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Synthetic cannabinoid receptor agonists (SCRAs) are a class of varied compounds that mimic the effects of natural cannabinoids found in cannabis. Because they have a wide range of diverse structures, they vary widely in their potency. The abuse of new psychoactive substances (NPS) in prisons was reported in many European countries and in the USA. In the present study, we have described the identification of SCRAs in 56 infused paper sheet samples, seized mainly in Brazilian prisons between 2016 and 2020. The materials were seized by local or federal law enforcement and analyzed by Sao Paulo State Police or Brazilian Federal Police using gas chromatography–mass spectrometry, attenuated total reflection-Fourier transform infrared spectroscopy, liquid chromatography–high-resolution mass spectrometry or nuclear magnetic resonance spectrometry. Most of these samples (87.5%) were seized in 2019–2020; seven different SCRAs were identified in samples, and the most frequently identified substances were MDMB-4en-PINACA (23.6%) and 5F-MDMB-PICA (36.4%), the newest SCRAs emerging recently. As observed in Europe and the USA, Brazil also shows the prevalence of indazole-3-carboxamides and indole-3-carboxamides among SCRAs seizures in the prison system. This phenomenon is spreading all over the world at this moment. These data on the prevalence could help to alert judicial authorities to shutting down the introduction of NPS, including SCRAs, into prisons to ensure safety and security for avoiding health risks of prisoners and staff, leading to positive effects in this population. To our knowledge, this is the first demonstration of SCRAs smuggling into prisons in Latin America.

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

[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.

[Abstract] The improvement in left ventricular assist device (LVAD) technology and scarcity of donor hearts have increased dramatically the population of the LVAD-supported patients and the probability of those patients to present to the emergency department with expected and non-expected device-related and patient-device interaction complications. The ageing of the LVAD-supported patients, mainly those supported with the 'destination therapy' indication, increases the risk for those patients to suffer from other co-morbidities common in the older population. In this second part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, definitions and structured approach to the LVAD-supported patient presenting to the emergency department with bleeding, neurological event, pump thrombosis, chest pain, syncope, and other events are presented. The very challenging issue of declaring death in an LVAD-supported patient, as the circulation is artificially preserved by the device despite no other signs of life, is also discussed in detail.

This research work focused on bioconversion of waste paper into soil conditioner and its effect on plants growth and soil microbial population. The effects were studied for 21 days and the number of seeds germinated and their height were measured at 3 days interval. Percentage (%) seed germination across the samples was 100 %. The height of the plants in soil treated with composted waste paper ranged between 80±0.98 mm and 643± 1.76 mm that of control soil ranged between 70±1.98 mm and 503±1.67 mm. The result for the microbial analysis revealed a total bacterial count range from 4.0± 1.01 to 6.9±1.03 x105cfu/g for soil samples treated with composted waste paper and 5.0±0.78 to 6.1±1.29 x105cfu/g for control. The results also revealed a total of eight bacterial genera and they include;Bacillussp,Pseudomonassp,E.coli,Micrcoccussp,Staphylococusssp,Proteussp,Enterobactersp,Klebsiellasp respectively. Total fungal count ranged from 1.5±0.97 to 2.9±0.92 x 105cfu/g for soil samples treated with composted waste paper. A total of five fungal genera were isolated and they includedAspergillussp,Penicilliumsp,Mucorsp,Rhizopussp, andSacharomycessp respectively. The most prevalent bacterium across the sample wasBacillussp with 33.33 % while the most prevalent fungus across the sample wasPenicilliumsp with 41.67 %.&nbsp

Invasive species can be particularly disruptive when they intersect with organisms of conservation concern. Stabilizing the declining eastern migratory population of monarch butterflies (Danaus plexippus) is projected to require extensive habitat restoration across multiple land use sectors including metropolitan areas. Numerous conservation programs encourage urban citizens to plant gardens with milkweeds, the obligate larval host plants of the monarch. Here, we show that predation by Polistes dominula, an invasive paper wasp that is particularly abundant in urban settings, can turn such sites into ecological traps for monarch larvae. Polistes dominula was the predominant paper wasp seen foraging in central Kentucky pollinator gardens. In 120 observed encounters with monarch larvae on milkweeds in gardens, most second to fourth instars were killed, whereas most fifth instars escaped by thrashing or dropping. The wasps bit and carried off second instars whole, whereas third and fourth instar kills were first gutted, then processed and carried away piecemeal. Predation on sentinel larvae was much higher in urban gardens than in rural settings. The wasps exploited ornamental butterfly “hibernation boxes” in pollinator gardens as nesting habitat. Polistes dominula is an under-recognized predator that may diminish the urban sector’s contributions to monarch habitat restoration.

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.

Huge quantity of paper mill wastes are dumped at the outskirt of factory as unwanted materials. Vermicomposting is an eco-friendly technique for beneficial conversion of different biodegradable/organic wastes into useful organic manure utilizing earthworms. Solid wastes generated in paper mills contain appreciable quantity of organic matter. Attempt was made for bio-conversion of Emami paper mill wastes with different numbers of Eisenia fetida (5–30 earthworms/2 kg substrate) for studying its influence on vermi-conversing time and quality of prepared vermicompost. Vermicomposting was carried out in trays following heap method and quality of final product was determined following both chemical analysis and bioassay on wheat seedlings. Application of more earthworms up to 20 numbers per 2 kg substrate made bio-conversion quicker but further addition of earthworm, however, delayed the process as some earthworms came out of beds and died probably due to competition for food among earthworms inside beds. Ten earthworms per kg paper mill wastes–saw dust–cow dung mixture (1:0.5:0.5 weight wise) was found as optimum earthworm population for preparing quality vermicompost having more major and secondary plant nutrients. Bioassay of this manure on wheat seedlings also confirmed the analytical findings. It is confirmed that earthworm population in vermibed played vital role in faster decomposition of paper mill wastes and releasing of more nutrients, which ultimately helped in better growth of wheat seedlings. Successful demonstration of vermicomposting technique will encourage local farmers for beneficial utilization of paper mill wastes in their agriculture.

The Centers for Medicare & Medicaid Services’ Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) measure has appropriately established sepsis as a national priority. However, the Infectious Diseases Society of America (IDSA and five additional endorsing societies) is concerned about SEP-1’s potential to drive antibiotic overuse because it does not account for the high rate of sepsis overdiagnosis and encourages aggressive antibiotics for all patients with possible sepsis, regardless of the certainty of diagnosis or severity of illness. IDSA is also concerned that SEP-1’s complex “time zero” definition is not evidence-based and is prone to inter-observer variation. In this position paper, IDSA outlines several recommendations aimed at reducing the risk of unintended consequences of SEP-1 while maintaining focus on its evidence-based elements. IDSA’s core recommendation is to limit SEP-1 to septic shock, for which the evidence supporting the benefit of immediate antibiotics is greatest. Prompt empiric antibiotics are often appropriate for suspected sepsis without shock, but IDSA believes there is too much heterogeneity and difficulty defining this population, uncertainty about the presence of infection, and insufficient data on the necessity of immediate antibiotics to support a mandatory treatment standard for all patients in this category. IDSA believes guidance on managing possible sepsis without shock is more appropriate for guidelines that can delineate the strengths and limitations of supporting evidence and allow clinicians discretion in applying specific recommendations to individual patients. Removing sepsis without shock from SEP-1 will mitigate the risk of unnecessary antibiotic prescribing for noninfectious syndromes, simplify data abstraction, increase measure reliability, and focus attention on the population most likely to benefit from immediate empiric broad-spectrum antibiotics.

