DO level ranged from 1.63 to 3.5 were found below the Environmental Conservation Rules (ECR), 1997 standard. Besides, the BOD, COD, and Mn ion concentrations of groundwater exceeded the drinking water standard. In most sampling sites, the WQI of the surface water showed ‘marginal’ category, and the groundwater quality showed 'fair' category. The study observed that the toxic effluents discharged from the paper mills caused harm to the aquatic ecosystem.

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

The paper presents a research on the disposal of the toxic waste of pulp and paper mill (sludge-lignin with the empirical formula CH1.51N0.05S0.03Cl0.01O0.54through its oxidation in supercritical water-oxygen fluid, including the case of using methane as a co-fuel. The experiments were carried out with a flow reactor of original design at a pressure of 25 MPa, temperature gradient along the vertical axis (from top to bottom: 390–600°C), and variation in the flow rate of the sludge-lignin (with the addition of NaOH, 1.6 wt %), oxygen, and methane. The experiments yielded data on the content of phenols in the water and the composition of the gaseous products collected at the outlet of the reactor versus the oxygen excess ratio. From these data, as well as the time dependences of the reactor wall temperature and the power of the ohmic heaters, it follows that using distributed supply of methane to compensate for the energy for heating of the reagents is preferable as compared with local inlet of methane to the upper part of the reactor. It has been shown that the addition of methane makes it possible to reduce the oxygen excess required for complete oxidation of the organic components of sludge-lignin.

Nitrogen-fixing bacteria (NFB) can reduce nitrogen at ambient pressure and temperature. In this study, we treated effluent from a paper mill in sequencing batch reactors (SBRs) and monitored the abundance and activity of NFB with a view to producing a sludge that could work as a biofertilizer. Four reactors were inoculated with activated sludge enriched with NFB and fed with a high C/N waste (100:0.5) from a paper mill. Though the reactors were able to reduce the organic load of the wastewater by up to 89%, they did not have any nitrogen-fixing activity and showed a decrease in the putative number of NFB (quantified with qPCR). The most abundant species in the reactors treating high C/N paper mill wastewater was identified by Illumina MiSeq 16S rRNA gene amplicon sequencing as Methyloversatilis sp. (relative abundance of 4.4%). Nitrogen fixation was observed when the C/N ratio was increased by adding sucrose. We suspect that real-world biological nitrogen fixation (BNF) will only occur where there is a C/N ratio ≤100:0.07. Consequently, operators should actively avoid adding or allowing nitrogen in the waste streams if they wish to valorize their sludge and reduce running costs. PRACTITIONER POINTS: Efficient biological wastewater treatment of low nitrogen paper mill effluent was achieved without nutrient supplementation. The sludge was still capable of fixing nitrogen although this process was not observed in the wastewater treatment system. This high C/N wastewater treatment technology could be used with effluents from cassava flour, olive oil, wine and dairy industries.

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

Oral corticosteroids (OCS) are frequently used for asthma treatment. This medication is highly effective for both acute and chronic diseases, but evidence indicates that indiscriminate OCS use is common, posing a risk of serious side effects and irreversible harm. There is now an urgent need to introduce OCS stewardship approaches, akin to successful initiatives that optimized appropriate antibiotic usage. The aim of this TSANZ (Thoracic Society of Australia and New Zealand) position paper is to review current knowledge pertaining to OCS use in asthma and then delineate principles of OCS stewardship. Recent evidence indicates overuse and over-reliance on OCS for asthma and that doses >1000 mg prednisolone-equivalent cumulatively are likely to have serious side effects and adverse outcomes. Patient perspectives emphasize the detrimental impacts of OCS-related side effects such as weight gain, insomnia, mood disturbances and skin changes. Improvements in asthma control and prevention of exacerbations can be achieved by improved inhaler technique, adherence to therapy, asthma education, smoking cessation, multidisciplinary review, optimized medications and other strategies. Recently, add-on therapies including novel biological agents and macrolide antibiotics have demonstrated reductions in OCS requirements. Harm reduction may also be achieved through identification and mitigation of predictable adverse effects. OCS stewardship should entail greater awareness of appropriate indications for OCS prescription, risk–benefits of OCS medications, side effects, effective add-on therapies and multidisciplinary review. If implemented, OCS stewardship can ensure that clinicians and patients with asthma are aware that OCS should not be used lightly, while providing reassurance that asthma can be controlled in most people without frequent use of OCS.

We demonstrated the thermally robust reduced graphene oxide (rGO)/boron nitride nanotube (BNNT) papers and their application in electromagnetic interference shielding. In order to overcome the thermal durability shortcomings of electromagnetic wave shielding paper based on rGO nanomaterial, rGO/BNNT electromagnetic interference (EMI) shielding paper having excellent thermal durability could be manufactured using BNNT nanomaterials having excellent chemical and thermal stability at high temperature. With the addition of a little BNNT, the durability against temperature can be increased by more than two times while there is little reduction in EMI performance.

Paper-based photodetectors have attracted extensive research interest owing to their environmentally friendly and highly deformable properties. Although perovskite crystals with outstanding optoelectronic properties have proved to be one of the most promising candidates for photodetectors, the development of paper-based photodetectors is hindered by the moisture absorptivity of paper and the instability of perovskite crystals in a humid atmosphere. In this study, we demonstrate a highly deformable and high-performance paper-based perovskite photodetector. The photodetector maintains its excellent performance even after exposure to a relative humidity of 60% for 120 h.

Patients with the dual burden of chronic kidney disease (CKD) and cardiovascular disease (CVD) experience unacceptably high rates of morbidity and mortality, which also entail unfavorable effects on healthcare systems. Currently, concerted efforts to identify, prevent and treat CVD in CKD patients are lacking at the institutional level, with emphasis still being placed on individual specialty views on this topic. The authors of this position paper endorse the need for a dedicated interdisciplinary team of subspecialists in cardio-nephrology that manages appropriate clinical interventions across the inpatient and outpatient settings. There is a critical need for training programs, guidelines and best clinical practice models, and research funding from nephrology, cardiology and other professional societies, to support the development of the subspecialty of cardio-nephrology. This position paper from the coordinating committee from the Working Group for Cardiorenal Medicine of the Spanish Society of Nephrology (S.E.N.) is intended to be the starting point to develop the subspecialty of cardio-nephrology within the S.E.N.. The implementation of the subspecialty in day-to-day nephrological practice will help to diagnose, treat, and prevent CVD in CKD patients in a precise, clinically effective, and health cost-favorable manner. Resumen: Los pacientes con enfermedad renal crónica (ERC) que presentan enfermedad cardiovascular (ECV) tienen índices de morbilidad y mortalidad inaceptablemente elevados, que impactan desfavorablemente sobre los sistemas de salud. En la actualidad, se requieren actuaciones multidisciplinares para identificar, prevenir y tratar la ECV en los pacientes con ERC, debiendo pues superarse la época de las actuaciones de las especialidades individuales. Los autores de este artículo respaldan la necesidad de un equipo interdisciplinar de subespecialistas en cardionefrología que gestione las intervenciones clínicas adecuadas en el entorno hospitalario y en el ambulatorio. Existe una gran necesidad de programas de formación, de guías y modelos de práctica clínica, y de fondos para la investigación en las sociedades de nefrología, cardiología y otras, para apoyar el desarrollo de la subespecialidad de cardio-nefrología. Este documento de opinión del comité coordinador del Grupo de Trabajo de Medicina Cardiorenal de la Sociedad Española de Nefrología (S.E.N.) pretende ser el inicio del desarrollo de la subespecialidad de Cardionefrología en el marco de la S.E.N. La implementación de la subespecialidad en la práctica nefrológica diaria contribuirá a diagnosticar, tratar y prevenir la ECV en los pacientes con ERC de una manera precisa, clínicamente efectiva y sanitariamente rentable.

From the moment of production, paper as a printing substrate is exposed to the process of natural ageing regardless of the type of cellulose fibres in its composition. Accordingly, the prints produced by the various printing techniques are also exposed to several factors that impair the quality of the print i.e. its colour over time. Therefore, it is very important to properly select the printing substrate for achieving a high quality of graphic products. For that purpose, three types of papers with hemp fibres were used as printing substrates which were printed with laboratory hand-operated instrument Esiproof using flexographic cyan (C), magenta (M), yellow (Y) and black (K) water-based inks. Prints were artificially aged in SunTEST XLS+ test chamber according to standard ASTM D 6789-02 for 48 and 96 hours. Based on changes in the reflectance spectra of each printed ink after exposure to electromagnetic radiation it was noticed how composition of printing substrate strongly influence on colour stability of prints due time. An increase of exposure time to electromagnetic radiation leads to a decrease in the value of the reflectance of the printing substrate and cyan, magenta and yellow prints. It was confirmed how electromagnetic radiation have the greatest impact on the reflectance of yellow print, while the black one is the most stabile regardless of the substrate it was printed on.

