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Purpose This study aimed to determine whether continual electronic patient-reported outcome (ePRO) measurements at home can capture the fluctuations in health-related quality of life (HRQOL) scores between visits. Methods We performed a randomized controlled trial to compare the scores obtained by standard practice (paper-based measurements in the hospital) to scores by continuous measurement of ePRO at home. Metastatic cancer patients were randomly assigned to either the paper-based ( n = 50) or the ePRO group ( n = 52). EQ-5D-5L and EORTC QLQ C-30 scores were obtained on 3 different chemotherapy days in the paper-based group. Meanwhile, scores were obtained on the chemotherapy day and on days 3, 7, 10, and 14 in the ePRO group during 2 cycles. The first hypothesis of our study was that both scores at the same time points would be equivalent despite different measurement frequency, place, or mode of measurement. The second hypothesis was that PRO score–adjusted time would be different between the groups. For equivalence, the endpoint was the mean EQ-5D-5L index value on the chemotherapy day before the outpatient treatment. Only if equivalence was shown, quality-adjusted life-days (QALDs) were considered using all the data. Results The adjusted mean difference in the EQ-5D-5L index was determined to be −0.013 (95% confidence interval [CI]: −0.049 to 0.022); the 95% CI did not exceed the equivalence margin. Similarly, the mean difference in global health status (2.28 [95% CI: −2.55 to 7.11]) also showed equivalence. However, the QALD by EQ-5D-5L was significantly lower in the ePRO group by 1.36 per 30 d (95% CI: −2.22 to −0.51; P = 0.0021). Conclusions Continual measurements of the HRQOL at home by ePRO may yield more detailed profiles of the HRQOL.

Cellulose paper, a material that is naturally derived, low cost, lightweight, eco-friendly, and mechanically deformable, plays important roles in producing next-generation flexible electronics. Following the booms in the development of functional electronics, the soft actuators built from cellulose paper have attracted great attention. In this focused review, the milestones and recent achievements of cellulose paper-based actuators are summarized. Electro-, thermal, moisture and magnetic actuation mechanisms are utilized to acquire energy from external stimuli. Corresponding functional materials and available fabrication techniques like film assembly and layer deposition are described. Programmable actions for the emerging applications in bionics, paper grippers and robots are realized by pursuing different strategies to control the responding deformation. Along with a conclusion, the existing challenges and possible solutions in evaluating and improving the performance of cellulose paper are summarized in the final section.

Nowadays, in the clinical, pharmaceutical, and environmental sectors, the development of facile and sensitive analytical methods and/or innovative devices for the follow-up and detection of antibiotics and pharmaceutical formulations, in general, are urgently needed and still challenging. This work declared three vital applications for broad-spectrum nitrofurantoin (macrofuran) antibiotic detection and quantification: A colorimetric method, a coated paper strip-based nano-lanthanum complex prototype and fabrication of smart electronic color sensor device-based coated paper strips. The colorimetric method showed a significant response upon increasing the concentration of the nitrofurantoin in a range between (1.0–100.0 ng/mL) via a visual color change from orange-yellow to red colors degree with detection and quantification limits of 0.175 and 0.53 ng/mL, respectively, whereas the nano-lanthanum complex coated paper strip prototype showed qualitative on-site sensing for nitrofurantoin via naked eye color changes which can be detected anywhere. Moreover, a smart prototype for detecting macrofuran in the means of paper color change in the RGB color component extraction algorithm and the grayscale projection value processing algorithm was fabricated. The change in RGB color on the coated paper strip was detected using an electronic color sensor device. The developed colorimetric method, coated paper strip, and the electronic color sensor device prototype exhibited fast, simple, costless, and selective towards macrofuran over the competing analyzed. As well as, showed good applicability in the different real samples spiked with different concentrations of macrofuran. Graphical abstract

