Diabetes mellitus (DM) is an important topic for public health in India and globally. The rise in the number of cases of diabetes in India is alarming as it will eventually increase the number of cases of diabetic retinopathy (DR). DM is related to many microangiopathic abnormalities, among which DR has recently emerged as a common cause of vision impairment in middle and low-income countries. If diagnosed on time, we can prevent vision impairment and complete blindness in patients with the help of proper treatment. Life-long retinal check-ups among people who have diabetes are an essential strategy for the early diagnosis of DR. In this article, we have focused mainly on the significance of DR in loss of vision, the risk factors associated with the disease, the proper pathogenesis of the disease, including the involvement of vascular endothelial growth factor (VEGF), the further consequences of the disease, screening techniques that are already available and those that need to be incorporated, and finally the treatment options available for the patients. The knowledge about this disease and various components related to it, be it either risk factors, pathogenesis, or screening techniques and treatment, would surely help clinicians better understand the condition to formulate strategies for its early diagnosis and cost-effective and sustainable treatment, which would ultimately result in providing better care to the patients. Diabetes mellitus (DM) is a matter of great concern for public health in India. The magnitude of DM has increased in the last five decades in urban and rural India from 3.4% and 2.3%, respectively, in 1973 to 19.2% and 15.1% correspondingly in 2015-2019, which is more than the worldwide urban (10.9%) and rural (7.3%) incidence of DM [The earlier stages of DR may not cause severe vision impairment like non-proliferative DR (NPDR). Diabetic macular oedema (DME) and proliferative DR (PDR) are collectively known as vision-threatening DR (VTDR) . If untrRisk factorsBad Metabolic ControlA timely and decent glycaemic control might delay and prevent the progress of DR. A higher risk of severity is related to high levels of glycated haemoglobin .PregnancyThis physiological condition is occasionally associated with rapidly progressing DR .PubertyThere is a very low threat of DR earlier to the onset of puberty, irrespective of the period of diabetes the person suffers from. Once the age of 13 years is attained, the severity and frequency of this disease increase . HormonaLipidsIt has already been proved that a high level of lipids is related to retinopathy. Elevated levels of hard exudates are associated with high levels of cholesterol. It is the high levels of triglyceride that determine the severity of retinopathy .High Blood PressureHigh blood pressure is one of the most researched systemic factors openly associated with DR. Although it is not clear if the hypertension is because of nephropathy, if so, then both are considered to be diabetic complications .NephropathyWhen different studies were conducted, the coincidence of DR and nephropathy was observed in both type 1 and type 2 diabetes. It is found that DR might be the most common microvascular problem of diabetes, which even precedes nephropathy .Syndrome of Sleep ApnoeaDR and macular oedema can worsen in diabetic patients suffering from sleep apnoea syndrome .Extent of DiabetesIt is undoubtedly the most significant factor. The incidence was 2% in diabetes type 1 patients with no more than two years of progression of diabetes. At the same time, the incidence was found to be 20% in type 2 diabetes patients taking treatment with insulin or without insulin with less than five years of progression of diabetes [Irrespective of the above-stated risk factors, readings have suggested an extensive deviation amongst the severity and development of DR that the already identified risk factors cannot entirely clarify. Hence, identifying biomarkers to simplify the danger or assess the healing reaction of DR is vital . OptimumPathogenesisDR is one of the microangiopathies of the retina. It is involved in the variations in the rheological properties and the blood's vascular wall. The incorporation of these factors leads to the obstruction of capillaries and to ischemia of the retina and leakage, which can be identified by angiography. The classic histopathological changes comprise a decrease in endothelial cells and pericytes and solidifying of the basilar membrane. Micro-aneurysms are actually the locations of external swelling of the capillary wall and are pathognomonic . ConcernPathogenesis involves numerous biochemical signal pathways. The amplified action of protein glycosylation and protein kinase C results in the creation of advanced glycation end products (AGE). This is further followed by cell communications comprising vascular endothelial growth factor (VEGF), which leads to new vessel formation in the anterior as well as posterior parts of the eye, the increase in vascular permeability outcomes in a leak, and the breakdown of the inner blood-retina barrier . AGE is ConsequencesRetinal damage and hard exudates occur due to the amplified permeability of vessels and drop in levels of lipids and plasma proteins. Micro-thrombosis with retinal micro-infarcts yields cotton wool spots identical to ischemia and hypoxia. Hypoxia yields an effect for discharging angiogenic factors and new vessel construction in the retina and iris. Oedema is produced especially in the macular area by the extravasated fluid . In the ScreeningTechnically, screening is a procedure of diagnosing an unrecognized disorder or disease with the help of tests in apparently healthy and asymptomatic people. World Health Organization (WHO) conditions for screening programs include: (i) the disorder must represent a significant public health problem, (ii) the disorder must have an identifiable latent/early stage, the screening procedure must be suitable for the public and healthcare professionals, (iii) the disorder must have adequate and well-recognized therapy choices, and (iv) the price of early identification and treatment should be thought about for whole healthcare spending, and the consequence of leaving the disease untreated . It is aTable Efforts to escalate the screening for DR must be supplemented by efforts to raise awareness and knowledge related to diabetes and its problems, especially DR, to confirm regular follow-up of the patients . VariousHospital-based DR screening modelPhysician ClinicsRegular physicians competent in utilizing a direct ophthalmoscope can observe the fundus of patients who have diabetes. Physicians are usually the initial interaction for people who have diabetes. Various diabetologists and physicians throughout the country have undertaken training for fundus investigation by the Public Health Foundation of India (PHFI), a certificate program of DR for increasing the number of optometrists as well as physicians. Sometimes physicians fear dilating the people for fundus inspection . UnfortuScreening at Non-Communicable Disease (NCD) ClinicsA wide-ranging platform has been started in public health NCD clinics in almost 10 regions throughout India to identify eye problems among individuals with diabetes . A natioHospitals and DispensariesSecondary care hospitals that have fundus cameras employ skilled eye experts for fundus imaging to screen patients with diabetes coming to their hospitals. Patients who have diabetes who went to several dispensaries under the Mumbai Municipal Corporation were examined for DR with the help of a mobile phone-based retinal camera by a trained healthcare worker. The pictures were categorized by a trained ophthalmologist as well as an AI system. The accuracy of the AI system in analyzing DR was almost 100%, and the specificity was 88.5%. The research displayed that the help of an automated offline algorithm integrated with a low-cost fundus camera could be an upgradable mode of DR screening in India .Tertiary Care Diabetes CentresScreening for DR is achievable predominantly in tertiary care diabetes centres as the patients with inadequate glycaemic control show up to those centres. Also, yearly follow-up appointments are more feasible in such establishments. Usually, patients with diabetes do not come to the ophthalmologist for DR screening because of a lack of awareness about the fact that eyes too can be affected by diabetes . The impMulti-Speciality Eye Care Facilities and Eye HospitalsCompetent ophthalmologists usually investigate DR using slit lamp bio-microscopy with the help of a 78 D/90 D lens and indirect ophthalmoscopy for a complete retinal check-up following dilatation of the pupil (mydriasis). Tertiary eye care centres provide fundus investigation knowledge and disease management with well-equipped facilities. All patients with diabetes coming to eye hospitals for a comprehensive eye test or refraction can be sent to the speciality retina clinic for high-value retinal imaging following mydriasis for precise DR identification and reasonable control of VTDR. On the other hand, the low number of eye hospitals and competent specialists is the obstacle to the widespread execution of such screening. To lessen the load on ophthalmologists, professional fellowship courses are being offered to increase the number of optometrists. To conclude, we can say that hospital-based screening programs are more specific and empower screening and DR findings in identified diabetes patients .TreatmentDespite optimal medical management of serum cholesterol level, blood glucose level, and blood pressure, several intraocular procedures have developed as regular treatments for DR . In the DR is a complication of DM. Even after various studies concerning the management modalities of DR and macular oedema, the limitation of proper medical resources resulted in a low fundus examination rate, which has delayed the identification and timely management of DR. On average, there is a five-year gap between the onset of symptoms and diagnosis of the disease, which should be used appropriately to prevent further progression. Hence, applying an automated screening technique and identifying specific biomarkers is vital for early diagnosis and proper treatment.