Perforation is used in multilayer tissue products, such as toilet and kitchen papers, as part of the converting process. Perforation facilitates the detachment of consecutive sheets by the user. The compromise between the strength required to detach a perforated sheet and the strength required to break a sheet affects the perforation efficiency. In this work, the mechanical behaviors of 15 commercial papers from different European producers were studied. A morphological analysis of the materials was performed, followed by the determination of their perforation efficiency (through tensile tests). A qualitative analysis of the cuts quality, along with a quantitative analysis of the same cuts dimensions was performed through an optical system. Finally, the stress concentration in the holes and the influence of the cuts distance were analyzed using a finite element model implemented in Abaqus/Standard finite element software. The results showed that a cut distance of 2.0 mm should not be used in these types of papers, and the perforation efficiency increased with the cut distance, regardless of the number of plies in the toilet paper. The stress concentration factor was also determined to have a limit value of 0.11. Papers above this limit value tear at the perforation line, as desired.

The environmental conditions of paper mills are suitable for the growth of slime-forming microorganisms due to the supply of nutrients, favorable temperature, and moisture. The slime formation causes the spoilage of raw materials & additives, breaks in the paper during papermaking, loss of production, reduces the hygienic quality of the end products, produces off-spec and rejected products, creates microbiological corrosion, and produces harmful gases. The main microorganisms are Bacteria (mainly Bacillus spp., Achromobacter spp., Enterobacter spp., Pseudomonas spp., Clostridium, etc.), Fungi (Aspergillus, Penicillium, Saccharomyces, etc.), and Algae. Besides the use of conventional toxic chemical biocides or slimicides, slime formation can also be controlled in an eco-friendly way using enzymes, bacteriophages, biodispersants, and biocontrol agents alone or along with biocides to remove the slime. Enzymes have shown their effectiveness over conventional chemicals due to nontoxic and biodegradable nature to provide clean and sustainable technology. Globally enzymes are being used at some of the paper mills and many enzymatic products are presently being prepared and under the trail at laboratory scale. The specificity of enzymes to degrade a specific substrate is the main drawback of controlling the mixed population of microorganisms present in slime. The enzyme has the potential to provide the chemical biocide-free solution as a useful alternative in the future with the development of new technologies. Microorganisms control in the paper mill may appear as a costly offer but the cost of uncontrolled microbial growth can be much higher leading to slime production and large economic drain.

Graphical abstract Enzyme-linked immunosorbent assay (ELISA) is widely used for the detection of disease biomarkers. However, it utilizes time-consuming procedures and expensive instruments, making it infeasible for point-of-care (POC) analysis especially in resource-limited settings. In this work, a multicolorimetric ELISA biosensor integrated on a paper/polymer hybrid microfluidic device was developed for rapid visual detection of disease biomarkers at point of care, without using costly equipment. This multicolormetric ELISA platform was built on multiple distinct color variants resulted from the catalytic oxidation of 3,3′,5,5′-tetramethylbenzidine (TMB) and the etching of gold nanorods (AuNRs). The vivid color changes could be easily distinguished by the naked eye, and their red mean values allowed quantitative biomarker detection, without using any sophisticated instruments. When this multicolorimetric ELISA was integrated on a paper/polymer hybrid analytical device, it not only provided integrated processing and high portability but also enabled fast assays in about 50 min due to the unique advantages of paper/polymer hybrid devices. The limit of detection of 9.1 ng/μL of the hepatitis C virus core antigen, a biomarker for hepatitis C, was achieved using this multicolorimetric ELISA platform. This multicolor ELISA analytical device provides a new versatile, user-friendly, affordable, and portable immunosensing platform with high potential for on-site detections of various viruses, proteins, and biomarkers for low-resource settings such as at home, public venues, rural areas, and developing nations. Supplementary Information The online version contains supplementary material available at 10.1007/s00216-021-03359-8.

A simple electrochemical approach has been strategically developed for in situ generations of ZnO nanoparticles using Zn rods as electrodes and hydrogen peroxide as the oxidant without the formation of any by-product. These ZnO nanoparticles were extended for remediation of pollutants present in paper mill effluents, and separation efficiency was found to be above 90% for hydrocarbons, 92% for lignin, 99% for phenol, and 93% of chemical oxygen demand (COD), as confirmed by gas chromatography-mass spectrometry and COD analysis. It was also observed that the experimental setup could successfully remove 99% of the color from the sample. These ZnO nanoparticles have been proven in the past to be antibacterial and were explored for its ability to inhibit the growth of both Gram-positive and Gram-negative bacteria in the effluent samples after the removal of toxic pollutants. Therefore, we proposed an electrochemical reaction for the in situ synthesis of ZnO nanoparticles for remediation of paper mill effluent as well as inhibit the bacterial growth in the treated effluent sample.

A wide variety of biomass is available all around the world. Most of the biomass exists as a by-product from manufacturing industries. Pulp and paper mills contribute to a higher amount of these biomasses mostly discarded in the landfills creating an environmental burden. Biomasses from other sources have been used to produce different kinds and grades of biomaterials such as those used in industrial and medical applications. The present review aims to investigate the availability of biomass from pulp and paper mills and show sustainable routes for the production of high value-added biomaterials. The study reveals that using conventional and integrated biorefinery technology the ample variety and quantity of waste generated from pulp and paper mills can be converted into wealth. As per the findings of the current review, it is shown that high-performance carbon fiber and bioplastic can be manufactured from black liquor of pulping waste; the cellulosic waste from sawdust and sludge can be utilized for the synthesis of CNC and regenerated fibers such as viscose rayon and acetate; the mineral-based pulping wastes and fly ash can be used for manufacturing of different kinds of biocomposites. The different biomaterials obtained from the pulp and paper mill biomass can be used for versatile applications including conventional, high performance, and smart materials. Through customization and optimization of the conversion techniques and product manufacturing schemes, a variety of engineering materials can be obtained from pulp and paper mill wastes realizing the current global waste to wealth developmental approach.

COVID 19 struck us all like a bolt of lightning and for the past 10 months, it has tested our resilience, agility, creativity, and adaptability in all aspects of our lives and work. Simulation centers and simulation-based educational programs have not been spared. Rather than wait for the pandemic to be over before commencing operations and training, we have been actively looking at programs, reviewing alternative methods such as e-learning, use of virtual learning platforms, decentralization of training using in situ simulation (ISS) modeling, partnerships with relevant clinical departments, cross-training of staff to attain useful secondary skills, and many other alternatives and substitutes. It has been an eye-opening journey as we maximize our staff's talent and potential in new adoptions and stretching our goals beyond what we deemed was possible. This paper shares perspectives from simulation centers; The SingHealth Duke NUS Institute of Medical Simulation which is integrated with an Academic Medical Center in Singapore, The Robert and Dorothy Rector Clinical Skills and Simulation Center, which is integrated with Thomas Jefferson University, Oakhill Emergency Department, Florida State University Emergency Medicine Program, Florida, USA and The Wellington Regional Simulation and skills center. It describes the experiences from the time when COVID 19 first struck countries around the world to the current state whereby the simulation centers have stWWarting functioning in their “new norm.” These centers were representative examples of those in countries which had extremely heavy (USA), moderate (Singapore) as well as light (New Zealand) load of COVID 19 cases in the nation. Whichever categories these centers were in, they all faced disruption and had to make the necessary adjustments, aligning with national policies and advisories. As there is no existing tried and tested model for the running of a simulation center during an infectious disease pandemic, this can serve as a landmark reference paper, as we continue to fine-tune and prepare for the next new, emerging infectious disease or crisis.

BackgroundThe analysis of the quality of food is important to protect humans from food-borne or food-based illnesses caused by pathogens, such as bacteria, fungi, viruses, and protozoa. Rapid identification of these pathogens is critical to ensure food safety. Various detection and identification strategies exist; however, they are laborious and time consuming and hence the detection takes longer time. The aim of this study was to develop the specific and fast method for the detection of contaminants in milk.ResultsIn this study, we have developed a simple paper-based PCR method with minimum sample preparation process. The 16S rDNA universal primers were used for the detection of bacterial contaminants. LacZ primers were used for coliform detection which causes serious illness and hence their detection is crucial. ITS region primers were used for fungal detection. The most unique thing about this study is use of Whatman paper no. 1 as sample carrier material. We developed and validated the paper-based PCR method and used it for the detection of microbes and coliforms using milk as a representative sample.ConclusionWe evaluated this method for its suitability in the detection of contaminant microbes using different milk samples. The paper-based method could successfully detect contaminants in the milk samples and the results were comparable to the traditional microbial detection method. The traditional microbiological method takes at least 18–20 h for detecting the presence of microbes in any sample but the developed paper-based PCR method can confirm the microbial presence in 2–3 h. This is very promising especially in the testing where sample sterility is crucial.

The goal of this position paper on ventilatory support at home for children is to provide expert consensus from Australia and New Zealand on optimal care for children requiring ventilatory support at home, both non-invasive and invasive. It was compiled by members of the Thoracic Society of Australia and New Zealand (TSANZ) and the Australasian Sleep Association (ASA). This document provides recommendations to support the development of improved services for Australian and New Zealand children who require long-term ventilatory support. Issues relevant to providers of equipment and areas of research need are highlighted.

