Co-pyrolysis of chicken feathers and macadamia nut shells, a promising strategy to create nitrogen-enriched electrode materials for supercapacitor applications

Global food waste emits substantial quantities of nitrogen to the environment (6.3 Mtons annually), chicken feather (CF) waste is a major contributor to this. Pyrolysis, in particular co-pyrolysis of nitrogen-rich and lignocellulosic waste streams is a promising strategy to improve the extent of pyrolytic nitrogen retention by incorporating nitrogen in its solid biochar structure. As such, this biochar can serve as a precursor for nitrogen-enriched activated carbons for application in supercapacitors. Therefore, this study investigates the co-pyrolysis of CF with macadamia nut shells (MNS) to create nitrogen-rich activated carbons. Co-pyrolysis increased nitrogen retention during pyrolysis from 9 % to 18 % compared to CF mono-pyrolysis, while the porosity was maintained. After removing undesirable inorganic impurities by dilute acid washing, this led to a specific capacitance of 21F/g using a scan rate of 20 mV/s. Finally, cycling stability tests demonstrated good stability with 73 % capacitance retention after 10 000 cycles.

The ALR-RSI score can be used to evaluate psychological readiness to return to sport after acute Achilles tendon tear

PURPOSE

The return to sport is one of the main goals following Achilles tendon tear repair. Several psychological factors influence the return to sport after a sports injury. The traditional tools to assess the return to sport do not take into account psychological factors. The ankle ligament reconstruction-return to sport injury (ALR-RSI), validated for ankle instability, is a score to evaluate psychological readiness to return to sport. The goal of this study was to validate the ALR-RSI score for the assessment of the readiness to return to sport after Achilles tendon repair.

METHODS

The ALR-RSI score, adapted from the anterior cruciate ligament-return to sport injury (ACL-RSI) score used following knee ligament reconstruction, was validated according to the international COSMIN methodology. Patients operated for Achilles tendon repair responded to the questionnaire during the rehabilitation period. The EFAS, FAAM and VISA-A scores were used as reference questionnaires.

RESULTS

A total of 50 patients were included. The ALR-RSI score was strongly (r > 0.5) correlated to the EFAS score: r = 0.68 [0.50-0.80] the FAMM sport score: r = 0.7 [0.52-0.84] the FAAM AVQ score (r = 0.6 [0.35-0.78]), and the VISA-A score (r = 0.54 [0.26-0.76]). The discriminant validity was good with the ALR-RSI, which was significantly lower in the patients that did not return to sport: 60.7 (40-81.4) compared to those that did: 83.2 (64.3-100) p = 0.001. Reproducibility was excellent with an intra-class correlation coefficient ρ of 0.99 [097-1.00]. The internal consistency was excellent (alpha coefficient = 0.95).

CONCLUSION

The ALR-RSI score provides a valid, reproducible assessment of the psychological readiness to return to sport in patients who undergo surgical Achilles tendon suture repair.

LEVEL OF EVIDENCE

III.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Psychotherapy of Biases in Cognition in Schizophrenia: the SlowMo Randomised Controlled Trial for Paranoia, Outcomes and Mechanisms

Reasoning biases, specifically jumping to conclusions and belief inflexibility, may play a causal role in persistent paranoia. SlowMo, a new digitally supported blended cognitive-behavioural therapy, targets these biases. Adopting the terms ‘fast’ and ‘slow thinking’ as a heuristic to support therapy, SlowMo encourages people to notice a tendency to fast thinking, and to slow down for a moment to reduce paranoia. SlowMo therapy is the first digital blended therapy for paranoia, employing face to face therapy sessions with interactive digital content, and using mobile technology to promote generalisation to daily life. We report a randomised controlled trial with N=362 participants with distressing and persistent (3+months) paranoia, comparing 8 sessions of SlowMo plus Treatment as Usual (TAU) with TAU alone. We examined SlowMo’s effectiveness in reducing paranoia and improving reasoning biases; its mechanisms of action; usability; and acceptability (Garety et al., 2021). Outcomes: SlowMo was beneficial for paranoia: 10 /11 paranoia measures at 12 weeks and 8/11 at 24 weeks demonstrated significant effects, and sustained moderate effects were observed on all observer-rated measures of persecutory delusions. Improvements in self-esteem, worry, wellbeing and quality of life were also reported. Mediation: Consistent with the theory-driven design and treatment rationale, improvements in slower thinking were found to mediate change in paranoia at 12- and 24-week follow-ups. However contrary to hypothesis, reduced fast thinking did not mediate change in paranoia, whereas worry did. These findings highlight the potential therapeutic mechanisms of action of SlowMo which which are discussed further. Garety P, Ward T, Emsley R, et al. Effects of SlowMo, a Blended Digital Therapy Targeting Reasoning, on Paranoia Among People With Psychosis: A Randomized Clinical Trial. JAMA Psychiatry. 2021;78(7):714–725. doi:10.1001/jamapsychiatry.2021.0326

POS1577-PARE WHAT PATIENTS VALUE AND NEED FROM HEALTHCARE IN THE DIAGNOSIS AND MANAGEMENT OF AXIAL SPONDYLOARTHRITIS

Background

The clinician’s understanding of what constitutes good quality care for axial spondyloarthritis (axial SpA) has been explored (1) and used to define quality standards (2,3). However, research into the patient perspective on what constitutes good quality care was lacking. The UK’s National Axial Spondyloarthritis Society (NASS) commissioned Headstrong Thinking, and its research partner, Community Research, to investigate this issue.

Objectives

The objectives of the research included: to explore the lived experience of those with an axial SpA diagnosis, to identify all the stages (domains) and milestones they identify and describe in their journey; to identify tangible person-centred indicators of “quality” in each of those stages, covering clinical care, patient care (non-clinical) and support for their mental health needs; to capture the everyday language used to articulate their values and needs around “quality”; and to understand possible differences between individual/subgroup experiences.

Methods

The project will use both qualitative and quantitative methods sequentially.

This paper reports only on the qualitative stage of the project, which comprised twelve individual depth interviews, conducted online, across a broad spectrum of people living with axial SpA in the UK, allowing for variation in age, sex, socioeconomic status, presence of children, length of time since diagnosis, physical symptoms and comorbidities.

