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UNLABELLED: Cannabis-based medicines are being approved for pain management in an increasing number of European countries. There are uncertainties and controversies on the role and appropriate use of cannabis-based medicines for the management of chronic pain. EFIC convened a European group of experts, drawn from a diverse range of basic science and relevant clinical disciplines, to prepare a position paper to empower and inform specialist and nonspecialist prescribers on appropriate use of cannabis-based medicines for chronic pain. The expert panel reviewed the available literature and harnessed the clinical experience to produce these series of recommendations. Therapy with cannabis-based medicines should only be considered by experienced clinicians as part of a multidisciplinary treatment and preferably as adjunctive medication if guideline-recommended first- and second-line therapies have not provided sufficient efficacy or tolerability. The quantity and quality of evidence are such that cannabis-based medicines may be reasonably considered for chronic neuropathic pain. For all other chronic pain conditions (cancer, non-neuropathic noncancer pain), the use of cannabis-based medicines should be regarded as an individual therapeutic trial. Realistic goals of therapy have to be defined. All patients must be kept under close clinical surveillance. As with any other medical therapy, if the treatment fails to reach the predefined goals and/or the patient is additionally burdened by an unacceptable level of adverse effects and/or there are signs of abuse and misuse of the drug by the patient, therapy with cannabis-based medicines should be terminated. SIGNIFICANCE: This position paper provides expert recommendations for nonspecialist and specialist healthcare professionals in Europe, on the importance and the appropriate use of cannabis-based medicines as part of a multidisciplinary approach to pain management, in properly selected and supervised patients. ispartof: EUROPEAN JOURNAL OF PAIN vol:22 issue:9 pages:1547-1564 ispartof: location:England status: published

The research progress in the centrifugal microfluidic platform provides great opportunities for simple and effective analytical measurements in a variety of areas including biomedical engineering. In this study, we propose an optical reader that can measure the transmittance in a very sensitive and rapid manner on a hybrid paper-polymer centrifugal disc platform. This device enables real-time monitoring of multiple samples by measuring the absorbance of the light transmitted through the paper integrated on the disc between the light emitting diode (LED) and the photodiode (PD) regardless of the ambient light condition. To confirm its efficiency, we analyzed one of the blood's important indicators, glucose in a successful manner within 10 s without any additional complex image analysis. In addition, we discussed the results by comparing with the reflectance-based methods and with those of the previously reported studies by introducing a figure of merit to evaluate the performance of the assay.

International audience; Advanced internet and multimedia set-top boxes are today massively based on 4*4 MIMO systems, with multi-sub-bands standards (Wifi bands, LTE, Bluetooth,…). Multiple antennas spatially distributed on the plastic casing become therefore a great challenge for cost and performances motivations, thus promoting flexible technology and substrate, for assembling subsystems , under compactness considerations, as well as electrical performances improvement. In this paper, we discuss about the characterisation of Multi-band antennas designed on an ultra-low cost material (a cellulosic substrate, i.e. a paper) with design challenges in terms of radiation efficiency maximization and wideband properties under compactness constraints. Simulation and measurements are proposed to validate the designs.

Background To increase effective communication in primary care consultations among older adults in Germany, the photo story is considered to be a useful tool based on Bandura’s social cognitive theory. With information technology helping to increase effective communication, the use of tablets is gaining attention in health care settings, especially with older adults. However, the effectiveness of tablet technology and photo stories has rarely been tested. Objective The aim is to compare the effectiveness of a photo story intervention to a traditional brochure. Both were delivered either in paper or tablet format. Methods A trial was conducted with 126 older adults, aged 50 years and older, who were approached and recruited by researchers and administrative staff from senior day care, doctors in rehabilitation centers, and trainers in sports clubs in Germany. Open and face-to-face assessment methodologies were used. Participants were randomly assigned to one of four intervention conditions: traditional brochure in paper format (condition 1) and tablet format (condition 2), and photo story in paper format (condition 3) and tablet format (condition 4). Each participant received a questionnaire and either the traditional brochure or photo story in a paper or tablet version. To evaluate the effectiveness of each intervention, participants completed evaluation questionnaires before and after each intervention. The second part of the questionnaire measured different indicators of health literacy, communication skills, health measurements, and possible underlying mechanisms. Results Compared to the traditional brochure, participants considered the photo story easier to understand (t124=2.62, P=.01) and more informative (t124=–2.17, P=.03). Participants preferred the paper format because they found it less monotonous (t124=–3.05, P=.003), less boring (t124=–2.65, P=.009), and not too long (t124=–2.26, P=.03) compared to the tablet format. Among all conditions, the traditional brochure with a tablet (condition 2) was also perceived as more monotonous (mean 3.07, SD 1.08), boring (mean 2.77, SD 1.19), and too long to read (mean 2.50, SD 1.33) in comparison to the traditional brochure in paper format (condition 1). Moreover, the participants scored significantly higher on self-referencing on the traditional brochure in paper format (condition 1) than tablet format for both types of the brochure (conditions 2 and 4). Conclusions Traditional brochures on a tablet seem to be the least effective communication option in primary care consultations among all conditions for older adults. The findings might be specific for the current generation of older adults in Germany and need to be replicated in other countries with larger sample sizes. Although information technology brings advantages, such as effective interventions in different fields and settings, it may also come with several disadvantages, such as technical requirements of the users and devices. These should be considered when integrating information technology into wider situations and populations. Trial Registration ClinicalTrials.gov NCT02502292; https://clinicaltrials.gov/ct2/show/NCT02502292 (Archived by Webcite at http://www.webcitation.org/747jdJ8pU)