Highlights • Standard procedures and appropriate assessment of exercise are proposed for the commonly used animal models related to chronic exercise (e.g., treadmill running, voluntary wheel running, swimming exercise, and resistance exercise) in cardiovascular research. • Optimal design of animal exercise studies in cardiovascular research should consider the choice of exercise models, control of exercise protocols, exercise at different stages of disease, and other factors, such as age, sex, and genetic background. • An optimal design for studying exercise-induced physiological cardiac growth and its related beneficial effects against cardiovascular diseases is presented., Growing evidence has demonstrated exercise as an effective way to promote cardiovascular health and protect against cardiovascular diseases However, the underlying mechanisms of the beneficial effects of exercise have yet to be elucidated. Animal exercise studies are widely used to investigate the key mechanisms of exercise-induced cardiovascular protection. However, standardized procedures and well-established evaluation indicators for animal exercise models are needed to guide researchers in carrying out effective, high-quality animal studies using exercise to prevent and treat cardiovascular diseases. In our review, we present the commonly used animal exercise models in cardiovascular research and propose a set of standard procedures for exercise training, emphasizing the appropriate measurements and analysis in these chronic exercise models. We also provide recommendations for optimal design of animal exercise studies in cardiovascular research, including the choice of exercise models, control of exercise protocols, exercise at different stages of disease, and other considerations, such as age, sex, and genetic background. We hope that this position paper will promote basic research on exercise-induced cardiovascular protection and pave the way for successful translation of exercise studies from bench to bedside in the prevention and treatment of cardiovascular diseases., Graphical abstract Image, graphical abstract

European pharmaceutical companies have a legal requirement to provide non-promotional Medical Information (MI) services to support healthcare professionals (HCPs) who are using their medicinal products. While the industry has self-regulating bodies with established Codes of Practice, these mainly focus on promotional messaging and commercial activities. In the absence of similar frameworks for MI, such services struggle to understand how to meet HCP digital expectations, often in fear of breaching the promotional codes. This is limiting access to the wealth of non-promotional patient-focussed information held within the industry. Meanwhile, a large volume of unregulated, low-quality information can be readily found on the internet. To understand the current status, the Medical Information Leaders in Europe (MILE) industry association performed a benchmarking survey which explored the online MI service provision of 13 mid-large pharmaceutical companies across Europe. This highlighted a great diversity in approach in terms of geographical coverage and content. Visibility and access for HCPs is complex, compromising online engagement and website utilisation. This MILE position paper highlights the critical need to establish a clear governance model, which empowers pharmaceutical company MI functions to provide unbranded, non-promotional, medicinal product information sources to support HCP online information needs. It is essential to build confidence, transparency and trust by establishing a practical quality framework with principles and standards for online MI services for HCPs.

International audience; In 2014 leading publishers withdrew more than 120 nonsensical publications automatically generated with the SCIgen program. Casual observations suggested that similar problematic papers are still published and sold, without follow-up retractions. No systematic screening has been performed and the prevalence of such nonsensical publications in the scientific literature is unknown. Our contribution is 2-fold. First, we designed a detector that combs the scientific literature for grammar-based computer-generated papers. Applied to SCIgen, it has a 83.6% precision. Second, we performed a scientometric study of the 243 detected SCIgen-papers from 19 publishers. We estimate the prevalence of SCIgen-papers to be 75 per million papers in Information and Computing Sciences. Only 19% of the 243 problematic papers were dealt with: formal retraction (12) or silent removal (34). Publishers still serve and sometimes sell the remaining 197 papers without any caveat. We found evidence of citation manipulation via edited SCIgen bibliographies. This work reveals metric gaming up to the point of absurdity: fraudsters publish nonsensical algorithmically generated papers featuring genuine references. It stresses the need to screen papers for nonsense before peer-review and chase citation manipulation in published papers. Overall, this is yet another illustration of the harmful effects of the pressure to publish or perish.

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.

The work aims to explore a microscopic observation system of paper surface and achieve high-precision stereoscopic observation with detail characterization of paper surface morphology. Based on the DT-400E precision program-controlled three-dimensional translation stage and KEYENCE LJV-7200 two-dimensional laser scanner, the hardware parts of our own system are developed to scan and transmit point cloud data of paper surface morphology to the computer. The corresponding system software will automatically process the point cloud data acquired from the laser scanner and generate the corresponding vivid 3D model and height histogram. This system scans and characterizes four different types of paper samples, allowing the human eye to visually distinguish the differences in surface morphology as well as automatically calculate the numerical differences in paper surface morphology parameters. The results of the applicability test show that the system is highly efficient in acquiring, observing, and evaluating the topography of the paper surface. The system can not only predict the paper surface quality of printed paper, but can also be extended to the evaluation of 3D printed surfaces.

In this paper, the implementation of artificial neural networks (multilayer perceptron [MLP] and radial base functions [RBF]) and the upgraded Markov chain model have been studied and performed to identify the human behavior patterns during rock, paper, and scissors game. The main motivation of this research is the design and construction of an intelligent robot with the ability to defeat a human opponent. MATLAB software has been used to implement intelligent algorithms. After implementing the algorithms, their effectiveness in detecting human behavior pattern has been investigated. To ensure the ideal performance of the implemented model, each player played with the desired algorithms in three different stages. The results showed that the percentage of winning computer with MLP and RBF neural networks and upgraded Markov model, on average in men and women is 59%, 76.66%, and 75%, respectively. Obtained results clearly indicate a very good performance of the RBF neural network and the upgraded Markov model in the mental modeling of the human opponent in the game of rock, paper, and scissors. In the end, the designed game has been employed in both hardware and software which include the Zana intelligent robot and a digital version with a graphical user interface design on the stand. To the best knowledge of the authors, the precision of novel presented method for determining human behavior patterns was the highest precision among all of the previous studies.

In this paper, we present a system for automatic evaluation of the quality of a question paper. Question paper plays a major role in educational assessment. The quality of a question paper is crucial to fulfilling the purpose of the assessment. In many education sectors, question papers are prepared manually. A prior analysis of a question paper might help in finding the errors in the question paper, and better achieving the goals of the assessment. In this experiment, we focus on higher education in the technical domain. First, we conducted a student survey to identify the key factors that affect the quality of a question paper. The top factors we identified are question relevance, question difficulty, and time requirement. We explored the strategies to handle these factors and implemented them. We employ various concepts and techniques for the implementation. The system finally assigns a numerical quality score against these factors. The system is evaluated using a set of question papers collected from various sources. The experimental results show that the proposed system is quite promising.

Background Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers. Method A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology. Results Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts’ opinion. Conclusions The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.

Combined paper mill biosolids (PB) are a well-known fertilizing source of nitrogen (N) and phosphorus (P). Many jurisdictions have established default values for estimating their agronomic N and P contribution, but nutrient release can vary with their chemical properties, and this has been little studied. The objective of this incubation study was to compare four PB of different sources along with a de-inking paper sludge (DPS) for their N and P release in three contrasting soils under controlled conditions (25 °C, 60% water-filled pore space). Treatments consisted of PB or DPS at 50 Mg fresh mass ha−1, PB at 30 Mg fresh mass ha−1 plus inorganic N to supply 100 kg available N ha−1, inorganic NP fertilizer, and an unfertilized control. Measurements of NO3 + NH4-N were made after 3 d and 1, 2, 3, 4, 6, 8, 12, and 16 wk of incubation. Mehlich-3 P was measured after 2 and 16 wk of incubation. Nitrogen mineralization generally declined a few days after PB addition and then gradually and constantly increased. The P mineralization of PB also increased with time. By the end of incubation, net N and P release averaged 30% (7%–49%) and 75% (16%–116%) of the NP fertilizer, respectively. The intensity of release, however, varied with material characteristics and soil type. Mineral N addition to the 30 Mg PB ha−1 promoted N release to a level comparable to NP fertilizer. Soil N immobilization occurred with the DPS application. Current default N value used for PB in Quebec and Ontario is appropriate but not P.

© European Stroke Organisation 2021, Purpose: Many daily-life clinical decisions in patients with cerebrovascular disease and cognitive impairment are complex. Evidence-based information sustaining these decisions is frequently lacking. The aim of this paper is to propose a practical clinical approach to cognitive impairments in patients with known cerebrovascular disease. Methods: The document was produced by the Dementia Committee of the European Stroke Organisation (ESO), based on evidence from the literature where available and on the clinical experience of the Committee members. This paper was endorsed by the ESO. Findings: Many patients with stroke or other cerebrovascular disease have cognitive impairment, but this is often not recognized. With improvement in acute stroke care, and with the ageing of populations, it is expected that more stroke survivors and more patients with cerebrovascular disease will need adequate management of cognitive impairment of vascular etiology. This document was conceived for the use of strokologists and for those clinicians involved in cerebrovascular disease, with specific and practical hints concerning diagnostic tools, cognitive impairment management and decision on some therapeutic options. Discussion and conclusions: It is essential to consider a possible cognitive deterioration in every patient who experiences a stroke. Neuropsychological evaluation should be adapted to the clinical status. Brain imaging is the most informative biomarker concerning prognosis. Treatment should always include adequate secondary prevention.

