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In the veterinary professional curriculum, methods of examination in many courses are transitioning from the traditional paper-based exams to electronic-based exams. Therefore, a controlled trial to evaluate the impact of testing methodology on examination performance in a veterinary physiology course was designed and implemented. Formalized surveys and focus group discussions were also used to determine student attitudes toward the examination formats. In total, 134 first-year veterinary students and 11 PhD/MS students were administered a total of 4 exams throughout 1 semester (2 on paper and 2 electronically) using a split-halves design. The paper (P) and electronic (E) exams contained 25 identical multiple-choice questions. Students were randomly assigned to two groups and were given exams in one of two sequences (E-P-E-P or P-E-P-E). Participants consented to and completed two anonymous surveys vis à vis their experience. Out of a maximum raw score of 25, the mean score for electronic examinations (20.8; 95% confidence interval, 20.3–21.2) was significantly ( P = 0.01) greater than that for paper examinations (20.3; 95% confidence interval, 20.0–20.7). However, students expressed numerous concerns with the electronic examination format, and, at the completion of the study, 87% preferred to take their examination on paper rather than the electronic format. These data show that student attitudes concerning the examination format are not primarily determined by examination results, and that the additional anxiety related to the electronic examination format plays a large role in student attitudes.

Increase in global population and growing disease burden due to the emergence of infectious diseases (Zika virus), multidrug-resistant pathogens, drug-resistant cancers (cisplatin-resistant ovarian cancer) and chronic diseases (arterial hypertension) necessitate effective therapies to improve health outcomes. However, the rapid increase in drug development cost demands innovative and sustainable drug discovery approaches. Drug repositioning, the discovery of new or improved therapies by reevaluation of approved or investigational compounds, solves a significant gap in the public health setting and improves the productivity of drug development. As the number of drug repurposing investigations increases, a new opportunity has emerged to understand factors driving drug repositioning through systematic analyses of drugs, drug targets and associated disease indications. However, such analyses have so far been hampered by the lack of a centralized knowledgebase, benchmarking data sets and reporting standards. To address these knowledge and clinical needs, here, we present RepurposeDB, a collection of repurposed drugs, drug targets and diseases, which was assembled, indexed and annotated from public data. RepurposeDB combines information on 253 drugs [small molecules (74.30%) and protein drugs (25.29%)] and 1125 diseases. Using RepurposeDB data, we identified pharmacological (chemical descriptors, physicochemical features and absorption, distribution, metabolism, excretion and toxicity properties), biological (protein domains, functional process, molecular mechanisms and pathway cross talks) and epidemiological (shared genetic architectures, disease comorbidities and clinical phenotype similarities) factors mediating drug repositioning. Collectively, RepurposeDB is developed as the reference database for drug repositioning investigations. The pharmacological, biological and epidemiological principles of drug repositioning identified from the meta-analyses could augment therapeutic development.

Background The pharmacological treatment of post-traumatic stress disorder (PTSD) is extremely challenging, as no specific agent has been developed exclusively to treat this disorder. Thus, there are growing concerns among the public, providers and consumers associated with its use as the efficacy of some agents is still in question. Aims We applied a dimensional and symptom cluster-based approach to better understand how the heterogeneous phenotypic presentation of PTSD may relate to the initiation of pharmacotherapy for PTSD initial episode. Method US veterans who served in the conflicts in Iraq and Afghanistan and received an initial PTSD diagnosis at the US Veterans Health Administration between 2008 and 2011 were included in this study. Veterans were followed for 365 days from initial PTSD diagnosis to identify initiation for antidepressants, anxiolytics/sedatives/hypnotics, antipsychotics and prazosin. Multivariable analyses were used to assess the relationship between the severity of unique PTSD symptom clusters and receiving prescriptions from each medication class, as well as the time from diagnosis to first prescription. Results Increased severity of emotional numbing symptoms was independently associated with the prescription of antidepressants, and they were prescribed after a substantially shorter period of time than other medications. Anxiolytics/sedatives/hypnotics prescription was associated with heightened re-experiencing symptoms and sleep difficulties. Antipsychotics were associated with elevated re-experiencing and numbing symptoms and prazosin with reported nightmares. Conclusions Prescribing practices for military-related PTSD appear to follow US VA/DoD clinical guidelines. Results of this study suggest that a novel dimensional and symptom cluster-based approach to classifying the phenotypic presentation of military-related PTSD symptoms may help inform prescribing patterns for PTSD. Declaration of interest None. Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Testing for antinuclear antibodies is the most frequently prescribed analysis for the diagnosis of rheumatic diseases. Indirect immunofluorescence remains the gold standard method for their detection despite the increasing use of alternative techniques. In order to standardize the manual microscopy reading, automated acquisition and interpretation systems have emerged. This publication enables us to present our method of interpretation and characterization of antinuclear antibodies based on a cascade of analyses and to share our everyday experience of the G Sight from Menarini. The positive/negative discrimination on Hep cells 2000 is correct in 85% of the cases. In most of the false negative results, it is a question of aspecific or low titers patterns, but a few cases of SSA speckled patterns of low titers demonstrated a probability index below 8. Regarding the pattern recognition, some types and mixed patterns are not properly recognized. Concerning the probability index correlated in some studies to final titer, the weak fluorescence of certain patterns and the random presence of artifacts that distort the index don't lead us to continue it in our daily practice. In conclusion, automated reading systems facilitate the reporting of results and traceability of patterns but still require the expertise of a laboratory technologist for positive/negative discrimination and for pattern recognition.

The psychometric properties of the paper-pencil and online versions of the Beliefs Toward Mental Illness Scale (BTMI) were examined in two studies with Latina/o individuals. In Study 1, 316 Latina/o participants completed the BTMI in a paper-pencil mode. The original three-factor model was found to be a poor fit model for the sample. Subsequent exploratory and confirmatory factor analyses identified a four-factor model as the best fitting model for the sample. The identified factors were Dangerousness, Social Dysfunction, Incurability, and Embarrassment. In Study 2, the identified best fit model was tested with 280 Latina/o participants who completed the BTMI online. The four-factor model had adequate fit. A series of measurement invariance tests on the fit model supported equal factor loadings, but rejected equivalent intercepts across paper-pencil and online administration methods, though partially equivalent intercepts and residuals were found. Consequently, modality-specific norms are recommended, depending on whether paper-pencil or online venues are utilized for administration.

