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The short-term mortality and rehospitalization rates after admission for acute heart failure (AHF) remain high, despite the high level of adherence to contemporary practice guidelines. Observational data from non-randomized studies in AHF strongly support the in-hospital administration of oral evidence-based modifying chronic heart failure (HF) medications (i.e., b-blockers, ACE inhibitors, mineralocorticoid receptor antagonists) to reduce morbidity and mortality. Interestingly, a well-designed prospective randomized multicenter study (PIONEER-HF) showed an improved clinical outcome and stress/injury biomarker profile after in-hospital administration of sacubitril/valsartan (sac/val) as compared to enalapril, in hemodynamically stable patients with AHF. However, sac/val implementation during hospitalization remains suboptimal due to the lack of an integrated individualized plan or well-defined appropriateness criteria for transition to oral therapies, an absence of specific guidelines regarding dose selection and the up-titration process, and uncertainty regarding patient eligibility. In the present expert consensus position paper, clinical practical recommendations are proposed, together with an action plan algorithm, to encourage and facilitate sac/val administration during hospitalization after an AHF episode with the aim of improving efficiencies of care and resource utilization.

In 2021, the International Council on Large Electric Systems (CIGRE) will celebrate its centenary. CIGRE Sessions are traditionally held face-to-face in Paris once every even-numbered year. However, in 2020, in response to the coronavirus pandemic, the organizers of the 48th CIGRE Session decided to hold a virtual meeting for experts, specialists, engineers, and researchers from all over the world. The result was an e-session that included engaging seminars, tutorials, and discussions. At the virtual meeting, participants discussed various problems and challenges currently affecting all areas of the energy sector. Current pressing issues include the development of informative diagnostic techniques for oil-filled equipment, as well as the potential applicability of environmentally friendly biodegradable synthetic and natural esters for use as liquid insulation in high-voltage equipment. This review presents the latest research, practical solutions and reports on the experience of applying new techniques and novel liquid insulating materials. Valuable and up-to-date information in these fields is provided by experts and specialists from all over the world.

The pulp and paper industry is one of the major consumers of water. Pulp and paper industrial wastewaters usually contain halogenated organic materials, because general use is made of chlorine-containing compounds as bleaching agents during pulp and paper manufacture. Kraft pulping is the most common commercial chemical delignification procedure. Chlorination is generally the first stage in kraft pulping and during this treatment phase, chlorinated organic compounds are produced. The chlorinated substances are extracted with dilute alkali from the pulp in the subsequent extraction phase. Chloro-organic compounds tend to persist in nature because of their inherent recalcitrance; they are often toxic to aquatic live; many are genotoxic and have the potential to migrate widely throughout the ecosystem, ultimately accumulating in the fatty tissues of organisms. Legislation has been introduced to limit the levels of these toxic compounds in effluents. Additionally, during bleaching treatments chromophoric, highly oxidized, polymeric lignin/chlorolignin derivatives are formed that give rise to a dark color in the effluent. The color poses an aesthetic problem and contributes to the biological oxygen demand. Several methods have been attempted for decolorization and detoxification of bleached kraft effluents. These include physicochemical and biotechnological methods. The problems underlying the physicochemical treatments are those associated with cost and reliability. Biotechnological methods have the potential to eliminate/ reduce the problems associated with physicochemical methods. This article reviews the research on the use of Biotechnological methods for treatment of pulp and paper mill effluents. The progress made and the further scope are also discussed.

The paper manufacturing process has several stages - Raw material preparation and handling, Pulp manufacturing, Pulp Washing and Screening, Chemical recovery, Bleaching, Stock Preparation, and Papermaking. Paper production is basically a two-step process in which a fibrous raw material is first converted into pulp, and then the pulp is converted into paper. The harvested wood is first processed so that the fibers are separated from the unusable fraction of the wood, the lignin. Pulp making can be done mechanically or chemically. The pulp is then bleached and further processed, depending on the type and grade of paper that is to be produced. In the paper factory, the pulp is dried and pressed to produce paper sheets. Post-use, an increasing fraction of paper and paper products is recycled. Nonrecycled paper is either landfilled or incinerated.