Purpose To develop a European White Paper document on oropharyngeal dysphagia (OD) in head and neck cancer (HNC). There are wide variations in the management of OD associated with HNC across Europe. Methods Experts in the management of specific aspects of OD in HNC across Europe were delegated by their professional medical and multidisciplinary societies to contribute to this document. Evidence is based on systematic reviews, consensus-based position statements, and expert opinion. Results Twenty-four sections on HNC-specific OD topics. Conclusion This European White Paper summarizes current best practice on management of OD in HNC, providing recommendations to support patients and health professionals. The body of literature and its level of evidence on diagnostics and treatment for OD in HNC remain poor. This is in the context of an expected increase in the prevalence of OD due to HNC in the near future. Contributing factors to increased prevalence include aging of our European population (including HNC patients) and an increase in human papillomavirus (HPV) related cancer, despite the introduction of HPV vaccination in various countries. We recommend timely implementation of OD screening in HNC patients while emphasizing the need for robust scientific research on the treatment of OD in HNC. Meanwhile, its management remains a challenge for European professional associations and policymakers.

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

The role of certain viruses in the etiology of some tumors is today indisputable, but there is a lack, however, of annoverview of the relationship between viruses and cancer with amultidisciplinary approach. For this reason, the Health Sciences Foundation has convened a group of professionals from different areas of knowledge to discuss the relationship between viruses and cancer, and the present document is the result of these deliberations. Although viruses cause only 10-15% of cancers, advances in oncology research are largely due to the work done during the last century on tumor viruses. The clearest cancer-inducing viruses are: HPV, HBV, HCV, EBV and, depending on the geographical area, HHV-8, HTLV-1 and HIV. HPVs, for example, are considered to be the causative agents of cervical carcinomas and, more recently, of a proportion of other cancers. Among the Herpes viruses, the association with the development of neoplasms is well established for EBV and HHV-8. Viruses can also be therapeutic agents in certain neoplasms and, thus, some oncolytic viruses with selective tropism for tumor cells have been approved for clinical use in humans. It is estimated that the prophylaxis or treatment of viral infections could prevent at least 1.5 million cancer deaths per year.

Approximately 10 years have passed since the Peritoneal Dialysis Guidelines were formulated in 2009. Much evidence has been reported during the succeeding years, which were not taken into consideration in the previous guidelines, e.g., the next peritoneal dialysis PD trial of encapsulating peritoneal sclerosis (EPS) in Japan, the significance of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs), the effects of icodextrin solution, new developments in peritoneal pathology, and a new international recommendation on a proposal for exit-site management. It is essential to incorporate these new developments into the new clinical practice guidelines. Meanwhile, the process of creating such guidelines has changed dramatically worldwide and differs from the process of creating what were “clinical practice guides.” For this revision, we not only conducted systematic reviews using global standard methods but also decided to adopt a two-part structure to create a reference tool, which could be used widely by the society’s members attending a variety of patients. Through a working group consensus, it was decided that Part 1 would present conventional descriptions and Part 2 would pose clinical questions (CQs) in a systematic review format. Thus, Part 1 vastly covers PD that would satisfy the requirements of the members of the Japanese Society for Dialysis Therapy (JSDT). This article is the duplicated publication from the Japanese version of the guidelines and has been reproduced with permission from the JSDT.

Allergo journal international 30(5), 155-168 (2021). doi:10.1007/s40629-021-00178-2, Published by Urban & Vogel, München

Rearrangements in the anaplastic lymphoma kinase (ALK) and proto-oncogene tyrosine-protein kinase ROS (ROS1) genes characterise two distinct molecular subsets of non-small cell lung cancer (NSCLC) tumours. Lorlatinib is a third-generation ALK/ROS1 tyrosine kinase inhibitor (TKI) shown to have systemic and intracranial activity in treatment-naive patients and in those who progressed on first- and second-generation TKIs. Despite being generally well tolerated, lorlatinib has a unique and challenging safety profile that includes hyperlipidaemia and central and peripheral nervous system adverse events (AEs). This article summarises a set of strategies designed to monitor and manage lorlatinib-related AEs that were agreed upon by a multidisciplinary panel of specialists in a meeting held in July 2020. Among the recommendations hereby described, special emphasis was placed on communication: prescribing physicians should inform patients and their families/caregivers about the likelihood and nature of lorlatinib AEs, encouraging them to report any symptoms, while at the same time reassuring them that most events are manageable and resolve spontaneously and have little to no interference with cancer treatment. Importantly, all patients should undergo a set of baseline assessments, including biochemical analysis, evaluation of cardiovascular risk, electrocardiogram (ECG), neurological evaluation and contrast-enhanced magnetic resonance imaging of the brain, which should be repeated regularly during lorlatinib treatment. Supportive medications to treat or relieve lorlatinib AEs were also discussed, as were the conditions requiring specialist consultations and/or adjustments in lorlatinib therapy. The overall goal of this article is to serve as a practical guide for oncologists to systematically and effectively approach lorlatinib AEs.

Social aggression is a pervasive feature of insect societies. In eusocial Hymenoptera, aggression among females can affect task performance and competition over direct reproduction (egg laying); in most species males participate in social interactions relatively rarely. Males of the independent-founding paper wasp Mischocyttarus mastigophorus are exceptional: they are aggressive toward female nestmates, leading us to explore the function of this unusual behavior. We applied social network analyses to data on M. mastigophorus social aggression to quantify sex differences in giving and receiving social aggression. The network analyses supported the pattern of biased male aggression toward female nestmates; females are relatively rarely aggressive to males. We then asked whether male aggression toward females was biased by females’ relative ovary development. Males were more aggressive toward females with better-developed ovaries, opposite to patterns of aggression among females. Because food brought to the colonies is often monopolized by dominant females, we suggest that males direct aggression toward socially dominant females with better-developed ovaries to obtain food. The implications of biased male aggression for female task performance and physiology are unknown.

This research presents a solar-blind (UVC) office paper-based photodetector that is self-biased, superflexible, nonwettable, high-performance, and high-voltage stable. In contrast to the traditiona...

The entire world seems to have responded to COVID-19 pandemic in a knee-jerk manner with a short mindset without building on the existing strengths of public health infrastructure. National governments cannot be blamed for this as we are dealing with a crisis that comes once in a lifetime. Realising this, the Organized Medicine Academic Guild (OMAG) an association of major health associations in this country has suggested measures for long-term solutions to COVID-19-like pandemics in the form of a policy paper by OMAG.

In this study, we developed a microfluidic paper analysis device (μPAD) for distance-based detection of Ag+ in water. The μPAD was manufactured by wax printing method on filter paper. Then, a layer of gold nanoparticles (AuNPs) was deposited and ascorbic acid was printed on the channel. In the detection, Ag+ was reduced by ascorbic acid and coated on the surface of the AuNPs on the channel, forming Au@Ag core/shell nanoparticles. Based on the capillary flow principle, different concentrations of Ag+ formed different distances of color ribbons. Thus, quantitative detection of Ag+ can be achieved by measuring the distance of the color ribbon. The detection limit of this method was as low as 1 mg·L−1 within 15 min and the interference of common metal ions in water can be eliminated. In conclusion, this method had successfully realized the leap from colorimetry to direct reading, realizing fast read and easy manipulation with low-cost.

The American Society for Parenteral and Enteral Nutrition (ASPEN) Position Paper focus is on applying the 4 ethical principles for clinician's decision-making in the use of artificially administered nutrition and hydration (AANH) for adult and pediatric patients. These basic principles are (1) autonomy, respect the patient's healthcare preferences; (2) beneficence, provide healthcare in the best interest of the patient; (3) nonmaleficence, do no harm; and (4) justice, provide all individuals a fair and appropriate distribution of healthcare resources. Preventing and resolving ethical dilemmas is addressed, with an emphasis on a collaborative, interdisciplinary approach. Optimizing early communication and promoting advance care planning, involving completion of an advance directive, including designation of a surrogate decision-maker, are encouraged. Clinicians achieve respect for autonomy when they incorporate the patient, family, community, country, geographical, and presumed cultural values and religious belief considerations into ethical decision-making for adults and children with a shared decision-making process. These discussions should be guided by the 4 ethical principles. Hospital committees and teams, limited-time trials, clinician obligation with conflicts, and forgoing of AANH are addressed. Specific patient conditions are addressed because of the concern for potential ethical issues: coma, decreased consciousness, and dementia; advanced dementia; cancer; eating disorders; and end-stage disease/terminal illness. Incorporated in the Position Paper are ethical decisions during a pandemic and a legal summary involving ethical issues. International authors presented the similarities and differences within their own country or region and compared them with the US perspective.

