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Three-dimensional (3D) printing is a technology that, for a multitude of raw materials, can be used in the production of complex structures. Many of the materials that currently dominate 3D printing (e.g. titanium, steel, plastics, and concrete) have issues with high costs and environmental sustainability. Wood powder is a widely available and renewable lignocellulosic material that, when used as a fibre component, can reduce the cost of 3D printed products. Wood powder in combination with synthetic or natural binders has potential for producing a wide variety of products and for prototyping. The use of natural binders along with wood powder can then enable more sustainable 3D printed products. However, 3D printing is an emerging technology in many applications and more research is needed. This review aims to provide insight into wood powder as a component in 3D printing, properties of resulting products, and the potential for future applications.

This study investigated the specific milling energy of rectangular pine (Pinus sylvestris L.) boards using a new size reduction technology, which can produce fine wood powders in a single-step operation. Multilinear regression (MLR) analysis was used to model the milling energy of a multi-blade shaft mill through a designed series of experiments having three input parameters: the moisture content of the board, milling blade speed and board feeding speed. The observed specific milling energy ranged from 60 to 172 kWh t−1 [DM] and the MLR model showed it was proportional to the blade speed and the moisture content. The results suggest that multi-blade shaft milling is a two-dimension extension of singular circular blade milling with regard to work piece shape and sawblade teeth engagement effects. The findings were compared with the specific milling energy of pine logs obtained in a previous study.

Objective The purpose of this study was to evaluate whether the clinical assessment of pelvic floor muscles and the diastasis recti abdominis could predict the severity of pelvic girdle pain during the first year postpartum. Methods Between 2018 and 2020, 504 women were recruited to this prospective longitudinal cohort study. At 2 to 3 months postpartum, their pelvic floor muscles and diastasis recti abdominis were assessed using vaginal palpation, observation, and caliper measurement. The participants completed the Pelvic Girdle Questionnaire (PGQ) at 2 to 3, 6, 9, and 12 months postpartum. Mixed-effect models were used to determine how the results of pelvic floor muscle and diastasis recti abdominis assessments predicted the PGQ score. A sub-analysis for middle to high PGQ scores was conducted. Results Maximal voluntary pelvic floor muscle contractions ≥3 (Modified Oxford Scale, scored from 0 to 5) predicted a decreased PGQ score (β = −3.13 [95% CI = −5.77 to −0.48]) at 2 to 3 months postpartum, with a higher prediction of a middle to high PGQ score (β = −6.39). Diastasis recti abdominis width did not have any significant correlation with the PGQ score. A sub-analysis showed that a diastasis recti abdominis width ≥35 mm predicted an increased PGQ score (β = 5.38 [95% CI = 1.21 to 9.55]) in women with pelvic girdle pain. Conclusion The distinction between weak and strong maximal voluntary pelvic floor muscle contractions is an important clinical assessment in women with postpartum pelvic girdle pain. The exact diastasis recti abdominis width, measured in millimeters, showed no clinical relevance. However, a diastasis recti abdominis width ≥35 mm was associated with a higher PGQ score, and further research about this cutoff point in relation to pain is needed. Impact This study highlights the importance of clinical assessment of pelvic floor muscles in patients with postpartum pelvic girdle pain. A better understanding of the role of this muscle group will enable more effective physical therapist treatment of pelvic girdle pain.

Purpose This review aimed to evaluate the certainty of evidence for the use of cryotherapy in patients with musculoskeletal disorders. Methods PubMed, Embase, Cochrane Library and AMED were searched from January 2000 to January 2018 (update June 2019) for systematic reviews (SRs) and randomized controlled trials (RCTs) reporting outcomes on pain, swelling, range of motion (ROM), function, blood loss, analgesic use, patient satisfaction and adverse advents. The papers were categorised into: surgical procedures, acute pain or injury and long-term pain or dysfunction. Methodological quality and risk of bias were assessed using the AMSTAR and the Swedish Health Technology Assessment instruments. Level of certainty of evidence was synthesized using GRADE. Study selection Eight SRs and 50 RCTs from a total of 6027 (+839) were included. In total 34 studies evaluated cryotherapy in surgical procedures, twelve evaluated cryotherapy use in acute pain or injury and twelve studies evaluated cryotherapy in long-term pain and dysfunction. Results The certainty of evidence is moderate (GRADE III) after surgical procedures to reduce pain, improve ROM, for patient satisfaction and few adverse events are reported. Cryotherapy in acute pain and injury or long-term pain and dysfunction show positive effects but have a higher number of outcomes with low certainty of evidence (GRADE II). Conclusion Cryotherapy may safely be used in musculoskeletal injuries and dysfunctions. It is well tolerated by patients. More advanced forms of cryotherapy may accentuate the effect. Future research is needed where timing, temperature for cooling, dose (time) and frequency are evaluated.

