Search

Chronic pancreatitis is associated with impaired quality of life, high incidence of comorbidities, serious complications and mortality. Healthcare costs are exorbitant. Some medical societies have developed guidelines for treatment based on scientific evidence, but the gathered level of evidence for any individual topic is usually low and, therefore, recommendations tend to be vague or weak. In the present position papers on chronic pancreatitis from the Societat Catalana de Digestologia and the Societat Catalana de Pàncrees we aimed at providing defined position statements for the clinician based on updated review of published literature and on multidisciplinary expert agreement. The final goal is to propose the use of common terminology and rational diagnostic/therapeutic circuits based on current knowledge. To this end 51 sections related to chronic pancreatitis were reviewed by 21 specialists from 6 different fields to generate 88 statements altogether. Statements were designed to harmonize concepts or delineate recommendations. Part 2 of these paper series discuss topics on treatment and follow-up. The therapeutic approach should include assessment of etiological factors, clinical manifestations and complications. The complexity of these patients advocates for detailed evaluation in multidisciplinary committees where conservative, endoscopic, interventional radiology or surgical options are weighed. Specialized multidisciplinary units of Pancreatology should be constituted. Indications for surgery are refractory pain, local complications, and suspicion of malignancy. Enzyme replacement therapy is indicated if evidence of exocrine insufficiency or after pancreatic surgery. Response should be evaluated by nutritional parameters and assessment of symptoms. A follow-up program should be planned for every patient with chronic pancreatitis. © 2021 Elsevier España, S.L.U.

Objective The purpose of this study was to develop a natural language processing (NLP) pipeline to identify incidental thyroid nodules (ITNs) meeting criteria for sonographic follow-up and to assess both adherence rates to white paper recommendations and downstream outcomes related to these incidental findings. Methods 21583 non-contrast chest CT reports from 2017 and 2018 were retrospectively evaluated to identify reports which included either an explicit recommendation for thyroid ultrasound, a description of a nodule ≥ 1.5 cm, or description of a nodule with suspicious features. Reports from 2018 were used to train an NLP algorithm called fastText for automated identification of such reports. Algorithm performance was then evaluated on the 2017 reports. Next, any patient from 2017 with a report meeting criteria for ultrasound follow-up was further evaluated with manual chart review to determine follow-up adherence rates and nodule-related outcomes. Results NLP identified reports with ITNs meeting criteria for sonographic follow-up with an accuracy of 96.5% (95% CI 96.2-96.7) and sensitivity of 92.1% (95% CI 89.8-94.3). In 10006 chest CTs from 2017, ITN follow-up ultrasound was indicated according to white paper criteria in 81 patients (0.8%), explicitly recommended in 46.9% (38/81) of patients, and obtained in less than half of patients in which it was appropriately recommended (17/35, 48.6%). Discussion NLP accurately identified chest CT reports meeting criteria for ITN ultrasound follow-up. Radiologist adherence to white paper guidelines and subsequent referrer adherence to radiologist recommendations showed room for improvement.

Laser-induced graphene (LIG) technology featuring low-cost, high-efficiency and scalability has presented great advantages in micro-supercapacitors (MSCs) fabrication. However, the limited capacitance of LIG based MSCs is still hindering their further development. Herein, we introduce joule heating as a critical in-situ treatment merged with the assembly of laser-induced graphene paper based MSCs (LIGP-MSCs) toward capacitive enhancement. By increasing heating-treatment temperature from ∼20 to 500 °C, the number of nanopores in LIGP continuously increases, attributed to the gradual decomposition of amorphous carbon components. The resulting joule-heated LIGP (J-LIGP) with improved specific surface area (160.97–533.49 m2/g) and pore volume (0.179–0.553 cm3/g) as well as superhydrophilic surface is highly suitable to be employed as J-LIGP-MSCs microelectrodes. By investigating process dependent performance, the J-LIGP-MSCs heated at 500 °C for 60 min delivers a significantly improved specific areal capacitance (CA) of 13.71 mF/cm2 at 10 mV/s, which is approximately six-fold higher than that of unheated LIGP-MSCs. By further exploring and optimizing the process efficiency, J-LIGP-MSCs with a CA of 12.61 mF/cm2 has been achieved by 550 °C heating for only 5 min. Along with superior mechanical flexibility, cyclability and structural modularity, the proposed in-situ joule heating treatment is finally proved to be a universal approach for consistently enhancing the CA of LIG based MSCs processed under various chemical modifications.