The present study illustrates the electrocoagulation remediation of paper mill wastewater for multiple response optimization. Multiple response optimization can be combined into one desirability function. All variables and responses varied for a unique global solution. The effect of basic electrocoagulation process variables pH (3–10), conductivity (3.15–10 mS/cm), electrode distance (1–2.5 cm) and current density (5–20 mA/cm2) on four response parameters such as chemical oxygen demand, color, total dissolved solids and total organic carbon has been analyzed experimentally and statistically. The global solution for these variables and responses obtained by software over a hundred design points. For unit desirability function variables conditions were pH 7.49, Conductivity 8.34 mS/cm, electrode distance 2.06 cm and current density 9.32 mA/cm2. In these global variable conditions, responses were observed to be COD 70.19%, Color 75.03%, TDS 70.69% and TOC 71.93%, respectively.

Flexible paper-based sensors may be applied in numerous fields, but this requires addressing their limitations related to poor thermal and water resistance, which results in low service life. Herein, we report a paper-based composite sensor composed of carboxylic carbon nanotubes (CCNTs) and poly-m-phenyleneisophthalamide (PMIA), fabricated by a facile papermaking process. The CCNT/PMIA composite sensor exhibits an ability to detect pressures generated by various human movements, attributed to the sensor's conductive network and the characteristic "mud-brick" microstructure. The sensor exhibits the capability to monitor human motions, such as bending of finger joints and elbow joints, speaking, blinking, and smiling, as well as temperature variations in the range of 30-90 °C. Such a capability to sensitively detect pressure can be realized at different applied frequencies, gradient sagittas, and multiple twists with a short response time (104 ms) even after being soaked in water, acid, and alkali solutions. Moreover, the sensor demonstrates excellent mechanical properties and hence can be folded up to 6000 times without failure, can bear 5 kg of load without breaking, and can be cycled 2000 times without energy loss, providing a great possibility for a long sensing life. Additionally, the composite sensor shows exceptional Joule heating performance, which can reach 242 °C in less than 15 s even when powered by a low input voltage (25 V). From the perspective of industrialization, low-cost and large-scale roll-to-roll production of the paper-based sensor can be achieved, with a formed length of thousands of meters, showing great potential for future industrial applications as a wearable smart sensor for detecting pressure and temperature, with the capability of electric heating.

Tacrolimus is one of the most effective and prevalent drugs used to combat vascularized composite allotransplantation rejection. We have fabricated a rapid and easy-to-use six-layer paper based microfluidic device using the principles of competitive immunoassays and vertical flow microfluidics for colorimetric detection of tacrolimus in a small volume of blood.

Lab-on-paper, or microfluidic paper-based analytical devices (μPADs), use paper as a substrate material, and are patterned with a system of microchannels, reaction zones and sensing elements to perform analysis and detection. The sample transfer in such devices is performed by capillary action. As a result, external driving forces are not required, and hence the size and cost of the device are significantly reduced. Lab-on-paper devices have thus attracted significant attention for point-of-care medical diagnostic purposes in recent years, particularly in less-developed regions of the world lacking medical resources and infrastructures. This review discusses the major advances in lab-on-paper technology for blood analysis and diagnosis in the past five years. The review focuses particularly on the many clinical applications of lab-on-paper devices, including diabetes diagnosis, acute myocardial infarction (AMI) detection, kidney function diagnosis, liver function diagnosis, cholesterol and triglyceride (TG) analysis, sickle-cell disease (SCD) and phenylketonuria (PKU) analysis, virus analysis, C-reactive protein (CRP) analysis, blood ion analysis, cancer factor analysis, and drug analysis. The review commences by introducing the basic transmission principles, fabrication methods, structural characteristics, detection techniques, and sample pretreatment process of modern lab-on-paper devices. A comprehensive review of the most recent applications of lab-on-paper devices to the diagnosis of common human diseases using blood samples is then presented. The review concludes with a brief summary of the main challenges and opportunities facing the lab-on-paper technology field in the coming years.

Cocaine (COC) is one of the most widely consumed illegal drugs around the world. Street COC is commonly adulterated with pharmaceutical compounds that mimic or intensify the COC's sensory effect. Adulteration is performed to increase the profit of criminal organizations and each one has their own way of doing it. Therefore, determining the composition of seized COC samples (chemical profile) provides evidence for the police to track criminal organization networks and their activity patterns. Using filter paper as a substrate, we developed a multiple detection paper-based analytical device (PAD) that combines colorimetric and electrochemical measurements to discriminate COC samples according to adulterant's content. A regular graphite lead modified with a gold film made from Au leaf (graphite/Au) to improve electron transfer was used as a working electrode. Silver and Ag/AgCl were used as auxiliary and reference electrodes, respectively. The colorimetric device was patterned using a laser cutter and coupled to the electrochemical device using a double-sided tape, allowing simultaneous analysis to gather more analytical information about COC samples. Graphite/Au was characterized by scanning and transmission electron microscopies and electrochemical assays. The simultaneous colorimetric and electrochemical analyses combined to principal component analysis improved the analytical characterization of COC trial samples and provided a fast discrimination based on the assembled database.

This study presents a paper-based thin-layer optical cuvette for absorption spectroscopy with a pneumatically driven pump for the introduction of an aqueous sample. The three major components, a sample reservoir, an open-channel as an optical path and a pneumatic pump, are patterned in polypropylene paper using an electronic cutting machine. When sealed with transparent tape, the patterned paper serves as the side walls of the paper-based cuvette with an integrated pneumatic pump. Due to the reduced pressure inside the open-channel caused by the depression of the pump with a finger, aqueous samples spotted onto the reservoir are introduced into the open-channel of the paper-based cuvette. We demonstrated that the paper-based cuvettes are compatible with conventional spectrophotometers for absorption spectroscopic measurements and capable of quantifying the concentrations of various colored dyes in aqueous samples.

Cleaner production of sugars and pulp from renewable feedstocks has captured significant scientific attention in the recent past because they can be used for various end applications. In the papermaking industry, a major fraction of hemicellulosic sugars is lost during the pulping. The present study aims at retrieving these hemicellulosic sugars through alkali-, hot-water-, and acid-mediated extraction prior to pulping, which otherwise would have been lost during pulping and washing of pulp. These retrieved sugars can be used as feedstocks for renewable energy and value-added products. Different pretreatments were applied, aided with varying temperature, chemical concentrations, and time. Substantial amounts of total reducing sugars (TRSs) up to 21.98, 13.2, and 15.01% were extracted prior to pulping by acid, alkali, and hot-water pretreatments. Compositions of mono sugars present in the treated liquor were also characterized and confirmed by high-performance liquid chromatography analysis. The morphological changes in the wheat straw after pre-extraction were studied using the field emission gun scanning electron microscopy technique. Pulping of untreated and pretreated wheat straw was carried out at different alkali charges (12, 14, and 16% NaOH). Among all, acid-pretreated straw showed an increase in pulp yield by 10.9% at a 16% alkali charge. Physical strength properties of different pulps were further examined. Alkali- and hot-water-pretreated straw pulp retained 94.26 and 83.16% tensile indices and 92.43 and 87.02% burst indices, respectively. An increase in tear index up to 4.32, 2.01, and 2.30% for alkali-, hot-water-, and acid-pretreated straw pulp was achieved, respectively. Hot-water- and alkali-pretreated wheat straw was observed to be conducive for paper production. The integrated use of wheat straw for extraction of underutilized sugars and pulp production in this way may serve as a key stepping stone for future biorefinery designs in pulp and paper mills.

Process-monitoring laboratories in the pulp and paper industry generally use a combination of wet chemical analyses and physical measurements to certify the fitness of a production pulp for a specific end-use. These laboratory tests require time and the effort of trained personnel, limiting their utility for real-time process control. Here we show that Raman probes of unrefined cellulosic pulps, well-suited to the online measurement of in-process materials, can predict the quality attributes of manufactured papers. The accuracy of prediction improves when the covariance is modelled in a reduced measurement space selected by a data-driven, feature-selection technique referred to as a Template Oriented Genetic Algorithm (TOGA). TOGA, combined with discrete wavelet transform (DWT), isolates functional-group features that correlate best with mechanical properties paper derived from refined pulp. Paper makers refine market pulps to build sheet strength using a beating process that decreases freeness as it increases fibre-fibre bonding. Methods demonstrated here predict manufactured sheet properties obtainable after any specified degree of refining from the Raman spectrum of an unrefined pulp. This analysis capacity will enable both vendors of market pulp and makers of sheet paper to specify in advance the amount of beating required to produce a desired product, thereby saving cost and conserving resources.

The paper industry wastewater even after bio-treatment at industrial scale is a major source of aquatic and soil pollution due to various unknown compounds. Hence, the study has focused on the detection of residual organic pollutants from the bleached and unbleached paper mill wastewater and both sources showed endocrine-disrupting compounds. The toxicity test with Phaseolus aureus seed germination showed inhibition of seed germination and alpha-amylase activity >25% in bleached and unbleached paper mill wastewater. The LC50 of Tubifex tubifex was noted of >50% after 48 hours incubation test. This revealed that the wastewater discharged from bleached paper mill is more toxic than unbleached paper mill waste this might be due to the use of more chemicals during bleaching and pulping process. This study has revealed that there is need to treat both paper mill wastewaters adequately prior to discharge.