The smart wearable device is a new breed of mobile device that offers diversified utilities for health, sport, and finance for consumers worldwide. The current study aims to investigate the provocation of the intention to use smart wearable payment devices among Malaysian consumers. The unified theory of technology acceptance and use of technology (UTAUT) was employed with the cross-sectional survey-based data to explain the adoption of the smart wearable payment device. Furthermore, the UTAUT model was extended with trust and lifestyle compatibility factors to investigate smart wearable payment device adoption. The survey-based data were collected through the online survey and analyzed through the symmetrical modeling approach of partial least squares structural education modeling (PLS-SEM) to evaluate theoretical associations between the study constructs. The fuzzy set qualitative comparative analysis (fsQCA) was employed as an asymmetrical approach. As a result, it was found that the ease of use, lifestyle compatibility, and trust significantly impacted the intention to adopt smart wearable payment devices. However, social influence and facilitating conditions did not support the intention of adopting smart wearable payment devices. Adopting these devices requires policy and infrastructure development to harness the adoption of smart wearable payment devices. This paper is concluded with study limitations and future research suggestions. Information and communication technologies (ICT) play a pivotal role in daily human life across the globe. Human health and sports activities are managed and facilitated using mobile devices that are linked to smartphones  in Malaysia, which regulates the nation's financial industry, has issued 45 non-bank and six bank e-money licenses  has been considered a robust theory to explore and understand technology adoption. The UTAUT advocated the existence of the power to demonstrate over 70% of the variance in the intention and adoption of technologies : perceived ease of use of wearable payment devices positively affects intention to adopt the smart wearable devices.Hypothesis : The perceived usefulness of wearable payment devices positively affects the intention to adopt smart wearable devices.Hypothesis : The perceived trust in wearable payment devices positively affects the intention to adopt the smart wearable device.Hypothesis : Lifestyle compatibility of wearable payment device positively affect the intention to adopt the smart wearable device.Hypothesis : The social influence of wearable payment devices positively affects the intention to adopt the smart wearable device.Hypothesis : Facilitating conditions for wearable payment devices positively affect intention to adopt the smart wearable device.Hypothesis . Based on the calculated Mardia's multivariate p-value, the study data showed a non-normality issue, provided that the p-values were below 0.05 . Hair et al.  recommenr2, Q2, and effect size f2 could explain the endogenous construct changes caused by the exogenous constructs  asymmetric modeling technique is developed by combining fuzzy sets and fuzzy logic Ragin, . AsymmetFour-step processes were proposed for the use of the fsQCA. The original study variables included the five-point Likert scales rescaled from 0 to 1, where 0 refers to the full non-membership of the set, while 1 depicts the full membership Ragin, . This prk∧ rows, where k shows the number of outcomes utilized in the analysis. In contrast, the row presents every possible combination among the causal conditions of the study  was utilized to achieve the discriminant validity for each study construct. This criterion was calculated with the square root of a particular construct AVE. Furthermore, the AVE square root for the construct should be higher than the correlation among the study's other constructs  on the intention to use the smart wearable payment devices represented 66.8% of the changes in the intention of using smart wearable payment devices. The predictive relevance (Q2) value for the part of the model amounted to 0.467, which demonstrated a large predictive relevance  indicated an insignificant but positive consequence of the perceived ease of use for smart wearable payment devices values on the intention to use smart wearable payment devices. The result formed no significant statistical support to accept the H1. The path value for the PUF and INT  indicated that the perceived usefulness of the smart wearable payment devices impacts the intention to use the smart wearable payment devices, and the effect is statistically significant and positive. The path between TRT and INT  illustrated the influence of trust in smart wearable payment devices on the intention to use smart wearable payment devices, which is positive and significant. The path coefficient for the SIN and INT  represented a positive but insignificant effect, which presented the support for not accepting the argument that social influence affected the intention to use the smart wearable payment devices and offered no support for accepting the H4.The model standardized path values, t = 5.599, p = 0.000), which illustrated the influence of the local compatibility on the intention to use the smart wearable payment devices, was positive and significant. Therefore, the path presented the support to accept H5. Furthermore, the path between FCN and INT  demonstrated the positive but insignificant influence of the facilitating conditions on the intention to use the smart wearable payment devices. The path from LCM to INT  and PLS-SEM model show that more of the LM benchmark yields more errors than the PLS-SEM model. The results deliver an acceptable indication that the PLS-SEM model performs well for the prediction purposes for out-of-sample results to predict intention to use smart wearable devices. The distribution of errors confirms that the intention to use smart wearable devices has high predictive power (see The assessment of predictive power of the current model was assessed. ower see .The fsQCA analysis necessitated a calibration of the conventional variable gauged with the Likert scales. Each latent variable was estimated from the average values of the respective items in the latent constructs (Hayat et al., k row was estimated. In the study with six casual conditions, the possible number of the combination was 64 (Ragin, A truth table with a 24 Ragin, . The fsQ4 Ragin, . However4 Ragin, . Table 94 Ragin, . The mos4 Ragin, .Furthermore, the first configuration demonstrated that the perceived ease of use, perceived usefulness, and facilitating conditions were adequate to achieve higher intention to use smart wearable devices despite the absence of trust, social influence, and lifestyle compatibility toward smart wearable payment devices. The first configuration covered 27.5% of the cases, uniquely describing 2.7% of the study cases with a higher intention to use smart wearable devices Ragin, . The secThe third configuration illustrated that the perceived ease of use, perceived usefulness, social influence, lifestyle compatibility, and facilitating conditions were suitable for achieving a higher intention to use smart wearable devices in the absence of trust toward smart wearable payment devices. The third configuration covered 60.8% of the cases and uniquely described 1.5% of the study cases for the higher intention to use the smart wearable devices, which presented a consistency score of higher than 0.80 Ragin, . The fouThe examination was performed on the causal asymmetry assumption based on fsQCA, which was a new absence of the higher intention to use smart wearable payment devices (Hayat et al., The current study examined the formation of the intention to adopt smart wearable payment devices among Malaysian adults as an extension of the UTAUT with symmetric and asymmetric analyses. The study results supported the argument that the perceived ease of use, perceived usefulness, trust, and lifestyle compatibility influence the intention to use wearable smart payment devices. The ease of use and usefulness of the wearable smart payment device encourage young Malaysian professionals' intention to use smart wearable payment devices. The current study outcomes were in line with the result by Aji et al.  that theHowever, social influence on the use of smart wearable payment devices was insignificantly negative in harnessing the intention to use smart wearable payment devices among the Malaysian samples. The young Malaysian respondents found that the important individuals around them did not favor using smart wearable payment devices. The result of the current study complemented the results by Gupta and Arora , in whicThe fsQCA analysis offered a unique understanding regarding the higher intention to adopt smart wearable devices among the study cases. Four causal combinations of input conditions contributed to the higher intention for using smart wearable payment devices. The perceived ease of use and usefulness required facilitative conditions to promote higher intention toward using smart wearable payment devices. Similarly, localized compatibility was critical in building a higher intention to use smart wearable payment devices. Lastly, social influence and trust played a role in instigating higher intention to use the smart wearable payment devices, although it only took place in 2% of the cases. However, the four causal combinations of conditions covered ~70% of the cases, indicating the critical role the factors played in building a higher intention to use smart wearable payment devices.The current work made a theoretical contribution with the empirical evidence that the UTAUT model can be extended with trust and lifestyle compatibility factors. The perception of trust and lifestyle compatibility significantly influence the intention to use the smart wearable device as a technology. These two factors can enhance the UTAUT predictive power and acceptable addition of the UTAUT as a technology acceptance model. Furthermore, the current work supports that trust and lifestyle compatibility are important factors, indicating a higher intention to use the smart wearable payment devices with the asymmetrical data analysis technique of fsQCA.The current work has made attempts to contribute to the current technology adoption literature and managerial implications. Specifically, the positive inclination toward smart wearable devices shows positive signs for smart wearable device manufacturers. Subsequently, it was argued that more business opportunities are developing to expand the business, which is in line with the report by NASDAQ . HoweverBuilding localized compatibility assists in improving smart wearable payment device intention, followed by the adoption of smart wearable payment devices. The financial regulators and financial institutions should work closely with the local communities to build trust and social acceptance, and provide convenience to the less-educated individuals to use contactless payment devices. In the current time of the COVID-19 pandemic, it would be necessary to offer facilitative conditions through policy and monetary incentives to promote the use of smart wearable and contactless payment devices. This action also helps the reduction of personal contact and the spread of COVID-19.Although a contactless payment system is the future of finance and banking, the right policy and managerial action should achieve higher penetration. Furthermore, the role of government support needs exploration, which contributes to understanding the role of facilitative conditions on the policy level that influences the adoption of smart wearable payment devices among the general public. In general, the availability of smart wearable payment devices, specifically contactless payment counters at shopping centers, facilitates the use of smart wearable payment devices. The mega and general store managers need to provide contactless payment devices to boost the adoption of smart wearable payment devices.There is an increase in the popularity of smart wearable devices for general health purposes and other relevant uses, while the acceptance of smart payment devices has increased over time (Karim et al., Three prime limitations associated with the current study included using the UTAUT model. Therefore, future studies may be required to employ other adoption models based on the values and concern-based adoption. The value-based adoption model highlighted the implication of the derived value or cost associated with adopting novel technologies. Furthermore, government support and personal inclination toward technology are important in adopting technology. For this reason, future study is suggested to incorporate government support and individual personal readiness for technology adoption. The last limitation was the use of cross-sectional data collected in the current study. To fully explore the adoption of smart wearable payment devices, a longitudinal research design should be employed to understand the continuous intention and consistent use.The original contributions presented in the study are included in the article/Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. The patients/participants provided their written informed consent to participate in this study.AS, MA, WH, and NZ: conceptualization, methodology, questionnaire design, data collection, and writing—original draft. NH and AA: conceptualization, formal analysis, and writing—reviewing and editing. All authors contributed to the article and approved the submitted version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


The authors raised some interesting points  related The authors stated that the pooled estimates were obtained by combining the continuous and dichotomized hazard ratios (HRs), and they suggested that we may have found different results by considering the two parameters separately. As suggested, we performed a meta-analysis differentiating between the studies reporting continuous HRs and those reporting dichotomized HRs. In particular, we either extracted the HRs and 95% confidence intervals (CIs) directly from each study, if reported, or estimated them indirectly using the method described by Tierney et al. . The HRscontinuous group. On the other hand, the other analyses identified no significant impacts of pTV on tumor control or survival. Moreover, high nTV was not associated with worse survival. As shown in The authors stated that some individual studies showed a significant impact of the tumor volume, analyzed using dichotomized or continuous variables. Adrian et al.  identifiWe thank the authors for their valuable comments on our study, which allowed us to improve the precision of our analysis. The current literature data do not suggest that the tumor volume represents a prognostic factor of high clinical significance in regard to the OPSCC. However, the low quality of the available studies and the high level of inter-study heterogeneity requires further attention in order to better define the roles of pTV and nTV.