Antimicrobial stewardship programs (ASPs) have made immense strides in optimizing antibiotic, antifungal, and antiviral use in clinical settings. However, although ASPs are required institutionally by regulatory agencies in the United States and Canada, they are not mandated for transplant centers or programs specifically. Despite the fact that solid organ transplant recipients in particular are at increased risk of infections from multidrug-resistant organisms, due to host and donor factors and immunosuppressive therapy, there currently are little rigorous data regarding stewardship practices in solid organ transplant populations, and thus, no transplant-specific requirements currently exist. Further complicating matters, transplant patients have a wide range of variability regarding their susceptibility to infection, as factors such as surgery of transplant, intensity of immunosuppression, and presence of drains or catheters in situ may modify the risk of infection. As such, it is not feasible to have a “one-size-fits-all” style of stewardship for this patient population. The objective of this white paper is to identify opportunities, risk factors, and ASP strategies that should be assessed with solid organ transplant recipients to optimize antimicrobial use, while producing an overall improvement in patient outcomes. We hope it may serve as a springboard for development of future guidance and identification of research opportunities.

Mitigation of global warming, energy security and industrial competitiveness urge the energy-intensive pulp and paper industry (PPI) to transform energy use practices. This study investigates how the PPI has responded to the need for the energy transition in the 2000s. Finland and Sweden as forerunners of energy-efficient operation and decarbonization of the PPI are used as target countries. Understanding of changes in energy consumption is complemented using decomposition analysis (Logarithmic Mean Divisia Index Method) and the energy efficiency index approach. Analysis of companies’ investments in energy technologies is used for explaining changes in energy production. Evidence of significant development towards the more sustainable operation of the PPI was found. Energy consumption per produced unit has decreased, i.e., energy efficiency has improved. Fossil fuels have been partially replaced with bio-based alternatives. Thus, the CO2 intensity has decreased substantially. The generation of renewable electricity has increased in both countries. Examples of Finland and Sweden indicate that the PPI has great potential to contribute to CO2 emission reduction worldwide in the future as energy efficiency can be further improved, and the share of fossil fuels can be decreased increasing the use of biofuels and self-generated green electricity at least in kraft pulp mills.

Neonatal and infantile cholestasis (NIC) can represent the onset of a surgically correctable disease and of a genetic or metabolic disorder worthy of medical treatment. Timely recognition of NIC and identification of the underlying etiology are paramount to improve outcomes. Upon invitation by the Italian National Institute of Health (ISS), an expert working grouped was formed to formulate evidence-based positions on current knowledge about the diagnosis of NIC. A systematic literature search was conducted to collect evidence about epidemiology, etiology, clinical aspects and accuracy of available diagnostic tests in NIC. Evidence was scored using the GRADE system. All recommendations were approved by a panel of experts upon agreement of at least 75% of the members. The final document was approved by all the panel components. This position document summarizes the collected statements and defines the best-evidence diagnostic approach to cholestasis in the first year of life.

Background The screening of biological hazards, chemical contaminants and allergens in food products is a major concern of food industry since they can cause serious illnesses and even lead to death. Therefore, there is a significant interest in developing low-cost, robust, and rapid detection methods for food safety and quality analysis. Conventional methods provide accurate analytical characteristics, but require well-equipped laboratories, trained personnel, costly reagents, and complicated sample preparation procedures prior to the detection in order to obtain reliable results. Hence, they are not always ideal for on-site food surveillance. Scope and approach This paper discusses the fundamentals of microfluidic paper-based analytical devices (μPADs) and reviews the recent progress in their usage for screening biological hazards, harmful chemical residues, and allergens in food products to systematically evaluate the strengths and weaknesses of this technology. It then covers future trends and useful strategies that could be employed in μPADs design and fabrication procedures to address the critical challenges in equipment-free food analysis. Key findings and conclusions μPADs offer promising avenues to revolutionize food safety and quality analysis with merits of equipment-free sample preparation and detection at low-cost. Despite the advancement in the microfluidic technology, the manufacturing of user-friendly sample-to-answer μPADs still requires intensive research studies to be employed for robust and sensitive food safety and quality analysis.

Palliative radiation therapy (pRT) is an effective tool for people with incurable cancer, in the treatment of many cancer-related symptoms such as pain, bleeding and dyspnea. As utilization rates for palliative radiation therapy increase, the demands on the healthcare system continue to grow. Radiation Therapists with advanced knowledge, skills and judgements began demonstrating their ability to practice autonomously in 2004, with the development of the Clinical Specialist Radiation Therapist (CSRT) role. Since this time, CSRTs with a specific focus in pRT (pCSRT) have been increasing in both numbers as well as their positive effects on the cancer care system. Integrating a pCSRT into the existing pRT system has resulted in increased access to and quality of pRT being delivered to palliative cancer patients. The benefits of the addition of pCSRTs to the cancer care system include increasing system capacity and increasing quality of care. This white paper provides information related to the improvements that can be realized in a RT program related to the care and treatment of its palliative patients by adding a pCSRT to the interprofessional healthcare team and suggest it as one of many strategies that can be undertaken to make improvements to access and quality of care.