This paper quantitatively investigates the compositions of the gaseous pollutants in the ambient air of a secondary fiber paper mill. Total volatile organic compounds (TVOC), formaldehyde (HCHO), sulfur compounds (H2S), and hydrocarbon compounds (CxHy) were analyzed on six sampling sites with photo-ionisation detector, acetylacetone spectrophotometric method, and gas detector. The results revealed that, the high levels of TVOC and CxHy were detected at the wet end of paper machine and the office area, respectively; all the H2S contents on the six sites exceeded the limit (0.06 mg m(-3)) seriously; the HCHO concentrations at other five sites were out of the limit (0.10 mg m(-3)) except for the wastewater treatment plant. Furthermore, the necessary discussions about the possible pollution sources were considered on the process flow, the chemical agents used, and the ambient conditions in the paper mill. For the sake of air pollution control in paper mills, these remarkable results and analysis lay some technical basis in the following researches that should attract more attentions.

The water demand for human activities is rapidly increasing in developing countries. Under these circumstances, preserving aquatic ecosystems should be a priority which requires the development of quality criteria. In this study we perform a preliminary prioritization of the risky substances based on reported ecotoxicological studies and guidelines for the Biobio watershed (Central Chile). Our specific aims are (1) reviewing the scientific information on the aquatic pollution of this watershed, (2) determining the presence and concentration of potential toxic substances in water, sediment and effluents, (3) searching for quality criteria developed by other countries for the selected substances and (4) prioritizing the most risky substances by means of deterministic ecotoxicological risk assessment. We found that paper and mill industries were the main sources of point pollution, while forestry and agriculture were mostly responsible for non-point pollution. The most risky organic substances in the water column were pentachlorophenol and heptachlor, while the most relevant inorganic ones were aluminum, copper, unionized ammonia and mercury. The most risky organic and inorganic substances in the sediment were phenanthrene and mercury, respectively. Our review highlights that an important effort has been done to monitor pollution in the Biobio watershed. However there are emerging pollutants and banned compounds—especially in sediments—that require to be monitored. We suggest that site-specific water quality criteria and sediment quality criteria should be developed for the Biobio watershed, considering the toxicity of mixtures of chemicals to endemic species, and the high natural background level of aluminum in the Biobio.

An important strategy to promote a strong sustainable growth relies on an efficient municipal waste management, and phasing out waste landfilling through waste prevention and recycling emerges as a major target. For this purpose, effective collection schemes are required, in particular those regarding selective waste collection, pursuing a more efficient and high quality recycling of reusable materials. This paper addresses the assessment and benchmarking of selective collection schemes, relevant to guide future operational improvements. In particular, the assessment is based on the monitoring and statistical analysis of a core-set of performance indicators that highlights collection trends, complemented with a performance index that gathers a weighted linear combination of these indicators. This combined analysis underlines a potential tool to support decision makers involved in the process of selecting the collection scheme with best overall performance. The presented approach was applied to a case study conducted in Oporto Municipality, with data gathered from two distinct selective collection schemes.

The amount of municipal solid waste (MSW) has been increasing steadily over the last decade by reason of population rising and waste generation rate. In most of the urban areas, disposal sites are usually located outside of the urban areas due to the scarcity of land. There is no fixed route map for transportation. The current waste collection and transportation are already overloaded arising from the lack of facilities and insufficient resources. In this paper, a model for optimizing municipal solid waste collection will be proposed. Firstly, the optimized plan is developed in a static context, and then it is integrated into a dynamic context using multi-agent based modelling and simulation. A case study related to Hagiang City, Vietnam, is presented to show the efficiency of the proposed model. From the optimized results, it has been found that the cost of the MSW collection is reduced by 11.3%.

Children who experience early caregiving neglect are very likely to have problems developing and maintaining relationships and regulating their social behavior. One of the earliest manifestations of this problem is reflected in indiscriminate behavior, a phenomenon where young children do not show normative wariness of strangers or use familiar adults as sources of security. To better understand the developmental mechanisms underlying the emergence of these problems, this study examined whether institutionally reared children, who experienced early social neglect, had difficulty associating motivational significance to visual stimuli. Pairing stimuli with motivational significance is presumably one of the associative learning processes involved in establishing discriminate or selective relationships with others. We found that early experiences of neglectful caregiving were associated with difficulties in acquiring such associations, and that delays in this developmental skill were related to children's social difficulties. These data suggest a way in which early social learning experiences may impact the development of processes underlying emotional development.

[Resumen] Se aborda el camino hacia la desaparición de los periódicos en soporte papel debido a la importante transformación del sector en los últimos anos como consecuencia, entre otros factores, del desarrollo de las tecnologías de la información y la comunicación y al cambio de hábitos de los consumidores de prensa. Mediante el empleo de modelos econométricos, tanto de regresiones cuadráticas como de análisis de relaciones de estabilidad a largo plazo entre variables, se trata de aproximar el ano en que la difusión de los diarios en papel será próxima a cero; lo mismo se plantea con la inversión publicitaria en el sector de la prensa impresa por ser una de sus principales fuentes de ingresos. Los resultados obtenidos no auguran un futuro muy esperanzador en el sector analizado, pues para las cabeceras tomadas como referencia y representación del sector, como son El país, El mundo, La razón y ABC la conclusión es que en 2020 entrarán en un estado crítico al situarse ahí el punto de ruptura de la difusión en papel. [Abstract] We discuss the disappearance of printed newspapers, an important transformation which is a result of, among other factors, the development of information and communication technologies, and the change of press consumers’ habits. By means of econometric models of quadratic regressions and co-integration models we try to approximate the year in which the diffusion of printed newspapers will be near to zero; next, we pose the same problem with regard to advertisement spending in the sector of the printed press because it is one of the main sources of revenue for newspapers. The results obtained do not predict a hopeful future in this sector; for the representative Spanish newspapers, El país, El mundo, La razón, and ABC, the conclusion is that they will have a negligible diffusion in printed formatbefore the year 2020.

Inspired by the paper platforms for 3-D cell culture, a paper-based microfluidic device containing drug concentration gradient was designed and constructed for investigating cell response to drugs based on high throughput analysis. This drug gradient generator was applied to generate concentration gradients of doxorubicin (DOX) as the model drug. HeLa cells encapsulated in collagen hydrogel were incubated in the device reservoirs to evaluate the cell viability based on the controlled release of DOX spatially. It was demonstrated that drug diffusion through the paper fibers created a gradient of drug concentration, which influenced cell viability. This drug screening platform has a great opportunity to be applied for drug discovery and diagnostic studies with simultaneous and parallel tests of drugs under various gradient concentrations.

