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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.

Recent decades have witnessed increasing interest in the concept of the circular economy within both the business world and political circles. The circular economy spans the entire life cycle of products from product design through production, marketing, and consumption, to waste management, recycling, and re-use, and enthusiasm for putting the concept into practice has been identified across different sectors of the economy. This exploratory case study reviews how some of the leading companies in the paper and retail industries, have publicly addressed the circular economy. The case study outlines the nature of the circular economy, provides a cameo literature review of published work on the circular economy, describes the approach adopted for the case study, reports the findings of the review of how the leading companies in the paper and retail industries have addressed the circular economy, and discusses some wider issues. Keywords: circular economy, case study, paper industry, retail industry, greenwash, economic growth

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.

Chemotherapeutic drugs have been widely used in the treatment of cancer disease for about 70 years. The development of new treatments has not hindered their use, and oncologists still prescribe them routinely, alone or in combination with other antineoplastic agents. However, all chemotherapeutic agents can induce hypersensitivity reactions (HSRs), with different incidences depending on the culprit drug. These reactions are the third leading cause of fatal drug-induced anaphylaxis in the United States. In Europe, deaths related to chemotherapy have also been reported. In particular, most reactions are caused by platinum compounds, taxanes, epipodophyllotoxins and asparaginase. Despite their prevalence and relevance, the ideal pathways for diagnosis, treatment and prevention of these reactions are still unclear, and practice remains considerably heterogeneous with vast differences from center to center. Thus, the European Network on Drug Allergy and Drug Allergy Interest Group of the European Academy of Allergy and Clinical Immunology organized a task force to provide data and recommendations regarding the allergological work-up in this field of drug hypersensitivity reactions. This position paper aims to provide consensus on the investigation of HSRs to chemotherapeutic drugs and give practical recommendations for clinicians that treat these patients, such as oncologists, allergologists and internists. Key sections cover risk factors, pathogenesis, symptoms, the role of skin tests, in vitro tests, indications and contraindications of drug provocation tests and desensitization of neoplastic patients with allergic reactions to chemotherapeutic drugs. Statements, recommendations and unmet needs were discussed and proposed at the end of each section.

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.

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.

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

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.

Around 60% of the paper worldwide is made from recovered paper. Especially adhesive contaminants, so called stickies, reduce paper quality. To remove stickies but at the same time keep as many valuable fibers as possible, multi-stage screening systems with several interconnected pressure screens are used. When planning such systems, suitable screens have to be selected and their interconnection as well as operational parameters have to be defined considering multiple conflicting objectives. In this contribution, we present a Mixed-Integer Nonlinear Program to optimize system layout, component selection and operation to find a suitable trade-off between output quality and yield.

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.

A good quality control system is important to be implemented to increase productivity and minimize defects in products. One of the quality control methods is failure mode and effect analysis (FMEA). This study uses the FMEA to identify the causes of the defects and recommend the prevention methods to overcome the causes of the defects in an Indonesian paper mill. The risk priority number (RPN) is calculated by multiplying the severity, occurrence, and detection of the failures that have been determined. Unsymmetrical and tainted products are the most dominant defects in the paper mill. An inappropriate machine setting is the cause of unsymmetrical products with the highest RPN of 343. The second highest RPN is problems with bleaching machines that caused tainted products with an RPN value of 216. This study offers suggestions to Indonesian paper mill to prevent and minimize defective products.

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.

Background The implementation of an electronic health record (EHR) with structured and standardized recording of patient data can improve data quality and reusability. Whether and how users perceive these advantages may depend on the preimplementation situation. Objective To determine whether the influence of implementing a structured and standardized EHR on perceived EHR use, data quality, and data reuse differed for users working with paper-based records versus a legacy EHR before implementation. Methods We used an electronic questionnaire to measure users' perception before implementation (2014), expected change, and perceived change after implementation (2016) on three themes. We included all health care professionals in two university hospitals in the Netherlands. Before jointly implementing the same structured and standardized EHR, one hospital used paper-based records and the other a legacy EHR. We compared perceptions before and after implementation for both centers. Additionally, we compared expected benefit with perceived benefit. Results We received 7,611 responses (4,537 before and 3,074 after implementation) of which 5,707 (75%) were from professionals reading and recording patient data. A total of 975 (13%) professionals responded to both before and after implementation questionnaires. In the formerly paper-based center staff perceived improvement in all themes after implementation. The legacy EHR center experienced deterioration of perceived EHR use and data reuse, and only one improvement in EHR use. In both centers, for half of the aspects at least 45% of responders experienced results worse than expected preimplementation. Conclusion Our results indicate that the preimplementation recording practice impacts the perceived effect of the implementation of a structured and standardized EHR. For almost half of the respondents the new EHR did not meet their expectations. Especially legacy EHR centers need to investigate the expectations as these might be different and less clear cut than those in paper-based centers. These expectations need to be addressed appropriately to achieve a successful implementation.

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.