Background Physical inactivity is a main cause of childhood obesity which tracks into adulthood obesity, making it important to address early in life. Physical activity on prescription (PAP) is an evidence-based intervention that has shown good effect on physical activity levels in adults, but has not been evaluated in children with obesity. This project aims to evaluate the prerequisites, determinants, and feasibility of implementing PAP adapted to children with obesity and to explore children’s, parents’, and healthcare providers’ experiences of PAP. Methods In the first phase of the project, healthcare providers and managers from 26 paediatric clinics in Region Västra Götaland, Sweden, will be invited to participate in a web-based survey and a subset of this sample for a focus group study. Findings from these two data collections will form the basis for adaptation of PAP to the target group and context. In a second phase, this adapted PAP intervention will be evaluated in a clinical study in a sample of approximately 60 children with obesity (ISO-BMI > 30) between 6 and 12 years of age and one of their parents/legal guardians. Implementation process and clinical outcomes will be assessed pre- and post-intervention and at 8 and 12 months’ follow-up. Implementation outcomes are the four core constructs of the Normalization Process Theory; coherence, cognitive participation, collective action, and reflexive monitoring; and appropriateness, acceptability, and feasibility of the PAP intervention. Additional implementation process outcomes are recruitment and attrition rates, intervention fidelity, dose, and adherence. Clinical outcomes are physical activity pattern, BMI, metabolic risk factors, health-related quality of life, sleep, and self-efficacy and motivation for physical activity. Lastly, we will explore the perspectives of children and parents in semi-structured interviews. Design and analysis of the included studies are guided by the Normalization Process Theory. Discussion This project will provide new knowledge regarding the feasibility of PAP for children with obesity and about whether and how an evidence-based intervention can be fitted and adapted to new contexts and populations. The results may inform a larger scale trial and future implementation and may enhance the role of PAP in the management of obesity in paediatric health care in Sweden. Trial registration ClinicalTrials.gov Identifier: NCT04847271, registered 14 April 2021.

This study investigated a new technique for obtaining wood powders from whole logs (Pinus sylvestris L.) in a single-step operation. The performance of a prototype multi-blade shaft mill (MBSM) was evaluated using a designed series of experiments including three input parameters, i.e., the moisture content of the log, milling blade speed and log feeding speed, combined with multilinear regression (MLR) analysis. The milling performance was characterised by specific milling energy, particle size distribution and bulk density of powder. For MBSM powders (80 to 95% particles

In this study, bio-adhesives from natural rubber latex (NRL) were combined with starch and formic acid to fabricate jute stick-based particleboards (JSPs). Different blends of NRL, starch, and formic acid, i.e., 6 : 1 : 1, 2 : 1 : 1, and 2 : 3 : 3, were used to produce particleboards using a pressing temperature of 180 °C and applied pressure of 5 MPa using a 5 min pressing time. The particleboards were tested for physical, mechanical, and thermal properties according to ANSI standards. Based on initial screening, the best formula (NRL/starch/formic acid of 2 : 3 : 3) was used to optimize the temperature and pressing time for the highest board performance. The highest density, tensile strength, modulus of elasticity, and modulus of rupture were 830 g cm−3, 10.51, 2380, and 20.05 N mm−2, respectively. Thermo-gravimetric analysis indicated that thermal decomposition of samples primarily occurred in a temperature range of 265 to 399 °C, indicating good thermal performance. The measured physical and mechanical properties of the produced JSPs fulfilled the production standards. However, fulfilling the water absorption and thickness swelling criteria was a challenge. The results indicate that NRL is a promising alternative binder when blended with starch and formic acid.

The effect of mechanical screening of severely contaminated forest fuel chips was investigated, focusing on main ash-forming elements and slagging tendency and other properties with relevance for thermal conversion. In this study, screening operations were performed according to practice on an industrial scale by combining a star screen and a supplementary windshifter in six different settings and combinations. Mechanical screening reduced the amount of ash and fine particles in the accept fraction. However, the mass losses for the different screening operations were substantial (20-50 wt %). Fuel analyses of the non-screened and the screened fuels showed that the most significant screening effect was a reduction of Si and Al, indicating an effective removal of sand and soil contaminations. However, the tested fuel's main ash-forming element's relative concentration did not indicate any improved combustion characteristics and ash-melting behavior. Samples of the accept fractions and non-screened material were combusted in a single-pellet thermogravimetric reactor, and the resulting ashes' morphology and elemental composition were analyzed by scanning electron microscopy-energy dispersive X-ray spectrometry and the crystalline phases by powder X-ray diffraction. Results from both these analyses confirmed that screening operations had no, or minor, effects on the fuels' ash chemistry and slagging tendencies, i.e., the fuels' proneness to ash melting was not improved. However, the reduction of ash and fine particles can reduce slagging and other operational problems in smaller and more sensitive combustion units.