The paper and pulp industry is one of the major industries that generate large amount of solid waste with high moisture content. Numerous opportunities exist for valorisation of waste paper sludge, although this review focuses on primary sludge with high cellulose content. The most mature options for paper sludge valorisation are fermentation, anaerobic digestion and pyrolysis. In this review, biochemical and thermal processes are considered individually and also as integrated biorefinery. The objective of integrated biorefinery is to reduce or avoid paper sludge disposal by landfilling, water reclamation and value addition. Assessment of selected processes for biorefinery varies from a detailed analysis of a single process to high level optimisation and integration of the processes, which allow the initial assessment and comparison of technologies. This data can be used to provide key stakeholders with a roadmap of technologies that can generate economic benefits, and reduce carbon wastage and pollution load.

BackgroundThe landmark US Multimodal Treatment of ADHD (MTA) study established the benefits of individualised medication titration and optimisation strategies to improve short- to medium-term outcomes in attention-deficit hyperactivity disorder (ADHD). This individualised medication management approach was subsequently incorporated into the National Institute for Health and Care Excellence (NICE) ADHD Clinical Guidelines (NICE CG78). However, little is known about clinicians' attitudes towards implementing these medication management strategies for ADHD in routine care.AimsTo examine National Health Service (NHS) healthcare professionals' consensus on ADHD medication management strategies.MethodUsing the Delphi method, we examined perceptions on the importance and feasibility of implementing 103 ADHD treatment statements from sources including the UK NICE ADHD guidelines and US medication management algorithms.ResultsCertain recommendations for ADHD medication management were judged as important and feasible to implement, including a stepwise titration of stimulant medication. Other recommendations were perceived as important but not feasible to implement in routine practice, such as weekly clinic follow-up with the family during titration and collection of follow-up symptom questionnaires.ConclusionsMany of the key guideline recommendations for ADHD medication management are viewed by clinicians as important and feasible to implement. However, some recommendations present significant implementation challenges within the context of routine NHS clinical care in England.

Four experiments were conducted to test whether recent developments in display technology would suffice to eliminate the well-known disadvantages in reading from screen as compared with paper. Proofreading speed and performance were equal for a TFT-LCD and a paper display, but there were more symptoms of eyestrain in the screen condition accompanied by a strong preference for paper (Experiment 1). These results were replicated using a longer reading duration (Experiment 2). Additional experiments were conducted to test hypotheses about the reasons for the higher amount of eyestrain associated with reading from screen. Reduced screen luminance did not change the pattern of results (Experiment 3), but positioning both displays in equal inclination angles eliminated the differences in eyestrain symptoms and increased proofreading speed in the screen condition (Experiment 4). A paper-like positioning of TFT-LCDs seems to enable unimpaired reading without evidence of increased physical strain. Practitioner Summary: Given the developments in screen technology, a re-assessment of the differences in proofreading speed and performance, well-being, and preference between computer screen and paper was conducted. State-of-the-art TFT-LCDs enable unimpaired reading, but a book-like positioning of screens seems necessary to minimise eyestrain symptoms.

BackgroundMental disorders of women during the postnatal period are a major public health problem. Compared with women's mental disorders, much less attention has been paid to men's mental disorders in the perinatal period. To date, there have been no reports in the literature describing secular changes of both maternal and paternal hospital admissions for mental disorders over the period covering the year before pregnancy (non-parents), during pregnancy (expectant parents) and up to the first year after birth (parents) based on linked parental data. The co-occurrences of couples' hospital admissions for mental disorders have not previously been investigated.AimsTo describe maternal and paternal hospital admissions for mental disorders before and after birth. To compare the co-occurrences of parents' hospital admissions for mental disorder in the perinatal period.MethodThis is a cohort study using paired parents' population data from the New South Wales (NSW) Perinatal Data Collection (PDC), Registry of Births, Deaths and Marriages (RBDM) and Admitted Patients Data Collection (APDC). The study included all parents (n=196 669 couples) who gave birth to their first child in NSW between 1 January 2003 and 31 December 2009.ResultsThe hospital admission rate for women with a principal mental disorder diagnosis in the period between the year before pregnancy and the first year after birth was significantly higher than that for men. Parents' mental disorders influenced each other. If a man was admitted to hospital with a principal mental disorder diagnosis, his wife or partner was more likely to be admitted to hospital with a principal mental disorder diagnosis compared with women whose partner had not had a hospital admission, andvice versa.ConclusionsMothers' mental disorders after birth increased more significantly than fathers. However, fathers' mental disorders significantly impacted the co-occurrence of mothers' mental disorders.

BackgroundThe widespread use of smartphones makes effective therapies such as cognitive–behavioural therapy (CBT) potentially accessible to large numbers of people.AimsThis paper reports the usage data of the first trial of Catch It, a new CBT smartphone app.MethodUptake and usage rates, fidelity of user responses to CBT principles, and impact on reported negative and positive moods were assessed.ResultsA relatively modest proportion of people chose to download the app. Once used, the app tended to be used more than once, and 84% of the user-generated content was consistent with the basic concepts of CBT. There were statistically significant reductions in negative mood intensity and increases in positive mood intensity.ConclusionsSmartphone apps have potential beneficial effects in mental health through the application of basic CBT principles. More research with randomised controlled trial designs should be conducted.

BACKGROUND Price's social competition hypothesis interprets the depressive state as an unconscious, involuntary losing strategy, which enables individuals to yield and accept defeat in competitive situations. AIMS We investigated whether patients who suffer from major depressive disorder (MDD) would avoid competition more often than either patients suffering from borderline personality disorder (BPD) or healthy controls. METHOD In a simple paper-folding task healthy participants and patiens with MDD and BPD were matched with two opponents, one with an unknown diagnosis and one who shared their clinical diagnosis, and they had to choose either a competitive or cooperative payment scheme for task completion. RESULTS When playing against an unknown opponent, but not the opponent with the same diagnosis, the patients with depression chose the competitive payment scheme statistically less often than healthy controls and patients diagnosed with BPD. CONCLUSION The competition avoidance against the unknown opponent is consistent with Price's social competition hypothesis. DECLARATION OF INTEREST G.H. received research support, consulting fees and speaker honoraria from Lundbeck, AstraZeneca, Servier, Eli Lilly, Roche and Novartis. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.