The use of machine perfusion (MP) in liver transplantation (LT) is spreading worldwide. However, its efficacy has not been demonstrated, and its proper clinical use has far to go to be widely implemented. The Società Italiana Trapianti d’Organo (SITO) promoted the development of an evidence-based position paper. A 3-step approach has been adopted to develop this position paper. First, SITO appointed a chair and a cochair who then assembled a working group with specific experience of MP in LT. The Guideline Development Group framed the clinical questions into a patient, intervention, control, and outcome (PICO) format, extracted and analyzed the available literature, ranked the quality of the evidence, and prepared and graded the recommendations. Recommendations were then discussed by all the members of the SITO and were voted on via the Delphi method by an institutional review board. Finally, they were evaluated and scored by a panel of external reviewers. All available literature was analyzed, and its quality was ranked. A total of 18 recommendations regarding the use and the efficacy of ex situ hypothermic and normothermic machine perfusion and sequential normothermic regional perfusion and ex situ MP were prepared and graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. A critical and scientific approach is required for the safe implementation of this new technology.

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

Organic electrochemical transistors (OECTs) have attracted great interest in the last few years as biochemical sensors due to their outstanding analytical performance, versatility, stability, and e...

BackgroundChronic rhinosinusitis is regarded as a chronic airway disease. According to WHO recommendations, it may be a risk factor for COVID-19 patients. In most CRSwNP cases, the inflammatory changes affecting the nasal and paranasal mucous membranes are type-2 (T2) inflammation endotypes. MethodsThe current knowledge on COVID-19 and on treatment options for CRS was analyzed by a literature search in Medline, Pubmed, international guidelines, the Cochrane Library and the Internet. ResultsBased on international literature, on current recommendations by WHO and other international organizations as well as on previous experience, a panel of experts from EAACI and ARIA provided recommendations for the treatment of CRS during the COVID-19 pandemic. ConclusionIntranasal corticosteroids remain the standard treatment for CRS in patients with SARS-CoV-2 infection. Surgical treatments should be reduced to a minimum and surgery preserved for patients with local complications and for those with no other treatment options. Systemic corticosteroids should be avoided. Treatment with biologics can be continued with careful monitoring in noninfected patients and should be temporarily interrupted during the course of the COVID-19 infection.

The paper industry is an important component in the Colombian economy, the need for the continuous use of paper and cardboard in different activities results in the generation of paper sludge, for this reason there is an imminent need to generate alternatives for the use of these industrial wastes. which have been on the rise in recent years. This study is divided into two stages, the first is the evaluation through experimental analysis of the demonstration of the effectiveness of paper mud as an important source of carbon in composting processes, the second is the life cycle analysis (LCA) of the Alternative replacement of Composting vs. Synthetic Fertilizers. The product obtained from the evaluation corresponds to a stabilized compost with chicken manure, which is an important source of Carbon, Nitrogen and Calcium Carbonate, resulting in an environmentally sustainable alternative compared to the use of synthetic fertilizers. In the future, an increase in the use of fertilizers is expected, due to the growth of the world population, which generates an expansion of food production and an imminent need to attend to it. The ALC provides a better understanding of the process and its environmental impacts, the results will allow us to conclude on the most appropriate management option by showing the advantages and disadvantages associated with the use of compost. Organic fertilizers, unlike synthetic fertilizers, improve the fertility, texture and structure of the soil in the long term, promoting good drainage, aeration, water retention and root penetration, in addition to contributing to the stabilization of pH in acidic soils. The main challenges in integrating composting from paper sludge and chicken manure is to balance the C / N ratio, making a balance of the nutrient mixture and thus improving composting times, the loss of humidity, temperature gain, microbiological control and porosity.

In order for enterprise imaging to be successful across a multitude of specialties, systems, and sites, standards are essential to categorize and classify imaging data. The HIMSS-SIIM Enterprise Imaging Community believes that the Digital Imaging Communications in Medicine (DICOM) Anatomic Region Sequence, or its equivalent in other data standards, is a vital data element for this role, when populated with standard coded values. We believe that labeling images with standard Anatomic Region Sequence codes will enhance the user’s ability to consume data, facilitate interoperability, and allow greater control of privacy. Image consumption—when a user views a patient’s images, he or she often wants to see relevant comparison images of the same lesion or anatomic region for the same patient automatically presented. Relevant comparison images may have been acquired from a variety of modalities and specialties. The Anatomic Region Sequence data element provides a basis to allow for efficient comparison in both instances. Interoperability—as patients move between health care systems, it is important to minimize friction for data transfer. Health care providers and facilities need to be able to consume and review the increasingly large and complex volume of data efficiently. The use of Anatomic Region Sequence, or its equivalent, populated with standard values enables seamless interoperability of imaging data regardless of whether images are used within a site or across different sites and systems. Privacy—as more visible light photographs are integrated into electronic systems, it becomes apparent that some images may need to be sequestered. Although additional work is needed to protect sensitive images, standard coded values in Anatomic Region Sequence support the identification of potentially sensitive images, enable facilities to create access control policies, and can be used as an interim surrogate for more sophisticated rule-based or attribute-based access control mechanisms. To satisfy such use cases, the HIMSS-SIIM Enterprise Imaging Community encourages the use of a pre-existing body part ontology. Through this white paper, we will identify potential challenges in employing this standard and provide potential solutions for these challenges.

In this study, the synthesis of the {001} facet of anatase TiO2 (T-{001}) was hydrothermally carried out by a two-step process (without using fluoride ions as capping agent); the synthesized T-{001} sample was characterized by XRD, FESEM and HRTEM. The T-{001} was used for improvement in biodegradability of paper mill wastewater in the batch and continuous system under UV light irradiation. The performance of T-{001} was compared to commercial TiO2 (P25). In the batch system, the effect of the pH, time and photocatalyst dosage on the COD removal were investigated. The results showed that alkaline condition enhanced photocatalytic degradation of COD. For batch system, biodegradability index (BOD5/COD ratio) improved from 0.12 to 0.71 by application of the T-{001}; whereas this improvement was 0.52 for P25 sample. For the continuous system, the TiO2 samples were immobilized on the glass media and utilized in a packed bed photoreactor (PBPR). The effect of different flowrates on the COD removal was investigated. To investigate the stability of the samples, the photocatalytic experiments were continuously carried out for 3 h; both samples showed considerable stability during this time. The final values of BOD5/COD ratio at flowrate of the 5.4 ml/min were 0.64 and 0.42 for CT-{001} and CP25, respectively.

This article discusses a scoping review of position papers aimed at enhancing the quality of life of people with intellectual disabilities. It describes the approach taken to conducting the scoping...

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.

Abstract Artificial intelligence developments are essential to the successful deployment of community-wide, MRI-driven prostate cancer diagnosis. AI systems should ensure that the main benefits of biopsy avoidance are delivered while maintaining consistent high specificities, at a range of disease prevalences. Since all current artificial intelligence / computer-aided detection systems for prostate cancer detection are experimental, multiple developmental efforts are still needed to bring the vision to fruition. Initial work needs to focus on developing systems as diagnostic supporting aids so their results can be integrated into the radiologists’ workflow including gland and target outlining tasks for fusion biopsies. Developing AI systems as clinical decision-making tools will require greater efforts. The latter encompass larger multicentric, multivendor datasets where the different needs of patients stratified by diagnostic settings, disease prevalence, patient preference, and clinical setting are considered. AI-based, robust, standard operating procedures will increase the confidence of patients and payers, thus enabling the wider adoption of the MRI-directed approach for prostate cancer diagnosis. Key Points • AI systems need to ensure that the benefits of biopsy avoidance are delivered with consistent high specificities, at a range of disease prevalence. • Initial work has focused on developing systems as diagnostic supporting aids for outlining tasks, so they can be integrated into the radiologists’ workflow to support MRI-directed biopsies. • Decision support tools require a larger body of work including multicentric, multivendor studies where the clinical needs, disease prevalence, patient preferences, and clinical setting are additionally defined.

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

Background Cutaneous leishmaniasis (CL) is generally diagnosed by molecular methods, including PCR, using biopsy samples, skin scrapings and clinical exudates. In this study, we assessed the PCR performance for diagnosis of CL using skin of biopsy samples vs PCR of skin lesion exudate samples on filter paper and compared the diagnostic concordance of PCR using both sampling methods. Methods We assessed the PCR performance using 80 skin biopsy samples and 80 filter paper samples containing exudates from skin lesions obtained from 74 patients with clinical suspicion of CL in Cusco, Peru. Results : PCR using skin biopsy samples had superior diagnostic accuracy compared with filter paper PCR (62.5% [50/80] vs 38.7% [31/80], respectively; p˂0.005) and the diagnostic concordance between both sampling methods was ‘moderate’ (kappa coefficient=0.50, 95% CI 0.98 to 1.0). Conclusions PCR using biopsy samples remains the standard for diagnosis of CL.