Background Musculoskeletal pain is globally a leading cause of physical disability. Many musculoskeletal-related pain conditions, such as low back pain, often resolve spontaneously. In some individuals, pain may recur or persist, leading to ong-term physical disability, reduced work capacity, and sickness absence. Early identification of individuals in which this may occur, is essential for preventing or reducing the risk of developing persistent musculoskeletal pain and long-term sickness absence. The aim of the trial described in this protocol is to evaluate effects of an early intervention, the PREVSAM model, on the prevention of sickness absence and development of persistent pain in at-risk patients with musculoskeletal pain. Methods Eligible participants are adults who seek health care for musculoskeletal pain and who are at risk of developing persistent pain, physical disability, and sickness absence. Participants may be recruited from primary care rehabilitation centres or primary care healthcare centres in Region Västra Götaland. Participants will be randomised to treatment according to the PREVSAM model (intervention group) or treatment as usual (control group). The PREVSAM model comprises an interdisciplinary, person-centred rehabilitation programme, including coordinated measures within primary health care, and may include collaboration with participants’ employers. The primary outcome sickness absence is operationalised as the number and proportion of individuals who remain in full- or part-time work, the number of gross and net days of sickness absence during the intervention and follow-up period, and time to first sickness absence spell. Secondary outcomes are patient-reported short-term sickness absence, work ability, pain, self-efficacy, health-related quality of life, risk for sickness absence, anxiety and depression symptoms and physical disability at 1 and 3 months after inclusion (short-term follow-up), and at 6 and 12 months (long-term follow-up). A cost-effectiveness analysis is planned and drug consumption will be investigated. Discussion The study is expected to provide new knowledge on the effectiveness of a comprehensive rehabilitation model that incorporates early identification of patients with musculoskeletal pain at risk for development of sickness absence and persistent pain. The study findings may contribute to more effective rehabilitation processes of this large patient population, and potentially reduce sickness absence and costs. Trial registration ClinicalTrials.gov Protocol ID: NCT03913325, Registered April 12, 2019. Version 2, 10 July 2020. Version 2 changes: Clarifications regarding trial aim and inclusion process.

Objective To explore how physically inactive patients, with metabolic risk factors, experienced long term treatment with physical activity on prescription. Design Qualitative content analysis of individual interviews after strategical sampling of respondents. Setting Fifteen primary health care centres in Gothenburg, Sweden. Subjects Twenty physically inactive patients, with one or more metabolic syndrome components, 9 women, 11 men, mean age 58 years (25–73); 10 patients were responders and 10 non-responders to the intervention. Main outcome measures Categories describing treatment effect and successful intervention Results The interviews revealed three categories of effect. First, individual adjustments contributed to increased physical activity. Second, follow-up and support were valuable aids for prioritising and maintaining lifestyle changes. Third, motivation could be higher if patients make their own choices and experienced positive health effects. The overarching emerging theme was ‘tailored physical activity on prescription with regular follow-ups can contribute to increased and maintained motivation and physical activity levels.’ Conclusion Physical activity on prescription in a Swedish primary care setting was successful when the recommended physical activity and follow up was individually adapted.KEY POINTSIndividually adapted physical activity on prescription gave insight to increase physical activity levels in a 5-year Swedish primary care intervention directed towards inactive patients with the metabolic syndromeMotivation increased for patients designing their own routines for physical activity.Experiences of positive health effects helped maintain or increase physical activity levels, and follow-up and support from healthcare professionals helped to prioritise life style changes.

BackgroundAcute low back pain is associated with pain and disability, but symptoms are often self-healing. The effectiveness of exercise therapy for acute low back pain remains uncertain with conflicting evidence from systematic reviews. The aim of this systematic review of systematic reviews was to assess the overall certainty of evidence for the effects of exercise therapy, compared with other interventions, on pain, disability, recurrence, and adverse effects in adult patients with acute low back pain.MethodsPubMed, the Cochrane library, CINAHL, PEDro, Open Grey, Web of Science, and PROSPERO were searched for systematic reviews of randomized controlled trials. Methodological quality was assessed independently by two authors using AMSTAR. Meta-analyses were performed if possible, using data from the original studies. Data for pain, disability, recurrence, and adverse effects were analyzed. Certainty of evidence was assessed using GRADE.ResultsThe searches retrieved 2602 records, of which 134 publications were selected for full-text screening. Twenty-four reviews were included, in which 21 randomized controlled trials (n= 2685) presented data for an acute population, related to 69 comparisons. Overlap was high, 76%, with a corrected covered area of 0.14. Methodological quality varied from low to high. Exercise therapy was categorized into general exercise therapy, stabilization exercise, and McKenzie therapy. No important difference in pain or disability was evident when exercise therapy was compared with sham ultrasound, nor for the comparators usual care, spinal manipulative therapy, advice to stay active, and educational booklet. Neither McKenzie therapy nor stabilization exercise yielded any important difference in effects compared with other types of exercise therapy. Certainty of evidence varied from very low to moderate.ConclusionsThe findings suggest very low to moderate certainty of evidence that exercise therapy may result in little or no important difference in pain or disability, compared with other interventions, in adult patients with acute low back pain. A limitation of this systematic review is that some included reviews were of low quality. When implementing findings of this systematic review in clinical practice, patients’ preferences and the clinician’s expertise also should be considered, to determine if and when exercise therapy should be the intervention of choice.Systematic review registrationPROSPERO: CRD46146, available at:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=46146.