WOS: 000380137500017 PubMed: 27146949 The aim of this study was the optimisation of a multi-analyte method for the analysis of primary aromatic amines ( PAAs) from napkins in order to support official controls and food safety. We developed a UHPLC- MS/ MS method for the simultaneous determination of 36 toxicologically relevant PAAs for paper and board. Good regression coefficients of the calibration curves in a range of 0.992- 0.999 and reproducibilities in a range of 2.3- 15% were obtained. Limits of detections ( LODs) were in the range of 0.03-1.4 mu g l(-1) and recoveries were in a range of 21-110% for all the amines. A total of 93 coloured paper napkin samples from different European countries were bought and extracted with water to determine the PAAs. The results showed that 42 of 93 samples contained at least one PAA. More than half of the detected PAAs are considered as toxic, carcinogenic or probably carcinogenic to humans by the International Agency for Research on Cancer ( IARC), or are classified as such in the European Union legislation on chemicals. Summed concentrations of PAAs in seven samples were higher than 10 mu g l(-1), the limit of summed PAA in the European Union plastic food contact material regulation. Also, eight PAAs, classified as Category 1A and 1B carcinogen in the European Union legislation of chemicals, were detected at concentrations higher than 2 mu g l(-1), exceeding the limit proposed by the Federal Institute for Risk Assessment in Germany. Aniline ( n = 14) was most frequently present in higher concentrations followed by o-toluidine, o-anisidine, 2,4-dimethylaniline and 4-aminoazobenzene. Red, orange, yellow and multicoloured paper napkins contained the highest concentrations of total PAAs (> 10 mu g l(-1)). Although the European Union has not harmonised the legislation of paper and board materials and, thus, there is no specific migration limit for PAAs from paper napkins, the present study showed that coloured paper napkins can contain toxic and carcinogenic PAAs at concentrations that are relevant for monitoring.

BackgroundTemperament and character have been shown to be important factors in understanding psychiatric and neurodevelopmental disorder. Adults with autism spectrum disorder (ASD) have repeatedly been shown to have a distinct temperament and character, but this has not been evaluated in relation to psychiatric comorbidity and ASD diagnostic stability.AimsTo examine temperament and character in males that were diagnosed with ASD in childhood and followed prospectively over almost two decades.MethodTemperament and character were assessed in 40 adult males with a childhood diagnosis of ASD. Results were analysed by the stability of ASD diagnosis over time and current psychiatric comorbidity.ResultsThree distinct temperament and character profiles emerged from the data. Those no longer meeting criteria for ASD had high reward dependence while those with a stable ASD diagnosis and psychiatric comorbidity showed elevated harm avoidance and low self-directedness and cooperativeness. Finally, those with a stable ASD and no comorbidity showed low novelty seeking and somewhat elevated harm avoidance.ConclusionsTemperament and character are important factors correlated with long-term diagnostic stability and psychiatric comorbidity in males diagnosed with ASD in childhood.

Photoinitiators are widely used to cure ink on packaging materials used in food applications such as cardboards for the packaging of dry foods. Conventional migration testing for long-term storage at ambient temperature with Tenax® was applied to paperboard for the following photoinitiators: benzophenone (BP), 4,4ʹ-bis(diethylamino)benzophenone (DEAB), 2-chloro-9H-thioxanthen-9-one (CTX), 1-chloro-4-propoxy-9H-thioxanthen-9-one (CPTX), 4-(dimethylamino)benzophenone (DMBP), 2-ethylanthraquinone (EA), 2-ethylhexyl-4-dimethylaminobenzoate (EDB), ethyl-4-dimethylaminobenzoate (EDMAB), 4-hydroxybenzophenone (4-HBP), 2-hydroxy-4-methoxybenzophenone (HMBP), 2-hydroxy-4ʹ-(2-hydroxyethoxy)-2-methylpropiophenone (HMMP), 2-isopropyl-9H-thioxanthen-9-one (ITX), 4-methylbenzophenone (MBP) and Michler’s ketone (MK). Test conditions (10 days at 60°C) were according to Regulation (EU) No. 10/2011 and showed different migration patterns for the different photoinitiators. The results were compared with the migration in cereals after a storage of 6 months at room temperature. The simulation with Tenax at 60°C overestimated actual migration in cereals up to a maximum of 92%. In addition, the effect of a lower contact temperature and the impact of the Tenax pore size were investigated. Analogous simulation performed with rice instead of Tenax resulted in insufficiently low migration rates, showing Tenax is a much stronger adsorbent than rice and cereals.

Purpose With the global expansion of technology, our reading platform has shifted from traditional text to hypertext, yet little consideration has been given to how this shift might help or hinder students' reading comprehension. The purpose of this study was to compare reading comprehension of computer-based and paper-based texts in adolescents with and without language-learning disabilities (LLD). Method Fourteen adolescents with LLD and 25 adolescents with typical language development (TLD) read literary texts in computer-based and paper-based formats and then answered reading comprehension questions. Results The LLD group scored significantly lower than the TLD group on the reading comprehension measure, but there were no significant between-group differences for reading or answering time. In addition, there were no significant within-group differences for the computer-based or paper-based conditions. Predictors for reading comprehension varied by group and condition. Conclusion Neither group appeared to be affected by the additional cognitive load imposed by hypertext in the computer-based condition; however, the load between conditions may not have been sufficient to differentially impact reading comprehension. Based on the regression analyses, it appears that working memory, oral language, and decoding differed in their contribution to reading comprehension for each group and condition.

Background: Randomized controlled efficacy trials (RCTs), the scientific gold standard, are required for regulatory approval of Alzheimer’s disease (AD) interventions, yet provide limited information regarding real-world therapeutic effectiveness. Objective: To compare the nature of evidence regarding the combination of approved AD treatments from RCTs versus long-term observational controlled studies (LTOCs). Methods: Comparisons of strengths, limitations, and evidence level for monotherapy [cholinesterase inhibitor (ChEI) or memantine] and combination therapy (ChEI + memantine) in RCTs versus LTOCs. Results: RCTs examined highly selected populations over months. LTOCs collected data across multiple AD stages in large populations over many years. RCTs and LTOCs show similar patterns favoring combination over monotherapy over placebo/no treatment. Long-term combination therapy compared to monotherapy reduced cognitive and functional decline and delayed time to nursing home admission. Persistent treatment was associated with slower decline. While LTOCs used control groups, adjusted for multiple covariates, had higher external validity, and favorable ethical, practical and cost considerations, their limitations included potential selection bias due to lack of placebo comparisons and randomization. Conclusions: Naturalistic LTOCs provide complementary long-term level II evidence to complement level I evidence from short-term RCTs regarding therapeutic effectiveness in AD that may otherwise be unobtainable. A coordinated strategy/consortium to pool LTOC data from multiple centers to estimate long-term comparative effectiveness, risks/benefits, and costs of AD treatments is needed.