With the increased awareness of reusing solid wastes for higher sustainability and the concern of water pollution associated with phosphorus over-emission, there are strong interests in developing solid waste based adsorbents for purifying phosphorus-containing wastewater. As a rich calcium resource, paper mill sludge (i.e., a major solid waste from pulping industry) can be used as phosphorus removal adsorbent after calcination. Thus, in this work, a simple and clean thermally treating route has been proposed for preparing calcium-containing biochar from paper mill sludge. The effect of the physicochemical properties of paper mill sludge and its carbonization condition on phosphorus adsorption has been analyzed. Moreover, the influence of some key adsorption parameters, e.g., biochar dosage, initial pH of solution, co-existing anions, initial phosphorus concentration and contact time has also been investigated. The results showed that the phosphorus adsorption data could be fitted well with pseudo-second-order kinetic and Langmuir isothermal models. The calculated maximum adsorption capacity of the as-prepared optimal calcium-containing biochar could reach to 68.49 mg·g−1 at 25 °C. Combined with the characterization results, it can be reasonably inferred that the adsorption process was chemisorption-dominated. Lastly, the application of this spent adsorbent in agriculture field has also been discussed. In brief, this work provided a feasible strategy for converting paper mill solid waste to an environmental functional material (i.e., calcium-rich biochar) for remediation of eutrophic water.

Objective The objective of this study was to develop the first edition of a Chinese evidence-based position paper on the management of oral leukoplakia (OLK). Study Design The consultant group for drafting the position paper consisted of 31 oral medicine specialists and 2 evidence-based medicine specialists. English studies (searched in PubMed, EMBASE, and the Cochrane Library) and Chinese studies (searched in China National Knowledge Infrastructure and WanFang) published before January 2018 were used. The quality of the study was assessed using the Grading of Recommendations Assessment, Development, and Evaluation grid, and the strength of the recommendations was determined based on the results of 3 rounds of voting among the consultant group members using the Delphi method. Results Twenty-two evidence-based guidelines for clinical management and monitoring of OLK were established in this position paper. A clinical path diagram for oral health practitioners was constructed based on the recommendations. Conclusion Current evidence suggests that management and monitoring of patients with OLK should be performed by experienced clinicians to control the lesion and for early detection of malignant transformation. However, all recommendations are based on evidence of low or extremely low quality and may require further modification as new evidence is produced.

This study optimizes a novel surfactant-assisted green liquor dregs (GLD) pretreatment of paper mill sludge (PMS), both of which are wastes from the kraft pulping industry, using a combined Response Surface Methodology (RSM) design. Optimized conditions give a maximal reducing sugar release of 16.38 g/L. A substantial reduction in heavy metals aluminum, chromium, cobalt, arsenic, lead, and copper after pretreatment illustrates the enhancement of substrate digestibility by reducing toxic elements. Separate hydrolysis and fermentation (SHF) and simultaneous saccharification and fermentation (SSF) for hydrogen production are assessed. SSF produced a hydrogen yield of 3.72 mL/g, displaying a 36.26% increase from pretreated PMS compared to SHF. These findings provide insights into possible methods of reducing process duration, energy input, and costs incurred with waste disposal within the paper industry. Furthermore, improved hydrogen yield using an SSF process demonstrates the potential beneficiation of pulp and paper GLD and PMS wastes.

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

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

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

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

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

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

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

Writing and presenting results is important for any research work. Publishing is not enough; it should be written clearly and consistently for others to read and cite. We present a review of different techniques, for improving the writing in research papers intended for publishing. These include how to write the title, whether to use active or passive voice, how long sentences should be, how to present the uncertainty, understanding the International System of Units (SI) writing conventions, how to assign authorship, how to effectively use references, how to present the work, and how to publish it in a journal. This paper is a summary of the main and most recent recommendations in the scientific field on how to write a research paper to increase its impact.

The following review paper thoroughly enables the readers to emulate the flexural behavior and impact test method for textile reinforced cementitious composites (TRCCs). The flexural parameters of ECCs corresponding to type of fiber material, fiber volume fraction, fiber volume length and strength parameters were discussed. For the textile reinforcement, the parameters like type of weaving pattern, mesh size, roving tex, fiber volume fraction and number of layers were discussed. Based on the tensile strength of textile fiber material, carbon, AR-glass, aramid and basalt fiber mesh were used for strengthening, repair works, plastering and reinforcement for thin elements. And also, the impact test performance on cementitious concrete composites is addressed as well as methods adopted for finding impact performance are discussed from the numerous literatures. This paper provides summary about the flexural and impact performance of textile fibers introduced into the concrete composites in different mesh sizes and fiber volume fractions. Generally, inclusion of textile fibers gives much more performance in tensile, toughness, flexural, energy absorption capacity and ductility in ECC composites. Many of the researchers have tried with different fiber materials for producing ECC and TRC composites separately, but only few of them used both have been discussed. Finally, from the literatures mostly artificial fibers are used for making textile reinforced composites.