A wheelchair ergometer has been developed for the study of wheelchair work. At each propulsion the peak torque can be examined, and there is an opportunity to directly study angular amplitude, power output, work etc. The physical capacity of the subject as well as the importance of chair adjustments upon performance can be evaluated.

Hardwood spent mushroom substrate was employed as a carbon precursor to prepare activated biochars using phosphoric acid (H3PO4) as chemical activator. The activation process was carried out using an impregnation ratio of 1 precursor:2 H3PO4; pyrolysis temperatures of 700, 800, and 900 °C; heating rate of 10 °C min−1; and treatment time of 1 h. The specific surface area (SSA) of the biochars reached 975, 1031, and 1215 m2 g−1 for the samples pyrolyzed at 700, 800, and 900 °C, respectively. The percentage of mesopores in their structures was 75.4%, 78.5%, and 82.3% for the samples pyrolyzed at 700, 800, and 900 °C, respectively. Chemical characterization of the biochars indicated disordered carbon structures with the presence of oxygen and phosphorous functional groups on their surfaces. The biochars were successfully tested to adsorb acetaminophen and treat two simulated pharmaceutical effluents composed of organic and inorganic compounds. The kinetic data from adsorption of acetaminophen were fitted to the Avrami fractional-order model, and the equilibrium data was well represented by the Liu isotherm model, attaining a maximum adsorption capacity of 236.8 mg g−1 for the biochar produced at 900 °C. The adsorption process suggests that the pore-filling mechanism mainly dominates the acetaminophen removal, although van der Walls forces are also involved. The biochar produced at 900 °C removed up to 84.7% of the contaminants in the simulated effluents. Regeneration tests using 0.1 M NaOH + 20% EtOH as eluent showed that the biochars could be reused; however, the adsorption capacity was reduced by approximately 50% after three adsorption–desorption cycles.

Background This systematic review aimed to assess the certainty of evidence for digital versus conventional, face-to-face physiotherapy assessment of musculoskeletal disorders, concerning validity, reliability, feasibility, patient satisfaction, physiotherapist satisfaction, adverse events, clinical management, and cost-effectiveness. Methods Eligibility criteria: Original studies comparing digital physiotherapy assessment with face-to-face physiotherapy assessment of musculoskeletal disorders. Systematic database searches were performed in May 2021, and updated in May 2022, in Medline, Cochrane Library, Cinahl, AMED, and PEDro. Risk of bias and applicability of the included studies were appraised using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and the Quality Appraisal of Reliability Studies tool. Included studies were synthesised narratively. Certainty of evidence was evaluated for each assessment component using GRADE. Results Ten repeated-measures studies were included, involving 193 participants aged 23–62 years. Reported validity of digital physiotherapy assessment ranged from moderate/acceptable to almost perfect/excellent for clinical tests, range of motion, patient-reported outcome measures (PROMs), pain, neck posture, and management decisions. Reported validity for assessing spinal posture varied and was for clinical observations unacceptably low. Reported validity and reliability for digital diagnosis ranged from moderate to almost perfect for exact+similar agreement, but was considerably lower when constrained to exact agreement. Reported reliability was excellent for digital assessment of clinical tests, range of motion, pain, neck posture, and PROMs. Certainty of evidence varied from very low to high, with PROMs and pain assessment obtaining the highest certainty. Patients were satisfied with their digital assessment, but did not perceive it as good as face-to-face assessment. Discussion Evidence ranging from very low to high certainty suggests that validity and reliability of digital physiotherapy assessments are acceptable to excellent for several assessment components. Digital physiotherapy assessment may be a viable alternative to face-to-face assessment for patients who are likely to benefit from the accessibility and convenience of remote access. Trial registration The review was registered in the PROSPERO database, CRD42021277624.

