Search

Edible oils form an integral component in the human diet as well as in the industrial preparations. Any adulteration in oil is concerning from nutritional as well as economical perspective. Although analytical techniques exist for detection of adulterants in oil, most of them require sophisticated instruments, and trained professionals. Microfluidic based lab-on-a-chip technologies have rapidly progressed over the recent years and offer promising alternatives in this regard. In this work, we report development of a paper-based microfluidic lab-on-a-chip for detection of palm oil contamination in sunflower oil. We use the paper-based microfluidic colorimetric detection approach that indicates the presence of adulteration in a visual manner. The data is analyzed using digitally acquired images along with ultraviolet–visible spectrophotometry. The paper-based microfluidic device is fabricated and tested for 10–50% (v/v) palm oil adulteration in sunflower oil. Further, we employ the device for free fatty acid content tests in oil samples. Visual signal acquired from the device is optimized by varying phenolphthalein proportions. The stability of visual colorimetric signal is examined over time and is found to remain steady over the trial period of six days considered in this work. The integration of the detection device with smartphone imaging can prove to be useful for onsite data collection. We believe the approach presented here can be extended to food quality monitoring portable platforms.

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

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

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

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

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

The waste of paper or the paper dump is a serious problem and its occurrence is widespread in various institutions. Wastepaper can be recycled to produce some important and usable products that are ecological and biodegradable. For example, it is used to extract new paper from the old by chemical decomposition. Other products such as paper plates, paper cups, paper spoons, tiles, toys, crafts, etc. can be formed from the slurry. This project also initiates a mould that makes cups and plates from the wastepaper management circuit. With learning institutions being the main consumers, most paper are usually eliminated after its use. The waste remains undeveloped and unused, although is a valuable resource. Studying the design of a manual, economical and efficient paper recycling machine, it can be surmised that the design uses the integration of the knowledge gained about the recycling technology that exists manually from the paper recycling machines used to form a cheap but effective paper recycling system. The advantages of the machine are not only of recycled paper, but also the advantages of the interaction of the manual drive system, which will also reduce the high cost. As the design is not 100% effective, the transmission, belt and chain transmission correspond to the estimated 90% efficiency using the 90% for the design. The power consumption for the design is 450 W and since an average user can produce 100 W constant, it takes 5 people to drive the machine.

This paper introduces a novel potential-resolved paper-based biosensor for simultaneous detection of multiple microRNAs (miRNAs) (taking miRNA-155 and miRNA-126 as examples) based on the bipolar electrode (BPE) electrochemiluminescence (ECL) strategy. The proposed multiple-channel paper-based sensing microfluidic platform was prepared by wax-printing technology, screen-printing method, and in situ Au nanoparticles (AuNPs) growth to form hydrophilic areas, hydrophobic boundaries, waterproof electronic bridge, driving electrode regions, and parallel bipolar electrode regions. CdTe quantum dots (QDs)-H2 and Au@g-C3N4 nanosheets (NSs)-DNA1 were used as dual electrochemiluminescence signal probes, and carboxylated Fe3O4 magnetic nanoparticles existed as carriers. CdTe QDs-H2/S2O82- and Au@g-C3N4 NSs-DNA1/S2O82- could exhibit two strong and stable ECL emissions at a drive voltage of 9 and 12 V, respectively, which can be used as effective potential-resolved signal tags. In addition, the proposed three-dimensional (3D) DNA nanomachine model and the target miRNA cycle strategy were used to achieve double amplification of electrochemiluminescence intensity. More importantly, the combination of the bipolar electrode system and the potential-resolved multitarget electrochemiluminescence method can greatly reduce the spatial interference between substances. The prepared ECL biosensor showed a favorable linear response for the detection of miRNA-155 and miRNA-126 with relatively low detection limits of 5.7 and 4.2 fM, respectively. With excellent sensitivity, the strategy may provide an efficient method for clinical application, especially in detection of trace multiple targets.

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

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

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

Food safety is always one of the most important issues for human being. With the variety of food, it is required to develop rapid, low-cost and convenient detection techniques for food safety. As a representative, paper-based detection techniques have developed rapidly from simple test papers to various microfluidic paper-based devices. The paper-based analytical devices combining paper platform with a variety of advanced analytical methods have shown great application prospects for rapid testing of food safety. In this review, the surface functionalization and modification of paper are introduced. Then, the construction and development of various detection techniques are discussed, including colorimetric analysis, fluorescent analysis, electrochemical analysis, surface enhanced Raman spectroscopic analysis, and multimethods on paper-based platforms for the application in rapid detection for food safety. Finally, the prospects and future challenges of rapid detection techniques in food safety are also discussed.

