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Background: Rickettsial diseases are difficult to diagnose in Bangladesh due to low index of suspicion and lack of diagnostic facilities in most laboratories especially in rural areas. Immunofluorescence assay (IFA) is the gold standard serological test for diagnosis of Rickettsial diseases. For serological diagnosis of rickettsial diseases, use of filter paper is an inexpensive and convenient method for collecting, storing, and transporting of blood samples with little space without refrigeration. Current study shows that the rickettsial diseases were present in febrile patients in Bangladesh. The study also compared the results of direct serum by IFA and filter paper serum spot followed by IFA as an alternative way of testing frozen samples. Materials and Methods: This observational study for evaluation of rickettsial diseases from direct serum by IFA and sera dried on blotting paper followed by IFA at the department of Virology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. A total of 152 patients’ sera were selected by systemic random sampling of every 3rd sera of 556 febrile patients who were tested negative for dengue and or Chikungunya virus infection. Forty cases were confirmed by IFA from direct sera. In addition, 60 samples were selected from 152 sera by systemic random sampling of every 3rd sera for blotting on filter paper for further IFA test. Out of 60 sera, 35 were confirmed by IFA from direct sera and of the 35 confirmed positive cases, 31(88.6%) were positive by IFA after blotting paper assay. Taking the IFA of direct sera as gold standard test, the sensitivity, specificity, positive predictive value and negative predictive value of IFA from blotting paper eluted sera were 88%, 100%, 100% and 86% respectively. Conclusion: The study showed the use of filter paper is an inexpensive and convenient method for storing and transporting samples for serological tests like IFA in diagnosis of rickettsial diseases. J Dhaka Medical College, Vol. 28, No.2, October, 2019, Page 153-158

The solid waste dumpsites of pulp and paper industries are prone to be turned into degraded lands due to the loss of vegetation cover. Such sites often possess drought, salinity and pH stresses as well as heavy metal contamination. Restoration of top soil by creating vegetation cover has proved to be the most sustainable approach to check land degradation. Therefore, to find some stress-tolerant species capable of creating vegetation cover in paper mill dumpsites, a vegetation composition study was conducted in a paper mill dumpsite. A total of seven plant species viz., Calotropis gigantea (L.) Dryand., Chromolaena odorata (L.) R.M. King & H. Rob, Mikania scandens (L.) Willd., R. communis L., Rotheca serrata (L.) Steane & Mabb., Senna sophera (L.) Roxb. and Solanum myriacanthum Dunal were found. To correlate the existence of these plants with stress condition of soil, the level of phytotoxicity in the dumpsite was assessed by studying seed germination status, proline accumulation, leaf relative water content (RWC), leaf pH, total chlorophyll content and ascorbic acid level of Ricinus communis as bioassay indices. The significantly lower percentage of seed germination in dumpsite soil, compared to control, revealed the phytotoxic nature of the soil of the dumpsite. The significantly higher level of proline, RWC, total chlorophyll and ascorbic acid in plant leaves from dumpsites than from the control soils indicated considerable stress in the dumpsite. Soil physicochemical and nutrient status analyses substantiated with the bioassay results. Despite apparent phytotoxicity, the presence of certain plant species in the dumpsite indicated their inherent stress tolerance capability to be prospected.

Introduction We developed low-cost, portable paper-based diagnostic devices for detection of human immunoglobulin M (IgM) and immunoglobulin G (IgG) in serum without any sample preparation. These devices can be used to help identify presence of diseases, used to provide rapid results ( Materials and Methods We successfully accomplished colorimetric detection of human IgG and human IgM using a sandwich-style assay within the microfluidic paper device via vertical flow immunoassay configuration. The reaction zone in the wax printed paper layer is a small circular pattern. Gold nanoparticles conjugated with anti-human IgG and IgM antibodies have been used for colorimetric detection of IgG or IgM by naked eye. Colorimetric signal can be precisely quantified through implementation of image analysis software which can be developed as an app for a smartphone. The size of the device is 2 cm × 2 cm × 1 mm. Results Colorimetric detection of human IgG was accomplished at 100 fg/mL concentration using a gold nanoparticle–conjugated anti-human IgG antibody. The developed platform has a dynamic range of IgM and IgG concentrations between 0.1 pg/mL and 100 μg/mL. These devices provided a color readout in Conclusions Because of the inherent simplicity of the device operation and their ease of use, there is no variation between samples and users of the device. This low-cost approach enables multiplexing with >1 measurement performed in parallel at the same time. We anticipate that because of the sensitivity, specificity, ease of use, and overall reliability, this approach will become a standard for diagnosis of diseases and health conditions.

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.