The author certifies that he, or any member of his immediate family, has no funding or commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research ® editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR ® or the Association of Bone and Joint Surgeons®.

PURPOSE: The purpose of the study is to review all peer-reviewed published reports of women receiving ovarian tissue transplantation (OTT) with frozen/thawed tissue (OTC) with respect to age, diagnosis, transplantation site, fertility outcome, and potential side effects, including data from all women in the Danish program. METHODS: A systematic review of the literature was performed in PubMed combined with results from all patients who had received OTT in Denmark up to December 2017. RESULTS: OTT has been reported from 21 different countries comprising a total of 360 OTT procedures in 318 women. In nine women, malignancy was diagnosed after OTT; none were considered to be directly caused by the OTT. Despite a potential under reporting of cancer recurrence, there is currently no evidence to suggest that OTT causes reseeding of the original cancer. Renewed ovarian endocrine function was reported in 95% of the women. Half of all children born following OTT resulted from natural conception, and newborns were reported to be healthy except for one neonate with a chromosome anomaly with a family disposition. Women who conceived after OTT were significantly younger than those who failed. CONCLUSION: This study found no indications of sufficient numbers of malignant cells present in the ovarian tissue to cause recurrence of cancer after OTT. Further, it is unlikely that OTC affects the well-being of children born. OTC is now an established method of fertility preservation in Denmark with public reimbursement. The current data encourage that women who require gonadotoxic treatment should be offered an individual evaluation considering fertility preservation. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10815-018-1144-2) contains supplementary material, which is available to authorized users.

In July 2007, IBM and Cambridge University’s Institute for Manufacturing (IfM ), in conjunction with BAE Systems, convened a group of leading academics and senior industrialists in a two-day symposium to address the critical questions facing the emerging field of Service Science , Management and Engineering (SSME ). The meeting, together with a consultation process involving over a hundred international respondents, created a white paper for universities, businesses and governments globally (IfM and IBM 2008). The report called for (1) the advancement of SSME as a distinct subject of research and education through intensive collaboration across disciplines, and (2) the creation of national Service Innovation Roadmaps (SIR) to double investment in service research and education worldwide by 2015. Since the white paper was released, exciting progress has taken place; many universities have started SSME courses while various governments released SIR reports (see Appendices I and II for lists of such initiatives). In the remainder of this chapter, we provide an updated summary of the white paper and revisit its original recommendations for SSME stakeholders.

This chapter examines the short term production, transportation and inventory planning problems encountered in the fine-paper industry. After positioning the problems in the context of a general supply chain planning system for the pulp and paper industry, a comprehensive synchronized production-distribution model is gradually developed. First, a model for the dynamic lot-sizing of intermediate products on a single paper machine with a predetermined production cycle is proposed. The model also plans the production and inventory of finished products. Then, we consider the lot-sizing of intermediate products on multiple parallel paper machines with a predetermined production sequence. Finally, simultaneous production and distribution planning for a single mill multiple distribution centers network is studied by considering different transportation modes between the mill and its Distribution Centers (DCs).

In the context of sustainable development, the assessment of the role the paper industry is of paramount importance. In the last years, the efforts of the paper industry towards ecologically sustainable paper recycling have faced growing problems of waste management since recovered paper processing leads to the production of considerable amount of waste (sludge) requiring disposal. The work outlines the current state of the utilisation of paper sludge for energy conversion. Focus of the paper is the assessment of the environmental feasibility of energy recovery from paper sludge associated with toxic emissions (like NOx, SO2, N2O, chlorinated organic compounds); the fate of some toxic metals (like Hg, Pb, Cd, Zn, Mn) deriving from dyes, fillers, and toxic pigments is discussed based on new research combustion data. The environmental impact of burning paper sludge is discussed showing the interdependence between sludge properties and combustion conditions. Recent data concerning co-combustion of paper sludge, particularly in conjunction with different biomass fuels (like wood and straw), are reported. Differences related to usage of paper sludge as a fuel in paper mill boilers and industrial power plants and their economic implications are presented. Future possible scenarios for paper sludge utilisation in energy recovery are also discussed.

