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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.

Introduction The assessment of the risk of virus transmission through papers, such as postcards, is important. However, the stability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza A virus (IAV) on different types of papers is currently unknown. Investigation of the survival time of these viruses on different types of papers will provide insights into their risk of long-distance transport by postal items. Methods We evaluated the stability of SARS-CoV-2 and IAV, mixed with a culture medium, on the surface of postcards with various coatings, including plain paper (PP), inkjet paper (IP), and inkjet photo paper (IPP). The surface structure of each paper was microscopically assessed. Results The surface structures of PP, IP, and IPP varied greatly depending on the presence or absence, and type, of coat layer, regardless of the base material. IP and IPP surfaces were less conducive to virus survival than PP surfaces, because of the difference in surface shapes. The survival times of SARS-CoV-2 on each paper were approximately 59.8 (PP), 6.5 (IP), and 9.8 h (IPP), and significantly longer than those of IAV (10.3, 1.8, and 3.3 h, respectively). Conclusions The risk of SARS-CoV-2 transmission via paper, such as postcards, is significantly higher than that of IAV transmission. While PP, IP, and IPP have the same base material, their surface structures differ, which affects viral stability. The IP and IPP surfaces are less suitable for virus survival. This study provides novel insights into the risks of viral transmission via paper.

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.

A novel paper-based analytical device (PAD) was prepared and applied to determine the xanthine oxidase (XOD) inhibitory activity of Salvia miltiorrhiza extracts. First, polycaprolactone was 3D printed on filter paper and heated to form hydrophobic barriers. Then the modified paper was cut according to the specific design. Necessary reagents including XOD for the colorimetric assay were immobilized on two separate pieces of paper. By simply adding phosphate buffer, the reaction was performed on the double-layer PADs. Quantitative results were obtained by analyzing the color intensity with the specialized device system (including a smartphone, a detection box and sandwich plates). The 3D-printed detection box was small, with a size of 9.0 cm × 7.0 cm × 11.5 cm. Color component G performs well in terms of linearity and detection limits and thus was identified as the index. The reaction conditions were optimized using a definitive screening design. Moreover, a 10 % glycerol solution was found to be a suitable stabilizer. When the stabilizer was added, the activity of XOD could be maintained for at least 15 days under 4 °C or -20 °C storage conditions. The inhibitory activity of Salvia miltiorrhiza extracts was investigated and compared to that of allopurinol. The results obtained with the PADs showed agreement with those obtained with the microplate method. In conclusion, the proposed PAD method is simple, accurate and has potential for point-of-care testing. It also holds promise for use in rapid quality testing of medicinal herbs, intermediate products, and preparations of traditional Chinese medicines.

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.

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.

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.

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.

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.

The World Federation for Ultrasound in Medicine and Biology (WFUMB) is addressing the issue of incidental findings (IFs) with a series of publications entitled "Incidental Imaging Findings-The Role of Medical Ultrasound." IFs are less commonly encountered in the spleen than in many other abdominal organs but remain a frequent dilemma in clinical practice. A histological diagnosis is rarely necessary for patient management. Many IFs, such as secondary spleens and splenic cysts, are harmless and do not require any further investigation. The diagnosis of many other focal splenic lesions is, however, often problematic. The following overview is intended to illustrate a variety of incidentally detected spleen pathologies such as size variants, shape variants, secondary spleens, focal splenic lesions and splenic calcifications. It should aid the examiner in establishing the diagnosis. Moreover, it should help the ultrasound practitioner decide which pathologies need no further investigation, those requiring interval imaging and cases in which immediate further diagnostic procedures are required.

This paper aimed to modify the ignitability of the bagasse paper by using talc powder, 1,3-di-aniline-2,2,2,4,4,4-hexachlorocyclodiphosph(V)azane, and nanocellulose crystal. The formation of cellulose nanocrystals (CNCs) was detected using transmission electron microscopy (TEM), X-ray diffraction (XRD). Thermal analysis as thermal gravimetric analysis (TGA) of the specimens recorded the improvement of the highest % of ash residue at 750 °C compared to the untreated one. The shape of the flame spread was studied. The ignition properties were studied for the untreated and treated specimens by limiting oxygen index (LOI) and flame chamber (UL/94), which recorded enhancing compared to the untreated specimen. This improvement was recorded either by measuring the mechanical properties (tensile strength, burst strength, elongation, and elasticity) of the specimens. The current article showed that the treated specimen was recorded the highest values compared to the untreated one in all physical, mechanical, and ignition properties, so these treatment paper sheets may be used as fire-retardant packaging materials.