Laser-cut paper patterns which are suitable for focusing terahertz radiation are presented. Such designs provide an extremely low-cost route for the prototyping and production of terahertz optical components. Diffractive binary Fresnel lenses have been explored using a multilayer paper stack and a liquid absorption method in order to phase shift THz radiation through paper by the optimum 180° The conventional Fresnel lens design has been extended to produce multiple focal spots and explore alternative shapes (e.g. hexagonal).

Currently, racial oil blotting papers are counted by hand. However, it takes a long time and this is hard work. Hence, an automatic counting system is necessary. In order to achieve this, we developed a cheap system using a webcam. This system firstly captures one image of arranged papers by shifting. Secondly, the paper boundaries are obtained as straight lines by utilizing the proposed image processing. By counting the acquired lines, the system outputs the number of papers. However, the captured image has noises such as the change of illumination and shadows. They make the extraction of the accurate boundaries difficult. For the accurate extraction, optimal parameters of the image processing must be set. Since the prediction of the optimal parameters in advance is difficult, the proposed method adopts genetic algorithm (GA). Also, Hough transformation for the straight line detection is improved. By applying the proposed method, the accurate paper counting is possible. For the experiment, 14 images were captured in various environments using a general webcam. Then, the proposed method was compared to a latest related work. As a result, F-measure of each method was 0.995 and 0.945.

International audience; The design of a dipole antenna printed on a paper substrate is presented in this paper. The antenna which integrates a compact balun is devoted for dual-band 2.4/5 GHz WLAN applications. The antenna is based on a double-side printed multilayer paper substrate and is fed with a coaxial cable for the testing. The simulated results of the whole structure are also presented in detail and compared with the measured performances.

Temperature is a critical extrinsic physical parameter that determines cell fate. Hyperthermia therapy has become an efficient treatment for tumor ablation. To understand the response of tumor cells under thermal shocks, we present a paper-based photothermal array that can be conveniently coupled with commercial 96-well cell culture plates. This paper chip device was fabricated in one step using Parafilm® and Kimwipers® based on a heat lamination strategy. Liquid was completely adsorbed and confined within the cellulose fibres of hydrophilic regions. Then, Prussian blue nanoparticles (PB NPs) as the photothermal initiator were introduced into the loading wells, and thermal energy was generated via near infrared (NIR) laser irradiation. After assembling the paper device with a 96-well plate, the temperature of each well could be individually controlled by varying the loading amount of PB NPs and laser irradiation time. As a proof-of-concept study, the effects of local thermal shocks on HeLa cells were investigated using MTT cell viability assay and Live/Dead cell staining. The variation of cell viability could be monitored in situ with controllable temperature elevation. The proposed paper photothermal array loaded with thermal initiators represents an enabling tool for investigating the hyperthermia responses of biological cells. Moreover, the facile fabrication technique for paper patterning is advantageous for customizing high-throughput microfluidic paper-based analytical devices (μPADs) with extremely low cost.

In this paper a compact, flexible, Multiband antenna is designed. It is having flexible Substrate of photographic paper which makes the antenna conformal. The antenna with two U slots cut in radiating patch is offset fed by microstrip lines gives the multiple bands of WLAN /WIMAX Application and two parasitic Elements improves the bandwidth of a typical microstrip antenna. The Measured results shows that the antenna resonates between Frequency band 2.10-2.95 GHz, 3.35-3.54 GHz and 5.04-6.0Hz.which are used for application such as Bluetooth, Wi-Fi, Zigbee, ISM 2.4GHz,WLAN WiMAX, and WLAN 5.2GHz.