Supercapacitors are favored by researchers because of their high power density, especially with the acceleration of people's life rhythm. However, their energy density, especially from the point of view of the whole energy storage device, is far lower than that of commercial batteries. In this work, a kind of customizable full paper-based supercapacitor device with excellent self-healing ability is fabricated by simple and low-cost screen printing, electropolymerization and dip coating methods. The resultant separator-free supercapacitor device exhibits both ultrahigh gravimetric and areal specific energy (power) densities of 39 Wh kg−1 (69 kW kg−1) and 692 μWh cm−2 (236 mW cm−2), achieving excellent supercapacitor performance. Notably, the addition of vitrimers endows the whole device with outstanding self-healing properties, which is helpful for enhancing the adaptability of the device to the environment. In addition, this kind of paper-based device also displays good photothermal and electromagnetic shielding performances. These striking features make paper matrix composites attractive in the fields of supercapacitors, medical photothermal treatment and electromagnetic shielding.

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

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

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

The transperineal approach is preferred to reduce prostate biopsy (PB)-related infections. Fluoroquinolones are suspended for prophylaxis of PB in the European Union; therefore, alternative antibiotics based on local resistance, or targeted prophylaxis, in conjunction with povidone-iodine rectal preparation are recommended for transrectal PB.

Objectives A recent paper by Doi et al. advocated completely replacing the relative risk (RR) with the odds ratio (OR) as the effect measure in clinical trials and meta-analyses with binary outcomes. Besides some practical advantages of RR over OR, Doi et al.’s key assumption that the OR is “portable” in the meta-analysis, that is, study-specific ORs are likely not correlated with baseline risks, was not well justified. Study designs and settings We summarized Spearman's rank correlation coefficient between study-specific ORs and baseline risks in 40,243 meta-analyses from the Cochrane Database of Systematic Reviews. Results Study-specific ORs tend to be higher in studies with lower baseline risks of disease for most meta-analyses in Cochrane Database of Systematic Reviews. Using an actual meta-analysis example, we demonstrate that there is a strong negative correlation between OR (RR or RD) with the baseline risk and the conditional effects notably vary with baseline risks. Conclusions Replacing RR or RD with OR is currently unadvisable in clinical trials and meta-analyses. It is possible that no effect measure is “portable” in a meta-analysis. In addition to the overall (or marginal) effect, we suggest presenting the conditional effect based on the baseline risk using a bivariate generalized linear mixed model.

In recent times, it has been witnessed that wireless systems based on IoT-based have developed rapidly in various sectors. The IoT (Internet of Things) is the network in which physical devices, equipment, sensors and other objects can communicate among themselves without human involvement. The WSN (Wireless Sensor Network) is a central component of the IoT, which has proliferated into several different applications in real-time. The IoT and WSNs now have various critical and non-critical applications impacting nearly every area of our everyday life. WSN nodes are usually small and battery-driven machines. Thus, the energy effective data aggregation techniques that increase the lifespan of the network are highly significant. Various approaches and algorithms for energy-efficient data aggregation in IoT-WSN systems were presented. This paper reviews the literature with specific attention to aspects of wireless networking for the preservation of energy and aggregation of data.

Objective This study collected randomized controlled trials (RCTs) published in the social sciences in China and assessed their risk of bias and reporting quality. Study Design and Setting Three databases were systematically searched for publications from January 2000 to June 2020 for RCTs in the social sciences published by Chinese researchers. The risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool (CCRBT), and reporting quality was assessed using the Consolidated Standards of Reporting Trials for Social and Psychological Interventions (CONSORT-SPI). Results A total of 316 RCTs were identified, including 204 articles in English and 112 articles in Chinese. The most frequently researched interventions focused on education (33.9%), and the most frequently studied population were students (32.9%). Eighty-seven percent of RCTs had intermediate reporting quality. Twenty-four of the 43 CONSORT-SPI sub-items had a compliance rate of less than 50%. Most RCTs had an unclear risk of bias for blinding outcome assessors (84.5%), blinding participants and personnel (82.9%), allocation concealment (73.1%), and random sequence generation (68.0%). A low proportion of CONSORT-SPI items were reported and, high proportion of the papers had unclear risk of bias. Conclusion The quality and reporting of RCTs in the social sciences needs improvement in China, especially for reporting methods and results. Most studies had an unclear risk of bias as they lacked important methodological information.

Enormous quantities of bagasse are being used as raw material in agro based large integrated pulp and paper mills. Anaerobic technology is an effective means of biodegradation of organic substance in wastewater and energy production of biogas that can be used as an alternative fuel. This study illustrates the effect of HRT on performance of lab scale hybrid upflow anaerobic sludge blanket (HUASB) reactor on treatment of pulp and paper mill bagasse wash water. The lab scale HUASB reactor was designed for an effective volume of 0.013 m3 with bio balls as packing media at the top of reactor and operated under mesophilic condition. After startup period, the reactor was operated with HRTs of 23.55, 15.98, 12.00, 10.03 and 7.97 h for the average influent COD concentrations of 2503.6 mg/L, 3918 mg/L, 5432 mg/L, 6608 mg/L and 7996 mg/L respectively. The results showed that the maximum COD removal efficiencies and TSS removal efficiencies were in the range of 68.60–92.19% and 89.56–94.66% respectively. The minimum and maximum biogas yield of 0.32 and 0.53 m3/kg CODa were obtained at influent concentration of 2503.6 mg/L and 7996 mg/L respectively.