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.

Fungi have the ability to transform organic materials into a rich and diverse set of useful products and provide distinct opportunities for tackling the urgent challenges before all humans. Fungal biotechnology can advance the transition from our petroleum-based economy into a bio-based circular economy and has the ability to sustainably produce resilient sources of food, feed, chemicals, fuels, textiles, and materials for construction, automotive and transportation industries, for furniture and beyond. Fungal biotechnology offers solutions for securing, stabilizing and enhancing the food supply for a growing human population, while simultaneously lowering greenhouse gas emissions. Fungal biotechnology has, thus, the potential to make a significant contribution to climate change mitigation and meeting the United Nation’s sustainable development goals through the rational improvement of new and established fungal cell factories. The White Paper presented here is the result of the 2nd Think Tank meeting held by the EUROFUNG consortium in Berlin in October 2019. This paper highlights discussions on current opportunities and research challenges in fungal biotechnology and aims to inform scientists, educators, the general public, industrial stakeholders and policymakers about the current fungal biotech revolution.

The term sarcopenia was introduced in 1988. The original definition was a “muscle loss” of the appendicular muscle mass in the older people as measured by dual energy x‐ray absorptiometry (DXA). In 2010, the definition was altered to be low muscle mass together with low muscle function and this was agreed upon as reported in a number of consensus papers. The Society of Sarcopenia, Cachexia and Wasting Disorders supports the recommendations of more recent consensus conferences, i.e. that rapid screening, such as with the SARC‐F questionnaire, should be utilized with a formal diagnosis being made by measuring grip strength or chair stand together with DXA estimation of appendicular muscle mass (indexed for height2). Assessments of the utility of ultrasound and creatine dilution techniques are ongoing. Use of ultrasound may not be easily reproducible. Primary sarcopenia is aging associated (mediated) loss of muscle mass. Secondary sarcopenia (or disease‐related sarcopenia) has predominantly focused on loss of muscle mass without the emphasis on muscle function. Diseases that can cause muscle wasting (i.e. secondary sarcopenia) include malignant cancer, COPD, heart failure, and renal failure and others. Management of sarcopenia should consist of resistance exercise in combination with a protein intake of 1 to 1.5 g/kg/day. There is insufficient evidence that vitamin D and anabolic steroids are beneficial. These recommendations apply to both primary (age‐related) sarcopenia and secondary (disease related) sarcopenia. Secondary sarcopenia also needs appropriate treatment of the underlying disease. It is important that primary care health professionals become aware of and make the diagnosis of age‐related and disease‐related sarcopenia. It is important to address the risk factors for sarcopenia, particularly low physical activity and sedentary behavior in the general population, using a life‐long approach. There is a need for more clinical research into the appropriate measurement for muscle mass and the management of sarcopenia. Accordingly, this position statement provides recommendations on the management of sarcopenia and how to progress the knowledge and recognition of sarcopenia.

Improvements in survival among cancer patients have revealed the clinical impact of cardiotoxicity on both cardiovascular and hematological and oncological outcomes, especially when it leads to the interruption of highly effective antitumor therapies. Atrial fibrillation is a common complication in patients with active cancer and its treatment poses a major challenge. These patients have an increased thromboembolic and hemorrhagic risk but standard stroke prediction scores have not been validated in this population. The aim of this expert consensus-based document is to provide a multidisciplinary and practical approach to the prevention and treatment of atrial fibrillation in patients with active cancer. This is a position paper of the Spanish Cardio-Oncology working group and the Spanish Thrombosis working group, drafted in collaboration with experts from the Spanish Society of Cardiology, the Spanish Society of Medical Oncology, the Spanish Society of Radiation Oncology, and the Spanish Society of Hematology.

This study examined the responses of a population of brook stickleback (Culaea inconstans) exposed to pulp mill effluent at Jackfish Bay, Lake Superior, Canada, in May 2007 and May 2011. Brook stickleback were extirpated from the effluent-receiving site, presumably due to anoxia after this period. Females at the effluent-receiving site had significantly larger gonad sizes in 2007 and 2011. In 2011, effluent-exposed female gonadal development was significantly advanced when compared with reference sites; they were the second most mature when compared among three different reference sites. Analysis of 7-ethoxyresorufin-O-deethylase activity revealed that effluent-receiving site females had greater CYP1A induction in 2007 and significantly greater CYP1A induction in 2011. Effluent-receiving site males showed significantly reduced CYP1A induction in 2007 and significantly greater induction in 2011. Chemical evaluation of sediment from the receiving environment showed elevated levels of resin acids and the polycyclic aromatic hydrocarbon, retene. Higher condition factors and more mature gonads were consistent with higher winter and spring temperatures modified by effluent or by lake vs. stream environments. Overall, effects on effluent-exposed brook stickleback were not consistent with reported effects in white sucker exposed to the same effluent in previous studies. This article has been made Open Access thanks to the kind support of CAWQ/ACQE (https://www.cawq.ca).

The ever-growing urban population faces challenges of ageing infrastructure. The process for renewing the infrastructure is costly, and current practices for maintaining and repairing are often ineffective and labour intensive. Road networks, for instance, which act as the arteries of cities, suffer from reoccurring potholes (in the UK, a pothole is filled every 21 s). A more effective way of maintaining road networks is through a proactive approach, where condition assessment and intervention are conducted throughout the asset life cycle. However, there are barriers to a proactive approach, including budget constraints and the lack of effective technology for early defect detection (followed by a cheap yet effective repair). This paper puts forward an automated system, currently in development, based on cutting-edge robotic technologies to address these barriers and help achieve an effective proactive infrastructure maintenance and repair system. Technologies developed include automated condition assessment measures to detect road defects and repair technologies using a novel three-dimensional (3D) printing method to seal road cracks and potholes. Sealing small cracks by using 3D printing techniques has shown promising results by achieving superior mechanical properties.

[Abstract] The growing population of left ventricular assist device (LVAD)-supported patients increases the probability of an LVAD- supported patient hospitalized in the internal or surgical wards with certain expected device related, and patient-device interaction complication as well as with any other comorbidities requiring hospitalization. In this third part of the trilogy on the management of LVAD-supported patients for the non-LVAD specialist healthcare provider, definitions and structured approach to the hospitalized LVAD-supported patient are presented including blood pressure assessment, medical therapy of the LVAD supported patient, and challenges related to anaesthesia and non-cardiac surgical interventions. Finally, important aspects to consider when discharging an LVAD patient home and palliative and end-of-life approaches are described.