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 2018, the position paper ‘Imaging the adult with congenital heart disease: a multimodality imaging approach’ was published. The paper highlights, in the first part, the different imaging modalities applied in adult congenital heart disease patients. In the second part, these modalities are discussed more detailed for moderate to complex anatomical defects. Because of the length of the paper, simple lesions were not touched on. However, imaging modalities to use for simple shunt lesions are still poorly known. One is looking for structured recommendations on which they can rely when dealing with an (undiscovered) shunt lesion. This information is lacking for the initial diagnostic process, during repair and at follow-up. Therefore, this paper will focus on atrial septal defect, ventricular septal defect, and persistent arterial duct. Pre-, intra-, and post-procedural imaging techniques will be systematically discussed. This position paper will offer algorithms that might help at a glance. The document is prepared for general cardiologists, trainees, medical students, imagers/technicians to select the most appropriate imaging modality and to detect the requested information for each specific lesion. It might serve as reference to which researchers could refer when setting up a (imaging) study.

Declining carbon (C) content in agricultural soils threatens soil fertility and makes soil prone to erosion, which could be rectified with organic soil amendments. In a 4‐yr field trial, we made a single application of three different organic sludges from the pulp and paper industry and studied their effects on cereal yield, soil C content, and fungal and bacterial composition. In laboratory rainfall simulations, we also studied the effects of the soil amendments on susceptibility to erosion and nutrient mobilization of a clay‐textured soil by measuring the quality of percolation water passing through 40‐cm intact soil monoliths during 2‐d rainfall simulations over four consecutive years after application. A nutrient‐poor fiber sludge reduced wheat yield in the first growing season, but there were no other significant effects on cereal yield or grain quality. An input of ∼8 Mg ha−1 C with the soil amendments had only minor effects on soil C content after 4 yr, likely because of fast microbe‐mediated turnover. The amendments clearly changed the fungal and bacterial community composition. All amendments significantly reduced suspended solids (SS) and total phosphorus (TP) concentrations in percolation water. The effect declined with time, but the reduction in SS and TP was still >25% 4 yr after application. We attributed the lower tendency for particle detachment in rain simulations to direct interactions of soil minerals with the added particulate organic matter and microbe‐derived compounds that stabilize soil aggregates. In soils with low organic matter content, pulp and paper industry by‐products can be a viable measure for erosion mitigation.

Background The outpatient setting is a key scenario for the implementation of antimicrobial stewardship (AMS) activities, considering that overconsumption of antibiotics occurs mainly outside hospitals. This publication is the result of a joint initiative by the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks, which is aimed at formulating a set of target actions for linking surveillance data with AMS activities in the outpatient setting. Methods A scoping review of the literature was carried out in three research areas: AMS leadership and accountability; antimicrobial usage and AMS; antimicrobial resistance and AMS. Consensus on the actions was reached through a RAND-modified Delphi process involving over 40 experts in infectious diseases, clinical microbiology, AMS, veterinary medicine or public health, from 18 low-, middle- and high-income countries. Results Evidence was retrieved from 38 documents, and an initial 25 target actions were proposed, differentiating between essential or desirable targets according to clinical relevance, feasibility and applicability to settings and resources. In the first consultation round, preliminary agreement was reached for all targets. Further to a second review, 6 statements were re-considered and 3 were deleted, leading to a final list of 22 target actions in the form of a practical checklist. Conclusions This White Paper is a pragmatic and flexible tool to guide the development of calibrated surveillance-based AMS interventions specific to the outpatient setting, which is characterized by substantial inter- and intra-country variability in the organization of healthcare structures, maintaining a global perspective and taking into account the feasibility of the target actions in low-resource settings.

This White Paper by the European Society for Swallowing Disorders (ESSD) reports on the current state of screening and non-instrumental assessment for dysphagia in adults. An overview is provided on the measures that are available, and how to select screening tools and assessments. Emphasis is placed on different types of screening, patient-reported measures, assessment of anatomy and physiology of the swallowing act, and clinical swallowing evaluation. Many screening and non-instrumental assessments are available for evaluating dysphagia in adults; however, their use may not be warranted due to poor diagnostic performance or lacking robust psychometric properties. This white paper provides recommendations on how to select best evidence-based screening tools and non-instrumental assessments for use in clinical practice targeting different constructs, target populations and respondents, based on criteria for diagnostic performance, psychometric properties (reliability, validity, and responsiveness), and feasibility. In addition, gaps in research that need to be addressed in future studies are discussed. The following recommendations are made: (1) discontinue the use of non-validated dysphagia screening tools and assessments; (2) implement screening using tools that have optimal diagnostic performance in selected populations that are at risk of dysphagia, such as stroke patients, frail older persons, patients with progressive neurological diseases, persons with cerebral palsy, and patients with head and neck cancer; (3) implement measures that demonstrate robust psychometric properties; and (4) provide quality training in dysphagia screening and assessment to all clinicians involved in the care and management of persons with dysphagia.

