Search

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

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

In the industrialized world, increasing productivity and profitability is very important for companies as a benchmark of success in business processes. Some literature has defined the success factor of the successful application of the concept of TPM as a tool to improve the productivity performance of the company, therefore improving the productivity performance of the company becomes the main thing in improving long-term sustainable profitability for the company . In the manufacturing industry pulp and paper mills, the contribution of the highest production costs is in raw materials (Pulp and chemical raw materials), followed by energy and packaging. The energy sector occupies the top three in the cost contributor to variable costs, it is triggered because in the pulp paper industry sector, the consumption value for electrical energy and heat is very high. Therefore, success in eliminating eight major losses is a major success factor in improving the profitability of the company. To analyze the effects of elimination of eight major losses, reduction of production costs and increase in profitability can be solved by evaluating the influence of all indicators of eight major losses using PLS-SEM. The data used is operational data co-generation plant production of PT. XYZ in 2019. From the research conducted it is known that the variable Overall Plant Effectiveness (OPE) is significantly influenced by 2 (two) of the 3 (three) constituent indicators, namely Availability and Performance, both indicators affect: Productivity Improvement, Decreased Production Costs and Increased Profitability of the Company. The priority of improvement that must be done by considering the production cost performance data from the review of variable costs of energy is elimination: Loss Shutdown losses (A1), Loss Production adjustment loss (A2), Equipment failure (A3), Process failure ( A4), Normal Production (A5), and abnormal production (A6).

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

The 14th edition of the Workshop on Recent Issues in Bioanalysis (14th WRIB) was held virtually on June 15-29, 2020 with an attendance of over 1000 representatives from pharmaceutical/biopharmaceutical companies, biotechnology companies, contract research organizations, and regulatory agencies worldwide. The 14th WRIB included three Main Workshops, seven Specialized Workshops that together spanned 11 days in order to allow exhaustive and thorough coverage of all major issues in bioanalysis, biomarkers, immunogenicity, gene therapy and vaccine. Moreover, a comprehensive vaccine assays track; an enhanced cytometry track and updated Industry/Regulators consensus on BMV of biotherapeutics by LCMS were special features in 2020. As in previous years, this year's WRIB continued to gather a wide diversity of international industry opinion leaders and regulatory authority experts working on both small and large molecules to facilitate sharing and discussions focused on improving quality, increasing regulatory compliance and achieving scientific excellence on bioanalytical issues. This 2020 White Paper encompasses recommendations emerging from the extensive discussions held during the workshop and is aimed to provide the Global Bioanalytical Community with key information and practical solutions on topics and issues addressed, in an effort to enable advances in scientific excellence, improved quality and better regulatory compliance. Due to its length, the 2020 edition of this comprehensive White Paper has been divided into three parts for editorial reasons. This publication (Part 3) covers the recommendations on Vaccine, Gene/Cell Therapy, NAb Harmonization and Immunogenicity). Part 1 (Innovation in Small Molecules, Hybrid LBA/LCMS & Regulated Bioanalysis), Part 2A (BAV, PK LBA, Flow Cytometry Validation and Cytometry Innovation) and Part 2B (Regulatory Input) are published in volume 13 of Bioanalysis, issues 4 and 5 (2020), respectively.

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

In 2015 the Spanish Society of Rheumatology (Sociedad Espanola de Reumatologia [SER]) published its position paper on biosimilar drugs. In this update, the SER, continues to manifest its unequivocal commitment to the sustainability of the health system of our country and is aligned with the measures that, without reducing quality of care, are aimed at ensuring its continuity. Since the publication of the previous position paper, the European Commission has authorized new biosimilar drugs, which provides an excellent opportunity to advance the efficiency of health care. In this new scenario of increased therapeutic offer of biologics, the SER considers it crucial to preserve the freedom of prescription of physicians who prescribe drugs based exclusively on the characteristics and individual circumstances of each patient, without forgetting the economic aspects there of.

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

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

The development of industry and of the Internet of Things (IoTs) have brought energy issues and huge challenges to the environment. The emergence of triboelectric nanogenerators (TENGs) has attracted wide attention due to their advantages, such as self-powering, lightweight, and facile fabrication. Similarly to paper and other fiber-based materials, which are biocompatible, biodegradable, environmentally friendly, and are everywhere in daily life, paper-based TENGs (P-TENGs) have shown great potential for various energy harvesting and interactive applications. Here, a detailed summary of P-TENGs with two-dimensional patterns and three-dimensional structures is reported. P-TENGs have the potential to be used in many practical applications, including self-powered sensing devices, human–machine interaction, electrochemistry, and highly efficient energy harvesting devices. This leads to a simple yet effective way for the next generation of energy devices and paper electronics.