Panic buying of toilet rolls in Australia began in early March 2020. This was related to the realisation that the novel coronavirus was spreading across the country. To the general population the impact of the virus was unknown. Gradually the federal government started closing the country’s borders. The panic buying of toilet rolls was not unique to Australia. It happened across all societies that used toilet paper rather than water to clean after defecation and urination. However, research suggests that the panic buying was most extreme in Australia. This article argues that the panic buying was closely linked to everyday notions of Western civilisation. Pedestal toilets and toilet paper are key aspects of civilisation and the fear of the loss of toilet paper is connected to anxiety about social breakdown, the loss of civilisation. This is the fear manifested in the perceived threat posed by the virus. Refereed/Peer-reviewed

The rate of pediatric inflammatory bowel disease (IBD) has been increasing over the last decade and this increase has occurred most rapidly in the youngest children diagnosed

Cancer-related cognitive decline (CRCD) may have particularly significant consequences for older adults, impacting their functional and physical abilities, level of independence, ability to make decisions, treatment adherence, overall quality of life, and ultimately survival. In honor of Dr. Hurria's work we explore and examine multiple types of screening, assessment and non-pharmacologic treatments for CRCD. We then suggest future research and clinical practice questions to holistically appreciate the complexity of older adults with cancer's experiences and fully integrate the team-based approach to best serve this population. (C) 2019 Elsevier Ltd. All rights reserved.

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.

Background One year after the declaration of the coronavirus disease 2019 (COVID-19) pandemic by the World Health Organization (WHO) and despite the implementation of mandatory physical barriers and social distancing, humanity remains challenged by a long-lasting and devastating public health crisis. Management Non-pharmacological interventions (NPIs) are efficient mitigation strategies. The success of these NPIs is dependent on the approval and commitment of the population. The launch of a mass vaccination program in many countries in late December 2020 with mRNA vaccines, adenovirus-based vaccines, and inactivated virus vaccines has generated hope for the end of the pandemic. Current Issues The continuous appearance of new pathogenic viral strains and the ability of vaccines to prevent infection and transmission raise important concerns as we try to achieve community immunity against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) and its variants. The need of a second and even third generation of vaccines has already been acknowledged by the WHO and governments. Perspectives There is a critical and urgent need for a balanced and integrated strategy for the management of the COVID-19 outbreaks organized on three axes: (1) Prevention of the SARS-CoV-2 infection, (2) Detection and early diagnosis of patients at risk of disease worsening, and (3) Anticipation of medical care (PDA). Conclusion The “PDA strategy” integrated into state policy for the support and expansion of health systems and introduction of digital organizations (i.e., telemedicine, e-Health, artificial intelligence, and machine-learning technology) is of major importance for the preservation of citizens' health and life world-wide.

Background A cross-sectional study (Miyara et al, 2020) conducted by French researchers showed that the rate of current daily smoking was significantly lower in patients with COVID-19 than in the French general population, implying a potentially protective effect of smoking. Objective We aimed to examine the dissemination of the Miyara et al study among Twitter users and whether a shift in their attitudes toward smoking occurred after its publication as preprint on April 21, 2020. Methods Twitter posts were crawled between April 14 and May 4, 2020, by the Tweepy stream application programming interface, using a COVID-19–related keyword query. After filtering, the final 1929 tweets were classified into three groups: (1) tweets that were not related to the Miyara et al study before it was published, (2) tweets that were not related to Miyara et al study after it was published, and (3) tweets that were related to Miyara et al study after it was published. The attitudes toward smoking, as expressed in the tweets, were compared among the above three groups using multinomial logistic regression models in the statistical analysis software R (The R Foundation). Results Temporal analysis showed a peak in the number of tweets discussing the results from the Miyara et al study right after its publication. Multinomial logistic regression models on sentiment scores showed that the proportion of negative attitudes toward smoking in tweets related to the Miyara et al study after it was published (17.07%) was significantly lower than the proportion in tweets that were not related to the Miyara et al study, either before (44/126, 34.9%; P Conclusions The public’s attitude toward smoking shifted in a positive direction after the Miyara et al study found a lower incidence of COVID-19 cases among daily smokers.

Background Measuring concentrations of metabolites of estradiol and progesterone in urine, instead of measuring serum concentrations, is common in research and also is used in patient care. The primary aim of this study was to demonstrate that analysis of urine samples dried on filter paper by gas chromatography with tandem mass spectrometry (GC–MS/MS) provides results similar to serum analyzed by radioimmunoassay (RIA). Secondary aims were to show that collection of four samples during the day (4-spot method) can be substituted for a 24-h collection, and that analysis of urine from dried samples is equivalent to liquid urine samples. Methods This prospective observational study compared results of urine and serum analyses. Urine samples from women throughout the menstrual cycle and single samples from postmenopausal women were evaluated. Urine was collected onto filter paper and dried. Dried urine was extracted, hydrolyzed, and derivatized prior to analysis by GC–MS/MS. Hormone concentrations were normalized to creatinine. Single samples were used to compare results of 24-h urine collection to the 4-spot method from a separate population of women and men. A subset of these samples were used to compare results from dried urine to liquid urine. Results The primary study showed good reliability in the comparisons between the dried urine and serum assays. During the menstrual cycles of a subset of four women, urine metabolite concentrations followed the same pattern as serum concentrations. Comparison of 4-spot to 24-h urine collections and of dried to liquid urine measurements had intraclass correlation coefficients (ICC) greater than 0.95, indicating excellent agreement. Conclusions For estradiol and progesterone, the dried urine assay is a good surrogate for serum testing. The 4-spot method can be used instead of 24-h urine collections and dried urine results are comparable to liquid urine. The dried urine assay is useful for some clinical assessments of hormone disorders and may be useful in large epidemiologic studies due to ease of sample handling. Electronic supplementary material The online version of this article (10.1186/s13065-019-0539-1) contains supplementary material, which is available to authorized users.

Bisphenol A (BPA), a well-known endocrine disruptor, is used as a color developer in thermal paper. More recently, some emerging structural analogues have been introduced to replace BPA due to the strengthened regulations concerning thermal paper. Nevertheless, very limited data are available regarding their occurrence and potential health risks. Here, thirteen potentially toxic compounds were investigated in paper products (120 thermal papers and 81 nonthermal papers) collected in Beijing, China. The results indicated that the replacement of BPA by alternatives such as Bisphenol S (BPS), Bis(2-chloroethyl)ether-4,4″-dihydroxydiphenyl sulfone copolymer (D-90), 4-hydroxyphenyl 4-isoprooxyphenylsulfone (D-8), Bis(4-hydroxyphenyl)sulfonylphenyl (BPS-MAE) and Bis-(3-allyl-4-hydroxyphenyl) sulfone (TGSA) has been significantly advanced in several types of thermal paper (i.e., market weight stickers, train tickets, express labels, air boarding passes and lottery tickets). The mean value for the total analyte concentrations in thermal paper was 6.06 mg/g, and the highest level found was 26.0 mg/g. In addition, the frequent detection of these chemicals in nonthermal paper (>80%, n = 81) demonstrated that the contamination in thermal paper can be spread into other recycled paper, such as corrugated boxes, newspapers, food contact papers, etc. The estimated daily intake of BPA and its alternatives through the handling of thermal paper was 0.025 μg/kg bw/day for the general population. This is the first report on the occurrence of various new BPA alternatives in paper products from China, which will be helpful for further risk assessment and making responsible replacement decisions.