The Veterans Health Administration (VHA) is the United States' largest integrated health care delivery system, serving over 9 million enrollees at nearly 1300 health care facilities. In addition to providing health care to the nation's military veterans, the VHA has a research and development program, trains thousands of medical residents and other health care professionals, and conducts emergency preparedness and response activities. The VHA has been celebrated for delivering high-quality care to veterans, early adoption of electronic medical records, and high patient satisfaction. However, the system faces challenges, including implementation of an expanded community care program, modernization of its electronic medical records system, and providing care to a population with complex needs. The position paper offers policy recommendations on VHA funding, the community care program, medical and health care professions training, and research and development.

The steady growth of corporate interest and influence in the health care sector over the past few decades has created a more business-oriented health care system in the United States, helping to spur for-profit and private equity investment. Proponents say that this trend makes the health care system more efficient, encourages innovation, and provides financial stability to ensure access and improve care. Critics counter that such moves favor profit over care and erode the patient-physician relationship. American College of Physicians (ACP) underscores that physicians are permitted to earn a reasonable income as long as they are fulfilling their fiduciary responsibility to provide high-quality, appropriate care within the guardrails of medical professionalism and ethics. In this position paper, ACP considers the effect of mergers, integration, private equity investment, nonprofit hospital requirements, and conversions from nonprofit to for-profit status on patients, physicians, and the health care system.

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

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

The pulp and paper industry has a great impact in the world. It has been manufactured for ages and ages, it is still booming up as industry in small scale and large scale levels. Despite the fact that they produce printing and writing papers, paper rolls, packaging material etc. they also produce large amount of waste materials from their Industry by Manufacturing. This when left untreated leads to environmental pollution, harsh contamination and so on. As every industry has its own waste water treatment methods to recycle, reuse and reduce pollution. This Industry also has its own criteria to carry out the process of waste water treatment, yet it lags in being efficient in it. By the sources collected and compared with other kinds of industries it is listed that pulp and paper manufacturing industry is one of the top most industries to produce large volumes of waste water which has degradable organics at higher level. Hence this paper aims to study the manufacturing process, waste water components released and its effect on environment, the treatment methods carried out and how it can be improvised efficiently in forthcoming days

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

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

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

The contamination of water and food in agricultural areas, where an enormous volume of pesticides is widely employed to enhance crop production, is a challenging reality. The rapid assessment of these contaminants is fundamental to assure water and food quality and safety, particularly for local community members. This work presents a nonexpensive and easy-operational paper-based testing device for the fast detection of insecticides (carbamates and organophosphates) in water samples. The structural design "dip-and-fold" allows us to carry out the analysis without introducing reagents or samples. The device is prepared using different high-quality papers to support the active acetylcholinesterase (AChE) and the customized chemical formulation for colorimetric detection. The chemical principle is based on the AChE inhibition reaction and Ellman's method. The experiments using standard solutions of carbofuran, propoxur, and chlorpyriphos indicated satisfactory detection at concentrations between 0.1 and 0.0001 mM, and the color results are revealed within 10 min. Therefore, this technique represents a promising alternative for implementing low-cost and efficient water monitoring and management solutions.

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

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

We breathe in a world where growing electronic wastages are a serious threat to our ecosystem, and therefore biodegradable devices are more in demand. We have unprecedentedly demonstrated broad-ban...

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

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

BACKGROUND: It is important to identify patients with monogenic IBD as management may differ from classical IBD. In this position statement we formulate recommendations for the use of genomics in evaluating potential monogenic causes of IBD across age groups. METHODS: The consensus included paediatric IBD specialists from the Paediatric IBD Porto group of the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and specialists from several monogenic IBD research consortia. We defined key topics and performed a systematic literature review to cover indications, technologies (targeted panel, exome and genome sequencing), gene panel setup, cost-effectiveness of genetic screening, and requirements for the clinical care setting. We developed recommendations that were voted upon by all authors and Porto group members (32 voting specialists). RESULTS: We recommend next-generation DNA-sequencing technologies to diagnose monogenic causes of IBD in routine clinical practice embedded in a setting of multidisciplinary patient care. Routine genetic screening is not recommended for all IBD patients. Genetic testing should be considered depending on age of IBD-onset (infantile IBD, very early-onset IBD, paediatric or young adult IBD), and further criteria, such as family history, relevant comorbidities, and extraintestinal manifestations. Genetic testing is also recommended in advance of hematopoietic stem cell transplantation. We developed a diagnostic algorithm that includes a gene panel of 75 monogenic IBD genes. Considerations are provided also for low resource countries. CONCLUSIONS: Genomic technologies should be considered an integral part of patient care to investigate patients at risk for monogenic forms of IBD.