The pulp and paper industry is currently faced with the challenge of substantially reducing the discharge of contaminants to the receiving environment. Water is of primary importance in the paper making process. The pulp and paper industry has been a large user of fresh water in comparison to several other manufacturing industries. Continuous progress has been made by the pulp and paper industry in reducing the fresh water use because of growing environmental concerns and stricter government regulations. Water use reduction in a paper mill has been accomplished primarily by closing up the water system. Water system closure, however, results in an increased concentration of suspended, dissolved and colloidal materials in the system, which in turn could result in a poor quality of paper and operational problems. Because of the solid buildup problems, paper mills are looking for alternative processes for internal treatment of water. Among the alternative processes, membrane separation process is getting an ever-increasing acceptance.

Although the pulp and paper industry is not part of Chemical Manufacturing, it is one of the major divisions of the chemical process industries. Containing some interesting chemistry, this industry employs many chemists and chemicals. It takes over 400 lb of chemicals to make 1 ton of paper.

We determine a duality between broadcast and multiple access channels that can be used to obtain the capacity region and optimal transmission strategy for one channel based on the capacity-achieving transmission strategy and region for the dual channel. This duality result in applicable to additive Gaussian noise and fading channels for several different notions of fading channel capacity, including ergodic capacity, outage capacity, and minimum rate capacity. We show that duality can be used to obtain any of these capacities for the fading broadcast channel from the same capacity on the dual MAC channel, and vice versa. We then apply this general result to obtain the minimum rate capacity of the fading multiple access channel, which also yields the ergodic and outage capacity as special cases. Next we turn our attention to broadcast channels with multiple antennas at the transmitter and receiver (the MIMO channel). Since this channel is in general non-degraded, its capacity region remains an unsolved problem. We establish a duality between the achievable region of the MIMO broadcast channel using Costa’s “dirty-paper” coding and the capacity region of the MIMO multiple-access channel, which is easy to compute. We also show that the dirty paper achievable region yields the sum-rate capacity of the MIMO broadcast channel.

The pulp and paper industries have recently devoted considerable research, at some cost, to the application of biotechnology to solve environmental problems associated with paper production. These problems relate mainly to the formation of organochlorides produced by bleaching of wood pulp.

A s the world’s general-interest orthopaedic journal, Clinical Orthopaedics and Related Research takes seriously its obligations to help support and disseminate research from scientists the world over. Musculoskeletal injury and illness do not respect political borders, and so CORR is proud to focus global expertise on global problems, and share the solutions with a truly global readership. Between 2012 and 2015, consumption of CORR’s content—as measured by downloads—has nearly doubled. In 2015, readers downloaded this Journal’s articles about 2 million times; some 60% of this usage came from outside North America. The research we publish, likewise, is global in origin; about half of CORR’s papers come from non-US centers. Our diverse editorial team includes more than two dozen international editors. This is critically important to us; cultural issues matter, local knowledge is invaluable, and specific editorial expertise about the patient populations surveyed helps us—and our readers—get the most out of the manuscripts we receive. We feel strongly that solving problems affecting all the world’s citizens calls for research from all around the world. With that in mind, we are proud to sponsor—and pleased to announce the winners of—a number of awards that help promote research in regions where the scientific infrastructure is still developing. The winners of the 2015 CORR Best-paper Awards for China and Latin America were chosen from among those papers published electronically in the Journal in the last 12 months, and they represent some can’t-miss reading. The winner of the CORR Bestpaper from China Award for 2015 came from Lanzhou University in northwest China, and is titled ‘‘Does Arthroplasty Provide Better Outcomes Than Internal Fixation At Midand Long-term Followup? A Meta-analysis’’ (DOI: 10.1007/s11999-015-43453). This paper by Jiang and colleagues [3] is not the first meta-analysis on femoral neck fracture treatment. In contrast to so many other important therapeutic dilemmas in orthopaedic surgery where the evidence is scanty, numerous well-designed randomized trials have compared surgical treatments for hip fractures. As such, earlier reports have pooled data on this subject [2, 4]. But this award-winning paper is special because it evaluates studies presenting longer-term followup using methods that are uncommonly robust, and so its conclusions—the functional benefits of arthroplasty are not offset by any discernible increase in mortality associated with that larger procedure—appear definitive. This is an enormous clinical problem, and we congratulate the authors on a job well done. The author certifies that he, or any members of his immediate family, has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request. The opinions expressed are those of the writers, and do not reflect the opinion or policy of CORR or The Association of Bone and Joint Surgeons.