Objective To explore whether the coronavirus disease 2019 (COVID-19) pandemic is associated with toilet paper hoarding and to assess which risk factors are associated with the risk of toilet paper hoarding. Design A systematic review and realist review were conducted. Data sources PubMed, Web of Science, Scopus and PsycINFO were searched (systematic review). PubMed, pre-prints and grey literature were also searched (realist review). The databases were searched from inception until October 2020. Study selection There were no restrictions on the study design. Outcomes and measures For the systematic review, toilet paper hoarding was the main outcome, and pathological use of toilet paper was the secondary outcome. For the realist review, the context-mechanisms-outcome (CMO) scheme included the COVID-19 pandemic (context), four proposed mechanisms, and one outcome (toilet paper hoarding). The four potential mechanisms were (1) gastrointestinal mechanisms of COVID-19 (e.g. diarrhoea), (2) social cognitive biases, (3) stress-related factors (mental illnesses, personality traits) and (4) cultural aspects (e.g. differences between countries). Eligibility criteria for selecting studies All studies of human populations were considered (including general population studies and clinical studies of patients suffering from mental health problems). Results The systematic review identified 14 studies (eight studies for the main outcome, six studies for the secondary outcome). Three surveys identified the role of the COVID-19 threat in toilet paper hoarding in the general population. One study pointed to an association between a personality trait (conscientiousness) and toilet paper buying and stockpiling as well as an additional significant indirect effect of emotionality through the perceived threat of COVID-19 on toilet paper buying and stockpiling. Six case reports of pathological use of toilet paper were also identified, although none of them were associated with the COVID-19 pandemic. The realist review suggested that of all the mechanisms, social cognitive biases and a bandwagon effect were potential contributors to toilet paper hoarding in the general population. The stressful situation (COVID-19 pandemic) and some personality traits (conscientiousness) were found to be associated with toilet paper hoarding. Cultural differences were also identified, with relatively substantial effects of toilet paper hoarding in several Asian regions (Australia, Japan, Taiwan and Singapore). Conclusions The COVID-19 pandemic has been associated with a worldwide increase in toilet paper hoarding. Social media and social cognitive biases are major contributors and might explain some differences in toilet paper hoarding between countries. Other mental health-related factors, such as the stressful situation of the COVID-19 pandemic, fear of contagion, or particular personality traits (conscientiousness), are likely to be involved. Registration PROSPERO CRD42020182308

To evaluate the effect of brown-rot fungi Oligoporus placenta and earthworm Eisenia fetida on decomposition of paper mill sludge, the paper mill sludge was mixed with cow dung in 0, 25, 50, 75, and 100% proportions and changes in physicochemical quality of waste mixtures was carried out for 28 days. All waste mixtures were treated with: Setup-I (E. fetida), Setup-II (O. placenta) and, Setup-III (E. fetida + O. placenta). A decrease in total organic carbon, C/N ratio and cellulose but an increase in total kjeldhal nitrogen, total phosphorus, total potassium and pH was recorded. The paper mill sludge in 50–75% proportion in feedstock showed the better results and rate of mineralisation were in order: Setup-III > Setup-I > Setup-II. The proportion of CD has direct role in waste mineralisation. The microbial population (bacterial, fungal and actinomycetes) and earthworm biomass were also high in Setup-III, suggesting the influence of brown-rot fungi on paper mill sludge humification. Results indicate that fungal inoculate in vermicomposting was effective in decomposing cellulose-rich industrial sludge.

Ageing is one of the greatest social and economic challenges of the 21st century for European societies. According to the latest population projections, by 2070, those aged 65 years and over will rise from 19% to 29%, while the share of those aged 80 and over will increase from 5% to 13% of the total population, which will be almost as large as the youngest population (aged 0–14) in that year.1 Because older people have different healthcare requirements, often developing disabilities or multimorbidity complications, health systems will need to adapt so they can provide adequate care for longer periods while remaining financially sustainable. The estimated change in the EU’s total public expenditure on the older population (the total public expenditure includes pensions, health care, long-term care, education and unemployment benefits) will increase from 25% of GDP in 2016 by 1.7 percentage points, reaching 26.7% in 2070. This will be caused mostly by spending on health care (+0.9 percentage points) and long-term care (+1.2 percentage points); the percentages refer to the baseline scenario.2 In view of such challenges, it is of the utmost importance that hospital pharmacists’ expertise in medicine use optimisation is fully utilised along the care pathway in order to mitigate problems prevalent in the older population, such as polypharmacy and drug adherence. Therefore, the following position paper of the European Association of Hospital Pharmacists (EAHP) outlines key points for policymakers to be mindful of in shaping responses. EAHP calls on national governments and health system managers to acknowledge hospital pharmacists’ drug expertise by investing in medication reconciliation and optimisation roles in all healthcare facilities, including nursing homes, as a key part of the European level response to the increasing prevalence of polypharmacy. EAHP calls for strengthened inter-sector communication, coordination and multidisciplinary collaboration as critical approaches …

This White Paper presents the foundational domains with examples of key aspects of competencies (knowledge, skills, and attitudes) that are intended for curriculum development and accreditation quality assessment for graduate (master’s level) education in applied health informatics. Through a deliberative process, the AMIA Accreditation Committee refined the work of a task force of the Health Informatics Accreditation Council, establishing 10 foundational domains with accompanying example statements of knowledge, skills, and attitudes that are components of competencies by which graduates from applied health informatics programs can be assessed for competence at the time of graduation. The AMIA Accreditation Committee developed the domains for application across all the subdisciplines represented by AMIA, ranging from translational bioinformatics to clinical and public health informatics, spanning the spectrum from molecular to population levels of health and biomedicine. This document will be periodically updated, as part of the responsibility of the AMIA Accreditation Committee, through continued study, education, and surveys of market trends.

China’s household paper industry saw steady growth in 2017 as the country’s economy stabilized and improved, while benefiting from increased population urbanization and consumption upgrading. On the other hand, under the circumstance of strict environmental protection and high fluctuation of external pulp price, the speed of capacity clearance is accelerating, thus driving the market share closer to the leading position. This Paper analyzes the assets and business performance of three companies, Hengan International Group Co. Ltd, Vinda International Holdings Limited and C&S Paper Co. Ltd, which are the first tier in Chinese household Paper industry. It is concluded that Hengan, as the industry leader, has a large volume and is now in a stable position. Vinda also has diversified development, but the situation is not objective. As a rising star, C&S focuses on living paper. Though it is small in size, it is growing rapidly, and has already surpassed Vinda.