This article analyses anthropometric forms used in three different Dutch contexts around 1900: an expedition in Dutch New Guinea, the Dutch police and prison registration system, where ‘Bertillonage’ was used to identify recidivist criminals, and a state-owned reform school for girls. The authors identify the loose form as an innovative ‘paper technology’ within anthropometry that opened up entirely new ways of linking bodies to identities and was critically important in inscribing bodies into knowledge systems. The article demonstrates how this crucial innovation within anthropometry took shape in practice. In order to show the techniques through which the inscription of bodies into knowledge systems took place, the article demonstrates how the forms organized, standardized and directed measuring practices and prepared the data for further use in filing systems. Moreover, it draws attention to the tension between the forms’ potential and actual practices. The article concludes by considering the ways these forms were filed and used as ‘data’ by judicial authorities, child protection professionals and racial and criminological scientists, each of whom produced different forms of ‘paper identity’ and whose anthropometric practices enacted different bodies.

Creation of new digital technologies let automate the reproduction of text and graphic information, led to the creation and development of the digital printing. Digital printing is a technology for producing prints in the printer based on the original layout, created as corresponding codes with a computer. One of the technologies of digital printing is a computer-to-press and one of the devices in this direction is risograph. The risograph printing quality is worse than offset printing. The text is printing with medium sharpness and images remind photos in old newspapers and require special preparation. But risograph is the most profitable solution for small and medium circulations from 50 up to 1000 sheets. Wide usage of risograph printing in typographies demands increase performance of the equipment with the high print quality of digital images. To improve the quality of risographic printing, the creation of methods is required to form the initial indicators of the original layout (clarity, correct transmission of halftones, contrast). At the same time, the result of obtaining high-quality images obtained by printing on a risograph is affected by surface microgeometry and the physical and mechanical properties of paper. So, the optical density of the ink layer on the print is largely determined by the structure of the sections of paper, in particular, absorbency and porosity. To obtain high-quality images on prints, it is necessary not only to customize the original layout, but also to select paper with such characteristics that would allow you to get the best result when printing on a risograph. Since the risograph occupies an intermediate place in quality between copying equipment and laser printing, a laser print is taken as the standard for print quality. And one of the tasks of the quality of risographic prints is to increase it to the quality of laser printing.

Background: Although some have noted that combining technical and marketing content is precarious, technical communication professionals are increasingly involved in content marketing, which includes the creation of white papers. Literature review: The little existing literature on white papers provides conflicting guidance about managing the combination of technical and marketing content. Both soft-sell and hard-sell marketing approaches have been recommended. One source of such inconsistent guidance may be the lack of agreement about definitions. Research on print advertisements has described hard and soft selling as multidimensional rather than binary aspects of persuasive appeals. Research question: Which dimensions of hard- and soft-sell appeals are predominant in white papers? Research methodology: To complete our descriptive study, we collected a corpus of documents labeled as white papers in TechRepublic, and then selected and trained three raters to complete a series of judgments about dimensions of persuasive appeals in the corpus. We aggregated those ratings, calculating the mean and standard deviation for the dimensions to describe their distribution across the corpus. Results/discussion: Overall, hard-sell dimensions were more prevalent than soft-sell dimensions. However, the soft-sell category of “implicitness” was also dominant. Conclusion: Our results demonstrate the value of treating hard and soft selling as multidimensional, complementary, and combinatory marketing appeals that allow, for example, a single white paper to be both “subjective” (soft sell), and “precise” (hard sell), or both “creative” (soft sell) and “informative” (hard sell).

Using similarity software to examine the quality of scientific papers is a nuisance. The significance of a scientific paper should be decided by the acknowledged experts. The practice of using the computer program to decide scientific papers must be rescinded or voided.

The Mediterranean Federation for the Advancing of Vascular Surgery (MeFAVS) was founded in 2018, with the aim to promote cooperation among vascular professionals within Mediterranean countries. Due to its prominent social and economic impact on national health systems, diabetic peripheral artery was selected as the very first topic to be investigated by the federation. In this second paper, different experiences from delegates of participating countries were shared to define common strategies to harmonize, standardize, and optimize education and training in the Vascular Surgery specialty.

Coronavirus disease 2019 (COVID‐19) first emerged in China in November 2019. Most governments have responded to the COVID‐19 pandemic by imposing a lockdown. Some evidence suggests that a period of isolation might have led to a spike in alcohol misuse, and in the case of patients with alcohol use disorder (AUD), social isolation can favour lapse and relapse. The aim of our position paper is to provide specialists in the alcohol addiction field, in psychopharmacology, gastroenterology and in internal medicine, with appropriate tools to better manage patients with AUD and COVID‐19,considering some important topics: (a) the susceptibility of AUD patients to infection; (b) the pharmacological interaction between medications used to treat AUD and to treat COVID‐19; (c) the reorganization of the Centre for Alcohol Addiction Treatment for the management of AUD patients in the COVID‐19 era (group activities, telemedicine, outpatients treatment, alcohol‐related liver disease and liver transplantation, collecting samples); (d) AUD and SARS‐CoV‐2 vaccination. Telemedicine/telehealth will undoubtedly be useful/practical tools even though it remains at an elementary level; the contribution of the family and of caregivers in the management of AUD patients will play a significant role; the multidisciplinary intervention involving experts in the treatment of AUD with specialists in the treatment of COVID‐19 disease will need implementation. Thus, the COVID‐19 pandemic is rapidly leading addiction specialists towards a new governance scenario of AUD, which necessarily needs an in‐depth reconsideration, focusing attention on a safe approach in combination with the efficacy of treatment., All health care systems need to be reorganized during and after the COVID‐19 pandemic, and also the CAATs in order to combine operator safety with patient safety and care. The multi‐disciplinary intervention involving experts in the treatment of AUD and ALD with specialists in the treatment of COVID‐19 disease will need implementation and the contribution of the family and of care‐givers in the management of AUD and ALD patients will play a significant role.