Preparing sustainable and highly efficient biochars as electrodes remains a challenge for building green energy storage devices. In this study, efficient carbon electrodes for supercapacitors were prepared via a facile and sustainable single-step pyrolysis method using spruce bark as a biomass precursor. Herein, biochars activated by KOH and ZnCl2 are explored as templates to be applied to prepare electrodes for supercapacitors. The physical and chemical properties of biochars for application as supercapacitors electrodes were strongly affected by factors such as the nature of the activators and the meso/microporosity, which is a critical condition that affects the internal resistance and diffusive conditions for the charge accumulation process in a real supercapacitor. Results confirmed a lower internal resistance and higher phase angle for devices prepared with ZnCl2 in association with a higher mesoporosity degree and distribution of Zn residues into the matrix. The ZnCl2-activated biochar electrodes’ areal capacitance reached values of 342 mF cm−2 due to the interaction of electrical double-layer capacitance/pseudocapacitance mechanisms in a matrix that favors hydrophilic interactions and the permeation of electrolytes into the pores. The results obtained in this work strongly suggest that the spruce bark can be considered a high-efficiency precursor for biobased electrode preparation to be employed in SCs.

A biomass amino silica-functionalized material was successfully prepared by a simple sol–gel method. 3-Aminopropyltriethoxysilane (APTES) was added to a tannin-rich grape residue to improve its physicochemical properties and enhance the adsorption performance. The APTES functionalization led to significant changes in the material’s characteristics. The functionalized material was efficiently applied in the removal of methyl orange (MO) due to its unique characteristics, such as an abundance of functional groups on its surface. The adsorption process suggests that the electrostatic interactions were the main acting mechanism of the MO dye removal, although other interactions can also take place. The functionalized biomass achieved a very high MO dye maximum adsorption capacity (Qmax) of 361.8 mg g–1. The temperature positively affected the MO removal, and the thermodynamic studies indicated that the adsorption of MO onto APTES-functionalized biomass was spontaneous and endothermic, and enthalpy is driven in the physisorption mode. The regeneration performance revealed that the APTES-functionalized biomass material could be easily recycled and reused by maintaining very good performance even after five cycles. The adsorbent material was also employed to treat two simulated dye house effluents, which showed 48% removal. At last, the APTES biomass-based material may find significant applications as a multifunctional adsorbent and can be used further to separate pollutants from wastewater.

The present work elucidates facile one-pot synthesis from biomass forestry waste (Norway spruce bark) and its chemical activation yielding high specific surface area (SBET) biochars as efficient lithium- and sodium-ion storage anodes. The chemically activated biochar using ZnCl2 (Biochar-1) produced a highly mesoporous carbon containing 96.1% mesopores in its structure as compared to only 56.1% mesoporosity from KOH-activated biochars (Biochar-2). The latter exhibited a lower degree of graphitization with disordered and defective carbon structures, while the former presented more formation of ordered graphite sheets in its structure as analyzed from Raman spectra. In addition, both biochars presented a high degree of functionalities on their surfaces but Biochar-1 presented a pyridinic-nitrogen group, which helps improve its electrochemical response. When tested electrochemically, Biochar-1 showed an excellent rate capability and the longest capacity retentions of 370 mA h g–1 at 100 mA g–1 (100 cycles), 332.4 mA h g–1 at 500 mA g–1 (1000 cycles), and 319 mA h g–1 at 1000 mA g–1 after 5000 cycles, rendering as an alternative biomass anode for lithium-ion batteries (LIBs). Moreover, as a negative electrode in sodium-ion batteries, Biochar-1 delivered discharge capacities of 147.7 mA h g–1 at 50 mA g–1 (140 cycles) and 126 mA h g–1 at 100 mA g–1 after 440 cycles. peerReviewed

This study utilized pulp and paper mill sludge as a carbon source to produce activated biochar adsorbents. The response surface methodology (RSM) application for predicting and optimizing the activated biochar preparation conditions was investigated. Biochars were prepared based on a Box–Behnken design (BBD) approach with three independent factors (i.e., pyrolysis temperature, holding time, and KOH:biomass ratio), and the responses evaluated were specific surface area (SSA), micropore area (Smicro), and mesopore area (Smeso). According to the RSM and BBD analysis, a pyrolysis temperature of 800 °C for 3 h of holding and an impregnation ratio of 1:1 (biomass:KOH) are the optimum conditions for obtaining the highest SSA (885 m2 g–1). Maximized Smicro was reached at 800 °C, 1 h and the ratio of 1:1, and for maximizing Smeso (569.16 m2 g–1), 800 °C, 2 h and ratio 1:1.5 (445–473 m2 g–1) were employed. The biochars presented different micro- and mesoporosity characteristics depending on pyrolysis conditions. Elemental analysis showed that biochars exhibited high carbon and oxygen content. Raman analysis indicated that all biochars had disordered carbon structures with structural defects, which can boost their properties, e.g., by improving their adsorption performances. The hydrophobicity–hydrophilicity experiments showed very hydrophobic biochar surfaces. The biochars were used as adsorbents for diclofenac and amoxicillin. They presented very high adsorption performances, which could be explained by the pore filling, hydrophobic surface, and π–π electron–donor–acceptor interactions between aromatic rings of both adsorbent and adsorbate. The biochar with the highest surface area (and highest uptake performance) was subjected to regeneration tests, showing that it can be reused multiple times. peerReviewed