The present study demonstrates the vermistabilization of paper mill wastewater sludge (PMS) spiked with cow dung (CD) employing indigenous epigeic earthworm Perionyx excavatus Perrier. A total of six treatments were prepared along with a positive control (PC) and negative control (NC). Twenty earthworms were released into each treatment including PC and NC without earthworms. The different proportions viz., T1 (CD – 100%), T2 (PMS:CD – 1:3), T3 (PMS:CD – 1:2), T4 (PMS:CD – 1:1), T5 (PMS:CD – 3:1), T6 (PMS:CD – 2:1), PC (PMS – 100%) and NC (PMS – 100%) and changes in chemical parameters and microbial properties were recorded during the course of 60 days. Vermistabilization caused a significant decrease in the level of heavy metals: Cd (2.9–27.8%), Cu (0.22–42.3%), Pb (1.3–56.3%) and Cr (0.8–46.2%). The bioconcentration factor (BCFs) was also calculated and great amount of heavy metals accumulated in their body (mg kg−1) that ranged from 0.31 ± 0.003–0.45 ± 0.007 for Cd, 0.12 ± 0.005–0.24 ± 0.003 for Cu, 0.15 ± 0.005–0.31 ± 0.006 for Pb and 0.29 ± 0.007–0.56 ± 0.001 mg kg−1 for Cr, accumulation of heavy metals are in the order: Cr > Cd > Pb > Cu. The physicochemical parameters of earthworm treated substrate such as electrical conductivity, total nitrogen, total phosphorus and total potassium were significantly increased; whereas, pH, total organic carbon, C:N ratio (carbon: nitrogen) and C:P ratio (carbon: phosphorus) were reduced after 60 days of vermistabilization. The vermistabilized materials also had a higher population of bacteria (98.90 ± 0.30 CFU × 106 g−1), fungi (43.75 ± 0.55 CFU × 103 g−1) and actinomycetes (67.65 ± 0.45 CFU × 105 g−1) than initial mixtures. Moreover, several histopathological changes were observed in earthworm tissues viz., disintegration of cells, irregular surface of epidermis, cellular debris, irregular cellular compartmentation, and oval-shaped nucleus. Higher level of histopathological abnormalities was recorded in PC (PMS-100%) while none were detected in lower concentrations of PMS. Furthermore, the study concludes that the paper mill sludge in a mixture of cow dung (1:1 ratio) can be a useful proposition for utilizing this hazardous waste through the adoption of vermitechnology.

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

In this study, a simple and fast procedure was developed and validated for the determination of bisphenol A (BPA) in paper products using synchronous fluorescence spectroscopy. The method was used for the determination of BPA in thirteen types of paper products, including thermal receipt papers, lottery tickets, bus tickets, business cards, mailing envelopes, flyers, napkins, printing paper, food contact paper, kitchen rolls, toilet paper, newspapers, and magazines. BPA was found in 98% of thermal receipt papers (n = 341) at concentrations ranging from below the limit of quantification (LOQ) to 27.7 mg g−1 with a geometric mean of 14.6 mg g−1 and a median of 17.7 mg g−1. The detection rate for other paper products was 96%, with BPA concentrations ranging from below the LOQ to 379 µg g−1 and a median of 17.3 µg g−1. The estimated daily intake for the adjusted bodyweight of BPA (calculated at median concentrations) through dermal absorption from handling papers was 14.5 and 1070 ng day−1 for the general population and occupationally-exposed individuals, respectively. The proposed analytical method is simple, fast, and cost-effective for the determination of BPA in paper samples. Moreover, an estimated daily exposure of Brazilians to BPA through dermal absorption from handling different types of papers is shown.

Asthma prevalence in Italy is on the rise and is estimated to be over 6% of the general population. The diagnosis of asthma can be challenging and elusive, especially in children and the last two decades has brought evidences that asthma is not a single disease but consists of various phenotypes. Symptoms can be underestimated by the patient or underreported to the clinician and physical signs can be scanty. Usual objective measures, like spirometry, are necessary but sometimes not significant. Despite proper treatment asthma can be a very severe condition (even leading to death) however new drugs have recently become available which can be very effective in its control. Since asthma is currently thought to be caused by inflammation, a direct measure of the latter can be of paramount importance. For this purpose, the measurement of Fractional Exhaled Nitric Oxide (FENO) has been used since the early years of the current century as a non-invasive, easy-to-assess tool useful for diagnosing and managing asthma. This SIP-IRS/SIAAIC Position Paper is a narrative review which summarizes the evidence behind the usefulness of FENO in the diagnosis, management and phenotypization of asthma.

Valorisation involves conversion of toxic compounds into value added products. The present study has tried to evaluate the potential of vermicomposting in management of different types of toxic paper mill wastes such as primary waste (VCP) and secondary waste (VCS) using Eisenia fetida for 60 days. The procedure was performed using sundried samples of paper mill wastes, cow dung and straw in different trial sets using different ratios. The study had revealed that the trial sets (VCP1 and VCS1) using ratio of paper mill waste: Cow dung: Straw (5:4:1) were effective in maintaining physiochemical parameters and different population attributes of earthworm. The present study had also demonstrated the enzymatic enrichment of vermicompost in terms of 19 enzymes such as α-Glucosidase, lipase, leucine aminopeptidase etc. in maintenance of C/N ratio of the compost. A significant reduction of heavy metals were noticed in vermicomposting of primary waste (VCP1) as Zn (40%) ​> ​Pb (36%) ​> ​Cr (28%) ​> ​Cu (25%) and secondary waste (VCS1) as Zn (44%) ​> ​Pb (41%) ​> ​Cu (19%) ​> ​Cr (13%). Such reduction of heavy metal was highly correlated with the reduction of C/N ratio of the vermicompost. The process of bioremediation was further manifested through the regular monitoring of bioaccumulation factor (BAF) among earthworm population in vermicomposting of primary waste (VCP1) as Zn (0.40) ​> ​Cu (0.23) ​> ​Cr (0.18) ​> ​Pb (0.11) and secondary waste (VCS1) as Zn (0.47) ​> ​Cu (0.25) ​> ​Cr (0.21) ​> ​Pb (0.14). Therefore, the study concludes that the ratio of paper mill waste, cow dung and straw (5:4:1) can be an efficient formulation in qualitative enrichment of different toxic organic paper mill wastes through vermicomposting.

The study investigates on activities of returning the usage paper boxes through online shopping among universities’ students in China. It also can investigate the similarity studies in online shopping at other countries and adopting the concept of reverse logistics.Online shopping is the most popular transaction at present especially among students and working adults for conveniences in lifestyles. Online shopping is able to reduce purchasing times, personal costs, having multiple choices with cheaper products. With regards of the package in on-line shopping, most of the sellers are using the designed paper boxes for packaging and sending them to their customers. Upon receiving, the buyers normally destroyed the paper boxes, throwing away into dust bin and some were kept for nothing. These will impact the environment, health and space for unnecessary. The activities on on-line shopping are increasing and the usages of paper boxes are worrying for the country. The population (2019) in China is approximately to 1.4 Billion with the penetration rates on online shopping reached 55.8%. The estimated amount of on-line shopping in 2019 closed to USD 1.9 Trillion and the volume is increasing between 8 -12 % every year. Online shopping is motivated by product range, price advantages and availability of reviews. This study also proposes a framework to improve understanding on which psychological factors may increase the rate on returning the paper-boxes from online-shopping. The framework uses the constructs of Theory of planned behavior (TPB) as a basis, extending an exogenous factors and applies to the pro-environmental activities’ context. At the end the articles show that the intention in returning the paper boxes from online shopping are not only affected by attitude, subjective norms andPerceived Behavioral Control (PBC) but also by exogenous factors.