Background/Aims: The incidence of disease outbreaks in clinical settings arising from ultrasound examinations is well documented, and is a source of worry. The ultrasound transducers and the coupling gel are potential sources of these infections since they come in direct contact with the patient’s skin. In this study, we examine the efficacy of the widespread practice of the use of plain non-sterile tissue paper in some low-cost private ultrasound centres in our locality as a method of disinfecting ultrasound transducers after each use. Its potential impact on nosocomial infection management in clinical practice is also examined. Methods: Swab samples from convex ultrasound transducers before and after transabdominal scanning of three consecutive patients were obtained from 10 different ultrasound centres in urban and rural areas of Enugu state. Ultrasound coupling gel samples were equally obtained, and all samples cultured for bacteria growth which was quantified in colony-forming units per ml (CFU/ml) and reported in 1000/ml. Paired sampled t-test was used to check for significance in a reduction in a bacterial load before and after the transducer was cleaned. Results: Nine different bacterial strains were isolated. Staphylococcus aureus and Klebsiella spp had the highest percentage of occurrence in all centres. Significant bacteria growth was recorded in the morning before the examination, and plain tissue paper significantly reduced the bacteria load in the ultrasound transducer. Conclusion: Even though disinfecting ultrasound transducers with non-sterile plain tissue paper alone is statistically effective and has the potential to minimize nosocomial infection, it is however not clinically effective and hence not advised.

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.

In this study, a microfluidic paper-based analytical device (mu PAD) was integrated with a smartphone app capable of offline (without internet access) image processing and analysis for the rapid colorimetric detection of glucose. A self-inking stamp was used to form hydrophobic channels on a piece of paper-towel due to its superior water absorption efficiency. As demonstrated, the developed sensor was employed for the colorimetric detection of glucose in artificial saliva in the linear scope of 0 - 1 mM with a calculated detection limit of 29.65 mu M. The experimental results show that the quantitative analysis of glucose with the proposed smartphone platform could be completed in less than one minute. The app developed for the smartphone platform is capable of extracting the color-changing area with an embedded image processing tool which could address the problem of color uniformity in the detection zones of mu PAD. The integrated platform has great potential to be used for non-invasive measurements of glucose in body fluids, like tears, sweat and saliva.

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.

Tissue paper conversion consists of the transformation of base tissue papers into finished tissue products to meet specific demands. When base tissue paper arrives at the converting line, it already holds different requirements that were met during its manufacture in the paper machine (e.g., grammage, bulk, tensile index, etc.). However, what happens during converting can still influence the performance and quality of the finished products. The current work addresses this topic and aims to evaluate the influence of converting conditions on the final softness. For that, two 5-ply finished tissue products were analyzed using different methodologies for their proper characterization in terms of softness and surface analysis. The analyzed products are composed by the same base tissue papers, but some changes were applied on their settings in the converting line. In particular, the base tissue papers arrangement and the embossing pressure affected the finished products, resulting in one of them being softer and more pleasant to touch, with a global handfeel (HF) value of 75.3 units, and the other revealed to be rougher and less pleasant, with a global handfeel (HF) value of 68.0 units.

This is a pre-copyedited, author-produced version of an article accepted for publication in European Journal of Preventive Cardiology following peer review. The version of record Kavousi, Pisinger, Barthelemy, Smedt, Koskinas, Marques-Vidal, Panagiotakos, Prescott, Tiberi, Vassiliou, Løchen. Electronic cigarettes and health with special focus on cardiovascular effects: position paper of the European Association of Preventive Cardiology (EAPC). European Journal of Preventive Cardiology (EJPC). 2020:2047487320941993, is available online at: https://doi.org/10.1177/2047487320941993. Background - Tobacco use is the single largest preventable risk factor for premature death of non-communicable diseases and the second leading cause of cardiovascular disease. In response to the harmful effects of tobacco smoking, the use of electronic cigarettes (e-cigarettes) has emerged and gained significant popularity over the past 15 years. E-cigarettes are promoted as safe alternatives for traditional tobacco smoking and are often suggested as a way to reduce or quit smoking. However, evidence suggests they are not harmless. Discussion - The rapid evolution of the e-cigarette market has outpaced the legislator’s regulatory capacity, leading to mixed regulations. The increasing use of e-cigarettes in adolescents and young individuals is of concern. While the long-term direct cardiovascular effects of e-cigarettes remain largely unknown, the existing evidence suggests that the e-cigarette should not be regarded as a cardiovascular safe product. The contribution of e-cigarette use to reducing conventional cigarette use and smoking cessation is complex, and the impact of e-cigarette use on long-term cessation lacks sufficient evidence. Conclusion - This position paper describes the evidence regarding the prevalence of e-cigarette smoking, uptake of e-cigarettes in the young, related legislations, cardiovascular effects of e-cigarettes and the impact of e-cigarettes on smoking cessation. Knowledge gaps in the field are also highlighted. The recommendations from the population science and public health section of the European Association of Preventive Cardiology are presented.

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.