Respiration is an action known to be essential and crucial for life. Unfortunately, in some cases such as illnesses and accidents various respiratory problems can be experienced. It might be difficult to maintain normal respiration for the people who have respiratory diseases. It is known that respiration monitoring of people who have respiratory problems, albeit for different reasons, is important in terms of their treatment and maintaining their life quality. Current respiration monitoring systems are expensive and bulky. Many of these systems are only available at hospitals or in laboratories. Low-cost, easy to use and portable respiratory monitoring devices are needed. Having these motivations, we aimed to monitor respiration by designing and producing a paper-based sensor that is easy to manufacture, low-cost, and highly responsive. The sensor, which is the subject of this thesis project, has potential to be used for different purposes such as measuring the humidity in the environment. In this project, we focused on designing a system for people who have respiratory problems by providing respiration monitoring data. In addition, according to the data obtained, we are able to analyze the health status of the users. Therefore, this sensor can be used both for the detection of respiration diseases and monitor the status of the patients. In this way, respiration related unhealthy situation can be detected and treated immediately. Solunum, yaşam için gerekli ve çok önemli bir eylemdir. Ne yazık ki hastalık ve kaza gibi bazı durumlarda çeşitli solunum problemleri yaşanabilmektedir. Solunum hastalıkları olan kişilerde solunumu sağlamak zor olabilir. Farklı nedenlerle de olsa kişilerin solunumunu takip etmenin onların tedavisi ve yaşam kalitelerinin artması açısından önemli olduğu açıktır. Mevcut solunum izleme sistemleri pahalı ve hantaldır. Bu sistemlerin çoğu sadece hastanelerde veya laboratuvarlarda mevcuttur. Düşük maliyetli, kullanımı kolay ve taşınabilir solunum izleme cihazlarına ihtiyaç vardır. Bu ve benzeri nedenlerle, üretimi kolay, düşük maliyetli ve yüksek duyarlıklı kâğıt tabanlı bir sensör tasarlayıp üreterek solunumu izlemeyi hedefledik. Bu tez projesine konu olan sensör, ortamdaki nemin ölçülmesi gibi farklı amaçlarla kullanılabilmektedir. Bu projede solunum izleme verilerini sağlayarak solunum problemi olan kişiler için bir sistem tasarlamaya odaklandık. Ayrıca elde edilen verilere göre kullanıcıların sağlık durumları hakkında da bilgi alabiliyoruz. Dolayısıyla bu sensör hem sağlık durumunun tespiti hem de hastaların takibi için kullanılabilmektedir. Bu sayede solunum problemleri hemen tespit edilebilecek ve tedavileri hızlı bir şekilde gerçekleştirilecektir.

This paper discusses some of the design choices underlying the development of watt-level integrated Doherty power amplifiers in the K and Ka band, focusing on compound semiconductor technologies. The key aspect of on-chip power combination is discussed, presenting and comparing some of the possible alternatives. Then, the impact on the achievable bandwidth and performance of different parameters is quantified, adopting an approximate analysis, which focuses on the Doherty output combiner and allows estimating the non-linear performance of the amplifier thanks to some simplifying assumptions, without requiring a full, non-linear model of the active devices. Two sample GaAs and GaN technologies are compared first, considering parameters that are representative of the currently available commercial processes, and then several power combination strategies are analyzed, adopting the GaN technology, which is currently the only one that allows achieving the power levels required by the applications directly on chip. Finally, some hints as to the impact of the output parasitic effects of the transistors on the presented analysis are given.

Contains fulltext : 237219.pdf (Publisher’s version ) (Open Access) Objective: To describe characteristics of randomised controlled trials (RCTs) conducted using electronic health records (EHRs), including completeness and transparency of reporting assessed against the 2021 CONSORT Extension for RCTs Conducted Using Cohorts and Routinely Collected Data (CONSORT-ROUTINE) criteria. Study design: MEDLINE and Cochrane Methodology Register were searched for a sample of RCTs published from 2011–2018. Completeness of reporting was assessed in a random sample using a pre-defined coding form. Results 183 RCT publications were identified; 122 (67%) used EHRs to identify eligible participants, 139 (76%) used the EHR as part of the intervention and 137 (75%) to ascertain outcomes. When 60 publications were evaluated against the CONSORT 2010 item and the corresponding extension for the 8 modified items, four items were 'adequately reported' for the majority of trials. Five new reporting items were identified for the CONSORT-ROUTINE extension; when evaluated, one was 'adequately reported', three were reported 'inadequately or not at all', the other 'partially'. There were, however, some encouraging signs with adequate and partial reporting of many important items, including descriptions of trial design, the consent process, outcome ascertainment and interpretation. Conclusion: Aspects of RCTs using EHRs are sub-optimally reported. Uptake of the CONSORT-ROUTINE Extension may improve reporting. 12 p.