Recent research breakthroughs have emerged from applied basic research throughout all scientific areas, including adult and paediatric gastroenterology, hepatology and nutrition (PGHAN). The research landscape within the European Society of Paediatric Gastroenterology and Nutrition (ESPGHAN) is also inevitably changing from clinical research to studies involving applied laboratory research. This position paper aims to depict the current status quo of basic science and translational research within ESPGHAN, and to delineate how the society could invest in research in the present and future time. The paper also explores which research areas in the field of PGHAN represent the current and future priorities, and what type of support is needed across the ESPGHAN working groups (WGs) and special interest groups (SIGs) to fulfil their research goals.

The introduction and wide use of devices, especially mobile ones, has changed the way learners read and do research for a variety of reasons, and this trend has attracted a number of studies conducted regarding reading on screen and on paper in addition to those dealing with the students’ behavior in using online resources to print ones. This paper aims at identifying the major findings and trends in reading research by describing the current state of knowledge and practice in the studies comparing reading on screen and on paper and to provide guidance for practitioners by analyzing and summarizing the existing research. The current review adopted a systematic review as the research methodology as well as the article selection and screening process. The articles published between 2009 and 2017 were reviewed, and 37 articles were included in the analysis. The review revealed that the research on onscreen and paper-based reading focused on comparing the learners’ performances in reading activities in both contexts and sharing preliminary findings and students’ views. However, the findings are inconclusive as mixed findings were produced as to the effects of reading on screen and on paper. Moreover, the review also indicates that practitioners are also interested in examining the factors and affordances in reading on screen. As a result, there is still further research needed to establish the factors affecting reading and comprehension while reading on screen and on paper.

Resumen Introduccion La pandemia por COVID-19 ha conllevado la suspension de la actividad programada en la mayoria de las Unidades de Endoscopia de nuestro medio. El objetivo del presente documento es facilitar el reinicio de la actividad endoscopica electiva de forma eficiente y segura. Material y metodos Se formulo una serie de preguntas consideradas de relevancia clinica y logistica. Para la elaboracion de las respuestas, se realizo una busqueda bibliografica estructurada en las principales bases de datos y se revisaron las recomendaciones de las principales instituciones de Salud Publica y de endoscopia digestiva. Las recomendaciones finales se consensuaron por via telematica. Resultados Se han elaborado un total de 33 recomendaciones. Los principales aspectos que se discuten son: 1) la reevaluacion y priorizacion de la indicacion; 2) la restructuracion de espacios, agendas y del personal sanitario; 3) el cribado de la infeccion, y 4) las medidas de higiene y los equipos de proteccion individual. Conclusion La AEG y la SEED recomiendan reiniciar la actividad endoscopica de forma escalonada, segura, adaptada a los recursos locales y a la situacion epidemiologica de la infeccion por SARS-CoV-2.

Current and past economic and financial crises have changed the behaviour of busi-ness leaders, managers, and investors, as well as accounting professionals (financial accountants, bookkeepers, management accountants, auditors). The fear of further financial crises has forced accounting reforms, the revision of auditing standards, and a restructuring of corporate governance systems in many countries to provide a relia-ble framework for companies’ activities and performance. The International Federa-tion of Accountants (IFAC) board founded the International Ethics Standard Board for Accountants (IESBA), which issued the Code of Ethics for Professional Account-ants (IFAC Code) as a set of globally accepted guidelines for ethical conduct. The first version was published in 1990, and it was recommended (but not mandatory) for IFAC members to adopt. Establishing a unified code of ethics was one of the major achievements of IFAC that provided solid guidelines for accounting professionals across the world. Prior research indicates that the IFAC Code has been moderately successful in the attempt to harmonise ethics standards for professional accountants worldwide. As globalisation continues to affect business culture and technology, and, consequently, the focus of business, the accounting profession must keep pace and reassess its role in the world economy, but also in society. This is especially important during economic and financial crises, when the classic entrepreneurial model is not sustainable. Not only can a code of ethics can provide a framework for appropriate employee behaviour and establish a better corporate culture, it can also improve lead-ership, help organisations to comply with government guidelines, and enable organisa-tions to be more socially responsible. Many ethical issues could be explored in the con-text of Corporate Social Responsibility (CSR), not only in times of crisis. The high-profile ethical failures of professional accountants in recent decades taught us the importance of ethics education. A professional accountant’s responsibility is not exclusively to satisfy the needs of an individual client or employing organization. All accountants should act in the public interest by complying with fundamental ethical principles (integrity, objectivity, professional competence and due care, confidentiality, and professional behaviour) since these principles establish the standard of expected behaviour. Therefore, accounting ethics should be promoted much more in education and in practice. Accounting and business educators have a special responsibility to ex-amine and teach ethics in the broader context of globalisation. Regulations and volun-tary standards aim at minimizing fraud and manipulation of business information, but ethical behaviour is the key to achieving an honest business environment and sustaina-ble growth.