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

The dissemination of emerging electronic devices increases considerably alongside with the Internet of Things (IoT) paradigm. Some key elements considered in these devices (e.g. rare-earth) are becoming critical materials and are associated with serious environmental concerns. Therefore, there is a major requirement for designing differently our electronic technologies at the early stages of the research process. Many reports present the promising properties of paper-based electronics as meant to address this challenge. Through technical and life cycle assessments, this article discusses the main design levers in terms of material and fabrication process choices for the eco-design of paper-electronics water quality sensors. Our results suggest conscientious choices of conductive nanomaterials and additive fabrication techniques.

Space Resource Utilization could reduce the mass, cost, and risks of future space activities. The many nonlinear and compounding effects mean that seemingly insignificant concept of operations choices can invalidate the conclusions of sophisticated analyses. Here we successively relax self-imposed constraints in a recent publication to demonstrate that the proximity of a market and the benefits of aerobraking cannot be omitted.

Objectives To present the history and potential for development of evidence-based (EB) social work in China. Study design and setting The conception and methodology of EB social work is a potential strategy to support high quality development of social work in China. This article documents and analyzes the progress of EB social work in China. We focus on current research, reasons, challenges, and strategies. Results EB social work started late in China. The number of EB social work literature and systematic reviews has increased since 2004. The development of EB social work has been uneven nationally with few practitioners and decision makers involved. However, more and more social work researchers received training in evidence-based practice through national workshops and conferences. Conclusion EB social work faced various challenges, but there are now more opportunities for EB social work development in China. Researchers, practitioners, managers and decision makers are encouraged to work together to establish a thorough methodological system and use existing evidence as much as possible when carrying out social work programs and services.

Photonic crystals film that possesses periodic dielectric structure have shown great prospect in developing environmentally friendly paper alternatives due to the unique properties of dye free and non-photobleaching, but their practical application is limited by the weak interaction between colloidal particles. Although some progress has been obtained, it is still a challenge to develop photonic paper with the desired mechanical and optical properties. Herein, multifunctional hard core/soft shell nanoparticles with controlled size are fabricated by semi-continuous seed emulsion polymerization method. Compared with convention colloidal particles, these core/shell nanoparticles can facile self-assemble into large-scale dense ordered structure film via dried at room temperature due to the relatively low glass transition temperature (Tg) of the shell layers. The facile fabrication route enables the continuous high-through put production of the photonic papers. The as-formed papers not only possess the capacity to solvent (water/ethanol) rewritable and multicolor painting, but also can rapidly reversible mechanochromic. Moreover, due to the good compatibility of core/shell interface, these photonic films possess excellent mechanical properties, demonstrating that this multifunctional film makes the fabrication of novel robust rewritable papers possible and enables visual monitoring of deformation degree.

Background Brugada syndrome is a rare inherited arrhythmic syndrome with a coved type 1 ST-segment elevation on ECG and an increased risk of sudden death. Many studies have evaluated risk stratification performance based on ECG-derived parameters. However, since historical Brugada patient cohorts included mostly paper ECGs, most studies have been based on manual ECG parameter measurements. We hypothesized that it would be possible to run automated algorithm-based analysis of paper ECGs. We aimed: 1) to validate the digitization process for paper ECGs in Brugada patients; and 2) to quantify the acute class I antiarrhythmic drug effect on relevant ECG parameters in Brugada syndrome. Methods A total of 176 patients (30% female, 43 ± 13 years old) with induced type 1 Brugada syndrome ECG were included in the study. All of the patients had paper ECGs before and during class I antiarrhythmic drug challenge. Twenty patients also had a digital ECG, in whom printouts were used to validate the digitization process. Paper ECGs were scanned and then digitized using ECGScan software, version 3.4.0 (AMPS, LLC, New York, NY, USA) to obtain FDA HL7 XML format ECGs. Measurements were automatically performed using the Bravo (AMPS, LLC, New York, NY, USA) and Glasgow algorithms. Results ECG parameters obtained from digital and digitized ECGs were closely correlated (r = 0.96 ± 0.07, R2 = 0.93 ± 0.12). Class I antiarrhythmic drugs significantly increased the global QRS duration (from 113 ± 20 to 138 ± 23, p Conclusions Automated algorithm-based measurements of depolarization and repolarization parameters from digitized paper ECGs are reliable and could quantify the acute effects of class 1 antiarrhythmic drug challenge in Brugada patients. Our results support using computerized automated algorithm-based analyses from digitized paper ECGs to establish risk stratification decision trees in Brugada syndrome.