Workers in a print shop are exposed to photocopier toner dust and paper dust over a prolonged period of time. However, there are only rare case reports of toner and paper dust induced lung damage in humans. We reviewed our consultation files for a period of 30 years from 1987 to 2018 to look for cases with a diagnosis of giant cell interstitial pneumonia (GIP), printer toner exposure and paper dust exposure resulting in lung disease. There were two cases which met our inclusion criteria. Slides, clinical histories and imaging were reviewed. Both the patients had worked in print shops, and had no history of exposure to hard metals. Patient 1 presented with shortness of breath and cough over several months, while patient 2 was asymptomatic at presentation. Both the patients underwent surgical lung biopsies. Histopathologic examination from both the cases showed a spectrum of pathology, including features of GIP, desquamative interstitial pneumonia, chronic bronchiolitis with lymphoid hyperplasia, and particulate matter consistent with toner. Energy dispersive spectroscopy was performed on one case, and it revealed no cobalt or tungsten particles. The unusual combination of findings is very suggestive that toner particles with or without paper dust exposure were responsible for the pathologic changes in the lungs of these patients. This possibility should be explored further with additional patients who work in print shops where they are exposed to paper dust and paper toner and have signs or symptoms of diffuse lung disease.

Development of selective and sensitive methods for on-site assay of tetracycline (TC) is of great significance for public health and food safety. Herein, a valid ratiometric fluorescence strategy using g-C3N4 nanosheets coupled with Eu3+ is designed for the assay of TC. In this strategy, both Eu3+ and g-C3N4 nanosheets serve as the recognition units of TC. The blue fluorescence of g-C3N4 nanosheets can be quenched by TC via the inner filter effect (IFE); meanwhile, the red fluorescence of Eu3+ can be enhanced by TC through the antenna effect (AE). The synergistic effect of AE and IFE caused by TC makes the developed ratiometric fluorescent sensor display a wide linear range for TC from 0.25 to 80 μM with a detection limit of 6.5 nM and a significant fluorescence color evolution from blue to red. Given its simplicity, free-label, excellent selectivity, high sensitivity, and recognizable color change, point-of-care testing systems, including smartphones and test paper-based assays, are developed for the visual sensing of TC. The integration of smartphones and test paper on a ratiometric fluorescent sensor greatly reduces the detection cost and time, providing a promising method for the qualitative discernment and semi-quantitative assay of TC on-site. Moreover, the potential application of the approach is also verified by detecting TC in milk.

This study demonstrates a method for patterning paper-based microfluidic devices. An octadecyltrichlorosilane (OTS) solution is used to coat a chromatography paper to make it hydrophobic. A low-temperature (~ 32.9 °C) atmospheric-pressure dielectric-barrier-discharge jet with a shadow mask is then used to pattern hydrophilic stripes on the OTS-coated hydrophobic paper. In this manner, 1-mm-wide hydrophilic stripes are patterned successfully. Liquids are demonstrated to be transported and mixed in the hydrophilic stripes. Water contact angle measurement, X-ray photoelectron spectroscopy, surface profiler, optical emission spectroscopy, and scanning electron microscopy are used to characterize effect of pattering.

Detecting the concentration of free chlorine is important for monitoring the quality of water. In this study, we report a nanohybrid paper-based chemiresistive sensor that can be used with smartphones to detect free chlorine ions. The sensor was fabricated using a simple and standardized coating process. The graphene and poly(3,4-ethylenedioxythiophene):poly(styrenesulfonate) (PEDOT:PSS) nanohybrid paper-based sensing device exhibited a more stable and intuitive response to free chlorine than that exhibited by the device using only PEDOT:PSS. The nanohybrid paper-based sensor was sensitive to free chlorine concentrations in a linear range of 0.1-500 ppm, and the limit of detection was 0.18 ppm. The sensor showed specificity for free chloride ions and detection capability in samples. The sensor was integrated as a module with an electric readout system, and the measured signals and results could be displayed in real time on a smartphone. Therefore, the proposed sensing platform is suitable owing to its portability, low cost, ease of use, and capability for on-site water quality measurement.

Proteinuria is a condition in which an excessive amount of protein is excreted in urine. It is, among others, an indicator of kidney disease or risk of cardiovascular disease. Rapid and reliable diagnosis and monitoring of proteinuria is of great importance for both patients and their physicians. For that reason, a paper-based sensor for proteinuria diagnosis was designed, optimized, and validated utilizing smartphone-assisted signal acquisition. In the first step, a few commonly employed protein assays were optimized and compared in terms of analytical performance on paper matrix. The tetrabromophenol blue method was selected as the one providing a sufficiently low limit of detection (39 mg·L−1) on the one hand and appropriate long-term stability (up to 3 months) on the other hand. The optimized assay was employed for protein-to-creatinine ratio (PCR) determination on a single paper-based sensor. For both analytes the linear ranges were within the clinically relevant range. The analytical usefulness of the developed sensors was demonstrated by a PCR recovery study in artificial urine. The obtained PCR recoveries were from ca. 80 to 150%.

Purpose The purpose of the study was to appraise the methodological quality of the highest impact blepharoplasty research and to describe prevalent research themes. Methods The 100 most highly cited research papers relevant to blepharoplasty were obtained from Web of Science, with no journal or date limitations applied. Data extraction included the study design, main research topic and specialty, outcome measures, and citation count. Each paper's level of evidence was independently evaluated by 2 authors according to the Oxford Centre for Evidence-Based Medicine system. Results Overall, the 100 most cited blepharoplasty research papers were cited by 4,194 papers. The mean number of citations for each paper was 73 (range: 42-239). Most of the papers presented level 4 (n = 51) or level 5 (n = 35) evidence, which is consistent with the predominance of case series (n = 47) and expert opinions (n = 18) amongst study designs. No papers achieved level 1 (highest) evidence. Six papers presented level 2 evidence and 8 papers presented level 3. Significant research foci included innovative surgical techniques (n = 65) and anatomical considerations (n = 10), with reconstructive and cosmetic implications. Senior authors were mainly affiliated with centers of plastic (n = 53) or ophthalmic/oculoplastic (n = 34) surgery. Only 3 papers used validated subjective or objective cosmetic outcome measures. Conclusions Despite a significant impact on current practice, the level of evidence of the highly cited blepharoplasty research was predominantly low. Robust research methodology, through well-designed studies and standardized outcome measures, is necessary to facilitate evidence synthesis and guide clinical practice.

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

Executive SummaryThe EC Directive 2013/59/Euratom states in article 56 that exposures of target volumes in nuclear medicine treatments shall be individually planned and their delivery appropriately verified. The Directive also mentions that medical physics experts should always be appropriately involved in those treatments. Although it is obvious that, in nuclear medicine practice, every nuclear medicine physician and physicist should follow national rules and legislation, the EANM considered it necessary to provide guidance on how to interpret the Directive statements for nuclear medicine treatments.For this purpose, the EANM proposes to distinguish three levels in compliance to the optimization principle in the directive, inspired by the indication of levels in prescribing, recording and reporting of absorbed doses after radiotherapy defined by the International Commission on Radiation Units and Measurements (ICRU): Most nuclear medicine treatments currently applied in Europe are standardized. The minimum requirement for those treatments is ICRU level 1 (“activity-based prescription and patient-averaged dosimetry”), which is defined by administering the activity within 10% of the intended activity, typically according to the package insert or to the respective EANM guidelines, followed by verification of the therapy delivery, if applicable. Non-standardized treatments are essentially those in developmental phase or approved radiopharmaceuticals being used off-label with significantly (> 25% more than in the label) higher activities. These treatments should comply with ICRU level 2 (“activity-based prescription and patient-specific dosimetry”), which implies recording and reporting of the absorbed dose to organs at risk and optionally the absorbed dose to treatment regions. The EANM strongly encourages to foster research that eventually leads to treatment planning according to ICRU level 3 (“dosimetry-guided patient-specific prescription and verification”), whenever possible and relevant. Evidence for superiority of therapy prescription on basis of patient-specific dosimetry has not been obtained. However, the authors believe that a better understanding of therapy dosimetry, i.e. how much and where the energy is delivered, and radiobiology, i.e. radiation-related processes in tissues, are keys to the long-term improvement of our treatments.

Heart failure is a complex syndrome affecting several organs including kidney, lungs, liver, brain muscles and sympathetic system. Each of these organs might contribute to its severity and prognosis. The prognosis assessment is critical for a correct heart failure management. It has already been demonstrated that a single parameter is weaker for prognosis than different parameters combined. The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score has been built and validated for heart failure with reduced ejection fraction (HFrEF) patients by considering cardiopulmonary exercise test data combined with clinical, laboratory and echocardiographic measurements. The betablockers treatment is a milestone in the HFrEF management. In the MECKI score database, the association of betablockers treatment with outcome has been investigated in different settings.