It was not until the middle of the nineteenth century that the paper industry started to use wood pulp for making paper. Before this, timber had been used for many other purposes—building ships, houses, and for making furniture and boxes, but the beginning of the paper-making industry using wood pulp caused great changes in the practice of cutting trees.

At present, the most common company level inventory performance yardstick is inventory costs in relationship to revenue. This yardstick does not adequately reflect differences in the scope of vertical integration between different companies. The first objective is to develop a suitable yardstick for inventory performance that could enable strategic or company level screening for the need for improvement. This new yardstick is then tested with pulp and paper industry statistics and annual report data.

The ISO standardization project “Conceptual Schema” ended in 1987 after publishing “TR9007: Concepts and terminology for the conceptual schema”. That was a technical report and was not an International Standard.

In this position statement on the question, How far harmonisation? I expresses the view that, in the context of our profession, our theories, as far a possible, must meet the stringent quality criteria which philosophers of science impose on other disciplines that deal with problems in domains of inter-subjective activity, such as the natural sciences. I also show that our present ‘tunes’ are played on almost one note, making any harmony rather thin and uninteresting. Sometimes I despair of our profession ever abandoning old, demonstrably weak ideas (conceptualist or naive objectivist ontologies, for example) or of ever raising its eyes above the technical layer of problems to face the other half of the issues before us. However, I justify my long-term optimism because I have not encountered any intrinsic difficulty in meeting the most exacting criteria of scientific quality in dealing with information systems. Only a general unwillingness to apply those criteria obstructs our progress.

The era of employing a grand monolithic approach to develop data processing systems is coming to an end. Systems developers are now realizing that there are many different ways to specify and program systems. While the traditional IF… THEN, DO WHILE approach is popular in many situations, it is far from being the best or only way. For instance, a medical diagnosis system might be implemented best with rules and an inference engine. In other situations, conditioning a neural network or genetic algorithm could produce the desired results much more efficiently. Elsewhere, a predicate logic or functional expression would be the best way to specify an application. In other words, if a system can be specified in many ways, why not choose the mix of approaches best for the problem at hand? Why be bound to only one way of doing things, when a combination of approaches might produce a result that is more economical, accurate, understandable, and elegant?

The American College of Medical Toxicology and the National Association of Medical Examiners convened an expert panel to generate evidence-based recommendations for the practice of death investigation and autopsy, toxicological analysis, interpretation of toxicology findings, and death certification to improve the precision of death certificate data available for public health surveillance. The panel finds the following: 1. A complete autopsy is necessary for optimal interpretation of toxicology results, which must also be considered in the context of the circumstances surrounding death, medical history, and scene findings. 2. A complete scene investigation extends to reconciliation of prescription information and pill counts. 3. Blood, urine, and vitreous humor, when available, should be retained in all cases. Blood from the femoral vein is preferable to blood from other sites. 4. A toxicological panel should be comprehensive and include opioid and benzodiazepine analytes, as well as other potent depressant, stimulant, and anti-depressant medications. 5. Interpretation of postmortem opioid concentrations requires correlation with medical history, scene investigation, and autopsy findings. 6. If death is attributed to any drug or combination of drugs (whether as cause or contributing factor), the certifier should list all the responsible substances by generic name in the autopsy report and on the death certificate. 7. The best classification for manner of death in deaths due to the misuse or abuse of opioids without any apparent intent of self-harm is "accident." Reserve "undetermined" as the manner for the rare cases in which evidence exists to support more than one possible determination.