Coronavirus disease 2019 (COVID‐19), a respiratory tract infection caused by a novel human coronavirus, the severe acute respiratory syndrome coronavirus 2, leads to a wide spectrum of clinical manifestations ranging from asymptomatic cases to patients with mild and severe symptoms, with or without pneumonia. Given the huge influence caused by the overwhelming COVID‐19 pandemic affecting over three million people worldwide, a wide spectrum of drugs is considered for the treatment in the concept of repurposing and off‐label use. There is no knowledge about the diagnosis and clinical management of the drug hypersensitivity reactions that can potentially occur during the disease. This review brings togetherall the published information about the diagnosis and management of drug hypersensitivity reactions due to current and candidate off‐label drugs andhighlights relevant recommendations. Furthermore, it gathers all the dermatologic manifestations reported during the disease for guiding the clinicians to establish a better differential diagnosis of drug hypersensitivity reactionsin the course of the disease.

Effective integration of learning technology tools in classrooms is a key component of 21st century higher education classrooms. The goal of the position paper is to provide a discussion from the results of the research study and to uncover the faculty members’ views and perceptions about implementing learning technology tools. Insights from this study revealed that it is a teaching technique and style of the faculty members in the use of these learning technology tools that determined the nature of their perception of success rather than the learning tools themselves.

Urgent care practice (UCP) is a novel concept for India. Urgent care primarily deals with injuries or illnesses requiring immediate care. Medical emergency and urgency can happen anywhere unannounced. Research has shown that 90% of the morbidities can be resolved within the community by primary care physicians lead teams. Given the changing professional demands, non-specialists tend to refer away far too many cases to specialists, undermining generalist medical care, particularly in Indian settings. The spillover of the patient load from the primary care setting to the tertiary care centers is enormous leading to resource mismatch. Family physicians and other primary care providers are best positioned to develop practices and provide good quality urgent care to society. Family physicians, general practitioners, and medical officers are already functioning as the frontline care providers for any emergency or medical urgency arising within communities. Urgent care is essentially ambulatory care or outpatient care outside of a traditional hospital emergency room. "UCP aims to provide timely support, which is easily accessible with a focus on good clinical outcomes, e.g. survival, recovery, lack of adverse events, and complications. Core interventions of urgent care are centered on the 4Rs - Rescue, Resuscitate, Relate, and Refer. At present, there are no available, established training model for future faculty, residents, and medical students on "UCP" in India.

Family medicine is the internationally recognized nomenclature for the academic discipline, knowledge domain, and medical specialty of primary care doctors, working in the community setting. Family medicine is defined as a specialty of medicine which is concerned with providing comprehensive care to individuals and families by integrating biomedical, behavioral, and social sciences in the community setting. The distinction of family medicine lies in the tradition of medical generalism, promoting whole person care, in a life cycle mode; providing optimal preventive, promotive, and curative healthcare services in a wide spectrum of setting from home to hospital. In 2016, 92nd report of the department-related parliamentary standing committee on health and family welfare on the “Functioning of the Medical Council of India” has emphasized the need for postgraduate in family medicine. The committee report has noted that “the medical education system is designed in a way that the concept of family physicians has been ignored. The committee recommends that the Government of India in coordination with State Governments should establish robust PG Programs in Family Medicine and facilitate introduction of Family Medicine discipline in all medical colleges. This will not only minimize the need for frequent referrals to specialist and decrease the load on tertiary care but also provide continuous healthcare for the individuals and families. The successive National Health Policies of Government of India–NHP 2002 and 2017 have emphasized the need of family medicine training in India. The recently enacted National Medical Commission Act 2019 has mandated NMC to promote training in family medicine at both undergraduate and postgraduate levels. Therefore, in the background of the stated policies of the Government of India the concept of family doctors, which was earlier neglected should be institutionalized within the mainstream medical education system of India. It is now time to accelerate and upgrade family medicine training and thereby strengthen the concept of comprehensive primary care in India. This white paper presents the review of family medicine training in India and proposes a way forward.

Contains fulltext : 229587.pdf (Publisher’s version ) (Open Access) In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points* Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.* Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.* Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".* Strict algorithms define the exact management of screen-detected nodules and incidental findings.* For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.