Carbon materials are known to be one of the most suitable platforms for the development of cold electron emitters. Here we explore field emission (FE) performance of so-called graphene paper that is a micrometer-thick foil obtained by stacking chemically exfoliated graphene layers. We find, that shaped into triangular form, graphene paper exhibits competitive FE characteristics, such as highcurrent densitys Table in time, and low threshold fields. In addition, we study the degradation of such graphene-based emitters under high emissions currents and discuss possible application for a transmissiontype X-ray source.

Flexible biosensors represent an increasingly important and rapidly developing field of research. Flexible materials offer several advantages as supports of biosensing platforms in terms of flexibility, weight, conformability, portability, cost, disposability and scope for integration. On the other hand, electrochemical detection is perfectly suited to flexible biosensing devices. The present paper reviews the field of integrated electrochemical bionsensors fabricated on flexible materials (plastic, paper and textiles) which are used as functional base substrates. The vast majority of electrochemical flexible lab-on-a-chip (LOC) biosensing devices are based on plastic supports in a single or layered configuration. Among these, wearable devices are perhaps the ones that most vividly demonstrate the utility of the concept of flexible biosensors while diagnostic cards represent the state-of-the art in terms of integration and functionality. Another important type of flexible biosensors utilize paper as a functional support material enabling the fabrication of low-cost and disposable paper-based devices operating on the lateral flow, drop-casting or folding (origami) principles. Finally, textile-based biosensors are beginning to emerge enabling real-time measurements in the working environment or in wound care applications. This review is timely due to the significant advances that have taken place over the last few years in the area of LOC biosensors and aims to direct the readers to emerging trends in this field.

In this communication a prototype of paper-based analytical device designed for simultaneous determination of orthophosphate and calcium ions, which levels are significant for hyperphosphatemia diagnostics, is presented. The laboratory-on-paper structure for two analytes detection was wax-printed on the surface of filter paper. These two-analyte disposable paper strips are combined with two paired LED-based fluorescence detectors and simple voltmeter used as recorder of analytical signal, what makes the developed device miniature, extremely low-cost, portable and user-friendly. Thus the developed device allows usage outside of specialized clinical laboratory. Moreover, each paper strip is disposable and its utilization is easy and fast and, additionally, burnt strip tests ensure waste non-infectious. The presented LED&Paper-based analytical device provides low detection limits: 1.4 μmol L−1 and 7.4 μmol L−1 for orthophosphate and calcium ions, respectively. The practical utility of the developed device for calcemia/phosphatemia diagnostics is demonstrated using control serum standards and real human serum.

Electrical fire is the most frequently occurred fire accident, and fire sensors with self-cutting and ultrasensitive fire-alarm response capability are urgent to be designed and developed. Herein, conductive reduced graphene oxide paper (RGOP) with hierarchical structure is prepared by a facile evaporation-assisted self-assembly of graphene oxide (GO) dispersion and then reduction by hydrazine hydrate vapor. The oxidative decomposition of RGOP containing sodium chloride (RGOP-NaCl) is promoted by the addition of NaCl. When being exposed to flame, RGOP-NaCl strips are readily ruptured. Based on this distinctive self-cutting performance of RGOP-NaCl under fire attacking, a novel fire detection and alarm device is designed by establishing controlling and operation circuits. Under fire encountering, an ultrafast warning response (approximately 5.3 s) of RGOP-NaCl is triggered. Fire-alarm time of RGOP-NaCl is adjustable by varying the content of NaCl. Furthermore, this RGOP-NaCl has the function of fuse and can cut off the conductive circuit timely under fire attacking. This finding will provide a novel thought for the design of advanced fire-alarm sensor and will also expand the application of graphene paper.