The present study was undertaken to know the effect of common mixed pulp and paper mill effluent discharge released from century pulp and paper mill Lalkuan, Nainital Uttarakhand on the blood morphology of Heteropneustes fossilis (Singhi). The various morphological changes were observed in the specimen, randomly collected with the help of cast net from (3 sites) different locations. The maximum changes were observed in the specimen collected from site 3 in compare to site 1 and 2 respectively. The formation of inclusion bodies, sickle cells, Cabot rings and ovalocytes were recorded along with nuclear fusion, membrane disruption and cell clumping of blood cells in the specimen collected from the site 3 (i.e. nearer to source of discharge) while in the specimen collected from site 2, the formation of tear drop cell, target cells, spherocytes and bi-nucleated cells were recorded along with the activity of cell clumping. The changes were found less in the specimen collected from site 1 in compare to the specimen of site 2 and 3 i.e. formation of ovalocytes, spherocytes and microcytes with the activity of membrane degeneration and agglutination in blood cells.

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.

Objectives: The objective of the study was to study the compressive strength of the partially replaced paper mill waste in cement. Methods/ Statistical analysis: The concrete cube specimen were prepared for compressive strength test. In this study, the cement has been replaced with 20%, 30%, 40% and 50% of hypo sludge. The specimens were cured for two different ages (7 days and 28 days) and tested for compressive strength. The quadratic polynomial prediction equation was proposed using Response Surface Methodology (RSM). The prediction model was developed using the experimental output results. Thus, the prediction model facilitates the further research work to be conducted by researchers on paper mill waste replacement. The rate analysis was also further carried out to show the cost effectiveness of using the waste replacement in cement. Findings: The test was conducted on the compressive strength (7 days and 28 days) of control specimen (0%) and partial replacement of 20%, 30%, 40% and 50% of cement using the hypo sludge. Thus, 20% replacement of cement using hypo sludge has shown good compressive strength than the control specimen. The cost of 20% paper mill waste was less when compared to the cost of control specimen. Novelty/ Applications: The compressive strength of 20% partial replacement of paper mill waste in cement can be used in further construction. The prediction model can be used to predict the future compressive strength of partially replaced paper mill waste concrete. Keywords: Ordinary Portland cement; Paper mill waste; Hypo sludge; Partial replacement; RSM

Due to the exponential growth of the number of subjects affected by coronavirus disease 2019 (COVID-19), the entire Italian health care system had to respond promptly and in a very short time with the need of semi-intensive and intensive care units. Moreover, trained dedicated COVID-19 teams consisting of physicians were coming from different specialties (intensivists or pneumologists and infectiologists), while respiratory therapists and nurses have been recruited to work on and on without rest. However, due to still limited and evolving knowledge of COVID-19, there are few recommendations concerning the need in respiratory rehabilitation and physiotherapy interventions. The presentation of this paper is the result of a consensus promoted by the Italian societies of respiratory health care professionals who contacted pulmonologists directly involved in the treatment and rehabilitation of COVID-19. The aim was to formulate the more proper and common suggestions to be applied in different hospital settings in offering rehabilitative programs and physiotherapy workforce planning for COVID-19 patients. Two main areas of intervention were identified: organization and treatment, which are described in this paper to face the emergency.

Anaerobic-oxic (AO) systems have been extensively adopted for the biological treatment of wastewater from recycled paper mills, which is characterized by high chemical oxygen demand (COD) concentrations and contains hundreds of organic compounds. In this study, an up-flow anaerobic sludge blanket (UASB) served as the anaerobic treatment of recycled paper mill wastewater. Then, either a sequential batch reactor (SBR) or a sequential batch biofilm reactor (SBBR) were adopted as aerobic treatment to treat the UASB effluent respectively. Parameters such as COD, BOD5, and TSS were measured to compare the treatment performance of SBR and the SBBR. After 80 days’ operation, COD removal efficiency of SBR and SBBR were 21.79 ± 3.4% and 38.38 ± 2.69% respectively; TSS removal efficiencies were 20.84 ± 5.15% and 47.02 ± 5.84% respectively. The results indicated that SBR was effective for removing residual organic matter in UASB effluent. However, SBBR showed significant advantages for the removal of COD and total suspended solids (TSS), which are ascribed to the effective biomass retention and biofiltration of SBBR.