In Taiwan, the incidence and prevalence of psoriatic arthritis (PsA) have risen significantly in recent years. Moreover, data from the Taiwan National Health Insurance Research Database (NHIRD) show that more than 85% of PsA patients are treated with just non-steroidal anti-inflammatory drugs (NSAIDs) and/or conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). Taiwanese clinicians have also expressed concerns regarding uncertainties in the diagnosis of PsA and the delayed, interrupted, and/or tapered use of biologics, as well as differences in therapeutic preferences between and within dermatologists and rheumatologists. To address these issues, the Taiwan Rheumatology Association and the Taiwanese Association for Psoriasis and Skin Immunology jointly convened a committee of 28 clinicians from the fields of rheumatology, dermatology, orthopedics, and rehabilitation, to develop evidence-based consensus recommendations for the practical management of PsA in Taiwan. A total of six overarching principles and 13 recommendations were developed and approved, as well as a treatment algorithm with four separate tracks for axial PsA, peripheral PsA, enthesitis, and dactylitis. Psoriasis (PsO) management was not discussed here, as the Taiwanese Dermatological Association has recently published a comprehensive consensus statement on the management of PsO. Together, these recommendations provide an up-to-date, evidence-based framework for PsA care in Taiwan.

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

Background: The cost-effectiveness of using a mobile diary app as an adjunct in dialectical behavior therapy (DBT) in patientswith borderline personality disorder is unknown.Objective: This study aims to perform an economic evaluation of a mobile diary app compared with paper-based diary cardsin DBT treatment for patients with borderline personality disorder in a psychiatric outpatient facility.Methods: This study was conducted alongside a pragmatic, multicenter, randomized controlled trial. The participants wererecruited at 5 Danish psychiatric outpatient facilities and were randomized to register the emotions, urges, and skills used in amobile diary app or on paper-based diary cards. The participants in both groups received DBT delivered by the therapists. Acost-consequence analysis with a time horizon of 12 months was performed. Consequences included quality-adjusted life years(QALYs), depression severity, borderline severity, suicidal behavior, health care use, treatment compliance, and system usability.All relevant costs were included. Focus group interviews were conducted with patients, therapists, researchers, and industryrepresentatives to discuss the potential advantages and disadvantages of using a mobile diary app.Results: A total of 78 participants were included in the analysis. An insignificantly higher number of participants in the papergroup dropped out before the start of treatment (P=.07). Of those starting treatment, participants in the app group had an averageof 37.1 (SE 27.55) more days of treatment and recorded an average of 3.16 (SE 5.10) more skills per week than participants inthe paper group. Participants in both groups had a QALY gain and a decrease in depression severity, borderline severity, andsuicidal behavior. Significant differences were found in favor of the paper group for both QALY gain (adjusted difference −0.054;SE 0.03) and reduction in depression severity (adjusted difference −1.11; SE 1.57). The between-group difference in total costsranged from US $107.37 to US $322.10 per participant during the 12 months. The use of services in the health care sector wassimilar across both time points and groups (difference: psychiatric hospitalization and 2.02; SE 3.19). Overall, the patients showed high acceptability and considered the app as being easy to use. Therapists worriedabout potential negative influences on the therapist-patient interaction from new work tasks accompanying the introduction ofthe new technology but pointed at innovation potential from digital database registrations.Conclusions: This study suggests both positive and negative consequences of mobile diary apps as adjuncts to DBT comparedwith paper diary cards. More research is needed to draw conclusions regarding its cost-effectiveness. Background:The cost-effectiveness of using a mobile diary app as an adjunct in dialectical behavior therapy (DBT) in patients with borderline personality disorder is unknown.Objective:This study aims to perform an economic evaluation of a mobile diary app compared with paper-based diary cards in DBT treatment for patients with borderline personality disorder in a psychiatric outpatient facility.Methods:This study was conducted alongside a pragmatic, multicenter, randomized controlled trial. The participants were recruited at 5 Danish psychiatric outpatient facilities and were randomized to register the emotions, urges, and skills used in a mobile diary app or on paper-based diary cards. The participants in both groups received DBT delivered by the therapists. A cost-consequence analysis with a time horizon of 12 months was performed. Consequences included quality-adjusted life years (QALYs), depression severity, borderline severity, suicidal behavior, health care use, treatment compliance, and system usability. All relevant costs were included. Focus group interviews were conducted with patients, therapists, researchers, and industry representatives to discuss the potential advantages and disadvantages of using a mobile diary app.Results:A total of 78 participants were included in the analysis. An insignificantly higher number of participants in the paper group dropped out before the start of treatment (P=.07). Of those starting treatment, participants in the app group had an average of 37.1 (SE 27.55) more days of treatment and recorded an average of 3.16 (SE 5.10) more skills per week than participants in the paper group. Participants in both groups had a QALY gain and a decrease in depression severity, borderline severity, and suicidal behavior. Significant differences were found in favor of the paper group for both QALY gain (adjusted difference −0.054; SE 0.03) and reduction in depression severity (adjusted difference −1.11; SE 1.57). The between-group difference in total costs ranged from US $107.37 to US $322.10 per participant during the 12 months. The use of services in the health care sector was similar across both time points and groups (difference: psychiatric hospitalization Conclusions:This study suggests both positive and negative consequences of mobile diary apps as adjuncts to DBT compared with paper diary cards. More research is needed to draw conclusions regarding its cost-effectiveness.