Findings from the qualitative stage will inform the questionnaire for the quantitative stage (target n=1,500), which will seek to validate and refine initial hypotheses and quantify differences between sub-groups.

Results

This paper presents a rich understanding of the impacts on mental, emotional, cognitive and practical aspects of life with axial SpA. A detailed picture of a wide range of clinical, psychological and practical adverse impacts around delayed diagnosis is described.

Further, the qualitative research found that, from the perspective of people with axial SpA, quality care consists of three elements, defined by patients as: to be seen, heard and believed; to experience a purposeful, consistent pathway of care, underpinned by effective administration and communication (rather than a series of care “snapshots”); and to be helped to know what they can do to help themselves, including making a care plan that evolves as needs change.

Individuals with multiple or complex comorbidities were less likely to report having experienced good quality care, as they defined it, in part due to the challenges of accessing a joined-up patient journey and their greater reliance on an effective cross- disciplinary (NHS) healthcare system.

Conclusion

Patients define quality care in the diagnosis and management of axial SpA differently to clinicians. Professionals involved in the diagnosis and care of people living with axial SpA (including rheumatologists, but also those involved in the wider care of people living with axial Spa, such as physiotherapists and even mental health professionals) would benefit from a greater understanding of the patient perspective.

The individual stories uncovered in this qualitative phase underline the importance of collecting and analysing quantitative data by demographics, life stage and by discrete phases in the diagnostic /ongoing patient (self) management journey.

References

[1]Kiltz U, Landewé RBM, van der Heijde D, et al Development of ASAS quality standards to improve the quality of health and care services for patients with axial spondyloarthritis Annals of the Rheumatic Diseases 2020;79:193-201.

[2]ibid

[3]National Institute for Health and Care Excellence (2018) Spondyloarthritis Quality Standard

Disclosure of Interests

None declared

A 4-year retrospective study of tonsillectomy rate and admission rate of tonsillitis and complications in the East of England and nationally

OBJECTIVES

Guidance set out by Scottish Intercollegiate Guidelines Network (SIGN) sought to restrict the frequency of elective tonsillectomy in reaction to the recognised and substantial risks of the procedure, namely pain and bleeding. With stricter criteria in place before a patient can undergo tonsillectomy, patients must endure more episodes of tonsillitis than was previously the case. The cost of managing tonsillitis and its complications as an inpatient is substantial to the NHS and also to the economy as a whole in missed work days. The authors sought to establish if the reduced rate of tonsillectomy performed had any effect on the rate of acute hospital admission for tonsillitis or the associated abscesses-peritonsillar, parapharyngeal and retropharyngeal.

METHODS

A retrospective multi-centre study reviewed admission data across a 4-year period. The rate of tonsillectomies performed for recurrent tonsillitis across four trusts in Mid-Essex was compared with the number of admissions for tonsillitis, peritonsillar, parapharyngeal and retropharyngeal abscesses. National hospital episode statistics data over a 5-year period was also analysed.

RESULTS

For the regional data in 2015, 979 tonsillectomies were performed across the four centres, reducing to 875 in 2018. There was no trend in the rates of acute tonsillitis requiring admission but the rates of peritonsillar abscess increased from 156 to 192 cases per year in the same period. This correlation was found not to be statistically significant in the measured sample size. The National hospital episode statistics data showed a significant correlation between tonsillectomy rates and admissions from complications of tonsillitis as well as the associated abscesses.

CONCLUSION

This study shows that the reduced tonsillectomy rate was correlated with an increased number of admissions with peritonsillar abscess regionally. Nationally reduced tonsillectomy rate is significantly associated with increased admissions with tonsillitis and all its complications. A decreased rate of tonsillectomy may be increasing the rate of serious tonsillitis. This has an impact on patient morbidity, an increasing financial burden on the NHS and the UK economy.

Remembering the past to live better in the future: A feasibility randomised controlled trial of memory specificity training for motivation in psychosis

BACKGROUND AND OBJECTIVES

People with a diagnosis of psychosis often experience low motivation and reduced activity levels. Autobiographical memory deficits have been identified in people with psychosis and this may limit the role of memory retrieval in supporting motivation. This pilot study adapted a recently developed protocol, Memflex, which aims to enhance autobiographical memory and has shown promise in depression. Our brief intervention targets experiential negative symptoms of psychosis using supported autobiographical memory retrieval.

METHOD

A sample of 31 participants with psychosis were recruited from inpatient and community settings and randomised in a 2:1 ratio to either a basic recall control or an enhanced recall intervention group. Participants were asked to generate positive autobiographical memories linked to activities they wish to repeat in the future. The enhanced recall condition received additional prompts from the Memflex protocol, and the basic recall condition received no additional support.

RESULTS

The intervention delivered was acceptable (rated >80%) and feasible (94% adherence) to those who took part. Participants were able to generate positive autobiographical memories linked to their goals and experienced appropriate emotions linked to these. The controlled preliminary effect sizes (0.2-0.34) showed encouraging signals for self-efficacy, motivation and a reduction in negative mood.

LIMITATIONS

As this was a pilot study with a small sample size between-group tests of statistical significance were not conducted, and therefore findings should be interpreted with caution.

CONCLUSIONS

These findings suggest that guided autobiographical memory retrieval may be an effective way tool for targeting motivation in people with psychosis.

Associations of antenatal maternal psychological distress with infant birth and development outcomes: Results from a South African birth cohort

BACKGROUND

Antenatal maternal psychological distress is common in low and middle-income countries (LMIC), but there is a dearth of research on its effect on birth and developmental outcomes in these settings, particularly in Sub-Saharan Africa. This study set out to identify risk factors for antenatal maternal psychological distress and determine whether antenatal maternal psychological distress was associated with infant birth and developmental outcomes, using data from the Drakenstein Child Health Study (DCHS), a birth cohort study in South Africa.