Cellulose triacetate (CTA) forward osmosis (FO) membrane from Hydration Technology Innovation (HTI), USA was tested in a locally fabricated FO system to concentrate synthetic and pulp and paper mill wastewater. The industry is among the 17 most polluted industries with intensive water consumption and wastewater generation (MoEFCC, Government of India). The CTA membrane was studied with deionized water as feed solution and 1 M NaCl as draw solution, which resulted into water flux of 5.8 L/m2h and reverse salt flux of 0.2 g/L. A concentration stepping method was used to determine the critical draw concentration with lignin solution as the model feed. There was no deviation in flux between the baseline (deionized water feed) and the lignin solution up to 1.5 M NaCl, but a marginal deviation (8% and 21% respectively at 2 M and 3 M) was seen thereafter. The average water flux after 24 h FO study with synthetic wastewater as feed solution (draw solution 2 M NaCl) was 8 L/m2h, and 80% water recovery. Similar study with pulp and paper wastewater as feed solution (draw solution of 1.5 M NaCl) was 5.4 L/m2h was with 62% water recovery. Lignin and COD rejection in pulp and paper mill wastewater was 90% and 64% respectively. The preliminary results indicate that FO is promising for water and lignin recovery from waste streams.

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

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.

The aim of this review is to introduce the information concerning advanced technology of ink-jet printing regarding characteristics and ink-jet paper. It is believed that ink-jet paper having suitable liquid absorption characteristics and drying techniques are required to improve image quality on high-speed inkjet printing. Although the development of high quality ink-jet paper is important, the demand or the dual-purpose coated paper that can be used with offset and ink-jet printing is expected to increase for the time being. Meanwhile, it is important to get cost down and raise the productivity of the inkjet paper to secure competitiveness comparable to that of offset coated paper. For those objectives we think that the development of new technologies is required for pigment development, composition design of the coating ingredients, and rheological characteristics analysis of coating colors.

Objective. This study aims 1) to acquire new information on alternative conference formats, including in the field of Library and Information Science (LIS), which have arisen as a result of the COVID-19 pandemic and restrictions on physical communication; 2) to clarify the role of such a communication channel as Conference proceedings within the scientific ecosystem, as well as the concepts "proceedings paper" and "conference paper".Methods. Examining the new conference formats and special features of the Conference proceedings involved the content from the web-sites of international conferences in the field of LIS and related sciences, the analysis of subject-specific papers and data from the bibliographic and abstract databases such as Scopus and the Web of Science Core Collection (WoS).Results. It has been proven that over the year 2020 the online and hybrid events have become an alternative format of physical conferences. It has been confirmed that the Conference proceedings from the influential international conferences refer to the types of publications categorized as "high-quality papers". The peculiarity of LIS university researchers is that, in addition to studying problems focused only on the library activities, there is a need to conduct research into various subjects that are major for their institutions. Conference proceedings can be published as a book (a series of books), in a journal, or as a serial publication. Papers from them may be indexed by WoS (as "proceedings paper") and/or by Scopus (as "conference paper"); however, the impact factors of the publications themselves are not available in these databases.Conclusions. In the year 2020, the new pandemic reality, representing a circumstance of irresistible force, stimulated the flourishing of creative and technological solutions for online conferences. For international conferences, it is mandatory to publish the materials presented by their participants. Proceedings paper (conference paper) in journals are similar to standard journal articles in their structure but they have a less rigorous review process, they are published faster at a lower scientific impact (citation level).

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

Pediatric acute liver failure (PALF) is a rare, rapidly progressive clinical syndrome with significant morbidity and mortality. The phenotype of PALF manifests as abrupt onset liver dysfunction, which can be brought via disparate etiology. Management is reliant upon intensive clinical care and support, often provided by the collaborative efforts of hepatologists, critical care specialists, and liver transplant surgeons. The construction of an age-based diagnostic approach, the identification of a potential underlying cause, and the prompt implementation of appropriate therapy can be lifesaving; however, the dynamic and rapidly progressive nature of PALF also demands that diagnostic inquiries be paired with monitoring strategies for the recognition and treatment of common complications of PALF. Although liver transplantation can provide a potential life-saving therapeutic option, the ability to confidently determine the certainness that liver transplant is needed for an individual child has been hampered by a lack of adequately tested clinical decision support tools and accurate predictive models. Given the accelerated progress in understanding PALF, we will provide clinical guidance to pediatric gastroenterologists and other pediatric providers caring for children with PALF by presenting the most recent advances in diagnosis, management, pathophysiology, and associated outcomes.