This paper considers health in cities from the perspective of complex adaptive systems. This approach has a number of important implications for intervention that do not emerge in traditional accounts of cities and health. The paper reviews various accounts of the nature of cities and of health as well as the traditional urban health and Healthy Cities movements. It then provides a framework for intervention and tests it against an actual case study. It concludes that a complex adaptive systems framework opens up fresh possibilities for improving health in urban contexts.

This paper addresses the issue of requirements of University ITEM systems. A guide to characteristics is presented which is supported by two international cases.

The Directorate-General Information Society and Media, part of the European Commission, supports the development and use of information and communication technologies (ICT) for the benefit of all citizens and for underpinning European competitiveness and growth. Its objective is to stimulate the continued development of an all-inclusive information society, and the assurance of trust and security is pivotal to this development. Security and privacy protection are moving targets, and bringing trust into the networked society is an open-ended, permanent and multistakeholder endeavour.

The grammage, ie., mass per unit area, is one of the most important quality factors in paper industry. The grammage of the paper web is constantly monitored during the paper manufacturing, and the ever rising pulling speeds and wider reels demand more accurate and faster methods to monitor the grammage changes in both the cross direction and in the machine direction. Nowadays, the standard method is to use radioactive beta rays, which method was invented in 1950s. The beta radiation is attenuated as a function of sample grammage, but the temperature of surrounding air, and the atomic number of the sample also affect the measured intensity of the beta rays. These effects can be conquered by calibration and by monitoring the temperature. But one technical difficulty remains, though. Only one measuring head is traversing across the paper web, which is quite a slow method to achieve the cross profile of the paper web [1–2].

The paper is a cellulose fiber base material and consequently it is heterogeneous at different scales. In addition, the paper exhibits two preferential axes of fiber orientation, from which it is easy to define the characteristics of an elementary bi-dimensional fiber network. A third axis, perpendicular to the first, corresponds to the stacking direction of individual networks. Following the example of composite layered media modeling, the paper presents three perpendicular planes of material symmetry. In other words, the paper is commonly assumed to be an orthotropic material [1]. The paper presents also various mechanical behaviors such as elasticity, viscoelasticity, non-linear elasticity. Furthermore the paper properties depend on both the temperature and the hygrometry [2]. At last, paper materials exist in the form of sheets; their thickness (100 µm on average) is very small beside their other dimensions.

Office settings in the 21st Century will undoubtedly take on a different character from what we see today. The development of computer and telecommunications equipment over the past four decades allows almost unlimited options for organizations in creating new working arrangements. The predominant use of paper as the media for recording, storing and transmitting information is now giving way to new electronic forms. Not only is information technology providing faster access to, and easier routing of documents, it is enabling new approaches, such as workflow mapping, task sequence optimization and flexible worker scheduling. These innovations are likely to dramatically change the nature of work. Yet, current trends are paradoxical — the paper industry reports record use of its parchment as managers and workers wonder they improve work in a new electronic world.

Three main research questions are identified for higher education to effectively address Lifelong Learning. Lifelong Learning is an educational issue, because it is pulled by the political agenda, by economical, social, civic, cultural, personal and also Information and Communication Technology (ICT) developments. From an employment related perspective ‘students’ in Lifelong Learning are knowledge workers (knowledge creators) and skills workers (knowledge appliers), basically learning at the workplace. From the social and civic perspective ‘students’ are people learning in ‘learning communities’. From a personal perspective students are persons following initial education to be effective in the workplace (employment related) and in society (community related). The role of ICT is one of empowerment, enhancement of creativity and support. Lifelong Learning is demand driven, flexible learning that will force educational institutions to change. In this special attention should be given to the relevance of Lifelong Learning for countries with emerging knowledge intensive economies.