The role of humidity sensors in different industries and field applications, such as agriculture, food monitoring, biomedical equipment, heating, and ventilation, is well known. However, most commercially available humidity sensors are based on polymers or electronic materials that are not degradable and thus contribute to electronic waste. Here, we report a low-cost, flexible, easy-to-fabricate, and eco-friendly parallel-plate capacitive humidity sensor for field applications. The sensor is fabricated from copper tape and tissue paper, where copper tape is used to create the plates of the capacitor, and tissue paper is used as a dielectric sensing layer. Along with the low cost, the high sensitivity, better response and recovery times, stability, and repeatability make this sensor unique. The sensor was tested for relative humidity (RH), ranging from 40% to 99%, and the capacitance varied linearly with RH from 240 pF to 720 pF, as measured by an Arduino. The response time of the sensor is ~1.5 s, and the recovery time is ~2.2 s. The experiment was performed 4–5 times on the same sensor, and repeatable results were achieved with an accuracy of ±0.1%. Furthermore, the sensor exhibits a stable response when tested at different temperatures. Due to the above advantages, the presented sensor can find ready applications in different areas.

Sustainable power generation for portable electronic devices is of high interest due to increasing energy demands. Miniaturized biofuel cells are well-reported for this purpose where ubiquitous fluids, like glucose or lactate, can be leveraged. However, such biofuel cells need enzymes to complete the catalysis, leading to many prevalent issues like the longevity of enzymes, complicated immobilization, additional mediators etc. Therefore, non-enzymatic glucose biofuel cells (NEGBFCs) are gaining interest due to their cost-effectiveness, high repeatability and excellent stability. However, based on our best knowledge such glucose biofuel cells are not reported in microfluidic environment, and therefore their potential is not exploited. Realization of the functionality of such NEGBFCs in a microscale is crucial to replace them with their enzymatic counterparts. In this work, for the first time, a microfluidic non-enzymatic glucose biofuel cell (μNEGBFC) is developed on a paper-based platform using metallic catalysts. The catalysts for electrocatalytic energy generation is fabricated using electrodeposition method and their detailed physicochemical characterizations are done. The μNEGBFC is capable of producing a power density of 12.5 μW/cm2 with a stable potential of 410 mV. This green power output can be used to operate low-power micro-devices and lab-on-chip sensors in a more continual and viable manner.