Inherited metabolic diseases (IMDs) belong to the group of rare diseases due to their low individual prevalence. Most of them are inherited in autosomal recessive fashion and represent good candidates for novel therapeutical strategies aimed at recovering partial enzyme function as they lack an effective treatment, and small levels of enzymatic activity have been shown to be associated with improved outcome and milder phenotypes. Recently, a novel therapeutic approach for genetic diseases has emerged, based on the ability of aminoglycosides and other compounds in allowing translation to proceed through a premature termination codon introduced by a nonsense mutation, which frequently constitute a significant fraction of the mutant alleles in a population. In this review we summarize the essentials of what is known as suppression therapy, the different compounds that have been identified by high-throughput screens or developed using a medicinal chemistry approach and the preclinical and clinical trials that are being conducted in general and in the field of IMDs in particular. Several IMDs have shown to be good models for evaluating readthrough compounds using patients’cells carrying nonsense mutations, monitoring for an increase in functional recovery and/or enzyme activity. Overall, the positive results obtained indicate the feasibility of the approach for different diseases and although the levels of protein function reached are low, they may be enough to alleviate the consequences of the pathology. Nonsense suppression thus represents a potential therapy or supplementary treatment for a number of IMD patients encouraging further clinical trials with readthrough drugs with improved functionality and low toxicity., Ministerio de Ciencia e Innovación (SAF2010–17272); Fundación Ramón Areces

The recovery and utilization of recovered paper have increased over past decades all over the world due to economic, environmental, and social issues. However, it is well known that an extended recovered paper collection is detrimental to its quality, either by the exploitation of lower quality sources such as households, or the spreading of commingled systems instead of selective collection systems. The influence of these two factors was assessed by analyzing the quality of different recovered paper grades used as raw material in a mill located in Madrid (Spain) producing newsprint and light weight coated paper from recovered paper. Part 1 of the paper deals with the impact of increased collection rates on the quality of recovered paper and Part 2 with the use of commingled collection systems. Results of Part 1 show that increased collection rates have a large impact on the quality of the recovered paper. The quality, measured as total unusable material and moisture contents, had deteriorated very rapidly in only four years (2005-2008) as a consequence of increased collection rates. Collection rates increased in Spain from 58.5% to 68.6% during this period, resulting in more than 50% increase of total unusable material and 25% of moisture content. The downgrading of the quality of recovered paper is one of the major threats for extending the current limits of paper recycling. Therefore, future challenge is to increase its availability but maintaining its quality.

In the course of an analysis, the analytic relationship can go through moments of difficulty generated by patient and analyst while they learn to "play" together. In this paper, different kinds of difficult relational moments are illustrated through fragments of a child analysis, and some components are explored that can catalyze the creative transformation of turbulence and the resumption of analytic "play." In particular, the author hypothesizes that some conscious feelings described by Winnicott as characterizing play, understood as the optimal functioning of the analytic process, can be indicators of the efficiency of--or, conversely, of difficulties in--the unconscious oneiric work carried out by the couple. These indicators may be useful in monitoring the process not so much in the immediate moment, but rather over a medium to long period. Considering these indicators can initiate the revival of a playful equilibrium in the bi-personal system on which play and the analytic field are based.

Medicines are most often oral solid dosage forms made into tablets or capsules, and there is little room for individualized doses. The drug substance and additives are processed through multiple production phases, including complex powder handling steps. In drug manufacturing, the control of the solid-state properties of active pharmaceutical ingredient (API) is essential and it offers opportunities for enhancement of drug delivery systems. In this context, inkjet printing technologies have emerged over the last decades in pharmaceutical and biological applications and offer solutions for controlling material and product characteristics with high precision. Here we report the concept of conventional inkjet printing technology to produce printable pharmaceutical dosage forms on porous substrates. Data are shown to demonstrate inkjet printing of APIs into paper substrates, and how the model drug substances (paracetamol, theophylline, and caffeine) are penetrating the porous substrates used. The method enables controlling not only the deposition but also the crystallization of the drug substances. We anticipate that the inkjet printing approach has immense potential in making sophisticated drug delivery systems by use of porous substrates in the future. For example, it may offer new perspectives for solving problems around poorly soluble drugs and dosing low-dose medicines accurately. Furthermore, with the advent of genetic mapping of humans, controlled inkjet dosing can bring solutions to fabricate on-demand individualized medicines for patients. © 2011 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 100:3386–3395, 2011

Papermill sludge (PMS) is generated during the wastewater treatment process of paper production. Its handling and disposal techniques are of great concern for the environment. It can be landfilled as a waste, or it can be recycled and converted into useful products of high value. It has a very promising application as an absorbing agent for the cleaning of water surfaces polluted with hydrophobic substances (vegetable, synthetic and mineral oils, animal fats, fuels, organic chemicals and even coal dust). Here, we present the pretreatment procedure (hydrophobation, mechanical and thermal treatments) of PMS that produces a lightweight absorbent material (HAWSC - high efficiency absorbent for water surface cleaning), which floats on the water surface and binds hydrophobic pollutants with considerably higher efficiency than commercially available mineral and synthetic absorbents. After its application, it can be incinerated, due to its high caloric value, to produce energy. The incineration residues can then be formed into granules that can be used as an efficient absorbent for fluids spilled onto solid surfaces.

Hand washing is a primary means of infection control. The Centers for Disease Control and Prevention (CDC), the Association for Professionals in Infection Control and Epidemiology, and the World Health Organization all cite handwashing with soap and water as important in preventing the spread of infectious diseases.1-3 The CDC states that “keeping hands clean is one of the most important steps we can take to avoid getting sick and spreading germs to others.”3 Numerous studies have demonstrated that handwashing in the school setting reduces infectious diseases, particularly respiratory and gastrointestinal infections.4-7 Handwashing reduces absenteeism among students and staff.4,7 However, many barriers to handwashing in the school environment have been described that can reduce compliance with handwashing. These barriers include insufficient time for students to wash, lack of education and promotion around hand hygiene, and insufficient handwashing facilities.4,8 Maintaining adequate handwashing supplies in student bathrooms is made difficult by lack of money, limited staff time, student vandalism, and misguided efforts by school staff to prevent messes in bathrooms. One large school district in New Mexico began environmental inspections in the fall of 2006 to address issues of hygiene and safety and to make improvements when indicated in their schools. They reported initial inspection findings from 91 schools in September 2006. Within those schools inspected, 25% of student bathrooms lacked soap and 38% lacked paper towels or hand dryers.9 A pilot study was conducted to measure the availability of handwashing supplies for students in public schools in New Mexico. The study further aimed to determine whether scheduled school nurse inspections of handwashing supplies in school bathrooms, with reporting of findings to appropriate school officials, would result in improved availability of handwashing supplies for students.