The problem of balancing coherence and flexibility in collaborative information system design is approached here with two pairs of concepts. Boundary objects can support communication for perspective taking between communities of practice. Conscripting devices can support communication for perspective making within a community of practice. These theoretical lenses are used to study the uses of the technical specification in paper machine projects. Our study showed that as a boundary object it provided enough flexibility to allow negotiations, and sufficient local structure, for carrying out work in both communities of practice, the customer and the manufacturer. As a conscription device in the relatively virtual manufacturer project team, however, it proved to be problematic, due to the unidirectional nature of its construction, its diminishing importance in the web of conscripting objects, and its inconvenience as a means for learning. In search for balancing coherence and flexibility, the issues identified seemed to relate to acknowledging the dialectics of perspective making and perspective taking with boundary objects and conscription devices, to the openness and modifiability of these objects, and to the bounded transparency of these processes.

Drawing processing has been researched but far beyond satisfaction for many years. An orientational objective is set in this paper as facilitating the reuse of old paper drawings in new CAD/CAM systems, and several ways to achieve it are also presented, in which primitive recognition and 2-D drawing understanding are still main problems.

Studies on aetiology are typically designed to establish links between determinants and outcomes. We have also included in this group studies that describe iatrogenic or harmful effects of medical interventions.

Studies on prognosis are characterised by observations of different outcomes of a disorder. They are focused on the spectrum of severity, on a certain stage of a disorder, etc. Their results are used in practice to predict future disease events.

In this chapter we discuss some issues about the validity, importance and usefulness of studies on treatment. Here, we work with a broad concept of treatment that is inclusive of primary, secondary and tertiary preventive interventions.

The remit of Working Group 8.2 (WG 8.2) is officially identified by the International Federation for Information Processing (IFIP) as “the interaction of information systems and the organization” and its “Scope and Aims” statement (http://www.ifipwg82.org/) talks of “building theories about the role and impact of IT in specific organizational contexts.” Thus, while WG 8.2 may not be the only group of IS researchers concerned with understanding the relationship between social context and the development and use of information systems, for example, WG 8.1 (“Design and Evaluation of Information Systems”) and WG 9.1 (“Computers and Work”) may be expected to share similar interests, the Group would seem a potentially important forum for research that seeks to address the social dimension of IS. To the extent, moreover, that interest in social context may be seen to be characteristic of the concerns of interpretative research methods, the growing acceptance of such methods in mainstream journals such as MIS Quarterly could be seen to place WG 8.2 in the vanguard of the IS field.

While methods for retrieving documents from large information repositories have improved a lot, presentation of the retrieved documents still leaves a lot to be desired. Important information on documents is usually presented as a textual listing of available metadata attributes such as document size, author information, date of creation, and so on. This requires the user to read and abstract from the presented metainformat ion.

Boron Neutron Capture Therapy (BNCT) can only be conceived in the framework of a large multidisciplinary team. Clinical papers presented at the Fifth International Symposium on Neutron Capture Therapy for Cancer can roughly be divided into 3 groups, according to the team to which the authors belong, each of which has its particular concerns, reflecting the level of advancement of the project. A number of papers stemmed from authors which were already applying BNCT to patients with intracranial tumors and melanomas,1-8 and these mostly reflected attempts to refine and improve the current treatment methods. An equal number stemmed from authors who intended to start clinical trials shortly,9-18 dealing with beam and treatment room design, quality control and clinical biodistribution of boron compounds, and protocol design. A small number of clinical papers dealt with those lesions, which may become candidates for BNCT, as well as with new boron compounds, preparing the future beyond intracranial tumors and melanomas, and beyond BSH and BPA.3,19,20

This paper argues that most workflow management support systems are vulnerable due to the single database architecture upon which they are based. Furthermore, the single server architecture creates a performance bottleneck when large quantities of workflows are being managed.

At long intervals the same question is raised: ‘Are we technicians, scientists, users of technology responsible for the problems that are caused by the introduction of technology?’ The answers given are not uniform, but the fact that the question is raised shows that we are beginning to realize that our technology is capable of, not only constructing the world, but destroying it as well. And we are becoming conscious of this destruction through the confrontation with environmental pollution, questions dealing with nuclear power, and more recently questions surrounding genetic engineering, such as DNA recombination, and the use of test-tube fertilization on older women.

In the context of this session on clinical implications there are four contributions on single motor unit studies. The first two of them use the technique of cross-correlation analysis between motor unit (MU) discharges recorded during steady voluntary contractions in human forearm muscles.