Endocytosis and cell compartments define eukaryotic cells and evolution has sculpted a complex subset of intracellular structures to arrange the modern cell. This process has been long, implicating each single organelle to eventually develop a functional consortium where spatio-temporal distribution becomes essential.Because of this intrinsic extreme complexity minor alterations must be repaired, replaced, or undergo reorganization. This is also important when it comes to biochemical processes within and between cellular compartments developing a new concept that implicates cell compartments not to function as individual and isolated entities, but as a dynamic and regulated ensemble facilitating the intracellular trafficking of lipids and proteins. The diverse intracellular compartments contribute to a global cell homeostasis and alterations provide new insights relevant for a number of human diseases and offer opportunities for the design of innovative therapies and treatments.2+ store and the compartment in charge for the biosynthesis of lipids, proteins and assembly of glycoconjugates . Indeed, the endoplasmic reticulum (ER) is the organelle “to rule them all”; it is the most extensive membrane compartment, lead regulator of membrane trafficking, the largest Canjugates .The 14 articles in this collection cover only a small part of the wide panorama, but representative aspects are discussed to understand membrane trafficking across organelles from a wide biological, biophysical, or engineering perspectives and where protein sorting, membrane traffic, and organelle dynamics are the targets and alterations may be the cause of disease.Artyokov et al., endocytosis of death receptors is explored. Tumour necrosis factor (TNF)-associated ligand inducing apoptosis (TRAIL) binds cell surface death receptors DR4 and DR5, initiating a signalling cascade that results in apoptosis. Through unknown mechanisms, some cancer cells are resistant to TRAIL-induced apoptosis, limiting the anti-cancer potential. Here, Artyokov et al. determine the role of DR4 and DR5 endocytosis in conferring sensitivity to TRAIL-induced apoptosis. The authors demonstrate that TRAIL binding universally stimulated endocytosis of DR4 and DR5 in sensitive and resistant cells alike, concluding that sensitivity to TRAIL-induced apoptosis arises through post-endocytosis mechanisms.Endocytosis plays a key role in the regulation of signalling from cell surface receptors. In an original research article by Hasegawa et al. review the importance of endosomal phosphatidylserine (PS) distribution on trafficking pathways. PS is the major anionic phospholipid in the plasma membrane but is also enriched on recycling endosomes where it recruits proteins involved in recycling and retrograde transport for cargo delivery to the plasma membrane and Golgi respectively. Here Hasegawa et al. discuss the role of PS flipping from luminal to cytosolic leaflets of recycling endosomes by the P4-ATPase ATP8A in recycling and retrograde traffic. PS flipping is likely to be coordinated with the recently identified transport mechanism of newly synthesized PS from the ER to recycling endosomes at ER:endosome contact sites to promote recycling and retrograde transport . On loss of the adaptor protein AP-3, that is defective in HPS, ATP8A1 accumulates on recycling endosomes, increasing the cytosolic exposure of PS, activating YAP and promoting cell division and migration.Membrane lipid composition is a key determinant of endocytic traffic and receptor signalling and ransport . Endosomransport , furtherToxoplasma gondii, the relevance of cholesterol transport  is underpinned using the cholesterol transport inhibitor U18666A demonstrating the potential of cholesterol for the recruitment of CHMP4, in MVBs formation, for optimum antigen presentation and parasite replication. Other related research  addresses the problem of cholesterol uptake, in the pathogenic yeast Candida glabrata, as strategy to decrease antifungals susceptibility for proliferation and the possibilities of using ERG25 in the stabilization of sterol-rich lipid domains as therapy.The Research Topic continues to highlight the significance of the lipid environment in membrane traffic and disease. The importance of cholesterol transport and distribution inside of cells is a recurring theme . Here, aSandoval et al.). LS patients present mutations in a gene encoding a phosphatase known as OCRL1. Megalin is proteolytically cleaved in its ectodomain and in LS patients reduced levels of this megalin fragment are detected. In addition, the levels of the receptor in endocytic/recycling compartments increase in the proximal tubule renal cells. The authors show that silencing OCRL1 mimics the altered parameters found in LS patients with a significant decrease of megalin at the plasma membrane, indicative of a reduced recycling of the receptor. Furthermore, in these LS conditions the phosphorylation levels of megalin were reduced, explaining, in part, the altered recycling transport. Sandoval et al. also uncovered the role of insulin in the reduction of megalin phosphorylation and trafficking to the plasma membrane. The generation of this LS-mimicking cellular model may potentially help to develop novel therapeutic tools for this disease.The family of low-density lipoprotein receptors (LDLR) plays a key role in cholesterol internalization and homeostasis . This faFader Kaiser et al.) and a second review about LD in the nucleus and their function at this novel sub-world . Both articles discuss and dissect the molecular components to correlate with the involvement in human pathologies.Lipid droplet (LD) landscape  is also Cabrera-Reyes et al.) focuses on lysosome homeostasis alterations in lipid-related disorders, particularly in prevalent diseases such as obesity and also in the less frequent Lysosomal Storage Diseases (LSDs), such as Niemann-Pick C (NPC) and Gaucher diseases and discusses the mechanisms involved in lysosomal alterations that are common among cells of metabolic tissues, including adipose tissue and the liver, which are primarily affected in these pathologies. An original research article of this collection  explores the relevance of alterations in c-Abl tyrosine kinase signalling in the LSD Niemann-Pick type A (NPA), a fatal neurodegenerative disorder caused by the deficiency in acid sphingomyelinase (ASM) activity and characterized by an accumulation of sphingomyelin in lysosomes and dysfunction in the autophagy-lysosomal pathway. The results show the participation of c-Abl signalling in NPA neurodegeneration and autophagy-lysosomal alterations, supporting the potential use of c-Abl inhibitors for the clinical treatment of NPA patients.In the recent years the lysosome has emerged as an essential organelle for cellular homeostasis, being not only involved in the degradation of complex substrates but also able of sensing the nutrient environment and participate in signal transduction, thereby regulating fundamental processes such as cellular clearance and autophagy . A revievia evoked exocytosis of WPBs following endothelial activation by inflammation or blood vessel damage . An original research article describes the interesting trafficking route of a vacuolar ATPase (vATPase) subunit on its way to maturing WPBs . WPBs are acidic organelles, and the low intraluminal pH is required for the proper folding (tubulation) of VWF in the organelle. Recently, vATPase activity and the vATPase V0a1 subunit were reported to be required for proper WPB acidification and biogenesis of the organelle  are a unique class of intracellular compartments performing specialized functions in different types of cells. In vascular endothelial cells, the prominent LROs are Weibel-Palade bodies (WPBs). They serve as storage organelles for the blood clotting von-Willebrand factor and the leukocyte receptor P-selectin that are released l damage . The unirganelle  and Lu eVargas et al.) identified an ER membrane protein called HERPUD1. Expression of a deletion mutant lacking the ubiquitin-like domain, critical for proteosomal degradation, negatively modulates autophagy. In addition, overexpression of this mutant leads to an increase in ER tubular stacks as well as an augment in the biogenesis of lysosomal vesicles. The authors propose that ER-lysosome intercommunication is promoted to favor cell survival under stress conditions, such as nutritional deficiency or certain drug treatments.Macroautophagy is a degradative pathway that intersects with both the lysosomal and the proteosomal pathway to maintain cellular homeostasis by degrading and recycling critical components. Increasing evidence indicates that autophagy can be regulated, either in a positive or negative way, by the ubiquitin proteasome system, indicating that both systems function as an interconnected network . An origvia dynamic close contacts with a plethora of tethers and molecular machineries in charge for transport and exchange of lipids, cholesterol, ions, and metabolites. MCS modulate endosome maturation, organelle positioning, metabolic platforms and for cellular homeostasis. A Mini Review in this collection  put together recent findings regarding a subset of annexins  are now at the crest of the wave in cell biology . The parannexins  and discIn summary, the present collection of research articles and reviews under this Research Topic highlights the advances in the field with novel insights to uncover the fine structure, distribution, and dynamics of molecular machineries and protein complexes in cell compartments. Throughout the collection, a relationship between the lipid environment and membrane trafficking/signalling pathways is emerging. The composition of membrane lipids is diverse and complex and key open questions remain about the maintenance of membrane lipid homeostasis and its influence over the endocytic pathway. A role for MCS in coordinating these dynamic and adaptable processes is becoming apparent but the picture in different physio/pathological situations is incomplete and key intracellular cholesterol transport mechanisms remain elusive. With improved understanding, new interventions to help in the cure of multiple human diseases become a possibility.