International audience; Advances in the diagnosis and management of congenital heart disease have led to a marked improvement in the survival of adult with congenital heart disease (ACHD) patients. However, ACHD patients are a heterogeneous population, with a large spectrum of anatomic substrates even within specific lesions. In addition, the nature of previous surgery and other intervention is highly variable rendering each patient unique and residual anatomic and haemodynamic abnormalities are very common. As the ACHD population continues to age, acquired heart disease will also require cardiac imaging assessment. It is increasingly recognized in ACHD community that the diagnostic utility of a multimodality cardiovascular approach is greater than the sum of individual tests. In ACHD patients, diagnostic information can be obtained using a variety of diagnostic tools. The aims of this document are to describe the role of each diagnostic modality in the care of ACHD patients and to provide guidelines for a multimodality approach. The goal should be to provide the most appropriate and cost-effective diagnostic pathway for each individual ACHD patient.

Background: Though women increasingly make up the majority of medical-school and other science graduates, they remain a minority in academic biomedical settings, where they are less likely to hold leadership positions or be awarded research funding. A major factor is the career breaks that women disproportionately take to see to familial duties. They experience a related, but overlooked, hurdle upon their return: they are often too old to be eligible for 'early-career researcher' grants and 'career-development' awards, which are stepping stones to leadership positions in many institutions and which determine the demographics of their hierarchies for decades to come. Though age limits are imposed to protect young applicants from more experienced seniors, they have an unintended side effect of excluding returning workers, still disproportionately women, from the running. Methods: In this joint effort by the European Society of Clinical Microbiology and Infectious Diseases, the Federation of European Microbiological Societies, the Infectious Disease Society of America, the International Society for Infectious Diseases and the Swiss Society for Infectious Diseases, we invited all European Congress of Clinical Microbiology and Infectious Diseases-affiliated medical societies and funding bodies to participate in a survey on current 'early-career' application restrictions and measures taken to provide protections for career breaks. Recommendations: The following simple consensus recommendations are geared to funding bodies, academic societies and other organizations for the fair handling of eligibility for early-career awards: 1. Apply a professional, not physiological, age limit to applicants. 2. State clearly in the award announcement that career breaks will be factored into applicants' evaluations such that: • Time absent is time extended: for every full-time equivalent of career break taken, the same full-time equivalent will be extended to the professional age limit. • Opportunity costs will also be taken into account: people who take career breaks risk additional opportunity costs, with work that they did before the career break often being forgotten or poorly documented, particularly in bibliometric accounting. Although there is no standardized metric to measure additional opportunity costs, organizations should (a) keep in mind their existence when judging applicants' submissions, and (b) note clearly in the award announcement that opportunity costs of career breaks are also taken into account. 3. State clearly that further considerations can be undertaken, using more individualized criteria that are specific to the applicant population and the award in question. The working group welcomes feedback so that these recommendations can be improved and updated as needed.

International audience; The population of patients with congenital heart disease (CHD) is continuously increasing, and a significant proportion of these patients will experience arrhythmias because of the underlying congenital heart defect itself or as a consequence of interventional or surgical treatment. Arrhythmias are a leading cause of mortality, morbidity and impaired quality of life in adults with CHD. Arrhythmias may also occur in children with or without CHD. In light of the unique issues, challenges and considerations involved in managing arrhythmias in this growing, ageing and heterogeneous patient population and in children, it appears both timely and essential to critically appraise and synthesize optimal treatment strategies. The introduction of catheter ablation techniques has greatly improved the treatment of cardiac arrhythmias. However, catheter ablation in adults or children with CHD and in children without CHD is more technically demanding, potentially causing various complications, and thus requires a high level of expertise to maximize success rates and minimize complication rates. As French recommendations regarding required technical competence and equipment are lacking in this situation, the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Affiliate Group of Paediatric and Adult Congenital Cardiology have decided to produce a common position paper compiled from expert opinions from cardiac electrophysiology and paediatric cardiology. The paper details the features of an interventional cardiac electrophysiology centre that are required for ablation procedures in adults with CHD and in children, the importance of being able to diagnose, monitor and manage complications associated with ablations in these patients and the supplemental hospital-based resources required, such as anaesthesia, surgical back-up, intensive care, haemodynamic assistance and imaging. Lastly, the need for quality evaluations and French registries of ablations in these populations is discussed. The purpose of this consensus statement is therefore to define optimal conditions for the delivery of invasive care regarding ablation of arrhythmias in adults with CHD and in children, and to provide expert and - when possible - evidence-based recommendations on best practice for catheter-based ablation procedures in these specific populations.

Traditional pen and paper based neuropsychological tests (NPT) for cognition assessment have several challenges limiting their use. They are time consuming, expensive, and require highly trained specialists to administer. This leads to testing being available to only a small portion of the population and often with wait times of several months. In clinical practice, we have found results tend not to be integrated effectively into assessment and plans of the ordering provider. Here we compared several tests using BrainCheck (BC), a computer-based NPT battery, to traditional paper-based NPT, by evaluating individual tests as well as comparing composite scores to scores on traditional screening tools. 26 volunteers took both paper-based tests and BC. We found scores of four assessments (Ravens Matrix, Digit Symbol Modulation, Stroop Color Word Test and Trails Making A&B Test) were highly correlated. The Balance Examination and Immediate/Delayed Hopkins Verbal Learning, however, were not correlated. The BC composite score was correlated to results of the Saint Louis University Mental Status (SLUMS) exam [1], the Mini-Mental State Examination (MMSE) [2], and the Montreal Cognitive Assessment (MoCA). Our results suggest BC may offer a computer-based avenue to address the gap between basic screening and formal neuropsychological testing.

Half the world's people currently live in rural and remote areas. About 70% of the world's 1.4 billion people who are extremely poor live in rural areas. The problem is that the majority of healthcare providers prefer to serve in urban areas. Only a comprehensive and systematic approach can address these inequities. India, the largest democratic republic in the world, possesses 2.4% of the world's land area and supports 16% of the world's population. According to census 2011, 68.84% of population resides in rural areas. Nearly 86% of all the medical visits in India are made by rural inhabitants with a majority still traveling more than 100 km to avail healthcare facility, of which 70%-80% is born out of pocket landing them in poverty. A country's approach must systematically and simultaneously address legal coverage and rights, health worker shortages, extension of healthcare protection, and quality of care. Only then can equitable access for all be fully achieved. Those living in rural areas have access to health protection and services that meet the criteria of availability, affordability, accessibility, acceptability, and quality. Family medicine as a broad specialty has its role from womb till tomb. 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. As an academic discipline, it includes comprehensive healthcare services, education, and research. A family doctor provides primary and continuing care to the entire family within the communities; addresses physical, psychological, and social problems; and coordinates comprehensive healthcare services with other specialists, as needed. The practitioners in family medicine can play an important role in providing healthcare services to the suffering humanity. The general practitioner's responsibility in Medicare includes management of emergencies, treatment of problems relating to various medical and surgical specialties, care of entire family in its environment, appropriate referrals, and follow-up. He or she is the first-level contact for the patients and his or her family. Family medicine is the ideal solution to growing rural healthcare challenges. This article is a formal position paper of the Academy of Family Physicians of India.