METHODS

Pregnant women were enrolled in the DCHS from primary care antenatal clinics. Antenatal maternal psychological distress was measured using the Self-Reporting Questionnaire 20-item (SRQ-20). A range of psychosocial measures, including maternal childhood trauma, depression, and posttraumatic stress disorder (PTSD) were administered. Birth outcomes, including premature birth, weight-for-age z-score and head circumference-for-age z-score, were measured using revised Fenton growth charts. The Bayley III Scales of Infant and Toddler Development was administered at 6 months of age to assess infant development outcomes, including cognitive, language, and motor domains in a subset of n=231. Associations of maternal antenatal psychological distress with psychosocial measures, and with infant birth and developmental outcomes were examined using linear regression models.

RESULTS

961 women were included in this analysis, with 197 (21%) reporting scores indicating the presence of psychological distress. Antenatal psychological distress was associated with maternal childhood trauma, antenatal depression, and PTSD, and inversely associated with partner support. No association was observed between antenatal maternal psychological distress and preterm birth or early developmental outcomes, but antenatal maternal psychological distress was associated with a smaller head circumference at birth (coefficient=-0.30, 95% CI: -0.49; -0.10).

CONCLUSION

Antenatal maternal psychological distress is common in LMIC settings and was found to be associated with key psychosocial measures during pregnancy, as well as with adverse birth outcomes, in our study population. These associations highlight the potential value of screening for antenatal maternal psychological distress as well as of developing targeted interventions.

Effectiveness of Ligand Denticity-Dependent Oxidation Protection in Copper MOD Inks

The recent cost-driven transition from silver- to copper-based inks for printing on flexible substrates is connected with new key challenges. Given the high oxidation sensitivity of copper inks before, during, and after the curing process, the conductivity and thereby the device performance can be affected. Strategies to limit or even avoid this drawback include the development of metal organic decomposition (MOD) inks with selected "protective" ligands. In this study, the influence of the ligand on the oxide formation during the ink decomposition process is described using a wide variety of in situ characterization techniques. It is demonstrated that bidentate ligands provide an improved oxidation barrier, although the copper preservation mechanism has its limits: oxygen can interfere in every reduction pathway depending on the curing duration and atmospheric conditions. The generated insights can be applied in the further evolution toward ambient-curable copper MOD inks.

EFSA's third Scientific Conference 'Science, Food, Society': concluding remarks

From 18–21 September 2018, EFSA hosted its third Scientific Conference on Science, Food and Society in Parma, Italy. This paper summarises the overall recommendations on future actions and research priorities of the conference and complements the earlier multi‐authored papers in this issue. The conference started and closed with the plenary sessions ‘where science meets society: putting risk assessment in context’ and ‘staying relevant in a changing world’, respectively. In between, there were seven breakout sessions five of which aimed at advancing risk assessment science in the areas of human health, the environment, biological hazards, nutrition and managing evidence, and two of which were dedicated to the societal aspects of risk assessment: engaging with society and envisioning the expertise of the future. During the 4 days of the event, participants addressed the complex interplay between science, risk assessment, policy and society, and explored how to advance food safety risk assessment to address the challenges of a changing world and ensure preparedness. Acknowledging that good science alone is no longer sufficient to ensure fit‐for‐purpose food safety risk assessments, EFSA must further build on its current five Strategic Objectives. To ensure that its risk assessments remain scientifically robust and sound, EFSA should strive for robust and fit‐for‐purpose risk assessments; consider food in the context of safety, nutrition and sustainability; and explore further how EFSA can work with other organisations to achieve the One Health/One Environment goals. In addition, EFSA should base scientific risk assessments on reliable science while capitalising on scientific advances; address scientific uncertainties; and fully publish the evidence and data used. In line with societal expectations, EFSA, in coordination with risk managers, should frame risk assessments through clear policy goals and problem formulation; be explicit about value judgements; communicate clearly and consistently and in coordination with risk assessors and risk managers; involve society; avoid conflicts of interest; and follow trustworthy processes.

Applying ecosystem services for pre-market environmental risk assessments of regulated stressors

Ecosystem services (ES) are the benefits that people obtain from ecosystems. Investigating the environment through an ES framework has gained wide acceptance in the international scientific community and is applied by policymakers to protect biodiversity and safeguard the sustainability of ecosystems. This approach can enhance the ecological and societal relevance of pre‐market/prospective environmental risk assessments (ERAs) of regulated stressors by: (1) informing the derivation of operational protection goals; (2) enabling the integration of environmental and human health risk assessments; (3) facilitating horizontal integration of policies and regulations; (4) leading to more comprehensive and consistent environmental protection; (5) articulating the utility of, and trade‐offs involved in, environmental decisions; and (6) enhancing the transparency of risk assessment results and the decisions based upon them. Realisation of these advantages will require challenges that impede acceptance of an ES approach to be overcome. Particularly, there is concern that, if biodiversity only matters to the extent that it benefits humans, the intrinsic value of nature is ignored. Moreover, our understanding of linkages among ecological components and the processes that ultimately deliver ES is incomplete, valuing ES is complex, and there is no standard ES lexicon and limited familiarity with the approach. To help overcome these challenges, we encourage: (1) further research to establish biodiversity–ES relationships; (2) the development of approaches that (i) quantitatively translate responses to chemical stressors by organisms and groups of organisms to ES delivery across different spatial and temporal scales, (ii) measure cultural ES and ease their integration into ES valuations, and (iii) appropriately value changes in ES delivery so that trade‐offs among different management options can be assessed; (3) the establishment of a standard ES lexicon; and (4) building capacity in ES science and how to apply ES to ERAs. These development needs should not prevent movement towards implementation of an ES approach in ERAs, as the advantages we perceive of using this approach render it more than worthwhile to tackle those challenges. Society and the environment stand to benefit from this shift in how we conduct the ERA of regulated stressors.