Cognitive function is impaired in depressive disorders. Among several factors implicated in regulation of the cognitive function, metabolic syndrome has been showed have a pivotal role cognitive functioning in healthy controls. However, the role of metabolic syndrome in regulating the cognitive functioning of subjects affected by depressive disorders is little studied.To investigate the effect of metabolic syndrome in regulation of cognition in unipolar and bipolar depression.One-hundred-sixty-five people affected by a depressive disorder  were enrolled at the Psychiatric and Clinic Psychology Unit of the University of Rome Tor Vergata, Rome, Italy. A group of healthy controls (HC) matched for agender and age was enrolled. The cognitive functions were evaluated with a computerized tool, THINC-it.UP and BP had lower performances in THINC-it cognitive domains than HC. Metabolic syndrome is a negative, independent predictor of low performance in the THINC-it cognitive domains of people with depressive disorders.Our findings confirm that metabolic syndrome has a prominent role in determining the cognitive efficiency in depressive disorders, independently by the presence of a unipolar or bipolar depressive disorder. Metabolic syndrome has to be considered a major factor that should be considered in the treatment strategies of cognitive functioning improvement of people affected by depressive disorders.No significant relationships.


This special issue summarizes the current trends in the development of biomimetic composite materials for tissue engineering and regenerative medicine applications. In a typical biomaterials approach, two-dimensional (2D) or three-dimensional (3D) culture systems made from different types of biomaterials have attracted more and more interest from tissue engineers . ThroughBiomimetic materials are synthetic or modified natural materials that mimic natural materials or follow a design motif derived from nature and are also very useful in designing composite materials to solve human problems . MoreoveBittencourt et al. gave an overview of the relationships between structural properties and function of spider silks for designing and generating spidroins through the principle of synthetic biology. Furthermore, they discussed the molecular structure effect of spidroins on the mechanical properties of materials, offering a summary of the recent progress in producing innovative structural materials by using recombinant bioengineered spidroins.Li and co-workers designed mussel-inspired nanocomposite polydopamine-based materials with good conductivity, high fluorescence quantum yields, and low cytotoxicity to regulate cell behaviors. Furthermore, they demonstrated that the conductive mussel-inspired nanocomposite materials have a promising potential to set an electroactive platform to enhance cell adhesion and growth and remove harmful cells via electronic control procedures.Yao and co-workers combined a tricalcium phosphate (TCP)-based gelatin scaffold (GGT) and electroacupuncture stimulation to accelerate the bone remodeling process. They focused on investigating the dual effect of chemical and physical stimuli from the composite scaffold and electrical stimulation on new bone regrowth in vitro and in vivo. The study provides potential interest in combining composite biomaterials and external stimulation to improve bone defects after injury.Xu et al. indicated the importance of experimental models precisely recapturing liver functions and reflecting the hepatotoxicity effect of the drug on the liver and the necessity of a 3D biomimetic composite material-based system for evaluating liver hepatotoxicity. Specifically, their composite hydrogel fibers provided a method to fabricate a 3D hepatic plate-like co-culture system that can recapture the characters of hepatic plate-like structure and have a bile secretion function applicable for chronic/acute drug hepatotoxicity evaluation.Borihindakul and his co-workers reviewed the features of two types of foot microstructures, spatula-shaped and mushroom-shaped, capable of generating adhesive foot. Subsequently, they discussed the technologies of dry, wet, magnetic, and pneumatic adhesion and the applications of bio-inspired adhesion in the design of climbing robots. Furthermore, they described the relationship between spatula- and mushroom-shaped microstructures and the creation of climbing robots that guide roboticists in selecting the adequate adhesive foot to reach the desired climbing ability for robot developments in the future.Khan et al. developed a bioinspired hybrid rigid-soft robot-foot from the morphology of inchworm legs to overcome the issue that few legged robots can crawl on curved metal pipe surfaces. They described that the robot foot consists of a rigid electromagnet part, and a soft toe covering endows the robot with the ability to be a metal pipe crawler. The study provides a strategy to design the robots meeting the requirements of crawling large oil and gas pipelines in inspecting the leakages and faults.Zhang et al. reviewed a topic about the role of the gecko tail in helping adaptive and robust climbing behaviors on sloped walls. Furthermore, they addressed the role of gecko and robot tails in the climbing performances. Moreover, they also analyzed and compared the feasibility of rigid and soft composite materials for designing the robots’ tails. The article provided the information to design and fabricate the climbing robots and addressed whether the tails are required for robots and the concept of selecting the adequate materials for the tails according to the motion types and desired functions in different environments.In conclusion, we would like to thank the participants for their contributions. We hope that this special issue will be helpful for the development of novel biomimetic composite materials in biomedical applications.


Melkersson-Rosenthal syndrome (MRS) consists of persistent or recurrent orofacial edema, relapsing facial palsy and fissured tongue. The complete triad of symptoms is uncommon, varying from 8 to 25%. The presentation of only one symptom is more common. The most frequent complaint is facial edema and enlargement of the lips. We describe a case of a 17-year-old Brazilian girl with limited edema of the lower lip and fissured tongue due to MRS. Her complaints had started two years before. She referred previous clinical treatments without success. We proposed intralesional injection of triamcinolone at 20 mg every 15 days associated with oral clofazimine at 50 mg/day for three months. The lip became normal after four triamcinolone injections. Recent studies have considered MRS a granulomatous disease, and possibly the initial presentation of Crohn's disease in orofacial area of some patients. MRS patients, therefore, should be screened and monitored for gastrointestinal symptoms. Corticosteroid treatment seems to be effective in reducing lip enlargement. We discus the clinical features of this disease, the treatment, and the importance of corticosteroid therapy in cases of MRS-related facial palsy. Swelling of the lips, plicated tongue (lingua plicata), and recurring facial paralysis characterize the Melkersson-Rosenthal syndrome (MRS). The classical triad occurs in 8% to 25% of cases.Miesher's cheilitis is characterized by recurring and painless localized lip swelling, and is part of the orofacial granulomatosis group (OFG).1 The chronic and recurring nature of the inflammation leads to fibrosis and permanent lip swelling, which makes treatment difficult, and relapses frequent. Histologically it is characterized by non-caseating granulomatous inflammation.3Recent studies have suggested an association between the OFG and Crohn's disease (CD), based on the histological similarity between both conditions and the occurrence of MRS manifestations as the initial presentation of CD.The aim of this study is to present the case report of a patient with granulomatous cheilitis and plicated tongue that had an excellent response to treatment with intralesional triamcinolone. We report the clinical progression, treatment options and the possible association between MRS and CD.A female Caucasian patient aged 17 years presented progressive and persistent swelling of the lips during the last two years.The physical examination showed localized swelling in the lower lip  and plicTreatment involved intralesional injection of a corticosteroid  and clofazimine (50mg/day) during 90 days. The lip swelling reduced markedly after the first month of treatment. Full resolution occurred after 4 sessions of corticosteroid use.Orofacial granulomatosis may precede or follow the diagnosis of CD by years. It could be seen as an oral mucosal manifestation of inflammation presenting in the digestive tract.5 Patients with MRS should be warned about the possible development of CD, and should undergo an assessment of the digestive tract.4,5The accepted treatment of orofacial granulomatosis with lip swelling is the intralesional injection of corticosteroids, combined or not with oral clofazimine.3.The Melkerson-Rosenthal syndrome has been described as a granulomatous disease, which has implications for its treatment. Follow-up of granulomatous cheilitis has shown that intralesional triamcinolone combined with oral clofazimine is an effective treatment.


Children with mental health issues are heavily dependent upon the attitude of their caregivers towards disease control and prevention. There is also a high risk of COVID-19 outbreaks in the mental health clinics  for children.Children with mental health issues are heavily dependent upon the attitude of their caregivers towards disease control and prevention. There is also a high risk of COVID-19 outbreaks in the mental health clinics  for children.The data from the Municipal Department of Health and Medical records of patients who were treated at the clinic from January to June in 2019 were compared. Statistical processing was carried out using the Chi-Square for 2 x 2 Contingency Table method.The study demonstrated the statistically significant difference in the types of mental health conditions that require more attention and in-patient emergency treatment options during the pandemic, including decompensation, exacerbation or manifestation of endogenous diseases, anorexia nervosa and suicidal manifestations. To prevent the spread of infection, a specific separate clinical unit was created for patients with severe mental health disorders and symptoms of COVID-19. Additionally, multiple changes were implemented in treatment protocols, staff duties and interactions with the patients’ caregivers.There was a higher demand for in-patient emergency treatment for children with severe mental health disorders in 2020, as compared to 2019. Timely introduced anti-epidemic measures made it possible to avoid outbreaks of COVID-19 in the children’s psychiatric hospital.