Background: Only a few studies with small sample sizes have compared electronic Objective Structured Clinical Examination (OSCE) rating checklists with traditional paper-based OSCE rating checklists. In this study, the examiner-perceived usability and preference for type of OSCE checklist (electronic vs. paper based) were compared, and the influence of OSCE checklist type on missed ratings was determined, for the Swiss Federal Licensing Examination in clinical skills for human medicine. Methods: All examiners in the Swiss Federal Licensing Examination in clinical skills for human medicine were invited over two subsequent years to evaluate the OSCE checklist type they had worked with during the examination. This was based on a questionnaire with 14 closed questions (i.e., demographic, checklist-type experience, perceived usability, checklist type preference). Furthermore, the numbers of missed ratings for the paper-based checklist were recorded. Results: The data from these examiners (n=377) with experience of both OSCE checklist types were analyzed. The electronic OSCE checklist was rated significantly higher on all usability aspects (i.e., ease of use, candidate rating and error correction, clarity, distraction using the checklist, overall satisfaction), except for the speed of registering comments (no significant difference). The majority of the examiners in both years (2014: 54.5%, n=60, 2015: 89.8%, n=230) reported preference for working with the electronic OSCE checklist in the future. Missed ratings were seen for 14.2% of the paper-based OSCE checklists, which were prevented with the electronic OSCE checklists. Conclusions: Electronic OSCE checklists were rated significantly more user-friendly and were preferred over paper-based OSCE checklists by a broad national sample of examiners, supporting previous results from faculty-level examinations. Furthermore, missed ratings were prevented with the electronic OSCE checklists. Overall, the use of electronic OSCE checklists is therefore advisable., Hintergrund: Nur wenige Studien mit kleinen Stichprobengrößen haben elektronische OSCE-Checklisten (Objective Structured Clinical Examination) mit traditionellen OSCE-Checklisten in Papierform verglichen. In dieser Studie wurden die von Prüfenden wahrgenommene Usability und Präferenz für den OSCE-Checklisten-Typ (elektronisch vs. papierbasiert) verglichen und der Einfluss des OSCE-Checklisten-Typs auf fehlende Bewertungen ermittelt für die Eidgenössische Clinical Skills-Prüfung Humanmedizin in der Schweiz. Methode: Die Prüfenden der Eidgenössischen Clinical Skills-Prüfung Humanmedizin wurden in zwei aufeinanderfolgenden Jahren gebeten, den OSCE-Checklisten-Typ zu bewerten, mit dem sie während der Prüfung gearbeitet hatten. Dies geschah anhand eines Fragebogens mit 14 geschlossenen Fragen (demographische Angaben, Erfahrung mit dem Checklisten-Typ, wahrgenommene Usability, Präferenz für den Checklisten-Typ). Außerdem wurde die Anzahl der fehlenden Bewertungen bei der papierbasierten Checkliste erfasst. Resultate: Die Daten derjenigen Prüfenden (n=377) mit Erfahrung mit beiden OSCE-Checklisten-Typen wurden ausgewertet. Die elektronische OSCE-Checkliste wurde bei allen Aspekten der Usability (einfache Benutzung, Kandidierendenbewertung und Fehlerkorrektur, Übersichtlichkeit, Ablenkung bei der Verwendung der Checkliste, Gesamtzufriedenheit) signifikant besser bewertet, mit Ausnahme der Geschwindigkeit des Erfassens von Kommentaren (kein signifikanter Unterschied). Die Mehrheit der Prüfenden in beiden Jahren (2014: 54.5%, n=60, 2015: 89.8%, n=230) gab an, in Zukunft lieber mit der elektronischen OSCE-Checkliste arbeiten zu wollen. Bei 14.2% der papierbasierten OSCE-Checklisten wurden fehlende Bewertungen festgestellt, welche mit elektronischen OSCE-Checklisten vermieden werden konnten. Schlussfolgerungen: Elektronische OSCE-Checklisten wurden von einer breiten nationalen Stichprobe von Prüfenden als deutlich benutzerfreundlicher eingestuft und gegenüber OSCE-Checklisten auf Papier bevorzugt, was frühere Ergebnisse von Prüfungen auf Fakultätsebene bestätigt. Außerdem wurden mit den elektronischen OSCE-Checklisten fehlende Bewertungen vermieden. Insgesamt ist die Verwendung elektronischer OSCE-Checklisten daher empfehlenswert.

Background: The Western Ontario and McMaster University osteoarthritis index (WOMAC) is the most commonly used indicator of disease-specific outcome in knee osteoarthritis (KOA) for its convenience and reliability. It has two formats— the paper-based WOMAC (p-WOMAC) and the electronic WOMAC (e-WOMAC). In China, the p-WOMAC has been widely used though e-WOMAC is yet untested. This study aims to test whether e-WOMAC is consistent with the p-WOMAC before and after the intervention. Methods: A total of 240 patients from Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (SHUTCM) will be randomly assigned in two groups which are named as group A and group B. This study is divided into three stages. In the first stage, patients in group A will be evaluated first by p-WOMAC and then by e-WOMAC. Patients in group B will be evaluated by e-WOMAC and then by p-WOMAC. In the second stage of the study, drug interventions will be implemented. 200mg celecoxib will be administered orally once a day starting from the second day of enrollment for a period of 21 days. The third stage is the consistency evaluation stage after intervention. The post-intervention evaluation will be conducted after administration. Patients in group A will be evaluated first by e-WOMAC and then by p-WOMAC. Patients in group B will be evaluated first by p-WOMAC and then by e-WOMAC. In order to avoid the possible bias because of patients’ potential memory, e-WOMAC and p-WOMAC will be taken for each patient at 15 minutes apart in the first and third stages. The comparison will include the overall score of the WOMAC, the score of each subscale and the score of individual items. Comparing the e-WOMAC with the p-WOMAC, the primary outcome of the study is the mean score difference in WOMAC, and the secondary outcomes are the score differences in three WOMAC subscales: pain, stiffness, and physical function. Discussion : This study will test reliability and comparability between e-WOMAC and p-WOMAC. Meanwhile, we will also collect and provide participants’ feedback after comparing two formats of the WOMAC. If the results are favorable, our findings will serve to demonstrate the equivalence of each version of the WOMAC so that it can be implemented in specialized medical activities. Likewise, our results will further demonstrate the feasibility of e-health for the personalize KOA treatment. Trial registration: ChiCTR, ChiCTR2100050914. Registered on 8 Sep 2021, https://www.chictr.org.cn/showproj.aspx?proj=133521 Keywords: Chinese electronic version of WOMAC, Verification, Protocol