Abstract Tissue paper softness relies on two major factors, the bulk softness, which can be indicated by the elasticity of the sheet, and surface softness. Measurement of surface softness is complicated and often requires a multi-step process. A key parameter defining surface softness is the topography of the surface, particularly the crepe structure and its periodicity. Herein, we present a novel approach to measure and quantify the tissue paper surface crepe structure and periodicity based on the detection of waviness along the sample using laser scanning confocal microscopy (LSM) and X-ray tomography (XRT). In addition, field emission scanning electron microscope (FESEM) was used to characterize the tissue paper surface. We demonstrate that surface topography is directly correlated to the erosion of the doctor blade, which is used to remove the dry tissue paper from the Yankee cylinder. Because of its accuracy and simplicity, the laser confocal microscopy method has the potential to be used directly on the production line to monitor the production process of the tissue paper. XRT revealed more structural details of the tissue paper structure in 3D, and it allowed for the reconstruction of the surface and the internal structure of the tissue paper. Graphic abstract

Lime mud, a kind of industrial waste that produced in paper mill, was proposed as CO2 sorbent in calcium looping process. The carbonation performance of the lime mud was investigated in a dual‐fixed bed reactor (DFR) and a thermogravimetric analyzer (TGA). The carbonation kinetics of the lime mud in the chemical reaction controlled stage was analyzed by a surface reaction‐controlled kinetic model. The results show that the lime mud presents much poorer carbonation performance during the chemical reaction controlled stage compared with the limestone, mainly due to the high content of chlorine in the lime mud. A prewash treatment process was used to decrease the chlorine content to mitigate the sintering of the lime mud when calcined at high temperature. After prewash treatment, the prewashed lime mud shows much higher CO2 capture capacity during the chemical reaction controlled stage compared with the lime mud. A prolonged carbonation process successfully further enhances the microstructure and improves the carbonation performance of the prewashed lime mud in the chemical reaction controlled stage. The lime mud can be effectively used as CO2 sorbent in calcium looping process after prewash treatment and the following prolonged carbonation treatment.

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.

The Lewis-Clark Valley is a rural area that includes the cities of Lewiston, Idaho and Clarkston, Washington and the surrounding areas. The largest industry in the Lewis-Clark Valley is a pulp paper mill located in Lewiston which emits particulate matter and odorous sulfur air pollutants. This study analyzed the Lewis-Clark Valley air composition and seasonal, temporal and spatial variations of volatile organic compounds (VOCs) from 2017 to 2018 to determine potential health risks of the paper mill emissions to the surrounding community. Both active and passive air sampling via sorbent tubes were analyzed by thermal desorption - gas chromatography-mass spectrometry (TD-GC-MS). Fifty VOCs including benzene, toluene, chloroform, dimethyl sulfide and dimethyl disulfide were measured in the ambient air of the Lewis-Clark Valley at ten different sites, totaling over 800 samples. In addition, passive sorbent tubes were deployed in 2018 to obtain monthly averages in Lewis-Clark Valley and three urban locations in Idaho and Washington for comparison. United States Environmental Protection Agency (2001) methodology was used to assess cancer risks in the community based on the upper confidence levels of five carcinogens and nine air toxics. The Lewis-Clark Valley had similar levels of benzene to urban areas but had a strong signature of chloroform and sulfides from the paper mill. The cumulative cancer risk was 2 x 10-6 - 11 × 10-6 mainly due to the compounds chloroform, benzene and carbon tetrachloride. The hazard index of other air toxics was less than one. Overall, these air pollutants were considered low risk to the local population.

Development of paper-based microfluidic devices that perform colorimetric measurements requires quantitative image analysis. Because the design geometries of paper-based microfluidic devices are not standardized, conventional methods for performing batch measurements of regularly spaced areas of signal intensity, such as those for well plates, cannot be used to quantify signal from most of these devices. To streamline the device development process, we have developed an open-source program called ColorScan that can automatically recognize and measure signal-containing zones from images of devices, regardless of output zone geometry or spatial arrangement. This program, which measures color intensity with the same accuracy as standard manual approaches, can rapidly process scanned device images, simultaneously measure identified output zones, and effectively manage measurement results to eliminate requirements for time-consuming and user-dependent image processing procedures.

Bladder cancer is the fourth most common cancer in men, and it is becoming a prevalent malignancy. Most of the regular clinical examinations are prompt evaluations with cystoscopy, renal function testing, which require high-precision instrument, well-trained operators, and high cost. In this study, a microfluidic paper-based analytical device (μPAD) was fabricated to detect nuclear matrix protein 22 (NMP22) and bladder cancer antigen (BTA) from the urine samples. Urine samples were collected from 11 bladder cancer patients and 10 well-beings as experiment and control groups, respectively, to verify the working efficiency of μPAD. A remarkable checkout efficiency of up to 90.91% was found from the results. Meanwhile, this method is feasible for home-based self-detection from urine samples within 10 min for the total process, which provides a new way for quick, economical, and convenient tumor diagnosis, prognosis evaluation, and drug response.

Background: Defining the optimal conduction of percutaneous-coronary-intervention (PCI) to treat bifurcation lesions has been the subject of many clinical studies showing that the applied stenting technique may influence clinical outcome. Accordingly, bifurcation stenting classifications and technical sequences should be standardized to allow proper reporting and comparison. Methods: The European Bifurcation Club (EBC) is a multidisciplinary group dedicated to optimize the treatment of bifurcations and previously created a classification of bifurcation stenting techniques that is based on the first stent implantation site. Since some techniques have been abandoned, others have been refined and dedicated devices became available, EBC promoted an international task force aimed at updating the classification of bifurcation stenting techniques as well as at highlighting the best practices for most popular techniques. Original descriptive images obtained by drawings, bench tests and micro-computed-tomographic reconstructions have been created in order to serve as tutorials in both procedure reporting and clinical practice. Results: An updated Main-Across-Distal-Side (MADS)-2, classification of bifurcation stenting techniques has been realized and is reported in the present article allowing standardized procedure reporting in both clinical practice and scientific studies. The EBC-promoted task force deeply discussed, agreed on and described (using original drawings and bench tests) the optimal steps for the following major bifurcation stenting techniques: (a) 1-stent techniques (“provisional” and “inverted provisional”) and (b) 2-stent techniques (“T/TAP,” “culotte,” and “DK-crush”). Conclusions: The present EBC-promoted paper is intended to facilitate technique selection, reporting and performance for PCI on bifurcated lesions during daily clinical practice.

Objective To compare the effectiveness of silicone sheets and paper tape in the prevention of postoperative cesarean section scars. Methods Patients undergoing horizontal cesarean section were included in this randomized controlled trial. Surgical wounds were divided into two halves. Patients randomly applied silicone sheets or paper tape to each side of their wound as assigned for 3 months. Wounds were assessed at 1, 3, 6, and 12 months after surgery. Researchers used the objective Vancouver Scar Scale (VSS) to evaluate the scars and the subjective visual analog scale (VAS) to evaluate itch, pain, and scar appearance. Results No significant differences between the silicone sheet and paper tape groups were noted at postoperative follow-ups with respect to VSS scores. The silicone sheet group had significantly better VAS scores for scar appearance than the paper tape group at 6 (6.81 ± 1.47 vs 6.19 ± 1.62, P = .03) and 12 (6.88 ± 2.01 vs 6.2 ± 2.08, P = .04) months' follow-up, respectively. Conclusions The silicone sheet group showed statistically significant differences in comparison with the paper tape group in terms of scar appearance as determined by the VAS. However, the differences were too small to be clinically meaningful.

With more than 23 million infections and more than 814,000 deaths worldwide, the coronavirus disease-2019 (COVID-19) pandemic is still far from over. Several classes of drugs including antivirals, antiretrovirals, anti-inflammatory, immunomodulatory, and antibiotics have been tried with varying levels of success. Still, there is lack of any specific therapy to deal with this infection. Although less than 30% of these patients require intensive care unit admission, morbidity and mortality in this subgroup of patients remain high. Hence, it becomes imperative to have general principles to guide intensivists managing these patients. However, as the literature emerges, these recommendations may change and hence, frequent updates may be required. How to cite this article: Juneja D, Savio RD, Srinivasan S, Pandit RA, Ramasubban S, Reddy PK, et al. Basic Critical Care for Management of COVID-19 Patients: Position Paper of Indian Society of Critical Care Medicine, Part-I. Indian J Crit Care Med 2020;24(Suppl 5):S244-S253.

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

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

Directed evolution has become an important method to unleash the latent potential of enzymes to make them uniquely suited for human purposes. However, the need for a large reagent volume and sophisticated instrumentation hampers its broad implementation. In an attempt to address this problem, here we report a paper-based high-throughput screening approach that should find broad application in generating desired enzymes. As an example case, the dehalogenation reaction of the halohydrin dehalogenase was adopted for assay development. In addition to visual detection, quantitative measurements were performed by measuring the color intensity of an image that was photographed by a smartphone and processed using ImageJ free software. The proposed method was first validated using a gold standard method and then applied to mutagenesis library screening with reduced consumption of reagents (i.e., ≤ 10 μl per assay) and a shorter assay time. We identified two active mutants (P135A and G137A) with improved activities toward four tested substrates. The assay not only consumes less reagents but also eliminates the need for expensive instrumentation. The proposed method demonstrates the potential of paper-based whole-cell screening coupled with digital image colorimetry as a promising approach for the discovery of industrially important enzymes.Key Points• A frugal method was developed for directed enzyme evolution.• Mutagenesis libraries were successfully screened on a paper platform.• Smartphone imaging was efficiently used to measure enzyme activities.