Background An assessment of the average level of evidence (LOE) of clinical research papers in peer reviewed orthopedic surgery journals has not previously been published. In this paper we report on the average LOE of papers published in six of the top English language orthopedic surgery journals. Methods Six well established orthopedic journals were identified by using the Google Scholar H5 Journal Index. We selected 6 of the top ten journals identified by the Index. The six journals that were evaluated for this project were as follows: The American Journal Of Sports Medicine (AJSM); Clinical Orthopedics and Related Research (CORR); Journal of Bone and Joint Surgery (JBJS); Knee Surgery, Sports, Traumatology, Arthroscopy (KSSTA); Journal of Arthroscopy (Arthros.); and the Journal of Shoulder and Elbow Surgery (JSES). Thirteen consecutive monthly issues (July, 2018 - July, 2019) of each journal were evaluated for the LOE of each clinical paper. The assigned LOE was used if published, or the level of evidence was assigned by the senior author (DAB) if one was not listed. For each journal, the overall mean LOE along with the variance and standard deviation was calculated with all confidence intervals set at 95%. Summary data was statistically analyzed to provide an overall mean LOE for the 6 journals evaluated. Results For AJSM, we evaluated 246 clinical research articles that had an average LOE of 2.96 +/- 0.16. For CORR, we evaluated 155 papers that had an average LOE of 2.83 +/- 0.19. For JBJS, we evaluated 164 papers that had an average LOE of 3.04 +/- 0.13. For KSSTA, we evaluated 402 papers that had an average LOE of 3.05 +/- 0.16. For Arthros. we evaluated 226 papers that had an average LOE of 3.19 +/- 0.10. For JSES, we evaluated 237 papers that had an average LOE of 3.25 +/- 0.13. In summary, for the 1425 clinical research papers published in 98 issues of 6 of the top orthopedic journals, we found the average Level Of Evidence to be 3.05 +/- 0.16. Conclusions The goal of scientific study design is to prove or disprove a hypothesis while minimizing bias and errors. The gold standard for therapeutic studies has been a double blind, randomized controlled trial (RCT). However, it is not possible or feasible for every clinical study to have a blinded RCT design. Additionally, clinically relevant and actionable data can come from studies that are not RCTs. In a medical discipline like orthopedics many interventions are invasive, making controlled trials or blinded trials unethical or technically not practical. Our analysis of over 1400 peer reviewed publications in one year in 6 of the top English language orthopedic journals reveals that the average level of evidence deemed worthy of publication is level 3. In terms of the most common study design, the average published clinical study in these orthopedic journals was a case-control study.

All-inkjet-printing of transistors has received much attention for low cost and flexible integrated circuits. However, most flexible field-effect transistors (FETs) based on the emerging two-dimensional materials suffer from the high cost of substrate and electrode materials. The requirements for high-temperature synthesis and precise control in processing add another layer of complexity. To overcome these issues, low-cost flexible paper-based MoS2 FETs were fabricated by inkjet printing of MoS2 channel materials on paper. Additionally, we proposed and achieved the mask-less and low-temperature formation of source and drain electrodes on paper using in-situ selective-area copper reduction. A low sub-threshold swing of 80 mV/dec, high on/off ratio of 105, and very high turn-on current (Ion) of 200 μA of the paper-based flexible MoS2 FETs were demonstrated using the proposed low-cost and facile all-inkjet-printing technique. The all-inkjet-printing technique assisted by in-situ copper reduction opens new opportunities for low-cost and batch fabrication of paper-based electronic devices in ambient conditions.

Objectives We assessed the proportion of primary health care (PHC) randomized controlled trial (RCT) protocols published in peer-reviewed journals that published results in subsequent papers in peer-reviewed journals; and whether this proportion changed over time. Study Design and Setting We searched (last update June 2019) for RCTs published in peer-reviewed journals reporting primary outcome results for 620 protocols that were published up to 2014 and were retrieved in PubMed. We recorded the absolute number and the proportion of protocols with published results per year; and estimated whether the proportion changed over time. Results Of the 620 published protocols, 525 (85%) disseminated their results through a published RCT by June 2019. The number of published protocols was increasing over time especially after 2001. However, the proportion of protocols per year with published results in subsequent papers was decreasing over time after 2002. Specifically, the proportion ranged from 86% to 96% for protocols published until 2010 while for those published from 2011 onward ranged from 76% to 86%. Mean time from protocol to results publication was 39 months (95% CI 37, 41). Conclusion Almost one-sixth of PHC trial protocols published in peer-reviewed journals did not publish their results in subsequent papers.