Guidance on harmonised methodologies for human health, animal health and ecological risk assessment of combined exposure to multiple chemicals

This Guidance document describes harmonised risk assessment methodologies for combined exposure to multiple chemicals for all relevant areas within EFSA's remit, i.e. human health, animal health and ecological areas. First, a short review of the key terms, scientific basis for combined exposure risk assessment and approaches to assessing (eco)toxicology is given, including existing frameworks for these risk assessments. This background was evaluated, resulting in a harmonised framework for risk assessment of combined exposure to multiple chemicals. The framework is based on the risk assessment steps (problem formulation, exposure assessment, hazard identification and characterisation, and risk characterisation including uncertainty analysis), with tiered and stepwise approaches for both whole mixture approaches and component‐based approaches. Specific considerations are given to component‐based approaches including the grouping of chemicals into common assessment groups, the use of dose addition as a default assumption, approaches to integrate evidence of interactions and the refinement of assessment groups. Case studies are annexed in this guidance document to explore the feasibility and spectrum of applications of the proposed methods and approaches for human and animal health and ecological risk assessment. The Scientific Committee considers that this Guidance is fit for purpose for risk assessments of combined exposure to multiple chemicals and should be applied in all relevant areas of EFSA's work. Future work and research are recommended.

This publication is linked to the following EFSA Supporting Publications article: http://onlinelibrary.wiley.com/doi/10.2903/sp.efsa.2019.EN-1589/full, http://onlinelibrary.wiley.com/doi/10.2903/sp.efsa.2019.EN-1602/full

Guidance on Communication of Uncertainty in Scientific Assessments

This document provides guidance for communicators on how to communicate the various expressions of uncertainty described in EFSA's document: 'Guidance on uncertainty analysis in scientific assessments'. It also contains specific guidance for assessors on how best to report the various expressions of uncertainty. The document provides a template for identifying expressions of uncertainty in scientific assessments and locating the specific guidance for each expression. The guidance is structured according to EFSA's three broadly defined categories of target audience: 'entry', 'informed' and 'technical' levels. Communicators should use the guidance for entry and informed audiences, while assessors should use the guidance for the technical level. The guidance was formulated using evidence from the scientific literature, grey literature and two EFSA research studies, or based on judgement and reasoning where evidence was incomplete or missing. The limitations of the evidence sources inform the recommendations for further research on uncertainty communication.

Screen-printing of flexible semi-transparent electrodes and devices based on silver nanowire networks

Silver nanowire networks have demonstrated significant potential as semi-transparent electrodes for various applications. However, for their widespread utilisation in devices, upscaled coating technologies such as screen-printing need to be explored and related to this, the formulation of suitable inks is indispensable. This work contributes to this effort by the synthesis of Ag-NW based formulations. The rheological characteristics that are essential for screen-printing are obtained by the addition of hydrophobically modified cellulose. The electrical and optical characteristics of screen-printed features on PET are compared by a Van der Pauw method and UV-vis spectroscopy. Despite the presence of the cellulose additive, the screen-printed electrodes exhibit a transmittance from 92.8% to 57.3% and a sheet resistance down to 27 Ohm sq^-1. Based on the percolation theory in composites, a mathematical expression is presented, which allows the in-depth analysis of the resulting opto-electrical properties. The application potential of the nanowire-containing formulations is finally demonstrated by screen-printing functional, flexible electroluminescent devices.

Guidance on risk assessment of the application of nanoscience and nanotechnologies in the food and feed chain: Part 1, human and animal health

The European Food Safety Authority has produced this Guidance on human and animal health aspects (Part 1) of the risk assessment of nanoscience and nanotechnology applications in the food and feed chain. It covers the application areas within EFSA's remit, e.g. novel foods, food contact materials, food/feed additives and pesticides. The Guidance takes account of the new developments that have taken place since publication of the previous Guidance in 2011. Potential future developments are suggested in the scientific literature for nanoencapsulated delivery systems and nanocomposites in applications such as novel foods, food/feed additives, biocides, pesticides and food contact materials. Therefore, the Guidance has taken account of relevant new scientific studies that provide more insights to physicochemical properties, exposure assessment and hazard characterisation of nanomaterials. It specifically elaborates on physicochemical characterisation of nanomaterials in terms of how to establish whether a material is a nanomaterial, the key parameters that should be measured, the methods and techniques that can be used for characterisation of nanomaterials and their determination in complex matrices. It also details the aspects relating to exposure assessment and hazard identification and characterisation. In particular, nanospecific considerations relating to in vivo/in vitro toxicological studies are discussed and a tiered framework for toxicological testing is outlined. It describes in vitro degradation, toxicokinetics, genotoxicity as well as general issues relating to testing of nanomaterials. Depending on the initial tier results, studies may be needed to investigate reproductive and developmental toxicity, immunotoxicity, allergenicity, neurotoxicity, effects on gut microbiome and endocrine activity. The possible use of read‐across to fill data gaps as well as the potential use of integrated testing strategies and the knowledge of modes/mechanisms of action are also discussed. The Guidance proposes approaches to risk characterisation and uncertainty analysis, and provides recommendations for further research in this area.

This publication is linked to the following EFSA Supporting Publications article: http://onlinelibrary.wiley.com/doi/10.2903/sp.efsa.2018.EN-1430/full

A Phase II Study of Pembrolizumab in EGFR-Mutant, PD-L1+, Tyrosine Kinase Inhibitor Naïve Patients With Advanced NSCLC

BACKGROUND

Despite the significant antitumor activity of pembrolizumab in NSCLC, clinical benefit has been less frequently observed in patients whose tumors harbor EGFR mutations compared to EGFR wild-type patients. Our single-center experience on the KEYNOTE-001 trial suggested that pembrolizumab-treated EGFR-mutant patients, who were tyrosine kinase inhibitor (TKI) naïve, had superior clinical outcomes to those previously treated with a TKI. As TKI naïve EGFR-mutants have generally been excluded from pembrolizumab studies, data to guide treatment decisions in this patient population is lacking, particularly in patients with programmed death ligand 1 (PD-L1) expression ≥50%.

METHODS

We conducted a phase II trial (NCT02879994) of pembrolizumab in TKI naive patients with EGFR mutation-positive, advanced NSCLC and PD-L1-positive (≥1%, 22C3 antibody) tumors. Pembrolizumab was administered 200 mg every 3 weeks. The primary endpoint was objective response rate. Secondary endpoints included safety of pembrolizumab, additional pembrolizumab efficacy endpoints, and efficacy and safety of an EGFR TKI after pembrolizumab.