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.

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.

Recently, the interest in active packaging utilization has increased with population growth, food demand and new consumer trend like food delivery services. This new system, however, requires the use of additives to extend the food product quality and safety as well as in maintaining the shelf-life. This study was to prepare the antimicrobial paper from I. cylindrica coated anionic nanocellulose crosslinked cationic to create a system with the ability to actively control microbe growth in the packaging materials. The process involved pulping of I. cylindrica using semi-chemical and soda chemical method. The antimicrobial paper was prepared by printing the pulp suspension in 60 g/m2 grammage in mold followed by the spray of anionic nanocellulose and subsequent soaking of the paper in cationic solution. The results showed the I. cylindrica paper coated anionic nanocellulose crosslinked with H+ and Al3+ cations were successfully produced. The paper produced was also observed to have antimicrobial activity against Gram-negative of E. coli and S. typhi as well as Gram-positive of S. aureus and B. subtilis bacteria. Furthermore, the best coating method was found on antimicrobial paper coated anionic nanocellulose crosslinked Al3+ as evidenced by smoother and compact surface structure.

There is growing demand for simple to operate, sensitive, on-site quantitative assays to investigate concentrations of drug molecules in pharmaceutical preparations for quality assurance. Here, we report on the development of two colorimetric analysis methods for the study the antibiotic doxycycline hyclate (DOX) and the nasal decongestant oxymetazoline hydrochloride (OXY), in solution as well as in their respective formulations. We compare a UV/vis spectrophotometry method with a color change recorded on a microfluidic paper-based analytical device (μPAD). Detection is based on the pharmaceutical compounds coupling with diazotized 4-aminoacetophenone (DAAP) under alkaline conditions to produce colored azo-dye products. These azo-compounds were monitored by absorbance at 425 nm for DOX and 521 nm for OXY, with linear calibration graphs in the concentration range of 0.5–35 mg L−1 (DOX) and 1.0–40 mg L−1 (OXY) and limits of detection of 0.24 mg L−1 (DOX) and 0.32 mg L−1 (OXY). For the μPAD method, color intensity was measured from photographs and a linear increase was observed at concentrations from above approximately 15 mg L−1 for both compounds and up to 35 mg L−1 for DOX and 40 mg L−1 for OXY. The developed methods were also applied to the formulated pharmaceuticals and no interference was found from the excipient. Thus, the paper-based device provides an inexpensive, simple alternative approach for use outside centralized laboratories with semi-quantitative capability.

A novel all-in-one paper-based sampling concept for mass spectrometric bottom-up protein analysis is here demonstrated in a chip format integrating instant immunocapture, protein reduction, - alkylation and tryptic digestion all in-device. Conventional laboratory grade filter paper was coated with the polymer 2-hydroxyethyl methacrylate-co-2-vinyl-4,4-dimethyl azlactone (pHEMA-VDM) with a subsequent covalent immobilization of the monoclonal antibody E27 targeting the biomarker human chorionic gonadotropin (hCG). In-device protein reduction and alkylation was optimized with regards to reagent concentration and reaction pH. The sampling concept showed a high degree of performance between 10 and 1000 ng/mL (R2 > 0.99) by a five-point calibration curve sampled with hCG spiked to human serum samples and freshly collected whole blood samples, respectively. LOD (experimentally obtained at 100 pg/mL (2.64 pM/0.9 IU/L)) was demonstrated to be up to ten times lower with more than six times faster sample preparation than what has previously been reported for on-paper analysis of hCG in human serum samples.