Waste management and recycling of wastages play an important role in having a sustainable city or eco-city. Rapid increasing population in some cities of the world and especially in developing countries cause a different kind of pollution such as air, water, noise, visual, etc. Wastages are directly associated with city contamination. Useful policies for recycling waste can reduce pollution and boost the economy of a country. This study investigates the influence of recycled concrete aggregate (RCA), Silica fume (SF), and paper sludge ash (PSA) on the workability, compressive strength, and acoustic emission behavior of concrete. 5 and 10% of cement were replaced by PSA and silica fume and 10 and 20% of coarse aggregate was replaced by the recycled aggregate. PSA and SF improved the Strength, and acoustic emission behaviors of concrete, moreover, the recycled aggregate also improved the properties of concrete.

Laboratory investigations provide physicians with objective data to aid in disease diagnosis, clinical decision making, and patient follow up. Clinical interpretation of laboratory test results relies heavily on the availability of appropriate population-based reference intervals (i.e. normative values) or decision limits developed through clinical outcome studies. Although reference intervals are fundamental to accurate laboratory test interpretation, and thus critically important to healthcare, the need for sound evidence-based reference intervals has been largely overlooked, particularly in the pediatric population. In the field of pediatric laboratory medicine, accurate age- and sex-specific reference intervals established using samples from healthy children and adolescents have not been readily available, forcing many clinical laboratories to report adult reference intervals with pediatric test results. When pediatric reference intervals are available, they have often been established with a small sample size, inpatient or outpatient samples, outdated methodologies, and/or inappropriate statistical procedures. To address these unacceptable limitations, several national and global initiatives have begun to close the critical evidence gaps in pediatric reference intervals. Notably, the Canadian Laboratory Initiative on Pediatric Reference Intervals (CALIPER) has made significant strides towards improving pediatric healthcare in Canada and globally. The present report is a white paper summarizing CALIPER, and provides a comprehensive compendium of the data generated through this project over the past decade as a single resource for clinical laboratory specialists, clinicians, and other healthcare workers. CALIPER launched an outreach campaign in 2008 to recruit healthy community children and adolescents, and developed a robust statistical algorithm, in accordance with the Clinical and Laboratory Standards Institute (CLSI) guidelines, to develop accurate age- and sex-specific pediatric reference intervals. The first CALIPER direct reference interval study was published in 2012, with age- and sex-specific reference intervals reported for 40 common biochemical markers. To date, CALIPER has collected health information and blood samples from over 9700 community children and adolescents, and has established a comprehensive database of age- and sex-specific reference intervals for over 100 biomarkers of pediatric disease. CALIPER has also performed a series of transference and verification studies to expand the applicability of the CALIPER database to five major analytical platforms, including Abbott, Beckman, Ortho, Roche, and Siemens. Through novel knowledge translation initiatives, the CALIPER Reference Interval Database has been made freely available online ( www.caliperproject.ca ) as well as on a mobile application (CALIPER Reference App), and it is used by clinical laboratories across Canada, the United States, and globally. In addition to establishing this comprehensive pediatric reference interval database, CALIPER has also performed a series of sub-studies, including examining how reference intervals are affected by pre-analytical factors (i.e. sample stability at specific storage conditions, fasting status and time of sample collection), biological variation (i.e. intraindividual and interindividual biological variation, reference change values), and ethnicity and pubertal development stage. In this white paper, extensive tables of pediatric reference intervals are provided for easy reference for clinical laboratories worldwide. All data reported have been published in over 20 peer reviewed publications and are also available through the CALIPER Reference Interval Database as well as the CALIPER Reference App for mobile devices.

Many Higher Education Institutions (HEIs) in Africa face challenges that require the intervention of national governments, development partners and other stakeholders. HEIs also require new investment paradigms to maximize students’ acquisition of work-ready skills, knowledge and attitudes to enable students to contribute effectively to the workforce. The objective of this study was to identify reforms and investments needed to strengthen Higher Education (HE) in Africa and to inform the design and implementation of future investments and policy for sustainable development. A systematic review approach, involving a synthesis of literature on this theme in Africa in recent years, by African governments, education networks, academia and international bodies, was employed. The study used data from UNESCO and World Bank databases which were blended with the synthesis of the literature. The obtained literature was analysed and synthesized on the basis of its relevance and value to the HEIs study discourse. Textual and thematic analysis tookcentre stage with a view to establishing current reforms in HEIs and the concomitant investments that national governments and other key stakeholders need to make to have robust HEIs. The study used the Human Capital Theory that postulates that the most efficient path to the national development of any society lies in the improvement of its population, which is considered as the human capital. Despite criticisms of the human capital theory at the individual level on the extent to which education is directly related to improvements in occupation or income, human capital theorists generally assume that after all the known inputs into economic growth have been explained, much of the unexplained residual variance represents the contribution of the improvement of human capital, of which education is seen as most important (Merwe, 2010). The results of the study show that HEIs have done very little to promote Intra-Africa Academic Mobility and nurture HEI-industry partnerships to address demand and supply aspects of the labour force. The massification of higher education, resulting in a democratization of education, and the advent of the knowledge economy and globalization, among other factors, are being experienced without commensurate planning and with no corresponding accompanying increase in resources to enable the HEIs cope with the increased student population. HEIs in Africa are sub-optimally capacitated to combat Africa’s pressing challenges such as unemployment, climate change and COVID-19 pandemic. The study points out that HEIs need to evolve in tandem with continental and global market needs to achieve Sustainable Development Goal (SDG) number 4 on quality education. Further, it recommends that HEIs should encourage Intra-Africa Academic Mobility and foster HEI-industry partnerships to address demand-and-supply aspects of the labour force. In this respect, HEIs in Africa should be developing curricula aimed at building capacity of leaders and professionals to respond to the need to decarbonize and dematerialize development in Africa and leverage on the Fourth Industrial Revolution. Consequently, HEIs must prepare students to be entrepreneurial and resilient; able to continue to learn and reinvent themselves and their careers throughout their lives. Indeed, HEIs should view themselves as creative hubs where partners come together and harness each other’s synergy to innovate and solve societal problems.