Intra-operative ultrasound has become a relevant imaging modality in neurosurgical procedures. While B-mode, with its intrinsic limitations, is still considered the primary ultrasound modality, intra-operative contrast-enhanced ultrasound (ioCEUS) has more recently emerged as a powerful tool in neurosurgery. Though still not used on a large scale, ioCEUS has proven its utility in defining tumor boundaries, identifying lesion vascular supply and mapping neurovascular architecture. Here we propose a step-by-step procedure for performing ioCEUS analysis of the brain, highlighting its neurosurgical applications. Moreover, we provide practical advice on the use of ultrasound contrast agents and review technical ultrasound parameters influencing ioCEUS imaging.

Atherosclerosis often affects the coronary arterial tree. Frequently the disease does not translate in significant narrowing of the vessels, thus determining only a non-obstructive disease. This condition that is described as non-obstructive coronary artery disease (NobsCAD) should be distinguished from the absence of disease (i.e. smooth coronary arteries) as it carries a specific prognostic value. The detection and reporting of NobsCAD should prompt preventive measures that can be individualized upon the degree of the underlying burden of disease. The accompanying clinical condition, the other cardiovascular risk factors present, and the description of the severity and extent of NobsCAD should provide the framework for an individualized treatment that should also consider the best available scientific evidence and guidelines. The description of NobsCAD represents important information to be collected whenever a coronary angiogram (both invasive and non-invasive) is performed. Treating the patient according to the presence and extent of NobsCAD offers prognostic benefits well beyond those offered by considering only the traditional cardiovascular risk factors. In order to reach this goal, NobsCAD should not be confused with the absence of coronary atherosclerosis or even ignored when detected as if it was a trivial information to provide.

The COVID-19 pandemic represents an unprecedented event that has brought deep changes in hospital facilities with reshaping of the health system organization, revealing inadequacies of current hospital and local health systems. When the COVID-19 emergency will end, further evaluation of the national health system, new organization of acute wards, and a further evolution of the entire health system will be needed to improve care during the chronic phase of disease. Therefore, new standards for healthcare personnel, more efficient organization of hospital facilities for patients with acute illnesses, improvement of technological approaches, and better integration between hospital and territorial services should be pursued. With experience derived from the COVID-19 pandemic,new models, paradigms, interventional approaches, values and priorities should be suggested and implemented.

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

Multiple sclerosis is a complex, autoimmune-mediated disease of the central nervous system characterized by inflammatory demyelination and axonal/neuronal damage. The approval of various disease-modifying therapies and our increased understanding of disease mechanisms and evolution in recent years have significantly changed the prognosis and course of the disease. This update of the Multiple Sclerosis Therapy Consensus Group treatment recommendation focuses on the most important recommendations for disease-modifying therapies of multiple sclerosis in 2021. Our recommendations are based on current scientific evidence and apply to those medications approved in wide parts of Europe, particularly German-speaking countries (Germany, Austria, Switzerland).Die Multiple Sklerose ist eine komplexe, autoimmun vermittelte Erkrankung des zentralen Nervensystems, charakterisiert durch inflammatorische Demyelinisierung sowie axonalen/neuronalen Schaden. Die Zulassung verschiedener verlaufsmodifizierender Therapien und unser verbessertes Verständnis der Krankheitsmechanismen und -entwicklung in den letzten Jahren haben die Prognose und den Verlauf der Erkrankung deutlich verändert. Diese Aktualisierung der Behandlungsempfehlung der Multiple Sklerose Therapie Konsensus Gruppe konzentriert sich auf die wichtigsten Empfehlungen für verlaufsmodifizierende Therapien der Multiplen Sklerose im Jahr 2021. Unsere Empfehlungen basieren auf aktuellen wissenschaftlichen Erkenntnissen und gelten für diejenigen Medikamente, die in weiten Teilen Europas, insbesondere in den deutschsprachigen Ländern (Deutschland, Österreich, Schweiz), zugelassen sind.

Since the first statement of the German Society of Oto-Rhino-Laryngology, hypoglossal nerve stimulation (HNS) is meanwhile an established treatment option for obstructive sleep apnea (OSA). There are three HNS systems available in Germany which differ in their technical details of the underlying comparable basic principle. For the unilateral HNS with respiratory sensing, several comparative studies, high-volume register analysis and long-term reports exist. The continuous HNS without respiratory sensing does not require a sleep endoscopy for indication. For the bilateral continuous HNS as the single partially implantable device, a feasibility study exists. For indication, the assessment of positive airway pressure failure by sleep medicine is crucial, and the decision for HNS should be made in discussion of other treatment options for at least moderate OSA. The implantation center holds primarily responsibility among the interdisciplinary sleep team and is primary contact for the patient in problems. This depicts why structural processes are required to secure outcome quality and minimize the complications. The aftercare of HNS patients can be provided interdisciplinary and by different medical institutions, whereat, minimal reporting standards to document outcome and usage are recommended.