RESULTS

Enrollment was ceased due to lack of efficacy after 11 of 25 planned patients were treated. Eighty-two percent of trial patients were treatment naïve, 64% had sensitizing EGFR mutations, and 73% had PD-L1 expression ≥50%. Only 1 patient had an objective response (9%), but repeat analysis of this patient's tumor definitively showed the original report of an EGFR mutation to be erroneous. Observed treatment-related adverse events were similar to prior experience with pembrolizumab, but two deaths within 6 months of enrollment, including one attributed to pneumonitis, were of concern.

CONCLUSIONS

Pembrolizumab's lack of efficacy in TKI naïve, PD-L1+, EGFR-mutant patients with advanced NSCLC, including those with PD-L1 expression ≥50%, suggests that it is not an appropriate therapeutic choice in this setting.

Guidance on Uncertainty Analysis in Scientific Assessments

Uncertainty analysis is the process of identifying limitations in scientific knowledge and evaluating their implications for scientific conclusions. It is therefore relevant in all EFSA's scientific assessments and also necessary, to ensure that the assessment conclusions provide reliable information for decision‐making. The form and extent of uncertainty analysis, and how the conclusions should be reported, vary widely depending on the nature and context of each assessment and the degree of uncertainty that is present. This document provides concise guidance on how to identify which options for uncertainty analysis are appropriate in each assessment, and how to apply them. It is accompanied by a separate, supporting opinion that explains the key concepts and principles behind this Guidance, and describes the methods in more detail.

This publication is linked to the following EFSA Journal article: http://onlinelibrary.wiley.com/doi/10.2903/j.efsa.2018.5122/full

Eu3+-Doped Y3−xSmxAl5O12 garnet: synthesis and structural investigation

Sm³⁺-Doped and Eu³⁺/Sm³⁺-co-doped yttrium aluminium garnets (YAG) have been synthesized by an environmentally friendly sol–gel method.

The principles and methods behind EFSA's Guidance on Uncertainty Analysis in Scientific Assessment

To meet the general requirement for transparency in EFSA's work, all its scientific assessments must consider uncertainty. Assessments must say clearly and unambiguously what sources of uncertainty have been identified and what is their impact on the assessment conclusion. This applies to all EFSA's areas, all types of scientific assessment and all types of uncertainty affecting assessment. This current Opinion describes the principles and methods supporting a concise Guidance Document on Uncertainty in EFSA's Scientific Assessment, published separately. These documents do not prescribe specific methods for uncertainty analysis but rather provide a flexible framework within which different methods may be selected, according to the needs of each assessment. Assessors should systematically identify sources of uncertainty, checking each part of their assessment to minimise the risk of overlooking important uncertainties. Uncertainty may be expressed qualitatively or quantitatively. It is neither necessary nor possible to quantify separately every source of uncertainty affecting an assessment. However, assessors should express in quantitative terms the combined effect of as many as possible of identified sources of uncertainty. The guidance describes practical approaches. Uncertainty analysis should be conducted in a flexible, iterative manner, starting at a level appropriate to the assessment and refining the analysis as far as is needed or possible within the time available. The methods and results of the uncertainty analysis should be reported fully and transparently. Every EFSA Panel and Unit applied the draft Guidance to at least one assessment in their work area during a trial period of one year. Experience gained in this period resulted in improved guidance. The Scientific Committee considers that uncertainty analysis will be unconditional for EFSA Panels and staff and must be embedded into scientific assessment in all areas of EFSA's work.

Ti surface doping of LiNi0.5Mn1.5O4−δ positive electrodes for lithium ion batteries

The particle surface of LiNi_0.5Mn_1.5O_4−δ (LNMO), a Li-ion battery cathode material, has been modified by Ti cation doping through a hydrolysis–condensation reaction followed by annealing in oxygen. The effect of different annealing temperatures (500–850 °C) on the Ti distribution and electrochemical performance of the surface modified LNMO was investigated. Ti cations diffuse from the preformed amorphous ‘TiO_x’ layer into the LNMO surface during annealing at 500 °C. This results in a 2–4 nm thick Ti-rich spinel surface having lower Mn and Ni content compared to the core of the LNMO particles, which was observed with scanning transmission electron microscopy coupled with compositional EDX mapping. An increase in the annealing temperature promotes the formation of a Ti bulk doped LiNi_(0.5−w)Mn_(1.5+w)−tTi_tO₄ phase and Ti-rich LiNi_0.5Mn_1.5−yTi_yO₄ segregates above 750 °C. Fourier-transform infrared spectrometry indicates increasing Ni–Mn ordering with annealing temperature, for both bare and surface modified LNMO. Ti surface modified LNMO annealed at 500 °C shows a superior cyclic stability, coulombic efficiency and rate performance compared to bare LNMO annealed at 500 °C when cycled at 3.4–4.9 V vs. Li/Li⁺. The improvements are probably due to suppressed Ni and Mn dissolution with Ti surface doping.

LiNi_0.5Mn_1.5O_4−δ surface is doped with Ti ion maintaining the spinel structure at 500 °C, higher annealing temperatures cause Ti diffusion from surface towards the core.

Clarification of some aspects related to genotoxicity assessment

The European Commission requested EFSA to provide advice on the following: (1) the suitability of the unscheduled DNA synthesis (UDS) in vivo assay to follow‐up positive results in in vitro gene mutation tests; (2) the adequacy to demonstrate target tissue exposure in in vivo studies, particularly in the mammalian erythrocyte micronucleus test; (3) the use of data in a weight‐of‐evidence approach to conclude on the genotoxic potential of substances and the consequent setting of health‐based guidance values. The Scientific Committee concluded that the first question should be addressed in both a retrospective and a prospective way: for future assessments, it is recommended no longer performing the UDS test. For re‐assessments, if the outcome of the UDS is negative, the reliability and significance of results should be carefully evaluated in a weight‐of‐evidence approach, before deciding whether more sensitive tests such as transgenic assay or in vivo comet assay would be needed to complete the assessment. Regarding the second question, the Scientific Committee concluded that it should be addressed in lines of evidence of bone marrow exposure: toxicity to the bone marrow in itself provides sufficient evidence to allow concluding on the validity of a negative outcome of a study. All other lines of evidence of target tissue exposure should be assessed within a weight‐of‐evidence approach. Regarding the third question, the Scientific Committee concluded that any available data that may assist in reducing the uncertainty in the assessment of the genotoxic potential of a substance should be taken into consideration. If the overall evaluation leaves no concerns for genotoxicity, health‐based guidance values may be established. However, if concerns for genotoxicity remain, establishing health‐based guidance values is not considered appropriate.