Summary Background The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a worldwide rapidly spreading illness, Coronavirus Disease 2019 (COVID-19). Patients fed enterally and parenterally at home are exposed to the same risk of infection as the general population, but more prone to complications than others. Therefore the guidance for care-givers and care-takers of these patients is needed. Methods The literature search identified no relevant systematic reviews or studies on the subject. Therefore a panel of 21 experts from 13 home medical nutrition (HMN) centres in Poland was formed. Twenty-three key issues relevant to the management of SARS-CoV-2 infection or COVID-19 in the HMN settings were identified and discussed. Some statements diverge from the available nutrition, surgical or ICU guidelines, some are based on the best available experience. Each topic was discussed and assessed during two Delphi rounds subsequently. Statements were graded strong or weak based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Results the panel issued 23 statements, all of them were graded strong. Two scored 85.71% agreement, eleven 95.23%, and ten 100%. The topics were: infection control, enrolment to HMN, logistics and patient information. Conclusions the position paper present pragmatic statements for HMN to be implemented in places without existing protocols for SARS-CoV-2 pandemic. They represent the state of knowledge available at the moment and may change should new evidence occurs.

Coronavirus disease 2019 (COVID-19) vaccine BNT162b2 received approval and within the first few days of public vaccination several severe anaphylaxis cases occurred. An investigation is taking place to understand the cases and their triggers. The vaccine will be administered to a large number of individuals worldwide and concerns raised for severe adverse events might occur. With the current information, the European Academy of Allergy and Clinical Immunology (EAACI) states its position for the following preliminary recommendations that are to be revised as soon as more data emerges. To minimize the risk of severe allergic reactions in vaccinated individuals, it is urgently required to understand the specific nature of the reported severe allergic reactions, including the background medical history of the individuals affected and the mechanisms involved. To achieve this goal all clinical and laboratory information should be collected and reported. Mild and moderate allergic patients should not be excluded from the vaccine as the exclusion of all these patients from vaccination may have a significant impact on reaching the goal of population immunity. Health care practitioners vaccinating against COVID-19 are required to be sufficiently prepared to recognise and treat anaphylaxis properly with the ability to administer adrenaline. A mandatory observation period after vaccine administration of at least 15 minutes for all individuals should be followed. The current data has not shown any higher risk for patients suffering from allergic rhinitis or asthma and this message should be clearly stated by physicians to give our patients trust. The benefit of the vaccination clearly outweighs the risk of severe COVID-19 development including the more than 30% of the population suffering from allergic diseases.

Nearly 7% of the world’s population lives with a hemoglobin variant. Hemoglobins S, C, and E are the most common and significant hemoglobin variants worldwide. Sickle cell disease, caused by hemoglobin S, is highly prevalent in sub-Saharan Africa and in tribal populations of Central India. Hemoglobin C is common in West Africa, and hemoglobin E is common in Southeast Asia. Screening for significant hemoglobin disorders is not currently feasible in many low-income countries with the high disease burden. Lack of early diagnosis leads to preventable high morbidity and mortality in children born with hemoglobin variants in low-resource settings. Here, we describe HemeChip, the first miniaturized, paper-based, microchip electrophoresis platform for identifying the most common hemoglobin variants easily and affordably at the point-of-care in low-resource settings. HemeChip test works with a drop of blood. HemeChip system guides the user step-by-step through the test procedure with animated on-screen instructions. Hemoglobin identification and quantification is automatically performed, and hemoglobin types and percentages are displayed in an easily understandable, objective way. We show the feasibility and high accuracy of HemeChip via testing 768 subjects by clinical sites in the United States, Central India, sub-Saharan Africa, and Southeast Asia. Validation studies include hemoglobin E testing in Bangkok, Thailand, and hemoglobin S testing in Chhattisgarh, India, and in Kano, Nigeria, where the sickle cell disease burden is the highest in the world. Tests were performed by local users, including healthcare workers and clinical laboratory personnel. Study design, methods, and results are presented according to the Standards for Reporting Diagnostic Accuracy (STARD). HemeChip correctly identified all subjects with hemoglobin S, C, and E variants with 100% sensitivity, and displayed an overall diagnostic accuracy of 98.4% in comparison to reference standard methods. HemeChip is a versatile, mass-producible microchip electrophoresis platform that addresses a major unmet need of decentralized hemoglobin analysis in resource-limited settings.

Survival prospects in adults with congenital heart disease (CHD), although improved in recent decades, still remain below expectations for the general population. Patients and their loved ones benefit from preparation for both unexpected and predictable deaths, sometimes preceded by a prolonged period of declining health. Hence, advance care planning (ACP) is an integral part of comprehensive care for adults with CHD. This position paper summarizes evidence regarding benefits of and patients' preferences for ACP and provides practical advice regarding the implementation of ACP processes within clinical adult CHD practice. We suggest that ACP be delivered as a structured process across different stages, with content dependent upon the anticipated disease progression. We acknowledge potential barriers to initiate ACP discussions and emphasize the importance of a sensitive and situation-specific communication style. Conclusions presented in this article reflect agreed expert opinions and include both patient and provider perspectives. ispartof: EUROPEAN HEART JOURNAL vol:41 issue:43 pages:4200-4210 ispartof: location:England status: published

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 Piepoli, M.F., Abreu, A., Albus, C., Ambrosetti, M., Brotons, C., Catapano, A.L. ... Tiberi, M. (2020). Update on cardiovascular prevention in clinical practice: A position paper of the European Association of Preventive Cardiology of the European Society of Cardiology*. European Journal of Preventive Cardiology (EJPC), 27(2), 181-205 is available online at: https://doi.org/10.1177/2047487319893035. European guidelines on cardiovascular prevention in clinical practice were first published in 1994 and have been regularly updated, most recently in 2016, by the Sixth European Joint Task Force. Given the amount of new information that has become available since then, components from the task force and experts from the European Association of Preventive Cardiology of the European Society of Cardiology were invited to provide a summary and critical review of the most important new studies and evidence since the latest guidelines were published. The structure of the document follows that of the previous document and has six parts: Introduction (epidemiology and cost effectiveness); Cardiovascular risk; How to intervene at the population level; How to intervene at the individual level; Disease-specific interventions; and Settings: where to intervene? In fact, in keeping with the guidelines, greater emphasis has been put on a population-based approach and on disease-specific interventions, avoiding re-interpretation of information already and previously considered. Finally, the presence of several gaps in the knowledge is highlighted.

The Hong Kong Diploma of Secondary Education (HKDSE) examination is a high-stakes matriculation system that determines the opportunity for higher education and social mobility for most local students. This means that content featured in the tests poses strong washback effects on classroom teaching and learning. Despite the fact that the Hong Kong Examination and Assessment Authority (HKEAA) recognizes the effects of washback and the necessity to use it in a positive way, certain aspects within the HKDSE English Language Reading Comprehension paper might have been overlooked. This paper looks at the genres, text sources and topics featured by the HKDSE examination since its inception in 2011. It finds that while there is an effort to diversify the topics featured and ensure their appropriacy to local candidates, the Authority falls short in utilizing a wide enough range of text genres in its examinations, possibly leading to narrowed English reading abilities in the population. Additionally, texts are also usually selected from sources that favor affluent, professional demographics, which has possible implications for the fairness of the test.

We consider discrete dynamical systems coming from the models of evolution of populations playing rock - paper - scissors game . Asymptotic behaviour of trajectories of these systems is described, occurrence of the Neimark-Sacker bifurcation and nonexistence of time averages are proved.