The clinical, educational, and research facets of lung transplantation have advanced significantly since the first lung transplant in 1963. The formation of the International Society for Heart and Lung Transplantation (ISHLT) and subsequent Registry has forged a precedent of collaborative teamwork that has significantly affected current lung transplantation outcomes. The Society for the Advancement of Anesthesia (SATA) is dedicated to developing educational platforms for all facets of transplant anesthesia. Additionally, we believe that the anesthetic training for lung transplantation has not kept pace with other advances in the field. As such, SATA presents for consideration these educational milestones and competencies for anesthetic fellowship training in the field of lung transplantation. The proposed milestones were designed on the framework of 6 core competencies created by the Accreditation Council on Graduate Medical Education. The milestones were identified by combining the expert opinion of our Thoracic Transplant Committee, our experience as educators, and literature review. We offer this White Paper to the anesthesiology and transplant communities as a starting point for the discussion and evolution of perioperative anesthetic care in the field of lung transplantation.

Developmental pharmacology describes the impact of maturation on drug disposition (pharmacokinetics, PK) and drug effects (pharmacodynamics, PD) throughout the paediatric age range. This paper, written by a multidisciplinary group of experts, summarizes current knowledge, and provides suggestions to pharmaceutical companies, regulatory agencies and academicians on how to incorporate the latest knowledge regarding developmental pharmacology and innovative techniques into neonatal and paediatric drug development. Biological aspects of drug absorption, distribution, metabolism and excretion throughout development are summarized. Although this area made enormous progress during the last two decades, remaining knowledge gaps were identified. Minimal risk and burden designs allow for optimally informative but minimally invasive PK sampling, while concomitant profiling of drug metabolites may provide additional insight in the unique PK behaviour in children. Furthermore, developmental PD needs to be considered during drug development, which is illustrated by disease- and/or target organ-specific examples. Identifying and testing PD targets and effects in special populations, and application of age- and/or population-specific assessment tools are discussed. Drug development plans also need to incorporate innovative techniques such as preclinical models to study therapeutic strategies, and shift from sequential enrolment of subgroups, to more rational designs. To stimulate appropriate research plans, illustrations of specific PK/PD-related as well as drug safety-related challenges during drug development are provided. The suggestions made in this joint paper of the Innovative Medicines Initiative conect4children Expert group on Developmental Pharmacology and the European Society for Developmental, Perinatal and Paediatric Pharmacology, should facilitate all those involved in drug development. ispartof: BRITISH JOURNAL OF CLINICAL PHARMACOLOGY vol:88 issue:12 pages:4965-4984 ispartof: location:England status: published

Over the last two decades, there has been growing interest from all stakeholders (government, manufacturers, and consumers) to make packaging more sustainable. Paper is considered one of the most environmentally friendly materials available. A qualitative study investigating consumers’ expectations and opinions of sustainable paper-based packaging materials was conducted where 60 participants took part in focus group sessions organized in two stages. In the first stage, participants expressed their opinions about currently available packages in the market and their expectations about a sustainable packaging material. In the second stage of the study, they evaluated five paper-based prototype packages for two product categories (biscuits and meat). Too much plastic and over-packaging were the key issues raised for current packages. Price and quality were the main driving forces for consumers’ purchase intent. While participants were impressed by the sustainable nature of the prototypes, the design did not necessarily meet their expectations, and they were not willing to pay more for a sustainable package. The key message that emerged from the discussions was the “3Rs”—Reduce, Reuse, and Recycle”—which should be the main points to consider when designing a sustainable packaging.

Ample interest for more efficient utilization of bio-based residues has emerged in the Nordic pulp and paper (P&P) industry, which uses virgin wood as feedstock. Although different bioenergy retrofit technologies for production of liquid, solid, and gaseous bioenergy products have been applied in the existing P&P mills, the number of installations remains small. The lack of profound knowledge of existing bioenergy retrofits hinders the replication and market uptake of potential technologies. This review synthesises the existing knowledge of European installations and identifies the key drivers and barriers for implementation to foster the market uptake of potential technologies. The bioenergy retrofits were reviewed in terms of technical maturity, drivers, barriers and market potential. Based on this evaluation, common drivers and barriers towards wider market uptake were outlined from political, economic, social, technical, environmental, and legal perspective. Technologies already commercially applied include anaerobic fermentation of sludge, bark gasification, tall oil diesel and bioethanol production, whereas lignin extraction, biomethanol production, hydrothermal liquefaction and hydrothermal carbonization are being demonstrated or first applications are under construction. The findings of this review show that a stable flow of residues at P&P mills creates a solid base for retrofitting. New innovative bio-based products would allow widening the companies' product portfolios and creating new businesses. Also, European Union's (EU) legislation drives towards advanced biofuels production. Wider uptake of the retrofitting technologies requires overcoming the barriers related to uncertainty of economic feasibility and unestablished markets for new products rather than technical immaturity.

Feedback is integral to the process of education but is not a simple process and in mass education and global systems presents numerous additional challenges. This paper, which is intended as an informative awareness-raising paper, provides a review of recent literature on the challenges that educators and students face when feedback is given and received. It conceptualizes feedback as a process that requires multiple inputs and should support the partnership between educators and students through dialogue and engagement. Feedback literacy that incorporates the role of emotion is seen as a key aspect of professional and student development to motivate and engage students.