In Sweden, physical activity on prescription (PAP) is used to support patients in increasing their levels of physical activity (PA). The role of healthcare professionals in supporting PA behavior change requires optimization in terms of knowledge, quality and organization. This study aims to evaluate the cost-effectiveness of support from a physiotherapist (PT) compared to continued PAP at a healthcare center (HCC) for patients who remained insufficiently active after 6-month PAP treatment at the HCC. The PT strategy was constituted by a higher follow-up frequency as well as by aerobic physical fitness tests. The analysis was based on an RCT with a three-year time horizon, including 190 patients aged 27–77 with metabolic risk factors. The cost per QALY for the PT strategy compared to the HCC strategy was USD 16,771 with a societal perspective (including individual PA expenses, production loss and time cost for exercise, as well as healthcare resource use) and USD 33,450 with a healthcare perspective (including only costs related to healthcare resource use). Assuming a willingness-to-pay of USD 57,000 for a QALY, the probability of cost-effectiveness for the PT strategy was 0.5 for the societal perspective and 0.6 for the healthcare perspective. Subgroup analyses on cost-effectiveness based on individual characteristics regarding enjoyment, expectations and confidence indicated potential in identifying cost-effective strategies based on mediating factors. However, this needs to be further explored. In conclusion, both PT and HCC interventions are similar from a cost-effectiveness perspective, indicating that both strategies are equally valuable in healthcare’s range of treatments.

In this work, Norway spruce (Picea abies(Karst) L.) bark was employed as a precursor to prepare activated carbon using zinc chloride (ZnCl2) as a chemical activator. The purpose of this study was to determine optimal activated carbon (AC) preparation variables by the response surface methodology using a Box–Behnken design (BBD) to obtain AC with high specific surface area (SBET), mesopore surface area (SMESO), and micropore surface area (SMICR). Variables and levels used in the design were pyrolysis temperature (700, 800, and 900 °C), holding time (1, 2, and 3 h), and bark/ZnCl2impregnation ratio (1, 1.5, and 2). The optimal conditions for achieving the highest SBETwere as follows: a pyrolysis temperature of 700 °C, a holding time of 1 h, and a spruce bark/ZnCl2ratio of 1.5, which yielded an SBETvalue of 1374 m2 g−1. For maximised mesopore area, the optimal condition was at a pyrolysis temperature of 700 °C, a holding time of 2 h, and a bark/ZnCl2ratio of 2, which yielded a SMESOarea of 1311 m2 g−1, where mesopores (SMESO%) comprised 97.4% of total SBET. Correspondingly, for micropore formation, the highest micropore area was found at a pyrolysis temperature of 800 °C, a holding time of 3 h, and a bark/ZnCl2ratio of 2, corresponding to 1117 m2 g−1, with 94.3% of the total SBETconsisting of micropores (SMICRO%). The bark/ZnCl2ratio and pyrolysis temperature had the strongest impact on the SBET, while the interaction between temperature and bark/ZnCl2ratio was the most significant factor for SMESO. For the SMICRO, holding time was the most important factor. In general, the spruce bark AC showed predominantly mesoporous structures. All activated carbons had high carbon and low ash contents. Chemical characterisation indicated that the ACs presented disordered carbon structures with oxygen functional groups on the ACs’ surfaces. Well-developed porosity and a large surface area combined with favourable chemical composition render the activated carbons from Norway spruce bark with interesting physicochemical properties. The ACs were successfully tested to adsorb sodium diclofenac from aqueous solutions showing to be attractive products to use as adsorbents to tackle polluted waters.Graphical abstract