Highlights •Mechanical stimuli-triggered optical responses of cholesteric liquid crystal devices are realized.•Self-powered bistable smart window and E-paper are demonstrated.•Self-powered optical switch is developed for remote control.Intelligent responsive devices are crucial for a variety of applications ranging from smart electronics to robotics. Electro-responsive cholesteric liquid crystals (CLC) have been widely applied in display panels, smart windows, and so on. In this work, we realize the mechanical stimuli-triggered optical responses of the CLC by integrating it with a triboelectric nanogenerator (TENG), which converts the mechanical motion into alternating current electricity and then tunes the different optical responses of the CLC. When the voltage applied on the CLC is relatively low (15–40 V), the TENG drives the switching between the bistable planar state and focal conic state of the CLC, which shows potential applications in self-powered smart windows or E-paper displays. When the voltage supplied by the TENG is larger than 60 V, a self-powered optical switch is demonstrated by utilizing the transformation between focal conic state and instantons homeotropic state of the CLC. This triboelectric-optical responsive device consumes no extra electric power and suggests a great potential for future smart electronics.

Advancements in technology have led to the use of smartphones as biosensor detectors. However, it is difficult to obtain stable color information of colorimetric sensors using multiple smartphones owing to different light conditions and image correction operations. In this study, we attempted color detection of the colorimetric paper chip using smartphone-embedded light-emitting diode (LED) and simple transformation calculation. This method enables the acquisition of stable color information using different smartphones by reducing the influence of external light sources. Moreover, we studied characteristics such as convergence and distinction of detection result details by the manufacturers and smartphones. These findings suggested the necessity of classification criteria for the use of smartphones to achieve optimal detection. In addition, white and black references were used to set the standard for color correction of various light sources. Based on our results, we conclude that this approach presents the possibility of smartphone-based colorimetric detection in practical applications.

International audience; Magnetic resonance imaging (MRI) has become the reference imaging for the management of a large number of diseases. The number of MR examinations increases every year, simultaneously with the number of patients receiving a cardiac electronic implantable device (CEID). A CEID was considered an absolute contraindication for MRI for years. The progressive replacement of conventional pacemakers and defibrillators by MR-conditional CEIDs and recent data on the safety of MRI in patients with "MR-nonconditional" CEIDs have progressively increased the demand for MRI in patients with a CEID. However, some risks are associated with MRI in CEID carriers, even with "MR-conditional" devices because these devices are not "MR-safe". A specific programing of the device in "MR-mode" and monitoring patients during MRI remain mandatory for all patients with a CEID. A standardized patient workflow based on an institutional protocol should be established in each institution performing such examinations. This joint position paper of the Working Group of Pacing and Electrophysiology of the French Society of Cardiology and the Société française d'imagerie cardiaque et vasculaire diagnostique et interventionnelle (SFICV) describes the effect and risks associated with MRI in CEID carriers. We propose recommendations for patient workflow and monitoring and CEID programming in MR-conditional, "MR-conditional nonguaranteed" and MR-nonconditional devices.

Antimicrobial resistance (AMR) continues to threaten global health. Although global and national AMR action plans are in place, infection prevention and control is primarily discussed in the context of healthcare facilities with home and everyday life settings barely addressed.\ud \ud As seen with the recent global SARS-CoV-2 pandemic, everyday hygiene measures can play an important role in containing the threat from infectious microorganisms.\ud \ud This position paper has been developed following a meeting of global experts in London, 2019. It presents evidence that home and community settings are important for infection transmission and also the acquisition and spread of AMR. It also demonstrates that the targeted hygiene approach offers a framework for maximizing protection against colonization and infections, thereby reducing antibiotic prescribing and minimizing selection pressure for the development of antibiotic resistance. If combined with the provision of clean water and sanitation, targeted hygiene can reduce the circulation of resistant bacteria in homes and communities, regardless of a country's Human Development Index (overall social and economic development). Achieving a reduction of AMR strains in healthcare settings requires a mirrored reduction in the community.\ud \ud The authors call upon national and international policy makers, health agencies and healthcare professionals to further recognize the importance of targeted hygiene in the home and everyday life settings for preventing and controlling infection, in a unified quest to tackle AMR.

Purpose Current trials on adjunctive treatment with antiseizure drugs often do not reveal results which are relevant for clinical practice. Method Therefore, an interdisciplinary group of German experts discussed a new framework for future antiseizure drug (ASD) trials in adults. This group included members of the executive board of the German Society of Epileptology, of the German institutes for health technology assessment (HTA), of patient organizations and of drug manufacturers. Agreement was reached by consensus decision making after intensive discussion of the findings of a narrative review of the current literature. Results The group jointly recommends that ASD trials in adults should be based on and include relevant patient groups, e.g. elderly patients and patients with relevant co-morbidities, should adopt a study duration of at least 12 months, should avoid placebo arms, should include active comparators of clinical relevance, may be designed as open label trials with blinded outcome measurements, should focus on patient relevant outcomes that reflect the impact of benefits and harms of treatments on daily living, such as seizure freedom and seizure severity as well as retention rate, functional outcomes and quality of life as compound measures, and should avoid arbitrary and non-sensitive primary endpoints such as dichotomized changes in seizure frequency. Conclusions This paper focused on improved head-to-head trials on adjunctive treatment with antiseizure drugs. The group welcomes any further work and discussion to enhance future studies which can be applied to the entire spectrum of potentially meaningful study populations and outcomes.