Colorectal cancer is among the most common cancers globally and carries a high mortality rate. The incidence of colorectal cancer has been increasing in the Middle East, including in Oman. While many countries have implemented a bowel cancer screening program, Oman has yet to establish one. A standard tool for bowel cancer screening is a fecal immunochemical test where a fecal sample is sent to a laboratory to check for blood content in the feces. In Oman, such fecal test kits are available at the primary health care level, but primary care physicians were unaware of the signs and symptoms or screening methods for colorectal cancer. This review article aims to assess the suitability of a colorectal cancer screening program in Oman using guidelines from the Supporting the Use of Research Evidence (SURE) collaboration. Colorectal cancer (CRC) is cancer of the colon and rectum. In 2016, CRC was reported as the third most common cancer worldwide among both sexes and the fourth leading cause of cancer-related death  , a group of high-income countries (HICs) with similar religious and cultural habits. These countries witnessed rapid industrialization and development over the past 40 years. During that time, residents of these countries also changed their lifestyles and dietary habits. Decreasing levels of physical activity, increased obesity, increased uptake of smoking, and unhealthy diets are some of the factors related to developing CRC among Arabs and Omanis .Although the countries in the GCC are considered low-risk for CRC, a review of the incidence of CRC in the Middle East by Alhurry et al. reported that the incidence of CRC was increasing, and the highest incidence rate of CRC among the GCC nations was in Kuwait, followed by Saudi Arabia .Like its GCC neighbors, Oman has witnessed a steady increase in CRC incidence from 1996 to 2015 . As per Fadhil et al. assessed the rising CRC incidences in the member countries of the GCC and advised the introduction of a CRC screening program in a phased manner . HICs liQatar has implemented similar screening programs for its population . As of tCriteria 1: Is the health problem important?As reported by the Global Cancer Observatory (GLOBOCAN), the incidence of CRC in Oman has risen to the most diagnosed cancer among men and the second most common cancer among both sexes in Oman Figure  9]. The. The9]. Studies have also reported that despite CRC affecting mainly older age groups, CRC in Oman has been diagnosed in younger patients , and patients often present with advanced stages of the disease . MortaliPresently, Omani nationals have free healthcare paid for entirely by the government. The burden of CRC is expected to increase significantly by 2040, and Oman is no exception . Actual Criteria 2: Are viable options available to address the problem?There are multiple screening tools and tests for CRC. Three fecal/stool tests are available: the guaiac fecal occult blood test (gFOBT), the FIT, and the multitargeted DNA stool test (FIT-DNA). The gFOBT uses a feces sample to detect heme, a component of hemoglobin. gFOBT can detect heme in certain foods like red meats, so patients should avoid heme-rich foods before performing this test. The FIT kit uses an antibody to detect the hemoglobin protein in the fecal sample. The FIT-DNA test kit detects DNA biomarkers and hemoglobin in the fecal sample. When stool passes through the colon, some of the colon's mucosa cells are shed along with it. If this mucosa contains cancerous cells, the DNA of the tumor will be detected.The specificity for these tests is high, ranging between 96.8% and 98.6%, but the sensitivity for advanced CRC is high in the FIT kits . The senOther screening tests for CRC are colonoscopy and computed tomography (CT) colonography. Colonoscopy is considered the gold-standard diagnostic modality for screening for CRC because this allows for visual confirmation of bowel tumors and access to biopsy the bowel mass/lesion. The main complication of this procedure is the possibility of colon perforation during the procedure. Another alternative screening test for CRC is the use of CT colonography. In this procedure, a small tube is inserted into the rectum to inflate the colon with air. The CT machine then scans the patient. The drawback of this procedure is that if suspicious polyps are identified on the scans, the patient will need a colonoscopy procedure to have these removed and sent to the histopathology laboratory for confirmation of the benign or malignant nature of the polyp.In Oman, primary healthcare centers all over the country are equipped with gFOBT kits . ColonosThe screening modalities listed above are all readily available in Oman. Like other HIC countries and Qatar, Oman could use gFOBT to screen patients aged 50-75 for CRC. Patients with positive results could be referred to the tertiary center for colonoscopy.Criteria 3: Is there an opportunity for change?Awareness of CRC screening among the Omani population has been documented to be low . This inGiven the rising incidence of CRC in the region and Oman, the high mortality in cancer deaths in the country, and a possible increase in awareness of CRC, a policy window might exist currently to persuade the Oman Ministry of Health to adopt national screening for CRC. Kingdon's multipolicy streams model could be applied in this setting, as shown in Figure The problem stream is the high incidence of CRC and CRC mortality in Oman, the low awareness of the population regarding CRC, and the availability of trained personnel in the healthcare sector. The political stream consists of administrators at the Ministry of Health, and the policy stream consists of multidisciplinary teams of doctors and nongovernment organizations (NGOs) who could emphasize the need for a CRC screening program in the country.Criteria 4: Is there important uncertainty about the problem and potential solutions?Qatar's CRC screening program commenced in 2016 as per the policies laid by the National Cancer Program . PatientA cross-sectional study by Al-Dahshan et al. reported low awareness of CRC risk factors and symptoms among the target population in Qatar despite a screening program that commenced in 2016 . SimilarOne issue the Oman healthcare system faces is the long waiting list for colonoscopy and surgical operation appointments. Patients from different regions of Oman insist on being treated in the main tertiary hospital of the country located in the capital, Muscat - the Royal Hospital. The colorectal surgery unit is present in the Royal Hospital only. Therefore, the Royal Hospital became a focal point for CRC referrals and management.Another issue the healthcare system faces is a shortage of operating theaters. The recent pandemic worsened the shortage when elective surgery cases were canceled or postponed, and only select patients with advanced CRC disease received surgical operations. With the intensive care units (ICUs) around the country saturated with COVID-19 patients, booking beds in the ICU for advanced CRC patients who required surgery represented a considerable challenge.Several issues must be addressed. The level of CRC awareness among the public needs to be increased. Media campaigns are required to educate the public on screening programs, especially the older age group of patients aged 50-75. Physicians at the primary healthcare centers need to be trained to be more vigilant when treating patients in this age group and offer testing kits to suspected patients. Besides the availability of test kits, follow-up of patients with positive results and fast-tracking their colonoscopy appointments are required. These measures will need considerable labor force and financial support.A multidisciplinary team consisting of stakeholders - medical personnel , patients, and NGOs  - would need to cooperate and meet with officials from the Ministry of Health to emphasize the issue of CRC and its shared burden. Only through these persistent discussions could a policy window be created, and a national screening program for CRC in Oman could commence.Criteria 5: Is relevant research evidence available?Published studies have confirmed that screening for CRC reduces a country's cancer burden ,30. EvenThe population must be educated that the primary prevention of CRC is by adopting healthier diets, including additional vegetables and fibers, and increasing physical activity. Secondary prevention is possible by adopting a screening program to look for and eliminate precancerous lesions using fecal tests followed by a colonoscopy if the result is positive . ScreeniCriteria 6: Is there interest in informed deliberation about the problem and potential solutions?Although patients' awareness of CRC in Oman was low, they were willing to undergo a screening test if advised by their doctor . In the Oman has witnessed an increase in the incidence of CRC and CRC-related death. A CRC screening program has not yet been implemented in Oman, but some neighboring countries have adopted such a program. Using the SURE guidelines, we assessed the suitability of a CRC screening program and identified a few challenges that could be encountered when implementing such a program in Oman. Some cultural and emotional barriers to accepting screening tests and diagnosing CRC exist. Physicians' awareness of CRC and its screening at the primary healthcare level was low. To reduce the cancer burden on Oman, a campaign to educate the population and doctors at the primary healthcare level should be launched to increase awareness of CRC. Following this, national screening guidelines must be published, and a CRC screening program must be adopted.


The field of psychiatry in Morocco has grown significantly since the 1970s, from less than 10 psychiatrists to the current number of around 400. The increased number of practising psychiatrists has enabled the expansion of local residency training programmes, which has been set up since 1974 to cater for the population needs of more than 36 million population of Morocco. This study is aimed to describe the current medical educational approach of the Moroccan postgraduate psychiatry training programme.This descriptive medical educational study was based on official training documents and interviews with local faculty members involved in the training.The entry requirement of the four-year Moroccan postgraduate psychiatry residency programme includes the completion of 1 year of foundation training and passing the entrance examination consisting of psychiatric semiology and pharmacology. The postgraduate residency programme is run by the local universities in collaboration with the Ministry of Health and accredited by the Moroccan government. Trainees have the option of taking up a voluntary or contractual position with the government or University Hospitals. All trainees will go through 34 months of general adult outpatient and inpatient, while liaison psychiatry training starts from the second year until the end of the training. On top of the core rotation, a trainee can opt for two months in old age and neuropsychiatry postings. Child and adolescent rotation is currently not available. Addiction psychiatry training is optional and can be done through a university diploma. The 4th year is a 12-month elective posting in any discipline that is relevant to psychiatry, which can be done either locally or abroad. Teaching methodologies involve lectures, seminars, ward rounds, case conferences, journal clubs, and skill training workshops. Formative assessments included case-based discussions and mini-clinical evaluation exercise. There are multiple high stakes summative assessments at year 1, year 2, year 3, and year 4. The summative assessment strategies includes modified essay question, clinical short case and long case. Viva voce is used to assess competency in research. Different mandatory skill competencies include electroconvulsive therapy, psychotherapy, and research.The advancement of local postgraduate psychiatry residency training in Morocco has improved the access of local trainees to quality training. Similar to other developing countries, Morocco requires more psychiatrists to improve the psychiatrists to population ratio so that the mental service can become more accessible to the local population.