ObjectivesEvaluation of the inter-rater reliability of clinical assessment methods for pelvic floor muscles and diastasis recti abdominis post partum.DesignA multicentre inter-rater reliability study.SettingThree primary care rehabilitation centres in Sweden.ParticipantsA total of 222 participants were recruited via advertising at Swedish maternity care units and social media. Eligibility for participation included female gender, ≥18 years, at maximum 3 months after childbirth. Exclusion criteria were chronic pelvic girdle pain and/or low back pain and/or pelvic floor tear grade III/IV. At each centre, 2 physiotherapists, with training and experience in pelvic floor assessment, assessed the 222 women according to a standardised protocol in random order.Outcome measuresInter-rater reliability of the assessment of pelvic floor muscle function (involuntary and voluntary contraction and voluntary relaxation) and diastasis recti abdominis (width, depth and bulging).ResultsVaginal palpation of maximal voluntary contraction revealed a kappa value of 0.69 (95% CI 0.62 to 0.76). Assessments of involuntary contraction and voluntary relaxation yielded inconsistent results, with slight-to-moderate weighted kappa values ranging from 0.10 to 0.51. After 2 months of training in applying this method, diastasis recti abdominis width measured at the umbilicus by calliper yielded an intraclass correlation coefficient value of 0.83 (95% CI 0.76 to 0.87). Assessments of diastasis recti abdominis depth and bulging showed moderate kappa values, with reservation for some inconsistency between the centres.ConclusionsVaginal palpation of pelvic floor muscle strength is a reliable method for the postpartum muscle assessment. Additional research is needed to identify reliable assessment method for other pelvic floor muscle functions like involuntary contraction and voluntary relaxation. With some training, a calliper is a reliable instrument for measuring the postpartum diastasis recti abdominis width. This study provides novel thoughts about how to measure diastasis recti abdominis depth and bulging.Trial registration numberNCT03703804.

A convenient approach to employ an elliptic load-deformation elastoplastic approximation has been proposed and used to evaluate the mechanical behavior of pinewood biofuel pellets from lab-scale compressive load-deformation measurements. Verification of model predictions has been attempted against apparent finite element method based simulations. A database of essential mechanical properties has been established. This submission is intended as a model for being able to study the deformation and breakage behavior using lab-scale compression tests.

The safety profile of a novel drug candidate is highly determinant of its chance of success to be launched for treatment of patients. The integration of predictive toxicology in the drug discovery process is essential to identify and mitigate potential safety issues in a timely manner and contributes to improved productivity in pharmaceutical R&D, especially for small molecules, which is the focus of this review. A range of predictive in vitro toxicology assays has been established, which we use as part of AstraZeneca's proactive discovery safety screening strategy, with the aim to influence chemical design and obtain candidate drugs with the right safety profile. Here, we discuss recent progress in some of the main areas of toxicity, such as cardiotoxicity, hepatotoxicity, CNS toxicity, genetic toxicity, and nephrotoxicity, and also considerations around assay validation, predictivity, and throughput, which are relevant to secure actual impact on drug design. Finally, we share our perspectives on future opportunities and innovation.

Caking can cause many problems in industries during processing or storage of particulate materials. Caking magnitude depends on several factors, for instance temperature, consolidation stress and storage time. In this research paper, a novel force displacement and easy-to-use caking tester for measuring quantitatively cake strength as a result of elevated temperature, consolidation stress and storage time is introduced. The developed tester outweighed the conventional uniaxial unconfined failure caking tester due to the defined location of the failure plane to maximise repeatability, the necessity for a lower quantity of powder, maximised exposed surface and lower wall friction as well as production costs. The experimental design has been conducted by changing the temperature, consolidation stress and storage duration. The results showed that the tester could distinguish cake strength between different experimental conditions. A statistical model has been successfully developed to study the effect of each variable on the cake strength.

Background Increased physical activity (PA) has positive effects on health and longevity. In Swedish healthcare, the physical activity on prescription (PAP) method reportedly increases patients’ PA levels for up to 12 months, but long-term follow ups are lacking. As it remains difficult to maintain lifestyle changes, our aim was to evaluate adherence and clinical effects at a 5-year follow-up of PAP treatment in primary healthcare. Methods This longitudinal, prospective cohort study included 444 patients, (56% female), aged 27–85 years, with at least one metabolic risk factor. Participants were offered PAP by nurses or physiotherapists. The PAP intervention included an individualised dialogue, a PA recommendation by written prescription, and individually adjusted follow-up over 5 years, according to the Swedish PAP model. Patient PA level, metabolic risk factors, and health related quality of life (HRQoL) were measured at baseline and at the 6-month, 1.5-year, 2.5-year, 3.5-year, and 5-year follow-ups. Estimated latent growth curves were used to examine levels and rates of change in the outcomes. Results The study dropout rate was 52%, with 215 of 444 patients completing the 5-year follow-up. At follow-up, the mean PA level had increased by 730 MET-minutes per week or 3 hours of moderate-intensity PA/week when compared to baseline. During the 5-year intervention, we observed significant positive changes (p ≤ 0.05) in 9 of 11 metabolic risk factors and HRQoL parameters: body mass index, waist circumference, systolic and diastolic blood pressure, fasting plasma glucose, triglycerides, cholesterol, high-density lipoprotein, and mental component summary. Conclusion This first evaluation of a 5-year PAP intervention in primary care demonstrated positive long-term (5 years) effects regarding PA level, metabolic health, and HRQoL. The recorded long-term adherence was ~50%, which is in line with medical treatment. Despite limitations, PAP can have long-term effects in an ordinary primary care setting.