Made available in DSpace on 2020-12-10T20:03:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-03-15 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Study Design. Cross-sectional study. Objective. To investigate the equivalence of electronic and paper version of self-report questionnaires for the assessment of disability, pain, fear of movement, depression, and physical activity of patients with chronic low back pain (LBP). Summary of Background Data. Paper and electronic versions of self-report questionnaires are commonly used for assessment of patients with LBP. However, the equivalence of self-report questionnaires commonly used for assessment of patients with chronic LBP remains unclear. Methods. Seventy-nine individuals with chronic LBP seeking physiotherapy care were recruited. Participants attended the clinic twice with an interval of 1 week and completed the self-reported questionnaires in a random order. The following questionnaires were administered: Roland Morris Disability Questionnaire (RMDQ); 11-point numerical rating scale (NRS); Tampa Scale for Kinesiophobia (TSK); Center for Epidemiological Studies-Depression (CES-D), and Baecke Habitual Physical Activity Questionnaire (BPAQ). To investigate the equivalence between the two questionnaire versions, intraclass correlation coefficient with 95% confidence interval and Bland-Altman plotting was used. Results. The paper and electronic versions of the RMDQ, TSK, and CES-D showed good reliability and the showed moderate reliability. In contrast, the NRS showed poor reliability between the electronic and paper versions. Conclusion. Our findings support that the electronic version of the RMDQ, TSK, CES-D, and BPAQ can be administered in clinical and research settings for assessment of patients with chronic LBP. Nevertheless, electronic version of the NRS for assessment of pain intensity should not be used interchangeably in clinical practice in patients with chronic LBP. Univ Estadual Paulista, Dept Fisioterapia, Fac Ciencias & Tecnol, Presidente Prudente, Brazil Univ Fed Minas Gerais UFMG, Dept Phys Therapy, Belo Horizonte, MG, Brazil Univ Estadual Paulista, Dept Educ Fis, Fac Ciencias & Tecnol, Presidente Prudente, Brazil Univ Estadual Paulista, Dept Fisioterapia, Fac Ciencias & Tecnol, Presidente Prudente, Brazil Univ Estadual Paulista, Dept Educ Fis, Fac Ciencias & Tecnol, Presidente Prudente, Brazil FAPESP: 2017/21336-8 FAPESP: 2016/03826-5 FAPESP: 2017/12246-5

Based on publications related to the use of micro- and nanofibrillated cellulose (MNFC) in papermaking applications, three sets of parameters (intrinsic and extrinsic variables, furnish composition, and degree of dispersion) were proposed. This holistic approach intends to facilitate understanding and manipulation of the main factors describing the colloidal behavior in systems comprising of MNFC, pulp fibers, and additives, which directly impact paper product performance. A preliminary techno-economic assessment showed that cost reductions driven by the addition of MNFC in paper furnishes could be as high as USD 149 per ton of fiber (up to 20% fiber reduction without adverse effects on paper’s strength) depending on the cost of papermaking fibers. It was also determined that better performance in terms of strength development associated with a higher degree of MNFC fibrillation offset its high manufacturing cost. However, there is a limit from which additional fibrillation does not seem to contribute to further strength gains that can justify the increasing production cost. Further research is needed regarding raw materials, degree of fibrillation, and combination with polyelectrolytes to further explore the potential of MNFC for the reduction of weight of paper products.

Objective: To compare the effectiveness of mobile video-guided home exercise program and standard paper-based home exercise program. Methods: Eligible participants were randomly assigned to either experimental group with mobile video-guided home exercise program or control group with home exercise program in a standard pamphlet for three months. The primary outcome was exercise adherence. The secondary outcomes were self-efficacy for exercise by Self-Efficacy for Exercise (SEE) Scale; and functional outcomes including mobility level by Modified Functional Ambulatory Category (MFAC) and basic activities of daily living (ADL) by Modified Barthel Index (MBI). All outcomes were captured by phone interviews at 1 day, 1 month and 3 months after the participants were discharged from the hospitals. Results: A total of 56 participants were allocated to the experimental group [Formula: see text] and control group [Formula: see text]. There were a significant between-group differences in 3-months exercise adherence (experimental group: 75.6%; control group: 55.2%); significant between-group differences in 1-month SEE (experimental group: 58.4; control group: 43.3) and 3-month SEE (experimental group: 62.2; control group: 45.6). For functional outcomes, there were significant between-group differences in 3-month MFAC gain (experimental group: 1.7; control group: 1.0). There were no between-group differences in MBI gain. Conclusion: The use of mobile video-guided home exercise program was superior to standard paper-based home exercise program in exercise adherence, SEE and mobility gain but not basic ADL gain for patients recovering from stroke.

The paper presents the results of the analysis on measured parameters of harmonics at the node of the high-voltage network. The measurements were made at the node connecting the pulp-and-paper mill to the 220 kV supply network. This load is nonlinear and has a large capacity. Particular attention is paid to the distributions of the current and voltage harmonics. The paper clearly shows probabilistic properties of the measured parameters of harmonics

A novel strain, designated WH2-56, was isolated from a slime sample collected from a paper company along the Yangtze River during March, 2018. Phylogenetic analyses based on 16S rRNA gene sequences revealed that strain WH2-56 was related to members of the genus Planomicrobium. Cellulolytic activity of the sample was screened and confirmed by Congo red-polysaccharide interactions and examined by broth culture using filter paper (FP) with no starch as the sole carbon source. Field emission scanning electron microscopy (FE-SEM) was used to confirm the delicate morphological changes of FP during bio-degradation. Different cellulosic materials were used to measure biodegradation effects and optimum incubation conditions. The activity of FPase and carboxymethyl cellulase (CMCase) were checked by 3,5-dinitrosalicylic acid (DNS agents) with different carbon sources, which showed a peak at 0.62 U/mL of CMCase on day 4, and at 0.38 U/mL of FPase on day 5.