E apresentada uma solucao de acondicionamento que foi desenvolvida no seguimento das intervencoes de conservacao e restauro realizadas num conjunto de doze rolos de pintura e caligrafia Chinesa da coleccao de Camilo Pessanha (1867 - 1926), pertencentes ao Museu Nacional de Machado de Castro e actualmente em deposito no Museu do Oriente, em Lisboa. O acondicionamento deste conjunto de obras enquadra-se num projecto promovido pela Fundacao Oriente que foi realizado no Departamento de Conservacao e Restauro do Instituto dos Museus e da Conservacao, a entidade responsavel pela supervisao. Sao referidas algumas especificidades relacionadas com a exposicao, os factores ambientais, o manuseamento e o acondicionamento dos rolos orientais.

This paper presents the conservation treatment of a group of twenty Chinese calligraphies and paintings. These artworks are part of the Camilo Pessanha (1867-1926) collection that belongs to the Museu Nacional de Machado de Castro, and are currently on loan to the Museu do Oriente in Lisbon. The project was managed by the Fundacao Oriente, and carried out at the conservation and restoration department of the Instituto dos Museus e da Conservacao. There were three groups of works of art: scrolls with paintings and calligraphy on paper; scrolls with paintings on gilded paper; and paintings on silk. A brief characterization of the oriental scroll is followed by an overview of the traditional oriental conservation techniques for this type of art, as well as recently described practices. Ethical and theoretical considerations relating to the conservation treatments will be also discussed.

Multimedia communication capabilities are rapidly expanding, and visual information is easily shared electronically, yet funding bodies still rely on paper grant proposal submissions. Incorporating modern technologies will streamline the granting process by increasing the fidelity of grant communication, improving the efficiency of review, and reducing the cost of the process.

The article focuses on the representation of whiteness in Fae Myenne Ng’s Bone (1993), in particular on how the aesthetic and the socio-historical strata of the novel intersect, how by saturating the imagery of Bone with whiteness, Ng conveys the first person Chinese American narrator’s positionality and the positionality of other Chinese American characters as members of the Chinese American community and members of broader American society. The images involving whiteness compose a kind of the palimpsest overwritten with personal and communal ethnic watermarks as well as repressed, surfacing and semi-articulated history of Leila’s family that she channels into the narrative, having engaged in the process of mentally retracing the past events and recovering the material evidence or rather what remains of it and what she believes will lead her to definitive answers. On the level of narrative imagery, whiteness is intricately interwoven with the traumas plaguing the narrator’s family. Explicitly, whiteness represents death, mourning, rejection and erasure, entailing marginalization suffered by Chinese Americans because of their non-normative racial and ethnic status. Yet, implicitly, whiteness is also a constituent element of the images which facilitate the process of healing – mainly bones and paper. Narrative imagery involving whiteness contributes to the bridging of the past and the present, forming a bridge between generations, a kind of rivet that allows to at least partly retrieve personal wholeness and recapture the broken promises.

Objectives: This study aimed to systematically identify and evaluate the readability and document complexity of currently available family history tools for the general public. Methods: Three steps were undertaken to identify family history tools for evaluation: (a) Internet searches, (b) expert consultation, and (c) literature searches. Tools identified were assessed for readability using the Simple Measure of Gobbledygook (SMOG) readability formula. The complexity of documents (i.e., forms collecting family history information) was assessed using the PMOSE/IKIRSCH document readability formula. Results: A total of 78 tools were identified, 47 of which met the criteria for inclusion. SMOG reading grade levels for multimedia-based tools ranged from 10.1 to 18.3, with an average score of 13.6. For print-based tools, SMOG ranged from 8.7 to 14.1, with an average score of 12.0. Document complexity ranged from very low complexity (level 1 proficiency) to high complexity (level 4 proficiency). Conclusion: The majority of tools are written at a reading grade level that is beyond the 8th grade average reading level in the United States. The lack of family history tools that are easy to read or use may compromise their potential effectiveness in identifying individuals at increased risk for chronic diseases in the general population.

The emergence of a new sign language since the late 1970s in Nicaragua enables us to capture the effects of successive cohorts of learners on an emerging grammar and to observe how elements are reshaped from one form and function to another. Here we document the contrastive use of a device that has been found to be central to the grammars of sign languages: the spatial modulation of signs. In Nicaraguan Sign Language, this device has two primary functions: expressing the participants of events (that is, indicating who), and describing locations and orientations of referents (that is, indicating where). We ask whether the two uses reduce to a single construction type, or if the more abstract who construction derived from the more iconic and concrete where construction. We compare the first two successive cohorts of deaf signers to acquire the language in its first decade. We find that as learners created new constructions to meet the new functions, they did not simply apply an already developed form more broadly, nor did they develop the more abstract application from the more iconic one. Instead, the more abstract who construction appears to have conventionalized first. Thus, the forms either emerged independently, or split very early in the 1980s, before either had developed as a consistently applied form.

A total of 1280 banknotes were obtained from food outlets in 10 different countries (Australia, Burkina Faso, China, Ireland, the Netherlands, New Zealand, Nigeria, Mexico, the United Kingdom, and the United States), and their bacterial content was enumerated. The presence of bacteria on banknotes was found to be influenced by the material of the notes, and there was a strong correlation between the number of bacteria per square centimeter and a series of indicators of economic prosperity of the various countries. The strongest correlation was found with the “index of economic freedom,” indicating that the lower the index value, the higher the typical bacterial content on the banknotes in circulation. Other factors that appear to influence the number of bacteria on banknotes were the age of the banknotes and the material used to produce the notes (polymer-based vs. cotton-based). The banknotes were also screened for the presence of a range of pathogens. It was found that pathogens could only be isolated after enrichment and their mere presence does not appear to be alarming. In light of our international findings, it is recommended that current guidelines as they apply in most countries with regard to the concurrent hygienic handling of foods and money should be universally adopted. This includes that, in some instances, the handling of food and money have to be physically separated by employing separate individuals to carry out one task each; whereas in other instances, it could be advantageous to handle food only with a gloved hand and money with the other hand. If neither of these precautions can be effectively implemented, it is highly recommended that food service personnel practice proper hand washing procedures after handling money and before handling food.

This study describes the validation of a new electronic appetite rating system, and a statistical variance model for visual analogue scale (VAS) research. Thirty volunteers rated hunger, fullness, desire to eat, prospective intake, thirst and liking on 100 mm paper VAS and on 70 mm electronic VAS presented on a Dell™ Pocket PC, after consuming breakfast, in a repeated trial. The electronic method was comparable in relative accuracy and reproducibility to the paper method, with weak differences between tests (within-subject SD ≤ 14 mm). The data obtained were used to generate a model for VAS data variability.