The adulteration of herbal medicines by dexamethasone or prednisolone is regarded as a serious problem in many communities. Herein, a novel platform for the separation and quantification of both target steroids in herbal medicines based on electrochemical paper-based analytical devices (ePADs) has been created. The ePAD was composed of Whatman SG81 chromatography paper, 3D-printed devices and a commercial screen-printed electrode. Whatman SG81 silica-coated paper was used for the separation of dexamethasone and prednisolone based on the difference in their partition coefficients during the flow of the mobile phase. The optimal mobile phase was composed of 60% ethyl acetate in cyclohexane and required 7 min for separation. The separated steroids on the paper were then quantified by electrochemical detection using differential pulse voltammetry, in which the 3D-printed devices facilitated the measurement. Analytical detection ranges of 10–500 μg mL−1 were obtained for both dexamethasone and prednisolone (r2 = 0.988 and 0.994, respectively). The limits of detection for dexamethasone and prednisolone were 3.59 and 11.98 μg mL−1, respectively, whereas the limits of quantification were 6.00 and 20.02 μg mL−1, respectively. The amounts of both target steroids derived from real herbal medicine samples determined by the proposed method were comparable to those obtained with assays using standard high-performance liquid chromatography. In addition, a simple evaporation step can be used to increase the concentration of the samples before analysis. These ePADs are simple, low-cost, rapid, and very promising for on-site quantitative detection.

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.

Polygalacturonase (PG) activity in plants can serve as an important index for plant disease. However, the conventional method to detect PG activity is a complex process and requires a skilled technician and expensive analytical equipment. In this study, a paper-based colorimetric sensor was developed based on the principle of the ruthenium red (RR) dye method for easy and simple measurement of PG activity. The proposed paper-based sensor has a three-layer structure for detection of PG activity in samples. The sensor sensitivity was enhanced by optimizing the pH of the sodium acetate buffer used in polygalacturonic acid (PGA)-RR complex formation and the reaction temperature for PG and the PGA-RR complex. Further, for quantitative analysis of PG activity, Delta RGB analysis was conducted to detect color changes in the sensing window of the sensor. Results presented that the linear measurement range of the paper sensor was 0.02-0.1 unit with the limit of detection of 0.02 unit, which showed a similar detection range, but a lower detection limit, compared to the spectrophotometry. Furthermore, PG activity based on culture condition was measured using samples from Sclerotium cepivorum to verify the potential application of the developed paper-based sensor in the field. The measured activity showed no statistically significant difference from the values obtained from the spectrophotometry at 95% confidence level. Therefore, the paper-based colorimetric sensor can be used to predict plant diseases in Allium crops during the stage of pathogen invasion, potentially contributing to the improvement of crop production.

Rapid and simultaneous in situ detection of multi-components is extremely crucial for the real-time monitoring of nutrients in fruits. Herein, a facile and user-friendly poly(carboxybetaine methacrylate)-coated paper-based microfluidic device (pCBMA-μPAD) has been exploited to synchronously identify and semi-quantify vitamin C, glucose, sucrose and fructose in fruits. The pCBMA was successfully grafted from the surface of paper sensor using a convenient and robust method, which was confirmed by Fourier transform infrared spectroscopy (FT-IR) and X-ray photoelectron spectrometry (XPS). The superior hydrophilicity and ultra-low fouling of pCBMA endowed the pCBMA-μPAD with remarkably rapid response (3 min), high sensitivity, good linear relationship and low detection limit (LOD) (vitamin C: y = 33.809 + 5.175x, R2 = 0.993, LOD = 0.179 mmol/L; glucose: y = −0.113 + 30.066lg(x), R2 = 0.988, LOD = 0.095 mmol/L; sucrose: y = −5.334 + 34.858lg(x), R2 = 0.996, LOD = 0.097 mmol/L; fructose: y = 4.996 + 23.325lg(x), R2 = 0.994, LOD = 0.140 mmol/L). Furthermore, satisfactory results were yielded in the detection of these nutrients in 9 fruits, which were much agreed well with those obtained by spectrophotometry. Such a portable and versatile pCBMA-μPAD will profoundly shape the future of food analysis, especially for the assessment of food quality and nutrition in the process of agricultural production and marketing.

Graphene oxide (GO) paper is an attracting structural material because of its high stiffness and light-weight. In order to exploit the high strength and stiffness of individual GO nanosheet into GO paper, the fabrication process must be optimized. In this study we fabricated ultra-stiff and strong GO paper by directed-flow vacuum filtration and compared its mechanical properties under different loading conditions. We also explored the effect of cross-linking with borax, thermal annealing and sonication to further enhance mechanical properties. The stiffest GO paper reported here has a tensile modulus of 109.9 GPa and a flexural modulus of 45.7 GPa. We also found that the flexural modulus of GO paper is significantly lower than the tensile modulus because of interlayer shearing, micro-buckling and delamination during flexural deformation. The properties of GO papers therefore need to be carefully selected for mechanical structures where flexion is the major deformation. This study provides significant insights about improving mechanical properties of GO paper and selecting GO paper for different loading conditions.