Researchers face difficulties in finding relevant papers to their research interest as the number of scientific publication is rapidly increasing on the web. Scientific paper recommenders have emerged as a leading solution to help researchers by automatically suggesting relevant and useful publications. Several approaches have been proposed on improving recommender systems. However, most existing approaches depend on priori user profiles, and thus they cannot recommend papers to new user. Furthermore, the existing approaches utilize non-public contextual information, and thus it cannot adequately find similarities between papers due to copyright restrictions. Also, the existing approaches consider only single level paper-citation relation to identify similarities between papers. Considering the above challenges, this paper presents a collaborative filtering based recommendation approach for scientific papers that does not depend on priori user profiles and which utilizes only public contextual information. Using citation context, we utilized 2-level paper-citation relations to find hidden associations between papers. The rational underlying this approach is that, two papers are co-occurred with same cited paper(s) and two papers are co-occurring with same citing paper(s) are significantly similar to some extent. To evaluate the performance of the proposed approach, publicly available datasets are used to conduct extensive experiments. The experimental results demonstrate that the proposed approach has significantly outperforms the baseline approaches in terms of precision, recall, F1, mean average precision, and mean reciprocal rank, which are commonly used information retrieval metrics. The novelty of this study is that, with the proposed approach, researchers are able to find relevant and useful publications over the internet regardless of their previous research experiences and research area.

This paper presents a broadband, simple, re-useable and low-cost approach for noninvasive sweat monitoring using a passive microwave circuit and a cellulose filter paper as a superstrate. The proposed sensor is composed of filter paper with the ability to absorb the sample liquid under test (LUT) placed on top of a coplanar waveguide (CPW) transmission line. Various samples of sodium chloride (NaCl) solutions with concentrations in the range of 0.01-2 mol/L and models of artificial sweat are used to test the proposed sensor. The difference in transmission coefficient (S21) between dry and wet states is used to determine the concentrations of tested solutions in the band of 1-6 GHz. The sensor detects concentrations as low as 0.01 mol/L (0.58 g/L) and quantities as low as 137 μL with a maximum sensitivity of 46.7 dB/g/L. The proposed sensor presents a simple approach to sample and characterize liquids with enhanced sensitivity and consistent performance using microwave signals.

Introduction. Pulp and paper enterprises accumulate large volumes of industrial waste buried in special accumulation cells. In order to choose a technology for treating above-sludge waters, we need to monitor their composition, which depends on the history of cells’ filling and their subsequent use. Methods. In the course of the study, we applied inductively coupled plasma mass spectrometry (ICP-MS). Results. We determined the content of 72 chemical elements in above-sludge water of 11 cells at Baykalsk Pulp and Paper Mill and 4 open water flows near industrial waste landfills, and performed a cluster analysis of the sample composition. As a result, we revealed the peculiarities of water composition, related to the history of cell filling and subsequent pilot experiments. It has been found that the cells with non-disturbed sediments have cleaner water. Out of 16 chemical elements subject to limitation (Na, Al, P, S, Cl, K, Cr, Mn, Fe, Ni, Cu, Zn, Sr, Mo, Cd, Pb), 11 elements exceed the limits established for wastewater discharged into water bodies within the ecological zones of the Baikal Natural Territory. Each cell is characterized by its own set of elements exceeding maximum allowable concentrations (MAC) and by the extent of such excess. Conclusion. Pilot experiments with cell sediments (joint grouting, drying, dewatering in press-filters) result in the disturbance of the “water/sediment” balance and increase the concentrations of most elements in above-sludge waters. The maximum amounts of elements (6–7) exceeding the MAC values are observed in water in the cells with disturbed sediments, water in the zone of ash slurry discharge, ash and sludge-lignin cells with industrial and household waste. When choosing a technology and procedures for treating above-sludge waters, it is necessary to take into account the specifics of their composition. Using the polluted water flow running into Lake Baikal during catastrophic floods in the summer of 2019 as an example, we show that it is possible to use multi-element ICP-MS analysis to search for sources of pollution from industrial facilities.