In this work, a new method of bricks making based on waste paper has been developed for the thermal insulation of buildings. This method involves converting paper waste into aggregates and combining them with a Portland cement binder. A physical and thermal characterization of the Aggregate of Waste Paper (AWP) is carried out, followed by a structural study by Scanning Electron Microscopy (SEM). Six Paper Brick Types are made with the mass dosage variation of the composite. After drying the bricks in the open air for 28 days, experimental investigations were carried out to determine the density, the water absorption, the compressive and flexural strength, and the propagation speed of ultrasonic waves. In addition, a SEM analysis combined with an Energy-Dispersive X-ray spectroscopy analysis (EDX) is performed to examine the adhesion between the AWP and the cement particles. The characterization results of the aggregates showed a low density and thermal conductivity amounting to170kg/m3 and 0.06 W/m.K, respectively, and the analysis of their microstructure by SEM demonstrated that their structure is composed of randomly distributed fibers. Moreover, the mechanical properties of the paper bricks are more resistant, since the compressive strength varies between 3.43 and 6.43 MPa, and their thermal properties are lower compared to the conventional bricks, from 0,0851 to 0,0978 W/m.K. Therefore, these findings clearly indicate that the newly made bricks represent an innovative solution for thermal insulation in buildings that can also be used as a structural material.

This paper reports the development and fabrication of a low-cost handheld point of care device that can quantify the concentration of biomarkers using a paper microfluidic assay. The commercially available light-to-digital converting sensor was used to achieve this objective. This RGB sensor was efficient in the digital values of the red, green, and blue components of the sample or object. It has an inbuilt white LED source, an array of photodiodes with color filters, an analog-to-digital converter module, and also an IR blocking filter. The sensor was interfaced with the Arduino UNO board, and the corresponding results were displayed on the serial monitor. This device was tested for manually prepared primary color samples and also for total protein. The colorimetric detection of protein was performed for 1 g dL-1 to 14 g dL-1 concentrations on a paper microfluidic device. The change in color intensity of the paper device with an increase in total protein concentration was monitored and calibrated the device for real sample analysis.

A novel platform of microfluidic paper-based analytical devices (μPADs) for dual detection of bisphenol A (BPA), a model analyte, was fabricated using an electronic digital plotter to create the stacked layer of μPADs and generate the lateral-flow channel without using an external pump. Two detection techniques, including electrochemical detection and laser desorption ionization mass spectrometric detection (LDI-MS), were used complementarily to improve the precision in the detection of BPA. The fluid sample was delivered to both detection zones by the capillary action, automatically generated from the fabricated microfluidic device. For an electrochemical sensor, two ballpoint pens filled with silver nanoparticles (AgNPs) and multiwall carbon nanotube (MWCNT) ink were used to print onto the paper with a contact printing method using a digital plotter. To further improve the sensitivity, zinc oxide (ZnO) was used to modify both electrochemical and LDI-MS detection zones. For BPA detection, high electrocatalytic properties and strong UV absorption of ZnO promote the electron transfer in the electrochemical sensor and ionization efficiency in LDI-MS with low interferences compared with a conventional organic matrix. Under optimal conditions, this platform showed a dual detection capability for BPA with a detection limit of 0.35 μM for electrochemical detection and with an ultralow detection limit of 0.01 pM for LDI-MS. This novel platform might be very useful for trace analyses requiring high precision detection of various analytes.

Tight assembly of stator windings with no insulation paper damage is a manufacturing challenge. We evaluate different sets of parts according to the following parameters: magnet wire thickness, stator slot smoothness, length of the straight magnet wire after the slot end, and type and amount of insulation cap at the end of the slot. These parameters have discrete values with small differences between them. The damage criterion is the decrease of the insulation paper breakdown voltage after assembly/disassembly of parts, assembled in a small set of designed experiments. Parameter values, i.e., levels at individual experiments are set by an orthogonal experiment matrix. Repetition of each experiment provides statistical significance. Data analysis shows that the additive model alone is not sufficient due to the high correlation of the parameters’ influences. We extend the model to include interparameter influences, which we model by adding a virtual parameter. The extended additive model generates parameter values that do not degrade the insulation paper breakdown voltage within the manufacturing process. These values are verified by repetitions of the control experiment.

The dispute concerned anti-dumping duties imposed by Australia on two exporters of A4 copy paper from Indonesia which Indonesia claimed were inconsistent with several provisions of the Anti-Dumping Agreement. Australia imposed these duties, ranging between 30% and 40%, on the basis of a comparison of constructed normal values with export prices. Those constructed values were based, for certain input items, on substitute values – prices of pulp exported by Brazilian and South American producers to China and Korea – rather than on the actual costs recorded in those exporters' financial records. These kinds of ‘cost adjustments’ currently rank among the most controversial topics in contemporary WTO anti-dumping case law.