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.

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.

Unprinting of paper can reduce multiple life-cycle stages in the recycling of paper to yield significant environmental impact. Laser-unprinting has been demonstrated for uncoated paper but causes significant damage to coated paper. This work explores a scalable optical (non-laser) process for unprinting coated paper. Printed coated paper is exposed to pulsed broad-spectrum Intense Pulsed Light (IPL) from a xenon lamp and the toner is then removed by dabbing gently with an ethanol wipe. While black toner is easily unprinted, unprinting of colored prints (red, blue, green) is best realized by incorporating an initial overprint of black toner. An unprinting throughput on the order of mm2/s is achieved. Three distinct regimes of unprinting are identified based on the extent of toner removal and damage of the paper. The optical properties of the unprinted paper, characterized via UV–Visible spectrophotometry, are correlated to these regimes to understand the potential for in-situ optical process monitoring. Scanning Electron Micrography and Fourier-Transform Infrared Spectroscopy are performed to understand the underlying mechanisms that govern the occurrence of the different unprinting regimes. Further, the potential impact of the developed approach on recycling of paper is discussed in the context of the capabilities of current optical unprinting approaches and the potential elimination of life-cycle stages in conventional paper recycling.

Made available in DSpace on 2019-10-06T17:04:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-06-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Development and application of a new, simple, inexpensive, and eco-friendly method is presented for the quantification of bumetanide in human urine samples for the detection of doping in sports. The method involves the use of a paper platform and digital image detection and is based on the reaction between bumetanide, p-dimethylaminocinnamaldehyde (p-DAC), and HCl in a methanolic medium, yielding a colored compound in a delimited area on a qualitative filter paper. The concentrations of p-DAC and HCl were optimized by a chemometric experimental design. After the addition of the reagents to the paper, digital images were obtained by scanning in a multifunctional printer and analyzed using the RGB pattern. The linear bumetanide concentration range was 6.90 × 10 −5 –1.37 × 10 −3 mol L −1 with R 2 = 0.993 and the limits of detection (LOD) and quantification (LOQ) were 3.60 × 10 −4 and 1.09 × 10 −4 mol L −1 , respectively. A SPE clean-up step for the samples were required to eliminate the interference of urinary urea. The recoveries obtained varied from 94% to 105%, indicating the absence of significant matrix effects or interferences in urine samples after clean-up step. The proposed method was successfully applied to the analysis of bumetanide in human urine samples. Instituto de Química Universidade Estadual Paulista “Júlio de Mesquita Filho” UNESP, R. Prof. Francisco Degni 55, P.O. Box 355 Instituto de Química Universidade Estadual Paulista “Júlio de Mesquita Filho” UNESP, R. Prof. Francisco Degni 55, P.O. Box 355 CAPES: 001 FAPESP: 2015/21733-1

The most common negative influences on lignocellulosic materials from biological point of view include invading of microorganisms, which have in humid environments of porous materials favourable conditions for growth and reproduction. The aim of this study was to assess the influence of selected compounds present in essential oils- EOs (linalyl acetate-LA and citral-C) and the accelerated ageing process on the chemical (cellulose degree of polymerization, content of saccharides), mechanical (tensile index) and physical (fibres length distribution) properties of papers. LA and C were evaluated as the compounds with the highest antimicrobial activity and therefore, they were applied into the paper mass in form of their vapours. Paper samples were prepared from five types of material. Chemical changes were evaluated by wet chemical methods, size exclusion chromatography and high performance liquid chromatography, mechanical property according to ISO 1924-2 standard and morphological properties of fibres by using Fiber Tester equipment. In the view of followed properties, the protecting impact of these EOs efficient compounds has a greater importance in their application before the ageing process itself, especially at wood pulp papers and papers produced from sulphate deciduous pulp. The contents of both holocellulose and a cellulose degree of polymerization were significantly correlated with the tensile index of the paper.