A paper-based electrode is a very attractive component for a disposable, nontoxic, and flexible biosensor. In particular, wearable biosensors, which have recently been attracting interest, not only require these characteristics of paper-based electrodes but must also be able to detect various ions and biomolecules in biological fluids. In this paper, we demonstrate the detection ability of paper-based metal electrodes for wearable biosensors as part of a wireless potentiometric measurement system, focusing on the detection of pH and sodium ions. The paper-based metal electrodes were obtained by simply coating a silicone-rubber-coated paper sheet with a Au (/Cr) thin film by sputtering then modifying it with different functional membranes such as an oxide membrane (Ta2O5) and a fluoropolysilicone (FPS)-based Na+-sensitive membrane, corresponding to the targeted ions. Satisfactory and stable detection sensitivities of the modified paper-based Au electrodes were obtained over several weeks even when they were bent to a radius of curvature in the range of 6.5 to 25 mm, assuming use in a flexible body patch biosensor. Moreover, the Na+ concentration in a sweat sample was evaluated using the paper-based Au electrode with the FPS-based Na+-sensitive membrane in a wireless and real-time manner while the electrode was bent. Thus, owing to their complex mesh structure, flexible paper sheets should be suitable for use as potentiometric electrodes for wearable wireless biosensors., Graphical abstarct

Research is devoted to the problem of recycling waste of the Baikal Pulp and Paper Mill, whose activity has caused serious damage to the ecological environment of Lake Baikal and its environs. Grouting waste production is currently the most effective possible decision to the problem of pollutants, such as sludge-lignin and ash, in water objects and groundwater. The results on the grouting of liquid and solid waste from the Baikal Pulp and Paper Mill, represented by sludge lignin and ash, are presented. Cement, liquid glass, colloidal silica, ammonium persulfate, hydrogen peroxide were used as the main hardeners. Samples were formed by mixing the original waste with astringent. The strength in time, shrinkage, resistance to water were studied. Samples formed on the basis of colloidal silica solution have a maximum uniaxial compressive strength of 0.4 - 0.5 MPa, on the basis of liquid glass—0.2 - 0.3 MPa. Adding fine sand increases the strength by 1.5 - 1.7 times. Samples based on ammonium persulfate and hydrogen peroxide do not have sufficient strength. Adding fine quartz sand increases the strength up to 1.0 - 1.2 MPa.

[Abstract] The accepted use of left ventricular assist device (LVAD) technology as a good alternative for the treatment of patients with advanced heart failure together with the improved survival of the LVAD-supported patients on the device and the scarcity of donor hearts has significantly increased the population of LVAD-supported patients. The expected and non-expected device-related and patient-device interaction complications impose a significant burden on the medical system exceeding the capacity of the LVAD implanting centres. The ageing of the LVAD-supported patients, mainly those supported with the 'destination therapy' indication, increases the risk for those patients to experience comorbidities common in the older population. The probability of an LVAD-supported patient presenting with medical emergency to a local emergency department, internal, or surgical ward of a non-LVAD implanting centre is increasing. The purpose of this trilogy is to supply the immediate tools needed by the non-LVAD specialized physician: ambulance clinicians, emergency ward physicians, general cardiologists, internists, anaesthesiologists, and surgeons, to comply with the medical needs of this fast-growing population of LVAD-supported patients. The different issues discussed will follow the patient's pathway from the ambulance to the emergency department and from the emergency department to the internal or surgical wards and eventually to the discharge home from the hospital back to the general practitioner. In this first part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, after the introduction on the assist devices technology in general, definitions and structured approach to the assessment of the LVAD-supported patient in the ambulance and emergency department is presented including cardiopulmonary resuscitation for LVAD-supported patients.

The possibility of exfoliating graphite into graphene sheets allows the researchers to produce a material, termed "graphene paper" (G-paper), conductive as graphite but more flexible and processable. G-paper is already used for electronic applications, like conductors, antennas, and heaters, outperforming metal conductors thanks to its high flexibility, lightness, chemical stability, and compatibility with polymeric substrates. Here, the effectiveness in the use of G-paper for the realization of electrodes on flexible plastic substrates and textiles, and their applicability as amperometric sensors are demonstrated. The performance of these devices is compared with commercial platforms made of carbon-based inks, finding that they outperform commercial devices in sensing nicotinamide adenine dinucleotide (NADH), a key molecule for enzymatic biosensing; the electrodes can achieve state-of-the-art sensitivity (107.2 ?A mm cm) and limit of detection (0.6 × 10 m) with no need of additional functionalization. Thanks to this property, the stable deposition of a suitable enzyme, namely lactate dehydrogenase, on the electrode surface is used as a proof of concept of the applicability of this new platform for the realization of a biosensor. The possibility of having a single material suitable for antennas, electronics, and now sensing opens new opportunities for smart fabrics in wearable electronic applications.

Bone mineral abnormalities (defined as Chronic Kidney Disease Mineral Bone Disorder; CKD-MBD) are prevalent and associated with a substantial risk burden and poor prognosis in CKD population. Several lines of evidence support the notion that a large proportion of patients receiving maintenance dialysis experience a suboptimal biochemical control of CKD-MBD. Although no study has ever demonstrated conclusively that CKD-MBD control is associated with improved survival, an expanding therapeutic armamentarium is available to correct bone mineral abnormalities. In this position paper of Lombardy Nephrologists, a summary of the state of art of CKD-MBD as well as a summary of the unmet clinical needs will be provided. Furthermore, this position paper will focus on the potential and drawbacks of a new injectable calcimimetic, etelcalcetide, a drug available in Italy since few months ago.