Early strength recovery after anterior cruciate ligament reconstruction using the fascia lata

INTRODUCTION

After undergoing anterior cruciate ligament (ACL) reconstruction, patients must recover at least 80% of their hamstring and quadriceps strength to be able to return to sports without risk to the graft. Harvesting of the patellar tendon leads to large deficits in quadriceps strength, while harvesting the hamstring tendons leads to large deficits in hamstring strength. However, there are no published studies on the strength deficit after ACL reconstruction with the fascia lata. The objective of this study was to evaluate the results of isokinetic testing in patients who underwent ACL reconstruction with a fascia lata graft and to analyze the individual factors affecting these results. The hypothesis was that preserving the quadriceps and hamstrings would lead to satisfactory isokinetic testing results by preserving the physiological balance between the flexor and extensor mechanisms in the leg.

MATERIALS AND METHODS

In this retrospective, single-center study, 53 patients had their quadriceps and hamstring strength recovery evaluated 6 months and 1 year post-ACL reconstruction by concentric isometric testing at a slow (90°/s) and fast velocity (240°/s). These results were analyzed as a function of individual characteristics such as age, sex, preinjury level and type of sports activity, and IKDC and Lysholm scores.

RESULTS

The quadriceps strength deficit at the slow and fast velocities was 27.5% and 22.5% at 6 months and 15.5% and 11% at 1 year, respectively. The hamstring strength deficit at the slow and fast velocities was 12.1% and 7% at 6 months and 8% and 6.4% at 1 year, respectively. The quadriceps to hamstring ratio at the slow and fast velocities was 66.7±16.5 and 71.3±15.5 at 6 months, and 61.1±14.9 and 67.6±12.5 at 1 year. Being less than 25 years of age, having a subjective IKDC grade or Lysholm score above 90, and being a professional athlete were significant predictors of better muscle strength recovery.

DISCUSSION

Isokinetic testing at 6 months and 1 year after ACL reconstruction surgery using the fascia lata showed that the quadriceps to hamstring ratio is close to physiological standards.

LEVEL OF EVIDENCE

IV retrospective study.

Toward High-Throughput Computational Screening of Carbon Nanotube Solvents

We use the corresponding distances method (CDM) to computationally assess the quality of 10 experimentally tested carbon nanotube (CNT) solvents. The CDM produces accurate and high-resolution potential of mean force curves from a single simulation per solvent. The method's very high efficiency allows us to investigate an unprecedented number of solvents in one study. The simulation results indicate that none of the tested molecules are solvents in the thermodynamic sense; instead, they are dispersants preventing reaggregation of already dispersed CNTs. We find that the dispersion free energy barrier correlates very well with the experimentally measured performance of the dispersants; i.e., the simulations place the solvents in the correct performance order. Our analysis of the structure-function relationship rationalizes this order.

A novel explanation for the increased conductivity in annealed Al-doped ZnO: an insight into migration of aluminum and displacement of zinc

A combined experimental and first-principles study is performed to study the origin of conductivity in ZnO:Al nanoparticles synthesized under controlled conditions via a reflux route using benzylamine as a solvent. The experimental characterization of the samples by Raman, nuclear magnetic resonance (NMR) and conductivity measurements indicates that upon annealing in nitrogen, the Al atoms at interstitial positions migrate to the substitutional positions, creating at the same time Zn interstitials. We provide evidence for the fact that the formed complex of Al_Zn and Zn_i corresponds to the origin of the Knight shifted peak (KS) we observe in ²⁷Al NMR. As far as we know, the role of this complex has not been discussed in the literature to date. However, our first-principles calculations show that such a complex is indeed energetically favoured over the isolated Al interstitial positions. In our calculations we also address the charge state of the Al interstitials. Further, Zn interstitials can migrate from Al_Zn and possibly also form Zn clusters, leading to the observed increased conductivity.

Guidance on the use of the weight of evidence approach in scientific assessments

EFSA requested the Scientific Committee to develop a guidance document on the use of the weight of evidence approach in scientific assessments for use in all areas under EFSA's remit. The guidance document addresses the use of weight of evidence approaches in scientific assessments using both qualitative and quantitative approaches. Several case studies covering the various areas under EFSA's remit are annexed to the guidance document to illustrate the applicability of the proposed approach. Weight of evidence assessment is defined in this guidance as a process in which evidence is integrated to determine the relative support for possible answers to a question. This document considers the weight of evidence assessment as comprising three basic steps: (1) assembling the evidence into lines of evidence of similar type, (2) weighing the evidence, (3) integrating the evidence. The present document identifies reliability, relevance and consistency as three basic considerations for weighing evidence.

This publication is linked to the following EFSA Supporting Publications article: http://onlinelibrary.wiley.com/doi/10.2903/sp.efsa.2017.EN-1295/full

Guidance on the assessment of the biological relevance of data in scientific assessments

EFSA requested its Scientific Committee to prepare a guidance document providing generic issues and criteria to consider biological relevance, particularly when deciding on whether an observed effect is of biological relevance, i.e. is adverse (or shows a beneficial health effect) or not. The guidance document provides a general framework for establishing the biological relevance of observations at various stages of the assessment. Biological relevance is considered at three main stages related to the process of dealing with evidence: Development of the assessment strategy. In this context, specification of agents, effects, subjects and conditions in relation to the assessment question(s): Collection and extraction of data; Appraisal and integration of the relevance of the agents, subjects, effects and conditions, i.e. reviewing dimensions of biological relevance for each data set. A decision tree is developed to assist in the collection, identification and appraisal of relevant data for a given specific assessment question to be answered.