The ACR Incidental Findings Committee (IFC) presents recommendations for managing adnexal masses incidentally detected on CT and MRI. These recommendations represent an update of those provided in our previous JACR 2013 white paper. The Adnexal Subcommittee, which included six radiologists with subspecialty expertise in abdominal imaging or ultrasound and one gynecologist, developed this algorithm. The recommendations draw from published evidence and expert opinion and were finalized by iterative consensus. Algorithm branches successively categorize adnexal masses based on patient characteristics (eg, pre- versus postmenopausal) and imaging features. They terminate with a management recommendation. The algorithm addresses most, but not all, pathologies and clinical scenarios. Our goal is to improve quality of care by providing guidance on how to manage incidentally detected adnexal masses.

Resumen Introduccion La pandemia por COVID-19 ha conllevado la suspension de la actividad programada en la mayoria de las Unidades de Endoscopia de nuestro medio. El objetivo del presente documento es facilitar el reinicio de la actividad endoscopica electiva de forma eficiente y segura. Material y metodos Se formulo una serie de preguntas consideradas de relevancia clinica y logistica. Para la elaboracion de las respuestas, se realizo una busqueda bibliografica estructurada en las principales bases de datos y se revisaron las recomendaciones de las principales instituciones de Salud Publica y de endoscopia digestiva. Las recomendaciones finales se consensuaron por via telematica. Resultados Se han elaborado un total de 33 recomendaciones. Los principales aspectos que se discuten son: 1) la reevaluacion y priorizacion de la indicacion; 2) la restructuracion de espacios, agendas y del personal sanitario; 3) el cribado de la infeccion, y 4) las medidas de higiene y los equipos de proteccion individual. Conclusion La AEG y la SEED recomiendan reiniciar la actividad endoscopica de forma escalonada, segura, adaptada a los recursos locales y a la situacion epidemiologica de la infeccion por SARS-CoV-2.

Cancer-related cognitive decline (CRCD) may have particularly significant consequences for older adults, impacting their functional and physical abilities, level of independence, ability to make decisions, treatment adherence, overall quality of life, and ultimately survival. In honor of Dr. Hurria's work we explore and examine multiple types of screening, assessment and non-pharmacologic treatments for CRCD. We then suggest future research and clinical practice questions to holistically appreciate the complexity of older adults with cancer's experiences and fully integrate the team-based approach to best serve this population. (C) 2019 Elsevier Ltd. All rights reserved.

In present investigation, electroless Ni-P-SiC/Ni-P-TiO2-ZrO2 nano-composite platings have been deposited upon mild steel substrate (AISI 1040). A homogeneous and consistent allocation of SiC, TiO2 and ZrO2 nano-particles into EL Ni-P matrix is recognized in as plated and heated (400°C) coupons respectively through SEM and EDAX methods. The investigated coupons exhibited resistance against corrosion in order as: 254SMO > SS2205 > Ni-P-TiO2-ZrO2 as-plated > Ni-P-TiO2-ZrO2 heat treated > Ni-P-SiC as-plated > Ni-P-SiC heat treated > SS316L. The corrosion resistance seems too dependent upon Cr, Mo and N content and hence correlate well with the PRE number of the respective alloys. The conventional materials of construction SS 316L are not suitable for both C and D washers. Avesta 254SMO shows immunity to attack in these environments. On the basis of corrosion resistance, mechanical properties and cost comparison, Avesta 254 SMO seems acceptable material for gaseous phase of C and D washers while duplex stainless steel 2205 and Ni-P-SiC/Ni-P-TiO2-ZrO2 as-plated and heated coatings seems acceptable for the other application in these washers.