This review presents the research conducted to date in the field of cement-based composites reinforced with waste paper-based cellulose fibres, focusing on their composition, mechanical properties, and durability characteristics. The literature demonstrates that the properties of raw material  significantly influence the formation of the cement composite binders. When considering fresh properties, the presence of silica and magnesium compounds generally lead to favourable effects on the setting of the cement composite when combined with waste paper cellulose fibre. Reduction in density values, i.e., approximately 25%, was observed with the inclusion of waste paper fibres from 20 to 80% in cement composites. The homogeneous dispersion of fibres in the matrix is one of the crucial factors to achieve in order to develop composites with well-balanced mechanical properties incorporating waste paper cellulose fibres. Hence, dispersion of fibres can be improved by increasing water quantity corresponding to the optimal value, which was a water/cement ratio of 0.64 leading to optimum strength properties of the composite. Even though the effect of fibre dispersion in the matrix improves with the addition of water, higher porosity and voids govern the strength properties beyond an optimum water-to-cement ratio. Higher porosity leads to an increase in the water absorption and a lowering of the thermal conductivity properties with the addition of paper fibre in cement binders. Paper fibre absorbs a high amount of water leading to higher water absorption. This phenomenon is related to the hydrophilic nature of cellulosic fibres absorbing some volume of water due to their microporous structure. One such industrial by-product is waste paper/cardboard and waste paper sludge from paper manufacturing.Management of waste has become an alarming issue around the world. Many countries are facing a serious challenge in disposing of waste nowadays. The current world population has been estimated to be 7.8 billion, and according to the United Nations (UN), it is predicted that the population will increase to 9.8 billion by the year 2050 . This laIt is estimated that Australia’s annual paper and cardboard usage is 235 kg per person . AccordiThe use of fibres in cement-based composite binders has been used for hundreds of years. Commonly used fibres in cement-based binders are steel, synthetic, and cellulose fibres, etc. Cellulose fibres used in concrete are eco-friendly, biodegradable, recyclable, and widely available throughout the world compared to other fibre types. Moreover, cellulose fibres exhibit interesting physical and mechanical properties, i.e., low density and well-balanced stiffness, toughness, and strength . CelluloPaper-based cellulose fibres used in cement-based composite are classified into two main categories: (1) waste paper sludge and (2) paper and cardboard waste. Waste paper sludge is also referred to as hypo-sludge . Bajpai Many studies have been performed using other recycled waste materials such as recycled coal bottom ash, waste lathe scraps, waste lathe fibres, and steel fibres extracted from waste tyres for cement-based composites ,12,13,14Published research on the use of paper-based waste cellulose fibre in concrete has not gained appreciable attention and limited research has been published  for cement-based composites ,19,20,216H10O5) comprises a long, repeating chain of carbon–hydrogen–oxygen units. Cellulose is water insoluble although it contains several hydroxyl groups. The physical–chemical properties of the paper-based waste cellulose fibres often depend on the pulping process, sources, cultivation and harvesting methods, and processing. The chemical and morphological properties reported for waste paper are presented in Paper is a natural polymer which consists of wood cellulose. Papers are manufactured using virgin pulp from wood and non-wood sources or a combination of virgin pulp and recycled pulp composed of cellulose fibre sources from recycled papers. Depending on the treatment used to destroy or weaken the inter-fibre bonds, the pulping processes can be mechanical, thermal, chemical, or some combination of these treatments. Chemical pulping (kraft pulp) removes most of the lignin present originally in the wood whereas mechanical pulping processes leave most of the lignin in the fibres. Most of cellulosic pulps are obtained chemically, which breaks the bonds that link lignin, hemicellulose, and cellulose. Cellulose is made of units of monomer glucose. The chemical structure of cellulose , strontium (Sr), Zirconium (Zr), and manganese (Mn) were present in trace (less than 0.1%). Therefore, the possibility of leaching heavy metals is insignificant . ResearcThe thermogravimetric analysis (TGA) carried out by Rajput et al.  determinRaut et al.  and RajpThe mix design and mechanical properties of waste paper-based cement composites are summarised in 3 [3 for 95–80% replacement of paper sludge, observing the lowest density value of 650–660 kg/m3 for 90–85% replacement of paper sludge for cement-based composite brick (paste)  prepared with cement (10% by weight) and cellulose paper sludge (89–85% by weight) waste ranges between 555 and 598 kg/m3 . However3  reported (paste) a. The buRajput et al.  reportedBoth splitting and flexural tensile strength reported by researchers showed a decreasing behaviour with waste paper sludge content c,d. PitrThe reported durability properties  of waste paper sludge-based cement composites are summarised in The mix design and mechanical properties of waste paper-based cement composites are summarised in 3, providing a lightweight construction material [Cellulosic fibres are more effective lightweight raw material. Addition of cellulosic fibres led to the reduction of density of cement composites, depending on the amount of cellulose fibres as well as the type of cellulose fibres. As the fibre content increases from 0 to 16%, bulk density decreases from 1972 to 1063 kg/mmaterial . A reducmaterial  with theThe study by Ashori et al.  investigFurthermore, the addition of 5% recycled cardboard kraft fibre showed 11.7 MPa compressive strength for cement-based composite binders reported by Haigh et al. . Mukesh Flexural strength does not show an incremental behaviour with waste paper/cardboard fibre content, as reported by Ashori et al.  and BentWater absorption and thermal conductivity variation of waste paper cement composite binders are illustrated in Hospodarova et al.  observedSeveral factors could lead to adverse effects on the fresh properties  of paper fibre composites. The amount of paper replacement, physical properties, and the carbon content of the waste paper fibre are the main reasons for the reduction of concrete workability. The water demand becomes larger with an increase in the waste paper fibre content. The paper exhibited a highwater absorption capacity due to its hydrophilic characteristics of the fibre. Paper fibre absorbs a large amount of water and consequently the consistency of the cementitious mixture is greatly reduced, thus resulting in lower workability. Even though there are no reported experimental data for setting time, it is hypothesised that the presence of silica and magnesium led to the improvement of the setting of the cement composite with the addition of waste paper.The addition of both waste paper and paper sludge has shown both increased and decreased mechanical properties in cement binders. The final properties of cellulose fibre cement composites depend on the fibre, the matrix components, and the manufacturing process. The mechanical performance of the composites depends not only on the matrix and fibre characteristics, but also on the interface properties. Besides the fibre length, the composite toughness is mainly governed by fibre–matrix bonding. A well-balanced interaction between the cement matrix and the fibres which allows fibre debonding and pull-out as well as the stress transfer from the matrix to the fibres is necessary to obtain cellulose cement composites with high toughness. Furthermore, a homogeneous dispersion of the fibres in the matrix, a low porosity of the matrix, and an optimised percentage of fibres is enough to reinforce the material while allowing a continuity of the matrix and are crucial factors to achieve in order to develop composites with well-balanced mechanical properties incorporating waste paper cellulose fibres. A higher amount of cellulose fibre resulted in difficulty of maintaining a homogenous mixture, thus reducing strength properties. In addition, the lower specific gravity of the paper fibre (about 0.45) causes fibres to float on top of the slurry and it creates a lack of homogeneous mixture in the composite so that the top surface of the composite fills with accumulated fibres. This resulted in reduced strength properties in cellulose fibre waste cement base composite binders .During the early stages of hydration, the saturation of gel pore water intensifies as C-S-H growth occurs. This changes the result of the capillary pores located near the cellulose fibres. The capillary pores decrease due to the hydrophilic nature of cellulose fibres, leaving an increase of consumed water within the matrix of the composite. This could result with a decrease in porosity as compared to composites containing hydrophobic fibres. However, addition of cellulose fibre could lead to increases in the porosity when compared with the specimens prepared without waste paper cellulose fibres. This is due to the fact that increasing the content of cellulose fibre yields a lot of voids in the specimen. This is hypothesised as one of the reasons that leads to a lower compressive strength and bulk density when compared with conventional PC concrete. The SEM observations by Sangrutsamee et al.  Figure  of the iOverall, the flexural strength does not show monotonic behaviour with addition of water paper cellulose fibre content. The flexural strength increases between 0 and 4% fibre content, probably due to the bridging effect of fibres in the matrix. However, beyond 4% replacement, the flexural strength decreases progressively afterwards . This deWhen adding waste paper cellulose fibres to cement, the amount of water needed is increased for compensating the water absorbed by fibres . MicrostOverall, all reported results indicate that the presence of a high amount of waste paper and water paper sludge in the mixture yields high water absorption. This phenomenon is related to the hydrophilic nature of cellulosic fibres absorbing some volume of water due to their microporous structure. Hence, paper fibre absorbs a high amount of water leading to higher water absorption. Furthermore, the chemical properties of the paper type affect the water absorption of the ultimate cement composite binders. Ashori et al.  reportedIt is highly recommended that future research should be undertaken over longer periods  to understand the long-term engineering performance. More investigation of the cellulose cement-based materials is needed based on air permeability, water permeability, carbonation, and sulphate and acid attack to ascertain performance with regard to the durability of the waste cellulose paper cement composite binders. Further research is recommended to investigate those in-depth microstructural and pore characteristics to understand the reaction mechanism, issues in the destruction of hemicellulose in an alkaline environment of the current matrix during long-term operation of products prepared with cardboard and paper waste, and other crucial factors that govern the mechanical and durability properties behind the performance of waste paper cellulose fibre cement composite binders. Moreover, numerical predictive modelling and carrying out large-scale tests in the laboratory scale for concrete elements will be a more practical and accurate way to find the behaviour of cellulose cement-based materials. Conducting a detailed analysis of environmental impact assessment and whole life costing of concrete integrated cellulose fibres from raw material preparation stage (cradle) to end of life (grave) stage is recommended for future studies considering circularity of this reclaimed waste into value-added applications.Reduction in density values, i.e., approximately 25% was observed with the inclusion of waste paper fibres from 20 to 80% in cement composites.The homogeneous dispersion of the fibres in the matrix was identified as one of the crucial factors to achieve in order to develop composites with well-balanced mechanical properties incorporating waste paper cellulose fibres.The dispersion of fibres can be improved by increasing water quantity corresponding to the optimal value (optimum water/cement of 0.64) leading to optimum strength performances (28 MPa compressive strength) of the composite.The waste paper cellulose fibre exhibited a high water absorption capacity due to its hydrophilic characteristics and microporous structure, thus leading to lower workability and higher water absorption with the addition of waste cellulose fibre in cement composite binders.The capillary pores decrease due to the hydrophilic nature of cellulose fibres, leaving an increase of consumed water within the matrix of the composite. This could result in a decrease in porosity as compared to composites containing hydrophobic fibres.This review presents the research conducted in the field of cement-based composites reinforced with waste paper-based cellulose fibres, focusing on their composition and engineering performance. The summary and the principal conclusions obtained from the review are presented as follows:


This study aims to investigate the significance of organizational ambidexterity (OA) in creating supply chain resilience (SCRES) during and after the COVID-19 pandemic. The methodological triangulation is applied in this study. A literature review, semi-structured online interviews and insights from open webinars serve as the sources of data. A framework, based on three pillars: validation, positioning and evaluation of business practices, is used for data analysis. The dependencies between OA activities and SCRES strategies are presented. The authors discuss their evolution during and in the post-pandemic period and outline the SCM trends in a strategic perspective. This paper investigates a pathway for closing the gap between OA theory and industry practice to create SCRES during and post-COVID-19 outbreak. This article starts the discussion on creating SCRES through OA. Future quantitative and qualitative research should explore the applicability of OA to enhance SCRES in a dynamic environment. Understanding the critical connection between exploitation and exploration practices and how OA influences SCRES provides valuable insight into the subject to supply chain managers supporting them in pursuing their roles successfully in the times of crisis. This study is focused on two concepts, OA and SCRES, of critical importance for how practitioners manage supply chains in the times of crisis. The resilience of supply chains to crises is crucial for the well-being of societies. Increasing complexity and unpredictability of global business environment reveals itself not through gradual changes, but through periodic discontinuities. These changes are driven by technological and social shifts, economic and political conditions, current and potential competitors  and explain its role in building SCRES strategies during and post-COVID-19 outbreak. We argue that ambidextrous activities (exploration and exploitation) are needed to implement reactive and build proactive SCRES strategies. OA enhance SCRES strategies not only during crisis but also in post-pandemic future.This study advances SCRES literature in important ways. First, it adds OA perspective to discussion on creating resilient SC. The OA perspective in supply chain management (SCM) literature was under researched  is perceived as a phenomenon of tensions in ensuring company survival. It is defined as the ability of an organization to do two things simultaneously  in multiple research databases: Ebsco, Emerald, Science Direct, Web of Science, Scopus and Wiley. Secondly, qualitative research methods were used to identify business practices that have been implemented within SCM. Authors’ participation in open virtual webinars provided the opportunity to learn from SC managers and discuss with them the strategies and practices developed for the improvement of SCRES in times of the COVID-19 pandemic. The following webinars specifically helped to identify business practices:What is the impact of the COVID-19 pandemic on your corporate strategy and business model? Is your company considering any changes to them in the post-pandemic period? If so, what changes do you envisage?What changes has the pandemic caused to the structure of your company’s SC? Is your company planning SC reconfiguration after the COVID-19 pandemic? If so, to what extent?What changes is the pandemic causing in business processes within your company’s SCM? Which of them have been developed during the pandemic and will be continued after it?What is the importance of relationships with SC links in the current pandemic crisis? Is your company considering changes in relationships management for the post-pandemic new normal? If so, what are they?What management tools (including technologies) support your company in SCM during the pandemic? Is your company planning a continuous development of some of them to address supply chain challenges after the COVID-19 outbreak? If so, what are they?Furthermore, the authors carried out 25 semi-structured online interviews (app. 60 min each) with professionals managing various business processes within international supply chains across different industries. Main questions asked during the interview were the following:The interviews were held between 6 March and 28 June 2020. The expert interviews collected during the research study were transcribed and pre-processed for coding purposes. Appendix 1 includes a dataset containing the respondent's designation along with quotes of statements directly relevant to the focus of the study. Quoted extracts from the interviews were transcribed and coded into unified and numbered SC practices. The structured data were subjected to a deeper analysis.The empirical qualitative data analysis was conducted using three stages of assessment methodology: validation (1), positioning (2) and evaluation (3). As a first step, basic, entry requirements check was carried out. The authors checked whether the identified practice was caused by the pandemic pressure. Only pandemic-induced practices were accepted for research data analysis. At parallel, practices have been cleaned up by excluding duplicates. As a second step, the selected practices were systemized and positioned according to the significance of two pillars of OA, which are exploitation and exploration. The third stage was devoted to the evaluation of practices in the light of SCRES strategies. The authors evaluated each practice taking into account types of SCRES strategies and their evolution during and post-COVID-19 outbreak. Furthermore, based on a dynamic approach, the authors explored the future potential of practices in the light of SCRES strategies and deeper discussed significant trends for SCM in the post-COVID-19 world.The in-depth analysis of qualitative empirical data in line with the above-mentioned research procedure allowed to identify 47 practices pursued by companies operating during the COVID-19 outbreak. As a result of their validation, the list was created as presented in Table The next step was the evaluation of the practices against SCRES strategy with reference to its three types: concurrent (C), reactive (R) and proactive (P). Reactive practices are, by definition, responses to disruptions caused, in this case, by a pandemic. By nature, these actions are intended to allow the organization to address issues as they arise, but also to learn lessons about further applicability after a disruption has occurred. Concurrent practices are similar in nature to reactive, but are distinguished by their abruptness of application due to the unpreparedness of companies for an unforeseen COVID-19 outbreak. Proactive practices refer to activities that build and enhance the ability to anticipate disruptions and achieve successfully defend against the risk before adverse consequences occur.Most of the practices carried out at the upstream supply chain, related to purchasing, sourcing and supplier relationship management, were reactive in their nature. The need for changes in business processes such as raw materials acquisition and components production was strongly emphasized. Closing borders and reducing air connections made it necessary to search for suppliers on local markets and increase importance of local suppliers in isolated regions and thus minimizing foreign supplies. Nearshoring was a frequent remedial practice when the local market was unable to meet supply chain expectations. Companies, heavily dependent on supplies from the Far East markets, began looking for business partners close to the borders of their home countries. Changing where goods are acquired is one side of the coin. On the other hand, the typical reaction was to control inventory levels in companies’ facilities and at suppliers' locations. All SCs links made efforts to increase inventory levels for raw materials, components, modules, systems and semi-finished products. Difficulties with access to direct production supplies and communication barriers have accelerated the development of activities towards consolidation of deliveries originating from multiple vendors. The criteria for selecting suppliers have therefore also changed. In the conditions of crisis, the role of cost criteria has decreased. Instead, the continuity of supply and flexible payment deadlines began to be guided. Managers also emphasized the importance of inventory levels and business confidence, that are closely related to the development of supplier relationships. SRM is though another very important area within SCM under conditions of uncertainty. Especially trust between trading partners has in many cases been put to the test of economic collapse. Trade was disrupted by factors such as shortening payment terms and renegotiating contracts ready to be signed. Decisions about whom to sell the strategic goods began to be made based on the existing relationships and the quality of the so far cooperation. Another activity typical of the pandemic response was establishing and developing communication through online platforms. This technological trend can also be observed in the case of digital transformation of purchasing processes and increasing control over purchasing budgets.The most far-reaching solution taken by companies was to shut down production. There were several reasons for such a categorical decision—reduced demand, lack of raw materials, willingness to limit inventory of finished products. At the same time, other companies focused efforts on maintaining the production continuity in cooperation with purchasing departments—so as to guarantee the necessary resources for production lines. Maintaining production was in many cases associated with a complete reorientation of this process, abandoning production abroad and starting domestic production. The factor contributing to such a change was the rationalization of the assortment and the introduction of new product categories at the expense of stopping production of goods for which demand has drastically decreased.Distribution is the SC process, where the changes caused by the pandemic have been most visible to consumers. Some of them were the result of the changes in production described above. New product categories appeared on the market, some products were withdrawn from sale, to sum up the assortment was rationalized. However, the key change concerned the methods of selling and delivering products. Companies, that have not done this so far, have started to develop multi-channel distribution. The e-commerce market has grown drastically with the accompanying services. Due to the care for customers and employees, simplified forms of contactless deliveries have been developed, and formalities have been reduced to a minimum. The care for the client also manifested itself through the practices related to its remote service. Communication and relationships with clients have been developed via digital platforms. To satisfy their psychological needs related to contact with other people, companies developed not only systems of chats and sales forums, but allowed them to return to telephone contact, which was losing its importance. Major changes also