IntroductionONCO-TreC platform consists of a mobile application delivered to patients as electronic diary and a web-based dashboard managed by healthcare professionals. We aim to compare the effectiveness of ONCO-TreC electronic diary with a standard paper diary, in improving adherence to oral cancer therapy in patients with solid and haematological tumours.Methods and analysisThis is an open label, superiority, randomised controlled trial conducted in two Italian oncology units. Patients will be randomised with a 1:1 ratio to electronic or paper diary. For both groups a counsellor will be responsible for drug and diary delivery. The evaluation period will end after six cycles of therapy. The primary aim is to compare the proportion of non-adherent patients in the two arms. Adherence will be measured through pill count; anyone who takes less than 90% of the total prescribed drug dose will be considered non-adherent. Assuming a percentage of non-adherent patients to oral therapy of 40% in arm B, and a 60% reduction in this percentage in arm A, a sample of 124 patients will provide 80% power to identify an absolute difference greater than 24 percentage points using a bilateral Fisher’s exact test with a significance level of 0.05. Considering a dropout rate of 10%, approximately 136 patients will have to be enrolled. The primary analysis will be performed on the intention-to-treat population. Secondary aims are to describe the reasons for non-adherence, the level of satisfaction of patients and healthcare professionals with the paper and electronic diary, and the impact of non-adherence in terms of healthcare costs.Ethics and disseminationEthical approval was obtained from Romagna Ethics Committee (CEROM), study ID 2108, prot. n. IRST 100.28 of 10/04/2020. Informed consent will be obtained from all study participants. Findings will be disseminated through peer-reviewed journals, conferences and event presentations.Protocol versionVersion 2, 6 April 2021.Trial registration numberNCT04826458.

Background: The Inventory of Physical Activity Barriers (IPAB) assesses physical activity participation barriers. Development, refinement, and psychometric evaluation of the IPAB occurred via an electronic format. However, various circumstances may require using a pen-and-paper format. As instrument formats are not always interchangeable, the authors aimed to establish whether 2 different formats (electronic and pen and paper) can be used interchangeably for the IPAB. Methods: This randomized crossover study included 66 community-dwelling adults aged 50 years and older (mean age = 73 [SD = 7.6]). Half the sample completed the electronic format of the IPAB first and the pen-and-paper format second, and the other half completed them in reverse order. Tests of equivalence and a Bland–Altman plot were performed. Results: The intraclass correlation coefficient between formats was .94, and kappa was .68. The mean difference between the 2 administration forms of the IPAB was 0.002 (P = .96). Both administration formats had high internal consistency (Cronbach alpha = .92 and .93) and illustrated construct validity (P ≤ .001 for both administration formats). Conclusion: Pen-and-paper and electronic formats of the IPAB are equivalent and, thus, can be used interchangeably among non-Hispanic whites who are highly educated. The format should be used consistently if completing preintervention and postintervention evaluations or comparing scores.