Due to the introduction of the European Union Landfill Directive, composting has become a potentially viable disposal route for some organic wastes. As waste-derived compost is frequently added to soil to improve soil quality, it is important to quantify the environmental risk posed by potentially toxic elements contained within it. Here we used a sequential chemical extraction procedure to investigate the temporal dynamics of heavy metals (Cu, Zn, Pb and Ni) during the co-composting of biosolids, deinking paper fibre and green waste. Overall, composting over 26 weeks reduced the availability of Ni, had no effect on Pb and slightly increased the availability of Cu and Zn. We conclude that although the total Cu and Ni concentrations in the compost exceed legislative guidelines for land application, due to their recalcitrant nature within the compost, this compost posed very little threat to soil or plant quality if used in agriculture or land restoration.

Objective: To investigate the ability of patients with myotonic dystrophy type 1 to recognise basic facial emotions. We also explored the relationship between facial emotion recognition, neuropsychological data, personality, and CTG repeat expansion data in the DM-1 group. Methods: In total, 50 patients with DM-1 (28 women and 22 men) participated, with 41 healthy controls. Recognition of facial emotional expressions was assessed using photographs of basic emotions. A set of tests measured cognition and personality dimensions, and CTG repeat size was quantified in blood lymphocytes. Results: Patients with DM-1 showed impaired recognition of facial emotions compared with controls. A significant negative correlation was found between total score of emotion recognition in a forced choice task and CTG repeat size. Furthermore, specific cognitive functions (vocabulary, visuospatial construction ability, and speed) and personality dimensions (reward dependence and cooperativeness) correlated with scores on the forced choice emotion recognition task. Conclusion: These findings revealed a CTG repeat dependent facial emotion recognition deficit in the DM-1 group, which was associated with specific neuropsychological functions. Furthermore, a correlation was found between facial emotional recognition ability and personality dimensions associated with sociability. This adds a new clinically relevant dimension in the cognitive deficits associated with DM-1.

Children now have considerable exposure to new information technologies (IT) such as desktop computers. A reported association between computer use and discomfort in children has prompted concerns about the musculoskeletal stresses associated with computer use. There were no detailed data on children reading and writing, nor any evidence on the variability of postures and muscle activity whilst children use IT. Twenty-four children (10–12 years old; 12 male) performed a reading and writing task using new IT (computer/keyboard/mouse with high display and mid height display) and old IT (book/paper/pen). Spinal and upper limb 3D posture and muscle activity were recorded and estimates of mean and variation calculated. The mean postures for children reading and writing with computers were more neutral than when they read and wrote with old IT. Similarly, mean muscle activity levels were lower during computer use than old IT use. However, new IT use also resulted in less variable, more monotonous postures and muscle activities. Moderate differences in computer display height had little effect on posture and muscle activity variation. Variation in musculoskeletal stresses is considered an important component of the risk of musculoskeletal disorders. Children should therefore be encouraged to ensure task variety when using new IT to offset the greater posture and muscle activity monotony.

The Cruces River, which is located in southwest Chile, suffered from dramatic changes after the opening of a large pulp mill in 2004. A large mass mortality of the vegetation occurred. In particular, the Brazilian elodea (Egeria densa), which is the main food source of many water birds in this ecosystem, disappeared. Because of this damage, different investigations took place and the goal of this research was a description of the water quality, including filtrate, suspended matter, and sediment. In this research, inorganic parameters were the main point of interest. Furthermore, finding relations between the sampling sites and the measured parameters by applying chemometric methods was another aim of this investigation. Water and sediment samples were collected from 19 sampling sites at the Cruces River in summer (February) 2007. Fifteen elements were analyzed by atomic spectroscopic methods in filtrate, suspended matter, and sediment. Furthermore, the dissolved organic carbon, humic acids, and microbiological parameters were examined. The quantitative description of the three different compartments indicates little influence of the pulp mill on the Cruces River. The comparison of the results with the Databank for Ecotoxicological Effect Data and Quality Targets illustrates the good quality of the water in the sanctuary. All quality targets, except for copper, are achieved. The amount of suspended matter increases with the beginning of the wetland. The multivariate statistical data analysis classifies the relations between the objects and variables. The influence of the sewage, which is blamed to be the reason for increased amount of suspended matter, cannot be evaluated by this investigation. The slight increase of the concentrations of the earth alkaline and alkaline metals might cause changes in the chemical equilibrium and, therefore, the amount of suspended matter increases. Applying cluster analysis separates sampling sites by the determination of similarities between these sampling sites by means of the variables. Space–time factor analysis revealed relations between the examined parameters. The sewage of the pulp mill is not significantly polluted by the analyzed parameters and a negative influence to the ecosystem cannot be proved. The impact of copper should be examined in further investigations. The Pichoy River, with high concentrations of iron in the filtrate, should be examined as well. Studies about the chemical equilibrium of iron and manganese oxides in relation to the alkaline and earth alkaline elements should take place.

Pharmacogenetic testing holds great promise to improve health outcomes and reduce adverse drug responses through enhanced selection of therapeutic agents. Since drug responses can be manipulated by verbal suggestions, it is of particular interest to understand the potential impact of pharmacogenetic test results on drug response. Placebo and nocebo-like effects may be possible due to the suggestive nature of pharmacogenetic information that a drug will or will not likely lead to improved health outcomes. For example, pharmacogenetic testing could provide further reassurance to patients that a given drug will be effective and/or cause minimal side effects. However, pharmacogenetic information could adversely affect drug response through negative expectations that a drug will be less than optimally effective or cause an adverse response, known as a nocebo-like effect. Therefore, a patient’s perceived value of testing, their understanding of the test results, and the manner in which they are communicated may influence therapeutic outcome. As such, physicians should consider the potential effect of pharmacogenetic test results on therapeutic outcome when communicating results to patients. Studies are needed to investigate the impact of pharmacogenetic information of therapeutic outcome.

As more and more substances have been shown in preclinical studies to be capable of preventing damage to the inner ear from exposure to noise, ototoxic drugs, ischemia, infection, inflammation, mechanical trauma and other insults, it is becoming very important to develop feasible and safe methods for the targeted delivery of drugs to specific regions in the inner ear. Recently developed methods for sampling perilymph from the cochlea have overcome major technical problems that have distorted previous pharmacokinetic studies of the ear. These measurements show that drug distribution in perilymph is dominated by passive diffusion, resulting in large gradients along the cochlea when drugs are applied intratympanically. Therefore, in order to direct drugs to specific regions of the ear, a variety of delivery strategies are required. To target drugs to the basal cochlear turn and vestibular system while minimizing exposure of the apical cochlear turns, single one-shot intratympanic applications are effective. To increase the amount of drug reaching the apical cochlear turns, repeated intratympanic injections or controlled-release drug delivery systems, such as biodegradable biopolymers or catheters and pumps, are more effective. However, if the applied substance does not easily pass through the round window membrane, or if a more widespread distribution of drug in the ear is required, then intralabyrinthine injections of the substance may be required. Intralabyrinthine injection procedures, which are currently in development in animals, have not yet been proven safe enough for human use.