took place in the area of inventory management of finished products and their flows. Distributors began to monitor their suppliers' inventory levels to a greater extent while maximizing their own levels. In many cases, it was decided to decentralize distribution centres and change the way of managing in order to be able to flexibly respond to the increased demand for e-commerce services.The results of the conducted research allowed to identify a small number of practices that were proactively implemented during a pandemic. This is due to the sudden COVID-19 outbreak and the focus of companies on responding to this threat. Proactive actions, that companies were taking during this time, mainly relate to the sourcing area. A very important factor from the perspective of business continuity is the diversification of supplier base. The multiple sourcing ensures a security in the case of discontinuation of supplies from one of the sources, as well as the possibility of dividing the volume of orders into multiple suppliers. It is related to another practice – global sourcing, aimed at expanding supplier base in a geographical scope.The added value of the assignments made at the evaluation stage is demonstration of a dynamic change of SCRES strategy. The practices were assessed not only in terms of their application during the COVID-19 outbreak. Based on the advanced analysis of the qualitative data, it was also possible to evaluate their character in the post-COVID-19 future. Figure Despite the evolution of practices in relation to the SCRES strategy over time, their nature does not change in terms of ambidexterity activities. They were arranged in relation to both discussed issues of OA and categorized referring to the strengthening or building the resilience of the future SC Fig. .Fig. 3SCReactive SCRES strategy based on exploitation This strategy includes a set of practices and potential actions of managers in the event of disruptions to keep business continuity. It was implemented during the COVID-19 outbreak and its nature in the future can be described as “only when needed”. It concerns activities based on internal SC resources that can be implemented relatively quickly. Regarding SCRES, reactive practices can be linked to the respond and recover phases.Reactive SCRES strategy based on exploration The essence of this strategy is taking corrective actions in response to disruptions, based on solutions that go beyond the resources of the SC. Most pre-pandemic practices that were “reactive exploration” have evolved towards proactive solutions.Proactive SCRES strategy based on exploitation This strategy includes practices aimed at systematic strengthening of the SCRES, based on the exploitation of available resources. They are typical of the earlier indicated SCRES readiness and growth phases. Organizations need to adopt a proactive approach to ensure resilience needed to absorb and avoid potential disruptions by not only returning to the original state through adaptation, but by surpassing it through developing specific elements to boost performance.Proactive SCRES strategy based on exploration This category includes practices aimed at increasing the SCRES by using external resources and searching for new forms of securing business operations and innovations. By incorporating these activities into proactive strategy, managers adopt a forward-looking approach to threats and develop an anticipatory capacity of enterprises.The SCRES strategies under organizational ambidexterity were classified into four categories:There are two types of proactive post-COVID-19 practices. The first one is mainly based on the exploitation of available resources. The second category includes practices aimed at increasing the SCRES by using exploration capabilities to search new external resources and forms of managing business operations. We classified all proactive practices oriented both to exploitation and exploration into four groups as presented in Table The identified trends are as follows: product assortment rationalization and development, reorientation of SCM strategies, reconfiguration of SC structures, processes and relations, as well as technological transformation of business processes and relationships management, and will be discussed in the next section. In the face of changing economic conditions, companies explore the business environment thus preparing themselves for market uncertainty. By incorporating these activities into proactive strategy, managers adopt a forward-looking approach to threats. Pandemic-induced practices will evolve in many cases to strengthen resilience and acquire anticipatory capacity in the post-pandemic COVID-19 outbreak phase.Researchers characterize the significance of the COVID-19 pandemic for supply chains management as a devastating impact  a single factory, supplier or region is to add more sources in locations not vulnerable to the same risks (Shih sks Shih . Van Hoesks Shih  listed tsks Shih  identifisks Shih . The recsks Shih . To concTechnological transformation of business processes and relationship management Technological transformation of business processes has had one of the greatest impacts on SCM in the COVID-19 pandemic. As Frederico (rederico  proves, rederico . KPMG (2rederico  reportedrederico  indicaterederico . Ivanov rederico  highlighthe ability of the supply chain to achieve SCRES capabilities through exploitation and exploration practices.Today’s organizations need to be ambidextrous to achieve long-term success or even to survive in a rapidly changing environment (Bahar and Akhtar The results of our research study confirm high importance of OA in creating SCRES during and after COVID-19 pandemic. Both exploitation and exploration practices within SCM have created a basis of SCRES strategies developed during COVID-19 pandemic. Furthermore, identified practices evolve in terms of proactive and reactive nature of SCRES strategy. Most of them will become proactive ones, based on exploitation or exploration, after the COVID-19 pandemic. The in-depth analysis of proactive practices revealed SCM trends, that may improve the SCRES under OA in the post-COVID-19 world, namely such as: product assortment rationalization and development, reorientation of SCM strategies, reconfiguration of SC structures, processes and relations, technological transformation of business processes and relationship management.The study contributes to the literature on SCM and SCRES in important ways. First the research extends understanding of SCRES by explaining the evolution of SCRES strategies and practices during and post-crisis based on the study of global COVID-19 pandemic. Second, it extends current research on the role of OA within supply chain management, highlighting issues related to SCRES strategies. Third, conclusions make a contribution to the research agenda focused on managing supply chains in the times of crisis. There is relatively little research linking SCRES with OA concept in the crisis perspective.How to create and implement SCRES strategies, using exploitation and exploration activities?How to develop synergies between exploitation and exploration practices in the light of the OA concept to enhance SCRES?Future research may address the following problems:There are several practical implications of the study for SCM. First, the organizational ambidexterity concept allows companies to survive and evolve through mitigation and overcoming disruption within SCM. This finding suggests that supply chain managers must develop new competences including exploitation and exploration capabilities for building SCRES. Second, the evolution of SCRES strategies based on ambidextrous activities informs managers that crisis may be a chance for proactive change and creation. Our research findings show that companies use both exploitation and exploration business practices during the COVID-19 pandemic. Organizational ambidexterity has proven to be a key ability in managing business processes in supply chains. Moreover, exploitation and exploration activities were used in the implementation of all types of SCRES strategies. It is worth emphasizing that the approach should be dynamic and focused on the evolution of practices depending on their development potential after the COVID-19 pandemic. Due to the managerial need to develop mainly proactive SCRES strategies, the authors outlined the SCM trends.This article starts the discussion on creating SCRES through OA. Although the presented qualitative study contributes to SCM knowledge and managerial practice, the need remains to understand interdependencies between exploitation and exploration activities in more details. Future quantitative and qualitative research should explore the influence of OA on SCRES and its applicability to successfully enhance SCRES in the “new normal” business environment. It is desirable to conduct an international research, that can provide valuable insights.


The COVID-19 pandemic has enforced the restructuring of inpatient psychiatric services. In the UK, the South London and Maudsley NHS Foundation Trust has introduced a triage ward system to ensure all patients have a COVID test prior to admission to the general ward with the aim to reduce COVID transmission amongst psychiatric inpatients.To characterise the flow of patients through a COVID-19 psychiatric triage ward and the protocol of assessment and management used.Descriptive analysis of patients admitted to a COVID-19 triage ward since its creation.The caseload of patients admitted to the COVID-19 triage ward since its inception will be presented. This will include the profile of patients admitted, their status  and their acceptance of COVID-19 tests. The protocol followed at this COVID-19 triage ward will be presented, and the challenges faced and suggestions to overcome them will be discussed.This presentation aims to share the workflow and protocols adopted at a COVID-19 triage ward in the UK, discussing challenges experienced as well as good practices.No significant relationships.


This data presented in this article pertain to measured data obtained from earth pressure balance (EPB) shield tunelling of Guangzhou-Foshan intercity railway project. The measured data consists of geological characteristics and the main shield parameters in each lining ring during shield tunnelling. The distribution of raw data was displayed, and the geological characteristics via field record were compared to the prediction results of improved stacking method. The value of the database is consideration of the relationship between shield operational parameters and geological characteristics encountered in the shield tunnelling area, including formations with soft soil, majority of soft soil, and majority of hard rock. The raw data was standardized and processed to low dimensional data by principal component analysis, which can be better used in geological characteristics classification. The presented data are applied to identify the geological characteristics in the article titled “Prediction of geological characteristics from shield operational parameters by integrating grid search and K-fold cross validation into stacking classification algorithm”. The operational parameters were collected from acquisition system in shield machine. Additionally, the transformed parameters were also considered as input data shown in this article. 2The shield parameters are the reaction of the geological characteristics variety. The geological conditions are always continued in a construction site. Therefore, the shield parameters can be clustered as factors to evaluate the types of geological characteristics In this article, six shield parameters and four transformed parameters were used to analyze the geological characteristics k dimensions (D). Then, 80% of the database was randomly selected as a training set, and the remaining 20% of the database was considered as test set The SCA-GS prediction model for geological characteristics was developed by Python program. Readers can contact the author to apply for the source program.Tao Yan: Calculation, Data curation, Methodology, Investigation, Writing-Original draft preparation, Writing - review & editing.The authors declare that this work does not involve the use of human subjects or experimentation with animals.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.