Childhood obesity has high societal and economic impact but current treatment approaches are sub-optimal. In the last decade, important studies have been conducted aiming to identify strategies to prevent obesity during critical periods of life. Updated recommendations for childhood obesity prevention are needed. We present data from systematic reviews and meta- analysis, randomised controlled trials (RCTs) and large observational studies, published from 2011 onwards that consider the possible role of the following factors in obesity development: breast-feeding; macronutrient composition and method of complementary feeding; parenting style; dietary patterns; sugar-sweetened beverage consumption; eating behaviour (eg, skipping breakfast, family dinners. etc); meal frequency and composition (fast foods, snacking), portion size; dietary modulators of gut microbiota (including pre-, pro-, and synbiotics); physical activity and sedentary behaviour. We used the Medline database and the Cochrane Library to search for relevant publications. Important research gaps were also identified. This position paper provides recommendations on dietary factors, food habits, and lifestyle to prevent childhood obesity development, based on the available literature and expert opinion. Clinical research and high-quality trials are urgently needed to resolve numerous areas of uncertainty.

The integration of literature in English Language Teaching (ELT) has been a contentious issue although it is commonly accepted that literature caters to a whole bunch of opportunities for foreign language teaching. The aim of this study is to point to the idea that incorporating literature into ELT classes can direct foreign language classes into more innovative path as it fosters language development with both traditional and digitally-supported communicative activities designed to develop critical thinking abilities, creativity and learner autonomy. In this regard short stories, with their privileges due to their reader-friendly length, creativity in language use encompassing refined literary elements, and the wide range of subjects they deal with offer many opportunities. In this study to link the theory with real life experiences step by step, following the critical considerations about literature, language and meaning construction, text-selection and the methodology, possible applications based on the short story called The Paper Menagerie by Ken Liu are suggested. Activities encompassing all the phases of reading process are developed to help teachers to overcome potential difficulties in collaboration with their students while creating a classroom atmosphere based on negotiation. The article concludes that reflective teachers, starting to develop their own understanding of literature, language, meaning construction and reading, enable their learners to experience the authenticity and creativity of this valuable source when forming an identity as an independent reader of literature in the second language. Literature holds many opportunities to renovate language classrooms to keep up with the 21st century improvements.

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.

pH of fluids is an important indicator in biomedical and environmental studies. Conventional pH analysis techniques are often either instrumentation-intensive, expensive or qualitative in nature. Microfluidics based analytical devices have emerged as powerful alternative to overcome some of the existing limitations. These devices are characterized by low reagent and sample volumes, controlled flow, cost-effectiveness and portability. In this work, we report a microfluidic paper-based lab-on-a-chip pH sensing platform that incorporates passive fluid flow of samples. The colorimetric pH detection is integrated with mobile phone based image acquisition, followed by digital image processing and analysis for quantitative interpretation of data. The images are analyzed using image processing algorithms and color space. Regression analysis of data acquired from digital image analysis was used to evaluate the mathematical model for estimation of pH. The insights gained by this work would prove useful in development and deployment of portable and miniaturized sensors.

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.

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.

Objectives: The aim of the study was to review the evidence regarding the clinical use and value of fecal calprotectin (FC) measurements in different gastrointestinal disorders in children. Methods: A literature search was conducted in the PubMed, MEDLINE, EMBASE, and Cochrane databases until October 31, 2019. Subtopics were identified and each assigned to individual authors. Results: A total of 28 recommendations were voted on using the nominal voting technique. Recommendations are given related to sampling, measurement methods, and results interpretation. The 14 authors anonymously voted on each recommendation using a 9-point scale (1 strongly disagree to 9 fully agree). Consensus was considered achieved if at least 75% of the authors voted 6, 7, 8, or 9. Conclusions: Consensus was reached for all recommendations. Limitations for the use of FC in clinical practice include variability in extraction methodology, performance of test kits as well as the need to establish local reference ranges because of the influence of individual factors, such as age, diet, microbiota, and drugs. The main utility of FC measurement at present is in the diagnosis and monitoring of inflammatory bowel disease (IBD) as well as to differentiate it from functional gastrointestinal disorders (FAPDs). FC, however, has neither utility in the diagnosis of infantile colic nor to differentiate between functional and organic constipation. A rise in FC concentration, may alert to the risk of developing necrotizing enterocolitis and help identifying gastrointestinal involvement in children with Henoch-Schonlein purpura. FC measurement is of little value in Cow's Milk Protein Allergy, coeliac disease (CD), and cystic fibrosis. FC does neither help to distinguish bacterial from viral acute gastroenteritis (AGE), nor to diagnose Helicobacter Pylori infection, small intestinal bacterial overgrowth (SIBO), acute appendicitis (AA), or intestinal polyps.