The job of the scientist is to discover, confirm, and communicate new knowledge. Writing research papers, as discussed in Chapter 8, is a prerequisite to communication, which includes presentations at meetings and publication in books and journals.

Paintings on the walls of caves inhabited by people thousands of years ago (Blakemore, 1988), illuminated manuscripts preserved from the Middle Ages, declarations of love carved on Victorian lace bobbins, the first attempts of four-year-old children to write their names; for thousands of years people have had a strong desire to make their mark, more or less permanently, on paper and other materials.

Those of us who believe that human welfare is significantly aided by technological progress have a clear motivation to accentuate the positive and to mitigate the negative consequences of technology. We thus share a common objective to allocate our limited societal resources effectively so as to improve public health and safety by minimizing real risks, both present and future.

Virus infections of the central nervous system (CNS) may result in the loss of myelin sheaths without axonal destruction. Severe neurological symptoms occur as a consequence of this phenomenon which is called primary demyelination. The sequence of events leading to primary demyelination during the course of viral infections of the CNS is only partially understood. Although it is well established that cytolytic infection of the Oligodendroglia cell can cause primary demyelination, mononuclear infiltrates in subacute and chronic courses of the disease indicate that immunological events may take part in this process (reviewed by Johnson (1)). For several reasons, investigations into the dynamic interactions between virus infection of the CNS and the local immune response cannot be conducted in man. (1) Usually clinical specimens are restricted to cerebrospinal fluid which gives limited information about pathological events occuring in the brain parenchyma (2). It is not known at which time point of the preceeding systemic infection, the virus enters the brain and biopsies are taken too rarely and infrequently to understand the kinetics of the events (3). The general absence of genetic homogeneity in man complicates attempts to detect the influence of the immunogenetic background on the course of the disease. In contrast, intracerebral infections of rodents with the murine hepatitis virus JHM (MHV-4) are excellent models to study the relationships between virus-induced demyelination and the local immune response. Based on the work of Cheever (2), animal models of JHM virus-induced demyelinating encephalomyelitis have been developed in mice as well as in rats (3–5). In recent years striking similarities in the course of the infection in both rodents have been detected which might give the impression that these two models can substitute for each other. However, subtle but important differences do exist. Therefore, in the present review attempts are made to summarize and compare the knowledge about demyelinating encephalomyelitides in rats and mice, giving emphasis to the role of the local immune response in the brain.

Pulp and paper mill effluents are complex mixtures of dissolved lignin and cellulose degradation products and other substances extracted during the pulping process. The toxicity of these effluents to fish has been documented (Howard and Walden, 1971; Wande, 1976; Walden and Howard, 1977). A number of investigators have shown that effluents and process streams from pulp and paper mills are mutagenic in Salmonella (Ander et al., 1977; Eriksson et al., 1979; Douglas et al., 1980) and cause chromosome damage in mammalian cells (Douglas et al., 1980). Over 300 compounds have been identified in studies on various pulp and paper mill effluents (reviewed in CPAR, 1978). Because of the extensive use of chlorine in the bleaching process, many of these compounds contain chlorine substitutions. Since first chlorination-stage liquors are consistently among the most mutagenic by-products of the pulping process, it has been suggested that chlorinated substances are responsible for a major portion of the mutagenicity found (Bjorseth et al., 1979; Nestmann et al., 1979; Nestmann et al., 1980; McKague et al., 1981; Rapson et al., 1980).

The rapid growth and development of diagnostic ultrasound is best evident in the significant technical advances apparent in instrumentation and its resultant increased capabilities. Unfortunately parallel advances in camera systems and photographic systems have not as yet been as apparent. At the present time, Polaroid film is most widely used in diagnostic ultrasound because of its easy access and convenience. The rapid growth of ultrasonic units utilizing photographic film for permanent recording of images necessitates a reassessment of available films and photographic papers for this purpose. In an attempt to establish the most desirable film and photographic paper for ultrasonic purposes, evaluation of currently available photographic materials were reviewed. Before such a review is presented a brief summary of some basic photographic and ultrasonic principles is necessary.