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

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

The main environmental risks in the area of landfills are considered, all aspects of their technological reclamation using waste from the Baikal PPM are discussed. The data on the creation of soil and grounds using lignin-destroying microbiological preparations are presented. The final stage of the remediation of the Solzan landfill is the creation of cadastral maps 8, 9, 10 modern forest nurseries on the site, protected by flood and mudflow protection structures.

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

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

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

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

Maturity of vermicomposted end products obtained from citronella bagasse (CB) and a mixture of citronella bagasse and paper mill sludge (CB + PMS) was determined employing the epigeic earthworm species Eisenia fetida. Two of the primary biological indicators—enzyme assay and germination index—were used for evaluation of vermicompost maturity. The enzyme assay includes the changes in dehydrogenase and urease activities in the final products. The test for germination index was performed on two economically important plant species Abelmoschus esculentus and Solanum melongena. The results revealed a significant increase in dehydrogenase and urease activities in the vermicompost samples over the raw materials and traditional compost. The enhancement was recorded 215.63–225.63% in dehydrogenase and 149.89–249.31% for urease in the end products obtained after 45 days of experimental trials. Further, the higher values of germination index in the vermicompost treatments as against the control confirm the suitability and stability of the vermicomposted final products.

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

The present investigation was designed to study the effect of sublethal concentration of paper mill effluent on the total protein and amino acid contents in muscles, liver and gill of Channa punctatus after exposure to 96 hours. A significant decrease in protein content with increase in amino acids content in muscles, liver and gill of effluent exposed fishes was observed. A reduction in the protein content and enhancement of free amino acids in the muscles, liver and gill of experimental fish suggests that the tissue protein might have undergone proteolysis, during the stressful situation. Thus, the present study concludes that the protein metabolism of fish Channa punctatus affected during effluent exposure and reduces the nutritive value of fish.

Biologicals have transformed the management of severe disease phenotypes in asthma, atopic dermatitis, and chronic spontaneous urticaria. As a result, the number of approved biologicals for the treatment of atopic diseases is continuously increasing. Although atopic diseases are among the most common diseases in the reproductive age, investigations, and information on half-life, pharmacokinetics defining the neonatal Fc receptors (FcRn) and most important safety of biologicals in pregnancy are lacking. Given the complex sequence of immunological events that regulate conception, fetal development, and the intrauterine and postnatal maturation of the immune system, this information is of utmost importance. We conducted a systematic review on biologicals in pregnancy for indications of atopic diseases. Evidence in this field is scare and mainly reserved to reports on the usage of omalizumab. This lack of evidence demands the establishment of a multidisciplinary approach for the management of pregnant women who receive biologicals and multicenter registries for long-term follow-up, drug trial designs suitable for women in the reproductive age, and better experimental models that represent the human situation. Due to the very long half-life of biologicals, pre-conception counseling, and health care provider education is crucial to offer the best care for mother and fetus. This position paper integrates available data on safety of biologicals during pregnancy in atopic diseases via a systematic review with a detailed review on immunological considerations how inhibition of different pathways may impact pregnancy.

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

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

This collaborative statement from the Digital Health Committee of the Heart Rhythm Society provides everyday clinical scenarios in which wearables may be utilized by patients for cardiovascular health and arrhythmia management. We describe herein the spectrum of wearables that are commercially available for patients, and their benefits, shortcomings and areas for technological improvement. Although wearables for rhythm diagnosis and management have not been examined in large randomized clinical trials, undoubtedly the usage of wearables has quickly escalated in clinical practice. This document is the first of a planned series in which we will update information on wearables as they are revised and released to consumers.