Flexible electronics have gained more attention for emerging electronic devices such as sensors, biosensors, and batteries with advantageous properties including being thin, lightweight, flexible, and low-cost. The development of various forms of allotropic carbon papers provided a new dry-manufacturing route for the fabrication of flexible and wearable electronics, while the electrochemical performance and the bending stability are largely influenced by the bulk morphology and the micro-/nanostructured domains of the carbon papers. Here, we evaluate systematically the intrinsic physicoelectrochemical properties of allotropic carbon-based conducting papers as flexible electrodes including carbon-nanotubes-paper (CNTs-paper), graphene-paper (GR-paper), and carbon-fiber-paper (CF-paper), followed by functionalization of the allotropic carbon papers for the fabrication of flexible electrodes. The morphology, chemical structure, and defects originating from the allotropic nanostructured carbon materials were characterized by scanning electron microscopy (SEM) and Raman spectroscopy, followed by evaluating the electrochemical performance of the corresponding flexible electrodes by cyclic voltammetry and electrochemical impedance spectroscopy. The electron-transfer rate constants of the CNTs-paper and GR-paper electrodes were similar to 14 times higher compared with the CF-paper electrode. The CNTs-paper and GR-paper electrodes composed of nanostructured carbon showed significantly higher bending stabilities of 5.61 and 4.96 times compared with the CF-paper. The carbon-paper flexible electrodes were further functionalized with an inorganic catalyst, Prussian blue (PB), forming the PB-carbon-paper catalytic electrode and an organic conducting polymer, poly(3,4-ethylenedioxythiophene) (PEDOT), forming the PEDOT-carbon-paper capacitive electrode. The intrinsic attribute of different allotropic carbon electrodes affects the deposition of PB and PEDOT, leading to different electrocatalytic and capacitive performances. These findings are insightful for the future development and fabrication of advanced flexible electronics with allotropic carbon papers. Funding Agencies|Swedish Research CouncilSwedish Research CouncilEuropean Commission [VR-2015-04434]; Royal Golden Jubilee Ph.D. program (RGJ) from the Thailand Research Fund [PHD/0212/2560]

Question Most adolescents live in low- and middle-income countries (LMIC), and about 10% of them face mental problems. The mental health provision gap in low- and middle-income countries could be addressed by evidence-based practices, however costs are implementational barriers. Digitalization can improve the accessibility of these tools and constitutes a chance for LMIC to use them more easily at a low cost. We reviewed free and brief evidence-based mental health assessment tools available for digital use to assess psychopathology across different domains in youth. Methods For the current study, instruments from a recent review on paper-based instruments were re-used. Additionally, a systematic search was conducted to add instruments for the personality disorder domain. We searched and classified the copyright and license terms available from the internet in terms of free usage and deliverability in a digital format. In the case that this information was insufficient, we contacted the authors. Results In total, we evaluated 109 instruments. Of these instruments, 53 were free and digitally usable covering 11 mental health domains. However, retrieving information on copyright and license terms was very difficult. Conclusions Free and digitally adaptable instruments are available, supporting the strategy of using instruments digitally to increase access. The instrument’s authors support this initiative, however, the lack of copyright information and the difficulties in contacting the authors and licence holders are barriers to using this strategy in LMIC. A comprehensive, online instrument repository for clinical practice would be an appropriate next step to make the instruments more accessible and reduce implementation barriers.

Background In the European Union it is mandatory to include paper package leaflets (PPL) with all medicines, including vaccines, to inform the recipient. However, it is difficult to meet the necessity for localized PPLs in each of the 24 official European languages. Replacing PPLs with electronic versions offers many advantages including redistribution across nations, reduced storage space, accessibility by the visually impaired, easily updated information or the addition of video content. We wanted to assess the attitudes of patients (vaccine recipients or their parents) to the potential of replacing PPL with electronic versions. Methods We surveyed vaccinees or their parents in four European countries—Belgium, Italy, Bulgaria and France—for their actual use of vaccine PPLs and their opinions about switching to an electronic package leaflet. Our survey was conducted online because of the COVID-19 pandemic and resulted in 2518 responses to a questionnaire targeted at three specific groups with particular information needs: parents of young children, pregnant women and the elderly (≥ 60 years). Results Our main findings are that currently vaccine PPLs are rarely used and frequently unavailable for the vaccinee. Across the four countries surveyed 55–82% of vaccinees would accept an electronic version, as did 64% when there was an option to request a printout of the leaflet. Conclusions We found that switching to electronic versions of vaccine PPLs is an acceptable alternative for the public, potentially increasing the quality and amount of information reaching vaccinees while eliminating some barriers to redistribution of vaccines between countries.