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

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

Feedback is beneficial to students’ learning process and overall achievement, but one of the common complaints from students about college education is regarding feedback. So, this study aimed to examine whether digital written feedback positively influences students’ learning experience and attitude toward learning. Digital written feedback refers to feedback provided through a learning management system as handwritten feedback added to a scanned copy of the student’s paper-based assessment using a smart pad and smart pencil. The study surveyed a diverse set of college students’ (n = 175) perceptions regarding feedback satisfaction, learning satisfaction, the usefulness of digital written feedback, and perceived achievement via an online survey. A one-way analysis of variance found a significant difference between feedback satisfaction and learning satisfaction according to the feedback method. A multiple regression analysis indicated the satisfaction and perceived usefulness of digital written feedback predicted perceived achievement. From the students’ open responses regarding the benefits of digital written feedback, five themes emerged, namely usability, psychological relief, accessibility, self-regulation, and acceptance. The implications for digital written feedback are discussed.

We report a paper-based photodetector made from mixed cation organic perovskite halide MA1–xFAxPbI3 (MA = methylammonium (CH3NH3); FA = formamidium CH(NH2)2). The detector shows a substantial photo...

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

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

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

The pulp and paper industry has significant sustainability implications and necessarily requires a careful consideration of direct and lower-tier suppliers for effective sustainable supply chain ma...

Refereed/Peer-reviewed At a paper manufacturing mill (PML) that had been previously part of an integrated pulp (bisulphite) and paper mills industry, cyanobacterial blooms were observed in the mill’s aerated stabilization basin (ASB) ponds at about 3 years after pulping had been discontinued. This study aimed to determine the factors that led to bloom occurrences and potential control strategies applicable to the paper manufacturing mill’s, aerated stabilization basin system that discharges wastewaters into a coastal lake. Following discontinuation of pulping, the colour of the wastewaters reduced to low levels (~ 10 Hazen units or less), while the levels of nutrient remained potentially supportive of cyanobacteria growth with total phosphorus at ~ 0.1 mg/L and total nitrogen at > 2.5 mg/L. Incidences of blooms in the ABS were associated with preceding average monthly rainfalls and wind speeds being less (~ 44% and ~ 7%, respectively) and average direct sunlight hours being greater (~ 9%) than the long-term average values. Zinc was investigated for control of cyanobacteria as this metal is less toxic to aquatic organisms and microflora than copper algaecides. In laboratory culture trials, zinc was found to inhibit growth of M. aeruginosa (strain MIC338) and Pseudanabaena sp. when dosed at ~ 2.5 mg/L. The inhibition of cyanobacteria by zinc was found to vary between ASB pond samples which had different in situ chlorophyll a levels. This study found that the PML wastewaters investigated can be supportive of cyanobacterial growth to bloom levels after discontinuation of pulping processes and that zinc has potential as a cyanobacteria control agent.

[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.

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

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

The pulp and paper industry is a highly energy-intensive and water-consuming industry. This industry is known for the utilization of a wide range of raw materials, containing cellulose fibers (generally wood, recycled paper, and agricultural residues), for the production of various grades of paper. There are several processes involved in the conversion of raw materials to the paper product such as raw material preparation, pulping, pulp washing and screening, bleaching, stock preparation, papermaking and chemical recovery. All the processes are facing issues regarding process efficiency, product quality, energy & water consumption, and cost and environment. There is a need for further improvement and upgrading the technologies but the scale of operations, technological obsolesce and cost of implementing new technologies are some of the major issues. The main thrust areas of pulp and paper processing require major interventions in the adoption of green and clean technologies.

Our dependency towards wood has reduced the number of forests especially in Indonesia. Hence, many people tried to use another material as a replacement of wood. One of them is composite. Department of Industrial Engineering Universitas Sebelas Maret has developed paper-based composite using newspaper waste in Praktikum Perancangan Teknik Industri (PPTI) II. Unfortunately, the quality of composite is not so good. This paper tried to understand the effect of factors to responses and discover the best combination of factors to obtain the best responses. The responses of this experiment are tensile strength, bending strength and impact value. The factors of this experiment are paper pulp, PVAc glue and water. Taguchi method is used to find the appropriate orthogonal array and Particle Swarm Optimization method to find the optimum combination of the factors. Orthogonal array used in this experiment is L9 (34). Through analysis, all of the factors are significant to tensile and bending strength, but they are not significant to impact value. The best combination of factors is 175 grams paper pulp, 130 grams PVAc glue and 175 ml water. Optimum results obtained for tensile strength is 0.7595 N/mm2, bending strength is 4.873 N/mm2 and impact value is 0.0138 J/mm2.

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

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

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.