The circular economy is considered by international institutions such as the United Nations and the European Union as the most urgent strategy to orient the economic development model towards sustainability. To find concrete applications, the circular economy requires greater awareness in consumers and businesses. The Italian paper industry, which boasts high levels of competitiveness at an international level, has initiated important restructuring and rationalization processes over the last decade with a view to recycling and sustainability. Only the final phase of the production process is yet to comply with all circular economy criteria, that is, the recovery of production waste (pulper). Hence, the actual technological and strategic challenge of the paper industry is to phase out landfilling of recyclable waste and implement energy recovery strategies, as well as promoting the use of renewable sources.

Synthetic organic compounds (SOCs) are reported as xenobiotics compounds contaminating the environment from various sources including waste from the pulp and paper industries: Since the demand and production of paper is growing increasingly, the release of paper and pulp industrial waste consisting of SOCs is also increasing the SOCs’ pollution in natural reservoirs to create environmental pollution. In pulp and paper industries, the SOCs viz. phenol compounds, furans, dioxins, benzene compounds etc. are produced during bleaching phase of pulp treatment and they are principal components of industrial discharge. This review gives an overview of various biotechnological interventions for paper mill waste effluent management and elimination strategies. Further, the review also gives the insight overview of various ways to restrict SOCs release in natural reservoirs, its limitations and integrated approaches for SOCs bioremediation using engineered microbial approaches. Furthermore, it gives a brief overview of the sustainable remediation of SOCs via genetically modified biological agents, including bioengineering system innovation at industry level before waste discharge.

EMS personnel in the U.S. continue to be overwhelmingly Caucasian and male, with 75% being male and 85% identifying as nonminority. While the population of the United States becomes more diverse in ethnicity, religion, and race, the EMS workforce remains largely homogenous and does not reflect the diversity of the population it serves. Given the growing diversity across the country, EMS personnel will increasingly be responding to calls for service involving patients with different cultural backgrounds than their own. This growing gap between providers and the population they serve may exacerbate already existing disparities in care.

Acima do título: "Dossiê: meio-ambiente em disputa" Bibliografia: p. 186 e notas de rodapé Disponível também em: https://www.scielo.br/j/civitas/a/KNPrfysCbx8YNQDZKyK5bQR/?lang=pt Artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional The incidence of paper mills in the Três Lagoas region, as of 2009, brought a series of commitments and consequences to the settlers of the agrarian reform. With the offer of unlimited tax exemptions, public financing through BNDES and other industrial development programs and projects, the industries established and started the processes for the duplication of their industrial plants. Already, the settlers are at the mercy, therefore, can not obtain access to investments, nor to the financing of public banks and other development agencies. In this perspective, the only source of financing for family agricultural production ends up being the paper mills themselves, through their PDS - sustainable development plans and programs. Only in the settlement where the research was given there are 181 lots, but less than 20 were benefited by the financing. In this sense, the form and the model of financing, the speed and volume of resources contributed are at the absolute and exclusive discretion of the own pulleys, which has social and economic repercussions among the settlers, creating as a zone of imprisonment of the settlers to the paper, here called cages of paper. A incidência de indústrias papeleiras na região de Três Lagoas, a partir de 2009, trouxe uma série de compromissos e consequências aos assentados da reforma agrária. Com a oferta de isenções fiscais ilimitadas, financiamento público via BNDES e outros programas e projetos de fomento industrial, as indústrias se estabeleceram e iniciaram os processos para duplicação de suas plantas industriais. Já, os assentados ficam à mercê, pois, não têm condições de obter acesso a investimentos, nem a financiamentos dos bancos públicos e demais agências de fomento. Nessa perspectiva, a única fonte de financiamento da produção agrícola familiar acaba sendo as próprias papeleiras, por meio de seus planos e programas de desenvolvimento sustentável (PDS). Apenas no assentamento onde se desenvolveu a empiria há 181 lotes, mas, menos de 20 foram beneficiados pelos financiamentos. Nesse sentido, a forma e o modelo de financiamento, a velocidade e o volume de recursos aportados ficam à discricionariedade absoluta e exclusiva das próprias papeleiras, o que repercute social e economicamente entre os assentados, criando como que uma zona de aprisionamento dos assentados às papeleiras, aqui denominadas cativeiros de papel. La incidencia de industrias papeleras en la región de Três Lagoas, a partir de 2009, trae serie de compromisos y consecuencias a los asentados de la reforma agraria. Con la oferta de exenciones fiscales ilimitadas, financiamiento público vía BNDES y otros programas y proyectos de fomento industrial, las industrias se establecieron e iniciaron los procesos para duplicación de sus plantas industriales. Ya, los asentados se quedan a merced, pues, no tienen condiciones de obtener acceso a inversiones, ni a financiamientos de los bancos públicos y demás agencias de fomento. En esta perspectiva, la única fuente de financiamiento de la producción agrícola familiar termina siendo las propias papeles, a través de sus PDS - planes y programas de desarrollo sostenible. Sólo en el asentamiento donde se dio la encuesta son 181 lotes, pero menos de 20 fueron beneficiados por las financiaciones. En este sentido, la forma y el modelo de financiamiento, la velocidad y el volumen de recursos aportados quedan a la discrecionalidad absoluta y exclusiva de las propias papeles, lo que repercute social y económicamente entre los asentados, creando como una zona de encarcelamiento de los asentados a las papeleras, aquí denominada cadenas de papel.