Norfloxacin (NOR) in milk may influence mammalian cell replication and bring about a decrease in the efficiency for treating infection in humans. However, current techniques for detecting NOR usually require expensive instruments and trained personnel. In this work, we have developed a low-cost and simple method via paper-based fluorescent immunoassay for highly sensitive and selective detection of NOR in milk at picogram level. The NOR monoclonal antibody labeled with quantum dots is used as a detection probe to recognize the corresponding NOR, which can quantitatively detect NOR on paper-based devices. The detection limits in aqueous solution and milk are 1 pg/mL and 10 pg/mL, respectively. The developed paper-based method provides a cheap, sensitive, eco-friendly, and rapid approach for quantitative detection of trace NOR in milk, which may find wide applications in food safety inspection. Noteworthy, the method is especially suitable for applications at resource-limited and on-site settings.

Flexible sensing devices have drawn tremendous attention in the past decades due to their potential applications in future hand-held, potable consumer, and wearable electronics. Here, we firstly developed an ultrasensitive wireless potentiometric aptasensor based on flexible freestanding graphene paper for kanamycin detection. Flexible graphene paper made from a simple vacuum filtration method was used as a biocompatible platform for effective immobilization of aptamer. A nuclease-assisted amplification strategy was introduced into this potentiometric biosensing system in order to significantly improve the detection sensitivity through a classic catalytic recycling reaction of target induced by the nuclease (DNase I). As expected, an ultra-low detection limit of 30.0 fg/mL for kanamycin was achieved. Furthermore, the developed potentiometric enzymatic aptasensor exhibits high selectivity, favorable flexibility, excellent stability and reproducibility, which holds great promising for its routine sensing application.

In this study, a waste pickling liquor from a steel mill, which is rich in iron and acid, was used as the main raw material to prepare a composite coagulant: polymeric ferric aluminum sulfate chloride (PFASC). The as-prepared PFASC was used, together with PAM, for the tertiary treatment of papermaking wastewater to decrease its COD and Chroma. The Results from FT-IR and XRD of PFASC, supported the conclusion that polymeric ferric aluminum hydroxide hydrates compounds/ complexes are formed in the synthesized PFASC. When applied to a waste water sample from a paper mill, PFASC, together PAM, leads to decreases in COD and Chroma by 65.3% and 71.2%, respectively (initial pH 7.5, 1 ml/L PFASC, 1.0 ppm PAM). The technology has been implemented at a paper mill, and the obtained results are consistent with those from the laboratory.

The non-process-elements (NPE's) in the pulp and paper production, in particular chloride (Cl−) and potassium (K+), eventually accumulate in a sodium sulfate recovery cycle of a paper plant, especially on boiler fly ashes (flue gas cleaning). This accumulation often leads to fouling and corrosion. Thus, in order to reduce such problems, a leaching unit is typically integrated aiming to remove Cl− and K+ and recover sodium sulfate (Na2SO4) from boiler fly ashes. In this context, this research is focused on investigating the effects of temperature, ash concentration and pH on the separation efficiency (Cl− and K+ removal and Na2SO4 recovery) of recovery boiler fly ashes using design of experiments in a devised laboratory setup. As expected from the literature, the results obtained reveals that concentration has the most significant effect on the response variables followed by temperature; whereas pH, not mentioned in this application so far, also has a significant effect. The optimum operating condition, which yields 84 wt% of Na2SO4 recovery and 97 wt% of Cl− and K+ removal, is achieved at 60 °C, 50 wt% of ash and pH 9.0. For practical applications, this optimal condition reduces the accumulation of NPE‘s and mitigates the risks of fouling and corrosion.

Diesel Particulate filters are considered one of the most efficient technologies to reduce particulate matter emitted by diesel engines. In this paper we study the development of catalytic ceramic papers based on Mn-Ce and their applications as soot particle filters in bench scale tests. Ceramic papers were prepared by a dual polyelectrolyte papermaking method and were impregnated with Mn and Ce precursors through a wet-spray procedure using a commercial fogger. Catalytic ceramic papers were tested as catalysts for the combustion of soot, which was obtained both from the burning of diesel fuel and directly from a bench test. In addition, the filtering capacity of catalytic ceramic papers was tested through opacity measurements by placing the ceramic papers in a suitable case at the end of the engine. Mn-Ce based catalysts were active in the soot combustion. The addition of citric acid considerably improved the catalytic performance of all the systems studied. This beneficial effect of citric acid is related to an improvement in the distribution of the catalytic material onto the ceramic fibers, being the mixed equimolar oxide Mn-Ce the most active catalyst.