Ultrasonically spray coated silver layers from designed precursor inks for flexible electronics

Integration of electronic circuit components onto flexible materials such as plastic foils, paper and textiles is a key challenge for the development of future smart applications. Therefore, conductive metal features need to be deposited on temperature sensitive substrates in a fast and straightforward way. The feasibility of these emerging (nano-) electronic technologies depends on the availability of well-designed deposition techniques and on novel functional metal inks. As ultrasonic spray coating (USSC) is one of the most promising techniques to meet the above requirements, innovative metal organic decomposition (MOD) inks are designed to deposit silver features on plastic foils. Various amine ligands were screened and their influence on the ink stability and the characteristics of the resulting metal depositions were evaluated to determine the optimal formulation. Eventually, silver layers with excellent performance in terms of conductivity (15% bulk silver conductivity), stability, morphology and adhesion could be obtained, while operating in a very low temperature window of 70 °C-120 °C. Moreover, the optimal deposition conditions were determined via an in-depth analysis of the ultrasonically sprayed silver layers. Applying these tailored MOD inks, the USSC technique enabled smooth, semi-transparent silver layers with a tunable thickness on large areas without time-consuming additional sintering steps after deposition. Therefore, this novel combination of nanoparticle-free Ag-inks and the USSC process holds promise for high throughput deposition of highly conductive silver features on heat sensitive substrates and even 3D objects.

Guidance on the risk assessment of substances present in food intended for infants below 16 weeks of age

Following a request from the European Commission to EFSA, the EFSA Scientific Committee (SC) prepared a guidance for the risk assessment of substances present in food intended for infants below 16 weeks of age. In its approach to develop this guidance, the EFSA SC took into account, among others, (i) an exposure assessment based on infant formula as the only source of nutrition; (ii) knowledge of organ development in human infants, including the development of the gut, metabolic and excretory capacities, the brain and brain barriers, the immune system, the endocrine and reproductive systems; (iii) the overall toxicological profile of the substance identified through the standard toxicological tests, including critical effects; (iv) the relevance for the human infant of the neonatal experimental animal models used. The EFSA SC notes that during the period from birth up to 16 weeks, infants are expected to be exclusively fed on breast milk and/or infant formula. The EFSA SC views this period as the time where health-based guidance values for the general population do not apply without further considerations. High infant formula consumption per body weight is derived from 95th percentile consumption. The first weeks of life is the time of the highest relative consumption on a body weight basis. Therefore, when performing an exposure assessment, the EFSA SC proposes to use the high consumption value of 260 mL/kg bw per day. A decision tree approach is proposed that enables a risk assessment of substances present in food intended for infants below 16 weeks of age. The additional information needed when testing substances present in food for infants below 16 weeks of age and the approach to be taken for the risk assessment are on a case-by-case basis, depending on whether the substance is added intentionally to food and is systemically available.

Scientific motivations and criteria to consider updating EFSA scientific assessments

EFSA is committed to assess and communicate the risks occurring in the food and feed chain from farm to fork and to provide other forms of scientific advice. This work, carried out by EFSA since its inception, has resulted in the adoption of thousands of scientific assessments. EFSA is obliged to re‐assess past assessments in specific regulatory contexts such as those on food and feed additives, active substances in plant protection products and genetically modified food and feed. In other sectors, the consideration for updating past EFSA scientific assessments is taken on an ad hoc basis mainly depending on specific requests by risk managers or on EFSA self‐tasking. If safety is potentially at stake in any area within EFSA's remit, the readiness to update past scientific assessments is important to keep EFSA at the forefront of science and to promote an effective risk assessment. Although this task might be very complex and resource demanding, it is fundamental to EFSA's mission. The present EFSA Scientific Committee opinion deals with scientific motivations and criteria to contribute to the timely updating of EFSA scientific assessments. It is recognised that the decision for updating should be agreed following careful consideration of all the relevant elements by the EFSA management, in collaboration with risk managers and stakeholders. The present opinion addresses the scientific approaches through which it would be possible for EFSA to increase the speed and effectiveness of the acquisition of new data, as well as, to improve the consequent evaluations to assess the relevance and reliability of new data in the context of contributing to the better definition of whether to update past scientific assessments.

Speed-Bridge arthroscopic reinsertion of tibial eminence fracture (complementary to the adjustable button fixation technique)

In comminuted fractures of the intercondyloid eminence of the tibial spine, the quality of the reduction and the arthroscopic fixation, notably adjustable suture button fixation, is sometimes disappointing with reduction defects of the anterior bone block. In the Speed-Bridge technique, the two traction sutures of the adjustable button fixation are replaced with two braided sutures of different colors. After the button is placed above the eminence, reduction is obtained by tightening the loop of the button. The accessory communitive fragments are then packed in the depression around the main fragment. A second row provides bone suturing for these accessory fragments; traction sutures of the button are attached anteromedially and laterally with knotless anchors to obtain a Speed-Bridge-type inverted-V bone suture. The Speed-Bridge arthroscopic reinsertion technique of the tibial eminence effectively completes the adjustable button bone suture technique for communitive fractures to obtain better reduction and good stability.

Cognitive-behaviour therapy for post-traumatic stress in schizophrenia. A randomized controlled trial

BACKGROUND

There is limited evidence for effective interventions in the treatment of post-traumatic stress symptoms within individuals diagnosed with schizophrenia. Clinicians have concerns about using exposure treatments with this patient group. The current trial was designed to evaluate a 16-session cognitive restructuring programme, without direct exposure, for the treatment of post-traumatic stress symptoms specifically within individuals diagnosed with schizophrenia.

METHOD

A multicentre randomized controlled single-blinded trial with assessments at 0 months, 6 months (post-treatment) and 12 months (follow-up) was conducted. A total of 61 participants diagnosed with schizophrenia and exhibiting post-traumatic stress symptoms were recruited. Those randomized to treatment were offered up to 16 sessions of cognitive-behaviour therapy (CBT, including psychoeducation, breathing training and cognitive restructuring) over a 6-month period, with the control group offered routine clinical services. The main outcome was blind rating of post-traumatic stress symptoms using the Clinician Administered PTSD Scale for Schizophrenia. Secondary outcomes were psychotic symptoms as measured by the Positive and Negative Symptom Scale and the Psychotic Symptom Rating Scale.