Fear conditioning is an evolutionarily conserved type of learning serving as a model for the acquisition of situationally induced anxiety. Brain function supporting fear conditioning may be genetically influenced, which in part could explain genetic susceptibility for anxiety following stress exposure. Using a classical twin design and functional magnetic resonance imaging, we evaluated genetic influences (h2) on brain activity and standard autonomic measures during fear conditioning. We found an additive genetic influence on mean brain activation (h2 = 0.34) and autonomic responses (h2 = 0.24) during fear learning. The experiment also allowed estimation of the genetic influence on brain activation during safety learning (h2 = 0.55). The mean safety, but not fear, related brain activation was genetically correlated with autonomic responses. We conclude that fear and safety learning processes, both involved in anxiety development, are moderately genetically influenced as expressed both in the brain and the body.

Objective The primary purpose of this study was to investigate the predictive ability of the Orebro Musculoskeletal Pain Screening Questionnaire (OMPSQ) in regard to work productivity (absenteeism and presenteeism) in early adulthood. Methods A prospective study was performed using data from the Raine Study Generation 2 (Gen2) 22-year follow-up. The OMPSQ was completed at baseline, and absenteeism and presenteeism assessed at 4 intervals over the following 12 months. Results In early adulthood, the full and short versions of the OMPSQ showed some predictive ability for work absenteeism but the Receiver Operator Characteristic demonstrated poor discrimination. There was no evidence of predictive ability for presenteeism. Conclusion Further work is required to increase the fidelity of screening for risk of reduced work productivity at the population level.

Biobased carbon materials (BBC) obtained from Norway spruce (Picea abies Karst.) bark was produced by single-step chemical activation with ZnCl2 or KOH, and pyrolysis at 800 °C for one hour. The chemical activation reagent had a significant impact on the properties of the BBCs. KOH-biobased carbon material (KOH-BBC) had a higher specific surface area (SBET), equal to 1067 m2 g−1, larger pore volume (0.558 cm3 g−1), more mesopores, and a more hydrophilic surface than ZnCl2-BBC. However, the carbon yield for KOH-BBC was 63% lower than for ZnCl2-BBC. Batch adsorption experiments were performed to evaluate the ability of the two BBCs to remove two dyes, reactive orange 16 (RO-16) and reactive blue 4 (RB-4), and treat synthetic effluents. The general order model was most suitable for modeling the adsorption kinetics of both dyes and BBCs. The equilibrium parameters at 22 °C were calculated using the Liu model. Upon adsorption of RO-16, Qmax was 90.1 mg g−1 for ZnCl2-BBC and 354.8 mg g−1 for KOH-BBC. With RB-4, Qmax was 332.9 mg g−1 for ZnCl2-BBC and 582.5 mg g−1 for KOH-BBC. Based on characterization and experimental data, it was suggested that electrostatic interactions and hydrogen bonds between BBCs and RO-16 and RB-4 dyes played the most crucial role in the adsorption process. The biobased carbon materials showed high efficiency for removing RO-16 and RB-4, comparable to the best examples from the literature. Additionally, both the KOH- and ZnCl2-BBC showed a high ability to purify two synthetic effluents, but the KOH-BBC was superior.

Resource-efficient wood chipping for forest-industrial processes demands large fractions of accept chips and small fractions of small-sized material, such as pin chips and fines. In Kraft pulping, a narrow distribution of wood chip thickness is important for even impregnation and for making high-quality pulp. Using newly developed forest-industrial drum-chipping technology, the investigation covered wood of varying moisture content, frozen versus unfrozen wood, and the use of different wood species. Using conventional techniques for analyzing wood chip dimensions, fast-grown spruce wood with high moisture content gave 4.2 % pin chips and fines, which was less than half of the fractions obtained with spruce wood with lower moisture content. A comparison between frozen and unfrozen pine resulted in slightly thinner and shorter chips for the frozen wood, but in both cases accept yields of up to ∼85 % were achieved. A comparison of different tree species (aspen, birch, pine, and spruce) resulted in larger accept fractions (∼90 %) for the hardwood species, even though the average length of these wood chips was as low as 17 mm. The results provide a first indication of how basic wood log properties affect the yields of accept chips and small-sized material when using modern industrial drum-chipping technology.