Agro-based pulp and paper mills in India are one of the most polluting industries; in addition, they are high consumers of raw water. Growing scarcity of high quality freshwater as well as stringent regulatory standards is compelling these units to explore appropriate water management options. Based on data obtained through a questionnaire survey and plant visits, this work provides an overview of the water use and effluent treatment status in Indian agro-residue and recycled pulp and paper mills. The challenges faced by this sector are reviewed and practices adopted by progressive units to minimize freshwater use are illustrated through case studies.

This article deals with a methodology for the design of routes for the "bin to bin" (BTB) collection of paper and cardboard waste (PCB) from small businesses, as well as with the new location and calculation of the number of containers needed in the streets for both commercial and non-commercial use due to the large amount of PCB deposited in them. This study was carried out in five shopping areas of the city of Leganés (Community of Madrid, Spain). One of the characteristics of the area is a high density of population and urban traffic. The tool used is the Geographical Information System (GIS-Arc-View). With it we can generate PCB points of high population density in commercial streets based on territorial analysis. We placed the special routes and the new container locations within a distance of 60 m of these collection points (CPT). The system calculates and optimizes six routes according to different urban restrictions. Finally, we provided service to 59% of the shops, which generate almost 82% of the PCB waste, using 160 min per day to collect 1027 kg of high quality PCB. If we compare the system with the system in place previously, we can conclude that the "bin to bin" (BTB) system improves the quality of the PCB in the containers, avoiding overflow and reducing the percentage of rejected material.

Objective: The aims of this study were to develop models of personality change after traumatic brain injury (TBI) based on information provided by the TBI survivor and a significant other (SO), and to compare the models generated from the two different sources of information. Methods: Individuals with and without TBI and an SO were interviewed separately about their current personality. The SOs were also interviewed about the personality of the TBI survivor before the injury. A subset of TBI survivors and their SOs were interviewed twice to assess test-retest reliability. Items which were not associated with personality change after TBI, which could not be measured reliably or which did not contribute to the model, were excluded. Results: Of the 123 original items, 29 items from the interview with the survivor and 31 items from the interview with the SO were retained to form the Brain Injury Personality Scales. Separate factor analyses of ratings from each interview (survivor and SO) resulted in seven first order factors. The second order factor analyses for each interview resulted in four factors. Concordance between the information obtained from the two interviews was low. Conclusions: The information obtained from the interviews with the TBI survivors and the SOs produced two models with a similar structure: three superordinate factors of personality items (affective regulation, behavioural regulation and engagement) and one superordinate factor of items relevant to mental state (restlessness and range of thought). Despite the similarity in structure, the content of the information obtained from the two interviews was different.

Prophylaxis against influenza is difficult, and current approaches against pandemics may be ineffective because of shortages of the two proven classes of antivirals in the face of a large-scale infection. Herbal/natural products may represent an effective alternative to conventional attempts to protect against infection by avian influenza virus. QR-435, an all-natural compound of green tea extract and other agents, has been developed to provide protection against a wide range of viral infections. The antiviral activities of several QR-435 preparations as well as QR-435 (1) green tea extract were tested against A/Sydney/5/97 and A/Panama-Resvir 17 strains of avian influenza virus H3N2 by means of an assay based on Madin-Darby canine kidney cells. Toxic effects of QR-435 formulations on these cells were also evaluated as were the virucidal properties of a commercially available mask impregnated with QR-435. The efficacy of a QR-435/mask combination was compared with that of the QR control/mask combination, an untreated mask, and no mask. QR-435 had significant in vitro activity against H3N2 at concentrations that were not associated with significant cellular toxic effects. The antiviral activity of QR-435 (1) was similar to that of QR-435. Masks impregnated with QR-435 were highly effective in blocking the passage of live H3N2 virus. These preclinical results warrant further evaluation of the prophylactic use of QR-435 against viral infection in humans.

India has a large number of paper manufacturing units, with mills varying in size of operations and type of product, scattered all over the length and breadth of the country. Present study deals with the survey of four different pulp and paper mills (Mill A, Mill B, Mill C and Mill D) in India, differing in their scale of operation as well as raw material usage. Physico-chemical characterization of wastewaters produced by different processing units like digestor house liquors, bleaching section, paper machine backwaters, combined inlet to the ETP and outlet to ETP, for all the four mills, was conducted. Different parameters like pH, Color, COD, BOD, percent Na, SAR, TDS and Total hardness were analyzed and compared. Highly significant differences were thus found between all the processing units of all four mills with p values < 0.01. This evaluation showed that though these mills have effluent treatment facilities installed in their premises, improvements are still needed to increase their efficiencies for treating the discharged wastewaters.

Background In the Western world, a significant portion of college students have gambled. College gamblers have one of the highest rates of problem gambling. To date, there have been no studies on gambling participation or the rates of problem gambling in India. Aims This study evaluated the prevalence of gambling participation and problem gambling in college students in India. It also evaluated demographic and psychosocial correlates of gambling in that population. Method We surveyed 5784 college students from 58 colleges in the district of Ernakulam, Kerala, India, using cluster random sampling. Students completed questionnaires that addressed gambling, substance use, psychological distress, suicidality and attention-deficit hyperactivity disorder (ADHD). Results A total of 5580 completed questionnaires were returned, and while only 1090 (19.5%) college students reported having ever gambled, 415 (7.4%) reported problem gambling. Lotteries were the most popular form of gambling. Problem gamblers in comparison with non-gamblers were significantly more likely to be male, have a part-time job, greater academic failures, higher substance use, higher psychological distress scores, higher suicidality and higher ADHD symptom scores. In comparison with non-problem gamblers, problem gamblers were significantly more likely to have greater academic failures, higher psychological distress scores, higher suicidality and higher ADHD symptom scores. Conclusions This study, the first to look at the prevalence of gambling in India, found relatively low rates of gambling participation in college students but high rates of problem gambling among those who did gamble. Correlates of gambling were generally similar to those noted in other countries. Since 38% of college students who had gambled had a gambling problem, there is a need for immediate public health measures to raise awareness about gambling, and to prevent and treat problem gambling in this population. Declaration of interest S.G. was (until October 2014) a member of the UK Responsible Gambling Strategy Board, and authored the Royal College of Psychiatrists’ Faculty report FR/AP/01 Gambling: The Hidden Addiction – Future Trends in Addictions (2014). Copyright and usage © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.