The International Working Group for Patients' Right to Nutritional Care presents its position paper regarding nutritional care as a human right intrinsically linked to the right to food and the right to health. All people should have access to food and evidence-based medical nutrition therapy including artificial nutrition and hydration. In this regard, the hospitalized malnourished ill should mandatorily have access to screening, diagnosis, nutritional assessment, with optimal and timely nutritional therapy in order to overcome malnutrition associated morbidity and mortality, while reducing the rates of disease-related malnutrition. This right does not imply there is an obligation to feed all patients at any stage of life and at any cost. On the contrary, this right implies, from an ethical point of view, that the best decision for the patient must be taken and this may include, under certain circumstances, the decision not to feed. Application of the human rights-based approach to the field of clinical nutrition will contribute to the construction of a moral, political, and legal focus to the concept of nutritional care. Moreover, it will be the cornerstone to the rationale of political and legal instruments in the field of clinical nutrition.

Person-centred care, with its central focus on the patient in partnership with healthcare practitioners, is considered to be the contemporary gold standard of care. This type of care implies effective communication from and by both the patient and the healthcare practitioner. This is often problematic in the case of the paediatric population, because of the many communicative challenges that may arise due to the child's developmental level, illness and distress, linguistic competency and disabilities. The principle of universal design put forth in conventions and legislation means that the design of products and services should be usable by all people, to the greatest extent possible. Augmentative and alternative communication encompasses strategies, for example pictures and apps, that are typically used with people with communication disability. In this position paper, we argue for the universal use of augmentative and alternative communication to support person-centred communication and care for children, regardless of age or potential disability. Clinical examples are shared from three different paediatric care settings where pictorial supports were applied universally. Interviews were conducted with children and adolescents (with and without disabilities), parents and healthcare practitioners, and the principles of universal design were used as a framework to demonstrate how person-centred communication is supported in paediatric care.

Introduction: Appropriate wheelchairs are often essential for the health and wellbeing of people with mobility impairments to enhance fundamental freedoms and equal opportunity. To date, provision has mainly focused on just delivering the wheelchair instead of following an evidence-based wheelchair service delivery process. In addition, many governments have not committed to a national wheelchair provision policy. Approach: To prepare this position paper, a systemic development model, founded on the sustainable human security paradigm, was employed to explore the global challenges to accessing appropriate wheelchairs. Positions: I: Consideration of key perspectives of wheelchair provision across the life course is essential to meet the needs to children, adults, older people and their families; II: Comprehensive wheelchair service delivery processes and a competent workforce are essential to ensure appropriate wheelchair service provision; III: Evaluations on wheelchair product quality development, performance and procurement standards are key as wheelchair product quality is generally poor; IV: Understanding the economic landscape when providing wheelchairs is critical. Wheelchair funding systems vary across jurisdictions; V: Establishing wheelchair provision policy is a key priority, as specific policy is limited globally. Conclusion: The vision is to take positive action to develop appropriate and sustainable wheelchair service provision systems globally, for me, for you, for us.

Three-dimensional (3D) tumor models have gained increased attention in life-science applications as they better represent physiological conditions of in vivo tumor microenvironments, and thus, possess big potential for guiding drug screening studies. Although various techniques proved effective in growing cancer cells in 3D, their procedures are typically complex, time consuming, and expensive. Here, we present a versatile, robust, and cost-effective method that utilizes a paper platform to create cryopreservable high throughput arrays of 3D tumor models. In the approach, we use custom 3D printed masks along with simple chemistry modifications to engineer highly localized hydrophilic ‘virtual microwells’, or microspots, on paper for 3D cell aggregation, surrounded by hydrophobic barriers that prevent inter-microspot mixing. The method supports the formation and cryopreservation of 3D tumor arrays for extended periods of storage time. Using MCF-7 and MDA-MB-231 breast cancer cell lines, we show that the cryopreservable arrays of paper-based 3D models are effective in studying tumor response to cisplatin drug treatment, while replicating key characteristics of the in vivo tumors that are absent in conventional 2D cultures. This technology offers a low cost, easy, and fast experimental procedure, and allows for 3D tumor arrays to be cryopreserved and thawed for on-demand use. This could potentially provide unparalleled advantages to the fields of tissue engineering and personalized medicine.

Objective Communication in healthcare has influenced and been influenced by the COVID-19 pandemic. In this position paper, we share observations based on the latest available evidence and experiential knowledge that have emerged during the pandemic, with a specific focus on policy and practice. Methods This is a position paper that presents observations relating to policy and practice in communication in healthcare related to COVID-19. Results Through our critical observations as experts in the field of healthcare communication, we share our stance how healthcare communication has occured during the pandemic and suggest possible ways of improving policy and professional practice. We make recommendations for policy makers, healthcare providers, and communication experts while also highlighting areas that merit further investigation regarding healthcare communication in times of healthcare crises. Conclusion We have witnessed an upheaval of healthcare practice and the development of policy on-the-run. To ensure that policy and practice are evidence-based, person-centred, more inclusive and equitable, we advocate for critical reflection on this symbiotic relationship between COVID-19 and the central role of communication in healthcare. Practice implications This paper provides a summary of the key areas for development in communication in healthcare during COVID-19. It offers recommendations for improvement and a call to review policies and practice to build resilience and inclusive and equitable responsiveness in communication in healthcare.