Chloride (Cl-) is an inorganic anion present in a broad range of samples (e.g. biological, environmental, food, water, etc.), the determination of which is of widespread significance. In this work, we translate the well-established traditional argentometric method (Mohr's precipitation titration) into a small, simple, portable, and low-cost paper-based microfluidic diagnostic device, which provides rapid and quantitative analysis. The developed device enables the determination of chloride sample volumes as small as 5 μL. A distance-based detection method is implemented providing fully instrument-free quantitation. The beneficial effects of channel geometry (variable widths with constant heights) on analytical parameters were investigated. Trapezoidal channels (channel width changes linearly with height) were used to create a gradient of paper surface (titrant) available for the reaction, compared to the typical uniform rectangular channels (constant channel width). The trapezoid with increasing width offered higher sensitivity and lower detection limits (i.e. 0.05 mM vs 0.1 mM from the rectangular channel) for chloride determination across the concentration range of 0.05-25 mM. In addition, the effect of concentration of the deposited reagent on the obtained distance signals was investigated using varying concentrations of titrant (AgNO3), which allowed determination of chloride across a wider dynamic range (up to 200 mM). The utility of the paper devices was demonstrated by determination of chloride in a variety of matrices including body fluids (sweat, serum, and urine) and water samples (drinking, mineral, river water).

We report the first use of a paper-based device as a simple, low-cost and rapid detection platform for simultaneous determination of antioxidant activity and total phenolic content in food samples. Two antioxidant activity assays including 2,2'-azino-bis(3-ethylbenzthiazoline-6-sulphonate) radical cation (ABTS) assay and cupric reducing antioxidant capacity (CUPRAC) assay and one total phenolic content assay, Folin Ciocaltue reagent (FC) assay were simultaneously employed as a proof-of-concept. The device composed of a central sample zone connected to four pretreatment zones and consecutive detection zones to accommodate all three assays and a sample blank measurement. The analysis was achieved by dropping the samples onto the sample zone to flow to the pretreatment and detection zones containing the stored reagents for each antioxidant assay making the color change that was measured using imageJ software. Assay optimization including key reagent concentrations, reaction time, and surface modification were carried out to obtain sensitive and wide linear rage analyses. Various antioxidant standards were then evaluated to determine the analytical features of the method. The paper-based assays were successfully applied to detect antioxidant activity and total phenolic content in 10 beverage samples with similar gallic acid equivalent (GAE) values to those obtained from traditional assays at a 95% confidence interval. Moreover, the GAE values of the samples obtained from three assay analyses were well correlated to each other with relatively high Pearson's correlation coefficients. These results indicated that the assays gave accurate results and are suitable for simultaneous analysis of antioxidant activity and total phenolic content in real samples.

The aim of this study was to assess postures and movements of the trunk and upper arm during paper mill work, and to determine the extent to which they differ depending on method of assessment. For each of 28 paper mill workers, postures and movements were assessed during three full shifts using inclinometer registration and observation from video. Summary metrics for each shift, e.g., 10th, 50th, and 90th posture percentile, were averaged across shifts and across workers. In addition, the standard deviation between workers, and the standard deviation between shifts within worker were computed. The results showed that trunk and arm postures during paper mill work were similar to other occupations involving manual materials handling, but the velocities of arm movements were lower. While postures determined by inclinometry and observation were similar on a group level, substantial differences were found between results obtained by the two methods for individual workers, particularly for extreme postures. Thus, measurements by either method on individuals or small groups should be interpreted with caution.