RESULTS

Both the treatment and control groups experienced a significant decrease in post-traumatic stress symptoms over time but there was no effect of the addition of CBT on either the primary or secondary outcomes.

CONCLUSIONS

The current trial did not demonstrate any effect in favour of CBT. Cognitive restructuring programmes may require further adaptation to promote emotional processing of traumatic memories within people diagnosed with a psychotic disorder.

Remarkable lowering in the synthesis temperature of LiMn2O4via citrate solution–gel synthesis facilitated by ethanol

Low temperature synthesis routes for cathode materials, such as LMO, are currently very important. Here, through an elaborate study on the chemistry behind the precursor and EtOH interaction, the thermal budget was drastically reduced at 250 °C.

Update: use of the benchmark dose approach in risk assessment

The Scientific Committee (SC) reconfirms that the benchmark dose (BMD) approach is a scientifically more advanced method compared to the NOAEL approach for deriving a Reference Point (RP). Most of the modifications made to the SC guidance of 2009 concern the section providing guidance on how to apply the BMD approach. Model averaging is recommended as the preferred method for calculating the BMD confidence interval, while acknowledging that the respective tools are still under development and may not be easily accessible to all. Therefore, selecting or rejecting models is still considered as a suboptimal alternative. The set of default models to be used for BMD analysis has been reviewed, and the Akaike information criterion (AIC) has been introduced instead of the log-likelihood to characterise the goodness of fit of different mathematical models to a dose-response data set. A flowchart has also been inserted in this update to guide the reader step-by-step when performing a BMD analysis, as well as a chapter on the distributional part of dose-response models and a template for reporting a BMD analysis in a complete and transparent manner. Finally, it is recommended to always report the BMD confidence interval rather than the value of the BMD. The lower bound (BMDL) is needed as a potential RP, and the upper bound (BMDU) is needed for establishing the BMDU/BMDL per ratio reflecting the uncertainty in the BMD estimate. This updated guidance does not call for a general re-evaluation of previous assessments where the NOAEL approach or the BMD approach as described in the 2009 SC guidance was used, in particular when the exposure is clearly smaller (e.g. more than one order of magnitude) than the health-based guidance value. Finally, the SC firmly reiterates to reconsider test guidelines given the expected wide application of the BMD approach.

Hippocampal Aβ expression, but not phosphorylated tau, predicts cognitive deficits following repeated peripheral poly I:C administration

Alzheimer's disease is marked by the accumulation of the amyloid-beta (Aβ) peptide, and increases in phosphorylation of the microtubule associated protein, tau. Changes in these proteins are considered responsible, in part, for the progressive neuronal degeneration and cognitive deficits seen in AD. We examined the effect of repeated consecutive peripheral poly I:C injections on cognitive deficits, central Aβ, and phosphorylated tau accumulation, following three treatment durations: 7, 14, and 21 days. Forty-eight hours after the final injection, animals were trained in a contextual fear-conditioning paradigm, and tested 24h later. Immediately after testing, the hippocampus was collected to quantify Aβ and phosphorylated tau accumulation. Results showed that, although poly I:C-induced Aβ was significantly elevated at all time points examined, poly I:C only disrupted cognition after 14 and 21 days of administration. Moreover, elevations in phosphorylated tau were not seen until the 14-day time point. Interestingly, phosphorylated tau expression then declined at the 21-day time point. Finally, we demonstrated that Aβ levels are a stronger predictor of cognitive dysfunction, explaining 37% of the variance, whereas phosphorylated tau levels only accounted for 0.2%. Taken together, these results support the hypothesis that inflammation-induced elevation in Aβ disrupts cognition, independently of phosphorylated tau, and suggest that long-term administration of poly I:C may provide a model to investigate the contribution of long-term inflammation toward the development of Alzheimer's-like pathology.

Protocol for a randomised controlled trial comparing aqueous with alcoholic chlorhexidine antisepsis for the prevention of superficial surgical site infection after minor surgery in general practice: the AVALANCHE trial

INTRODUCTION

Surgical site infection (SSI) after minor skin excisions has a significant impact on patient morbidity and healthcare resources. Skin antisepsis prior to surgical incision is used to prevent SSI, and is performed routinely worldwide. However, in spite of the routine use of skin antisepsis, there is no consensus regarding which antiseptic agents are most effective. The AVALANCHE trial will compare Aqueous Versus Alcoholic Antisepsis with Chlorhexidine for Skin Excisions.

METHODS AND ANALYSIS

The study design is a prospective, randomised controlled trial (RCT) with the aim of investigating the impact of two different antiseptic preparations on the incidence of superficial SSI in patients undergoing minor skin excisions. The intervention of 0.5% chlorhexidine gluconate (CHG) in 70% alcohol will be compared with that of 0.5% CHG in aqueous solution. The trial will be conducted in four Australian general practices over a 9-month period, with 920 participants to be recruited. Consecutive patients presenting for minor skin excisions will be eligible to participate. Randomisation will be on the level of the patient. The primary outcome is superficial SSI in the first 30 days following the excision. Secondary outcomes will be adverse effects, including anaphylaxis, skin irritation, contact dermatitis and rash and patterns of antibiotic resistance.

ETHICS AND DISSEMINATION

The study has been approved by the James Cook University Human Research Ethics Committee (HREC). Findings will be disseminated in conference presentations and journals and through online electronic media.

DISCUSSION

RCTs conducted in general practice differ from hospital-based projects in terms of feasibility, pragmatism and funding. The success of this trial will be cemented in the fact that the research question was established by a group of general practitioners who identified an interesting question which is relevant to their clinical practice and not answered by current evidence.

TRIAL REGISTRATION NUMBER

ACTRN12615001045505; Pre-results.

From liquid to thin film: colloidal suspensions for tungsten oxide as an electrode material for Li-ion batteries

Using a colloidal suspension, electrochemically active tungsten oxide thin films (150 nm) have been prepared via ultrasonic spray deposition using two different current collectors, namely TiN and Pt.