This document was prepared thanks to the collective expertappraisal, carried out by the Anses’expert group‘GECUCovid-19’(ANSES opinion 2020-SA-0037), chaired by Sophie Le Poder and whose members for the animal health component are cited in the authors.; International audience; In late December 2019, an outbreak of clustered cases of pneumonia associated with a novel coronavirus was reported by the Chinese authorities to the World Health Organization (WHO). Several initial confirmed cases were linked to a wetmarket selling live animals and seafood products in Wuhan(Hubei province), China (Huang et al.,2020). On 30 January 2020, the WHO declared the outbreak a Public Health Emergency of International Concern. On 11 February 2020, the causative pathogen was officially named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), responsible for Coronavirus Disease 2019 (COVID-19) (DuToit, 2020). Severe Acute Respiratory Syndrome Coronavirus 2 is mainly transmitted from person to person, by direct or indirect contact, through infectious microdroplets emitted wheninfected individuals spit, sneeze or cough (Bernard Stoecklin et al.,2020). The massive circulation of this new pandemiccoronavirus with a probable zoonotic origin raised questions on its ability to spillover to animal species and on the potential consequences of such events on both animals and humans. This public health concern came to the attention of animal health authorities given the close contacts between humans and domestic animals. Therefore, in France, the French Agency for Food, Environmental and Occupational Health and Safety (ANSES) established an Emergency Collective Expert Appraisal Group (Groupe d’Expertise Collective d’Urgence, GECU‘Covid-19’). The GECU ‘Covid-19’ urgently convened on 4 March 2020 and 8 April 2020 to conduct an evaluation of the potential role of domestic animals in the ongoing COVID-19 pandemic.

Background In Victoria, Australia, public hospitals are administered through a system of devolved governance. Overall, Victoria's public health system has a record of good performance when comparing measurable safety outcomes to the rest of Australia. However, in 2015 a cluster of preventable perinatal deaths were identified at a health service in Melbourne's outer fringes. Questions What were the factors that contributed to these preventable deaths, and what were the outcomes of the four key inquiries commissioned by the Victorian government after the identification of the cluster? What can be learnt by comparing this crisis in one Victorian health service to similar events at other health services in Australia and the United Kingdom? Methods This paper discusses the crisis at the Victorian health service and expands on the factors that contributed to the crisis, the inquiries, subsequent recommendations, and the response from the Victorian state government. Similarities between this case and others in Australia and the United Kingdom are discussed. Findings A common theme in the four inquiries into the crisis at the health service in Victoria was that inadequate clinical governance was a key factor that led to these events. As a result, a number of significant changes were implemented across the state to improve patient safety across all areas of health care. When comparing this Victorian crisis to similar events at other health services across the world, inadequate clinical governance consistently appears as a key contributing factor to poor clinical outcomes. Discussion All cases discussed had a delay in the identification of clusters of poor clinical outcomes. This was found to be a direct result of inadequate clinical governance structures at both a local and government level. Conclusion A robust clinical governance framework that is enacted at both the government and the health organisation level is essential to deliver high quality and safe patient care.

Background Over the last number of years, the healthcare system has become more complex in managing increasing costs and outcomes within a defined budget. To be effective through reform, especially moving forward from the COVID-19 pandemic, healthcare leaders, specifically in nursing, have an increased need for business acumen beyond traditional leadership and management principles. Aim This paper examines the concept of business acumen in the profession of nursing, specifically for managers and higher nurse leaders, establishing whether these skills are optional or essential. Discussion Nurses learn and develop broad skills in leadership and management, but less specifically about business or the broader system. With a contemporary Australian health system aiming to be more effective, nurses may require a greater level of business acumen to adequately understand the mechanics of business decision making in the system when designing care models, as well as representing the business potential of nursing in balance with clinical outcomes through reform. Conclusion The modern nurse, in addition to clinical skills, may need a foundational understanding of business evolving throughout their career, to maximise innovative growth across the system, in meeting the healthcare needs of our community now and into the future. Without a foundation level of business acumen and an understanding of the system across the profession, nurses may not be empowered with their full potential of being a strong voice influencing health system reform.

Objectives Unlike the technological advances in cross-sectional imaging, the adoption of CR and DR has been relatively overlooked in terms of the additional radiographer skills and competences required for optimal practice. Furthermore, projection radiography is often referred to as basic, plain or other words suggesting simplicity or entry-level skill requirements. Radiographers’ professional identity is connected with the discourse expressed via the language used in daily practice and consequently, if the perception of projection radiography is regarded as simple practice not requiring much reflection or complex decision-making, apathy and carelessness may arise. The purpose of this narrative review was to raise projection radiography from its longstanding lowly place and re-position it as a specialist imaging field. Key findings Danish pre-registration radiography curricula contain little mention of projection radiography and a low proportion (n = 17/144; 11.8%) of Danish radiography students chose to focus on projection radiography within publicly available BSc. theses between 2016 and 2020 as compared to topics related to CT and MRI (n = 60/144; 41.7%). Conclusion By changing how we as the profession perceive the role and position of projection radiography, we can start to rebuild its lost prestige and demand a greater, more detailed and clinically relevant educational offering from academic partners. For this to commence, the language and terminology we use to describe ourselves and tasks undertaken must reflect the complexity of the profession. Implications for practice Regardless of imaging modality, every patient should be assured that a radiographer with expertise in acquiring images of diagnostic quality undertakes their examination. Reclaiming the prestige of projection radiography may lead students and radiographers to recognize projection radiography as a demanding specialist field for the benefit of the patients.