Early and precise diagnosis of cancer is critical for a better prognosis. Here, we describe a simple and cost-effective plasmonic paper as a surface enhanced Raman scattering (SERS) substrate in combination with magnetic separation for cancer screening. The plasmonic paper was fabricated by immersing plain filter paper into gold nanorod solution and the SERS property of the paper was evaluated using 4-mercaptobenzoic acid (4-MBA) and rhodamine 6 G (R6 G), which showed an enhancement factor (EF) in the range of 106–108. HT-29, a colorectal cancer cell line that highly expresses epithelial cell adhesion molecule (EpCAM), served as the target cells; non-EpCAM-expressing cells, namely fibroblasts and red blood cells (RBCs), were used as negative controls. Intrinsic SERS spectra of the target and control cells showed distinctive patterns on the plasmonic paper due to differences in their structure and components. A combination of principal component analysis (PCA) and k-nearest-neighbor algorithm (k-NN) was employed to analyze and distinguish the acquired HT-29 and fibroblast SERS spectra, demonstrating a diagnostic sensitivity and specificity of 84.8% and 82.6%, respectively, whereas the differentiation between HT-29 and RBCs SERS spectra showed a sensitivity and specificity of 96.4% and 100%, respectively. The magnetic separation was applied to capture the target cells from cell mixtures followed by PCA and k-NN analysis. The identification of the captured cells as cancerous cells from the HT-29 and fibroblast mixture indicated an accuracy of 83.7%, while that from a mixture of HT-29 and RBCs was 98.2%. Thus, the simple paper-based SERS substrate with the assistance of magnetic enrichment and multivariate analysis offers a potent new platform for cancer cell detection and screening.

In this communication, a novel surface modification method of the paper surface using 3-aminopropyltriethoxysilane (APTES) and gold nanoparticles is reported. This functionalized paper (flower-shaped paper-based microfluidic devices (F-PMD) for simultaneous assay of multiple analytes) is used for determination of total lipid profiling (TLP) in a single device. Here, we have determined total cholesterol along with low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglycerides (TGL). The LDL and HDL were estimated by erasing the non-HDL and non-LDL components with a help of precipitating reagents. Standard graphs prepared by the present paper-based method nicely correlates with the conventional method (calculated by Roche- COBAS C111 autoanalyzer) with Pearson Correlation Coefficient (R) of 0.903, 0.9727, 0.9939 and 0.9866 respectively for total cholesterol, LDL, HDL and triglycerides. The present assay device is intended to assist in the screening of individual’s lipid level for diagnosis of disorders involving high cholesterol level in the blood or for metabolic disorders associated with lipid and lipoprotein. As this is affordable, miniaturized, easily portable, self-testing and rapid, the present assay device can be used easily by pre-clinical, non-professionals, children in schools, labs, etc as a point-of-care diagnostics.

The present study was conducted to form polysaccharide-based multilayers of cationic starch (CS)/anionic starch (AS), and CS/carboxymethyl cellulose (CMC) on broke chemi-mechanical pulp (BCMP) fibers. It aimed to examine the buildup of CS/AS and CS/CMC polyelectrolyte multilayers (PEM) on the fibers surface, and explore the effects of PEM formation on the properties of the resulting papers. The assembly of PEM was analyzed by using zeta (ζ-) potential, water retention value (WRV), SEM micrographs, and paper properties such as thickness and strength. The results of ζ-potential inversions indicated successful constitution of PEM on the BCMP fiber surface by assembling CS/AS or CS/CMC multilayers. Further, larger ζ-potential variations occurred in depositing CS/CMC PEM, due to more charge of CMC, which presumably formed a layer with greater potential of absorption. Based on the SEM images, the surface of PEM-treated fibers was rougher, compared to the untreated fibers due to the coating with starch. Furthermore, the PEM fabrication resulted in creating fibers with higher degree of WRV, which was consistent with the significant improvement of the sheet strengths. Finally, the strength enhanced papers made from PEM-treated fibers with tensile index of about 37.33 ± 1.47 N m/g vs 22.24 ± 1.23 N m/g or 11.60 ± 0.57 N m/g for the papers made from original CMP and untreated BCMP fibers, respectively, may diminish the challenges related to web breaks in the paper machine conveying BCMP broke fibers.

In this study, we designed a rapid colorimetric sensing system using competitive ELISA test on a microfluidic paper-based analytical device for the detection of ketamine, a frequently abused drug. Oral fluid was selected for the test to facilitate the collection of samples based on its advantages of low infection risk, noninvasiveness of sample collection, and decreased chance of sample adulteration. After optimization of the operation parameters, including reaction temperature, vibration washing time, reaction time, and antibody concentration, the resulting assay can be completed in as little as 6 min with a detection limit of 0.03 ng/mL. Moreover, we developed an Android smartphone app to analyze and measure the results of the test, further enhancing the test’s portability, and image recording and data transmission capabilities. In order to test the feasibility and performance of the optimized colorimetric assay, 90 oral fluid samples from drug abuse patients were tested. The paper-based platform features 90% sensitivity (confidence interval (CI): 76.34–97.21%) and 92% specificity (CI: 80.77–97.78%) for ketamine analysis. This competitive paper-based ELISA sensing system provides a rapid, convenient, sensitive, and high-throughput approach for drug monitoring.