PurposeThis position paper urges a drive towards clarity in the key definitions, terminologies and habits of speech associated with digital engineering and building information modelling (BIM). The ultimate goal of the paper is to facilitate the move towards arriving at an ideal definition for both concepts.Design/methodology/approachThis paper takes the “explanation building” review approach in providing prescriptive guidelines to researchers and industry practitioners. The aim of the review is to draw upon existing studies to identify, describe and find application of principles in a real-world context.FindingsThe paper highlights the definitional challenges surrounding digital engineering and BIM in Australia, to evoke a debate on BIM and digital engineering boundaries, how and why these two concepts may be linked, and how they relate to emerging concepts.Originality/valueThis is the first scholarly attempt to clarify the definition of digital engineering and address the confusion between the concepts of BIM and digital engineering.

This Special Issue presents the seven best papers from the 30thIFAMA 2020 World Congress, reflecting the richness and quality of the agri-food business and management scholarship that IFAMA facilitates and promotes. They reveal the diversity of research topics and current practices related to the most pressing agri-food business and management issues. Whether the papers discuss vegetable producers cooperatives in Cambodia, innovation intermarries and enhancing collaboration in Sweden, or information nudges in ornamental plant labeling in the United States, the papers in this Special Issue illustrate the need for variegated professional and academic skills and expertise represented in IFAMA.

Patients with heart failure (HF) who contract SARS-CoV-2 infection are at a higher risk of cardiovascular and non-cardiovascular morbidity and mortality. Regardless of therapeutic attempts in COVID-19, vaccination remains the most promising global approach at present for controlling this disease. There are several concerns and misconceptions regarding the clinical indications, optimal mode of delivery, safety and efficacy of COVID-19 vaccines for patients with HF. This document provides guidance to all healthcare professionals regarding the implementation of a COVID-19 vaccination scheme in patients with HF. COVID-19 vaccination is indicated in all patients with HF, including those who are immunocompromised (e.g. after heart transplantation receiving immunosuppressive therapy) and with frailty syndrome. It is preferable to vaccinate against COVID-19 patients with HF in an optimal clinical state, which would include clinical stability, adequate hydration and nutrition, optimized treatment of HF and other comorbidities (including iron deficiency), but corrective measures should not be allowed to delay vaccination. Patients with HF who have been vaccinated against COVID-19 need to continue precautionary measures, including the use of facemasks, hand hygiene and social distancing. Knowledge on strategies preventing SARS-CoV-2 infection (including the COVID-19 vaccination) should be included in the comprehensive educational programmes delivered to patients with HF. This article is protected by copyright. All rights reserved. [Abstract copyright: This article is protected by copyright. All rights reserved.]

There is a need for a paradigm shift across mental health in primary care to improve the lives of millions of Europeans. To contribute to this paradigm shift, the European Forum for Primary Care (EFPC-MH) working group for Mental Health, produced a Position Paper for Primary Care Mental Health outlining 14 themes that needed prioritizing. These themes were developed and discussed interactively during the EFPC conferences between 2012 and 2019. The Position Paper on Mental Health gives direction to the necessary improvements over the next ten years. The themes vary from preferable healthcare model to the social determinants highlighting issues such as inequalities. The Statement of Mental Health in Primary Care will be established in cooperation with fellow organizations. ispartof: Primary Health Care Research And Development vol:21 issue:e56 pages:1-8 ispartof: location:England status: published

This study aims to analyze the factors that influence firm value, where the independent variables consist of ownership structure, capital structure and gender diversity, and financial performance as a mediation. The research used is Pulp & Paper companies listed on the Indonesia Stock Exchange for the period 2015 – 2019. Using samples from 7 manufacturing companies. By using a sample of 7 manufacturing companies. The test analysis used is the SmartPLS 3.0 program. Based on the results of the study, ownership structure and gender diversity have no significant effect on firm value, capital structure and financial performance have a significant positive effect on firm value, and financial performance has no significant effect on mediating ownership structure and capital structure on the firm. The limitation of this study is to use financial reports sourced from the Indonesia Stock Exchange (IDX) for the pulp and paper sector from 2015-2019 and have financial reports for 5 consecutive years. The implications of this research are expected to provide information for investors on things that can affect the value of the company, especially the paper industry sector.How to Cite:Fernando, W., & Setiawan, T. (2021). Analisis Model Atas Faktor Penentu Nilai Perusahan (Studi Pada Perusahaan Pulp and Paper yang Terdaftar di BEI 2015-2019). Akuntabilitas: Jurnal Ilmu Akuntansi, 14(2), 231-242.