The Sharīʿah affords considerable concern for human emotions, with its rulings seeking to remove the deliberate and accidental types of harm that may be inflicted on individuals or society. The principle of medical confidentiality protects patients’ dignity and avoids potential harm if otherwise practised. Texts from the Quran and Sunnah substantiate that unjustified disclosure of secrets is prohibited and whoever breaches confidentiality is to be punished. This paper explores the origins of Islamic ethical framework vis-a-vis dealing with privacy, particularly confidential information acquired by health professionals. For that, this paper attempts to explore various āyāt (Quranic verses) and aḥādīth (Prophetic traditions) related to privacy, and thus to analogically deduct various aspects of confidentiality in the context of medical ethics. As a result, it aims to discourse on key principles of medical confidentiality from an Islamic juristic perspective, discussing its types and conditions.

The increasing chronicity and multimorbidities associated with people living with HIV have posed important challenges to health systems across the world. In this context, payment models hold the potential to improve care across a spectrum of clinical conditions. This study aims to systematically review the evidence of HIV performance-based payments models. Literature searches were conducted in March 2020 using multiple databases and manual searches of relevant papers. Papers were limited to any study design that considers the real-world utilisation of performance-based payment models applied to the HIV domain. A total of 23 full-text papers were included. Due to the heterogeneity of study designs, the multiple types of interventions and its implementation across distinct areas of HIV care, direct comparisons between studies were deemed unsuitable. Most evidence focused on healthcare users (83%), seeking to directly affect patients' behaviour based on principles of behavioural economics. Despite the variability between interventions, the implementation of performance-based payment models led to either a neutral or positive impact throughout the HIV care continuum. Moreover, this improvement was likely to be cost-effective or, at least, did not compromise the healthcare system's financial sustainability. However, more research is needed to assess the durability of incentives and its appropriate relative magnitude.La creciente cronicidad y multimorbilidades asociadas con las personas que viven con el VIH han planteado importantes desafíos para los sistemas de salud en todo el mundo. En este contexto, los modelos de pago tienen el potencial de mejorar la atención en un espectro de condiciones clínicas. Este estudio tiene como objetivo revisar sistemáticamente la evidencia de los modelos de pagos basados ​​en el desempeño aplicados al dominio del VIH. Las búsquedas bibliográficas se realizaron en marzo de 2020 utilizando múltiples bases de datos y búsquedas manuales de artículos relevantes. Los artículos se limitaron a cualquier diseño de estudio que considere la utilización en el mundo real de modelos de pago basados ​​en el desempeño aplicados al dominio del VIH. Se incluyeron un total de 23 artículos de texto completo. Debido a la heterogeneidad de los diseños de los estudios, los múltiples tipos de intervenciones y su implementación en distintas áreas de la atención del VIH, las comparaciones directas entre diferentes estudios se consideraron inadecuadas. La mayoría de la evidencia se centró en los usuarios de la salud (83%), buscando afectar directamente el comportamiento de los pacientes basándose en los principios de la economía del comportamiento. A pesar de la variabilidad entre las intervenciones, la implementación de modelos de pago basados ​​en el desempeño generó un impacto neutral o positivo en todo el proceso de atención del VIH. Además, es probable que esta mejora sea costo-efectiva o, al menos, no comprometa la sostenibilidad financiera del sistema de salud. Sin embargo, se necesita más investigación para evaluar la durabilidad de los incentivos y su magnitud relativa apropiada.

Mass screening for congenital hypothyroidism in newborns has been developed because the irreversible mental retardation caused by this disorder can be prevented by early treatment. These programs include measurement of thyrotropin or total thyroxine (T4), or both, in dried blood samples. Measurement of total T4 is useful for detecting primary, secondary, and tertiary hypothyroidism, but gives false-positive results for subjects with abnormal concentrations of thyroxine-binding globulin (TBG), who do not need to be treated. Hence, we developed an enzyme immunoassay (EIA) and a radioimmunoassay (RIA) for measuring free T4 (FT4) in dried blood samples on filter paper.