We report the colorimetric detection of dopamine (DA) on microfluidic paper-based analytical devices (μPADs) using an oxidation-reduction method. Here, dopamine reacts with ferric chloride forming reduced Fe2+ that subsequently reacts with phenanthroline to form the red tris(1,10-phenanthroline)iron(II) complex. The devices were fabricated by wax printing and changes in color intensity were recorded using a common cell phone. Subsequent analysis using Photoshop software, yielded a limit of detection (LOD) for DA of 0.37 μmol/L with a linear range of 0.527–4.75 μmol/L and relative standard deviation of 0.11% (inter-day) and 0.15% (intra-day) for n = 15 paper chips. The effects of detection conditions have been investigated and are discussed. Cow serum samples and human blood serum and plasma samples were detected. The work, herein, demonstrates the potential of this method as a low cost and rapid colorimetric technique to detect DA in real samples.

This study explored a click method of using filter paper (FP) and a polydimethylsiloxane (PDMS) polymer coating solution to prepare a cost-effective volatile organic compound (VOC) preconcentrating sampler. This is the first report of successfully cross-linking a hydrophobic polymer with cellulose in filter paper via a sol-gel method and its application to the preconcentration of headspace VOCs. Our Fourier transform infrared spectroscopy analysis results of the PDMS-coated filter paper (FP-PDMS) showed that the spectral intensity of the alcoholic O H stretch from FP or PDMS was reduced by the addition of trifluoroacetic acid to the PDMS solution, which indicated that an alcohol group in PDMS underwent cross-linking with another alcohol group in the cellulose or PDMS. Scanning electron microscopy (SEM) images of FP-PDMS revealed that the fibrous structure of the FP surface was partially compromised by the PDMS coating, but the porous structure of FP is partially preserved. The addition of the PDMS coating to the FP increased the efficiency of the preconcentration of headspace VOCs evaporated from water. Three types of carbon additives, activated carbon, graphite, and fullerene, were tested in order to evaluate their effects on headspace VOC preconcentration efficiency for FP-PDMS, with the addition of activated carbon found to provide the largest increase in preconcentration efficiency. The extent of the enhancement of the preconcentration efficiency provided by the carbon additives varied with the VOC compounds, as well the type of carbon additive. The FP-PDMS both with and without activated carbon can be used to successfully preconcentrate benzene, toluene, ethylbenzene, and m-xylene from sub-ppb water samples with the headspace gas sampling method.

Background and purpose Spirometry is often technically challenging for patients. Previous studies have demonstrated the potential benefits of spirometry in the community pharmacy setting. This study compared pharmacy students' perceptions and attitudes toward performing spirometry, as well as implementing spirometry in clinics and community pharmacies through experiencing spirometry first-hand versus completing paper-based active learning exercises. Educational activity and setting First-year (N = 102) and second-year (N = 70) pharmacy students were provided with the same pre-class materials to learn about the spirometry process. During class, first-year (P1) students performed spirometry tests, while second-year (P2) students completed paper-based active learning exercises about spirometry without performing the test. A survey was provided to each group at the end of the class to: (1) compare students’ perception of the difficulty of performing spirometry, and (2) identify patient, clinic, and pharmacy barriers to implementing spirometry testing. Findings P1 students perceived performing spirometry as significantly more difficult compared to P2 students. Both P1 and P2 students perceived correct posture and breathing technique, and patient discomfort as the most difficult parts of performing spirometry. Significantly more P1 students (91.1%) perceived spirometry as a “helpful and noninvasive tool to screen for pulmonary diseases” than P2 students (54.1%). Summary Students who experienced spirometry perceived it to be more difficult than those who completed paper-based active learning exercises. Incorporating spirometry into a pharmacy curriculum could be an opportunity to increase students’ insight of the difficulty of performing spirometry and their appreciation for the clinical services pharmacists can provide.