Introduction The Ministry of Public Health in Lebanon is in the process of converting the surveillance reporting from a cumbersome paper-based system to a web-based electronic platform (DHIS-2) to have real-time information for early detection of alerts and outbreaks and for initiating a prompt response. Objectives This paper aimed to document the Lebanese experience in implementing DHIS-2 for the disease surveillance system. It also targets to assess the improvement of reporting rates and timeliness of the reported data and to disclose the encountered challenges and opportunities. Methodology This is a retrospective description of processes involved in the implementation of the DHIS-2 tool in Lebanon. Initially, it was piloted for the school-based surveillance in 2014; then its use was extended in May 2017 to cover other specific surveillance systems. This included all surveillance programs collecting aggregate data from hospitals, medical centers, dispensaries, or laboratories at the first stage. As part of the national roll-out process, the online application was developed. The customized aggregated-based datasets, organization units, user accounts, specific and generic dashboards were generated. More than 80 training sessions were conducted throughout the country targeting 1290 end-users including health officers at the national and provincial levels, focal persons who were working in all public and private hospitals, laboratories, and medical centers as well. Completeness and timeliness of reported data were compared before and after the implementation of DHIS-2. The unveiled challenges and the main lessons learned during the roll-out process were discussed. Results For laboratory-based surveillance, completeness of reporting increased from 70.8% in May to 89.6% in October. Timeliness has improved from 25 to 74%. For medical centers, an improvement of 8.1% for completeness and 9.4% in timeliness was recorded before and after training sessions. For zero reporting, completeness remains the same (88%) and timeliness has improved from 74 to 87%. The main challenges faced during the implementation of DHIS-2 were mainly infrastructural and system-related in addition to poor internet connectivity, limited workforce, and frequent changes to DHIS-2 versions. Conclusion Implementation of DHIS-2 improved timeliness and completeness for aggregated data reporting. Continued on-site support, monitoring, and system enhancement are needed to improve the performance of DHIS-2.

Graphene papers (GPs) have revolutionized the area of sensors toward low-cost, user-friendly and wearable/portable owning to their unique properties such as scalable production capacity, tunable microstructure, and extraordinary mechanical flexibility. They can be utilized as versatile building blocks by regulating their architectures to enhance various properties like electronic property, thermal conductivity and mechanical strength. Furthermore, thanks to the excellent compatibility, GPs as support materials are able to associate with other materials through various interaction forces to realize specific functionalization. With the impressive performances mentioned above, lots of smart devices like flexible sensors, advanced wearable/stretchable electronics, and high-performance point-of-care analytical devices are continually and rapidly being developed. Herein, this review aims at offering a critical engineering insight from smart architecture of macroscopic GPs to sensor application, with the emphasis on purpose-driven specific dual-mode functionalization (structural functionalization and foreign materials functionalization). We summarize the multiple possibilities to functionalize graphene and its derivative based papers/films/membranes. The sensing application of GPs in human health management, food contaminant inspection, and environmental monitoring is evaluated just before leading to our conclusions and perspectives.

Paper-like electronics with thin multi-layer structures, which can be repeatedly bent and twisted like paper, are promising for diverse innovation application. Employing surface-mounted flexible strain sensors is a general way to monitor the bending characteristics of each layer inside paper-like electronics, however, the deviation of measured strain will reach up to 15% on account of the layer-to-layer interface sliding, neutral axes offset resulted from the extra effect of the flexible strain sensor. Here, we proposed a precise measurement method to evaluate the surface bending strain of paper-like electronics by using flexible sensors. In combination with the effects of the thickness, length, etc, a strain compensation model has been established to compensate the measurement deviation. Meanwhile, a slip failure model has been developed to guide the design of the sensitivity unit within the non-sliding area of the flexible sensor. Validated by finite element analysis and experiment, the bending strain of paper-like electronics (eg., ∼50 μm) can be evaluated much more accurate compared to the frequent access one. The newly-proposed method provides a powerful basis for further research of paper-like electronics.