Optimizing performance of iron-rich sludge ash as cost-effective oxygen carrier by calcium-based additive for syngas production from biomass chemical-looping gasification.

Chemical-looping gasification tests were conducted on pine sawdust using thermogravimetric analyzer and horizontal sliding resistance furnace to investigate the regulation effects of calcium-based additive on iron-rich sludge ash oxygen carrier. The impacts of temperature, CaO/C in mole, multiple redox cycles, CaO addition modes on gasification performances were analyzed. The TGA results indicated that the CaO addition could effectively capture CO2 from syngas to from CaCO3, which subsequently decomposed at high temperatures. From in-situ CaO addition experiments, the temperature rise resulted in higher syngas yields, while a decrease in syngas LHV. With the CaO/C growing, the H2 yield grew from 0.103 to 0.256Nm3/kg at 800.0℃, and the CO yield boosted from 0.158 to 0.317Nm3/kg. Multiple redox manifested that the SA oxygen carrier and calcium-based additive kept higher reaction stability. The possible reaction mechanisms showed that the syngas variations from BCLG were influenced by the calcium roles and valence change of iron.

Exploring Metrics to Establish an Optimal Model for Image Aesthetic Assessment and Analysis.

To establish an optimal model for photo aesthetic assessment, in this paper, an internal metric called the disentanglement-measure (D-measure) is introduced, which reflects the disentanglement degree of the final layer FC (full connection) nodes of convolutional neural network (CNN). By combining the F-measure with the D-measure to obtain an FD measure, an algorithm of determining the optimal model from many photo score prediction models generated by CNN-based repetitively self-revised learning (RSRL) is proposed. Furthermore, the aesthetics features of the model regarding the first fixation perspective (FFP) and the assessment interest region (AIR) are defined by means of the feature maps so as to analyze the consistency with human aesthetics. The experimental results show that the proposed method is helpful in improving the efficiency of determining the optimal model. Moreover, extracting the FFP and AIR of the models to the image is useful in understanding the internal properties of these models related to the human aesthetics and validating the external performances of the aesthetic assessment.

Population pharmacokinetic and optimization of polymyxin B dosing in adult patients with various renal functions.

AIMS: Current FDA-approved label recommends that the dosage of polymyxin B should be adjusted according to renal function. However, the correlation between polymyxin B pharmacokinetics (PK) and creatinine clearance (CrCL) is poor. This study aimed to develop a population PK model of polymyxin B in adult patients with various renal functions and to identify a dosing strategy. METHODS: A retrospective PK study was performed in 32 adult patients with various renal function. Nonlinear mixed effects modelling was applied to build a population PK model of polymyxin B followed by Monte Carlo simulations which designed polymyxin B dosing regimens across various renal function. RESULTS: Polymyxin B PK analyses included 112 polymyxin B concentrations at steady state from 32 adult patients, in which 71.9% of them were critically ill. In the final PK model, CrCL was the significant covariate on CL (typical value 1.59 L/h; between-subject variability 13%). The mean (SD) individual empirical Bayesian estimate of CL was 1.75 (0.43) L/h. In addition, a new dosing strategy combining the PK/pharmacodynamic (PD) targets and Monte Carlo simulation indicated that the reduction of polymyxin B dose in patients with renal insufficiency improved the probability of achieving optimal exposure. For severe infections caused by organisms with minimum inhibitory concentration (MIC) ≥ 2 mg/L, a high daily dose of polymyxin B might be possible for bacterial eradication, but the risk of nephrotoxicity is increased. CONCLUSIONS: Renal function plays a significant role in polymyxin B PK, and the dose of polymyxin B should be adjusted according to CrCL in patients with renal insufficiency.

[Pollution Characteristics and Health Risk Assessment of Microorganism Pollutions in the Beiyun River].

Microorganism pollution in rivers is of great importance to the protection of watershed water quality and public health management. As a typical watershed of the Haihe River watershed, the Beiyun River was chosen as the study area, and the characteristics and health risk of microorganism pollution were assessed from a comprehensive perspective. The results showed that the microbial contamination of the fecal sources was serious during the wet season, and the microbial amount at most river sections was more than 105 MPN·L-1. During the normal season and dry season, the microbial amount was approximately 103-105 MPN·L-1. Therefore, no obvious change could be observed. The fecal pollution in the agricultural river sections was the most severe, and the water quality of over 60% of these river sections was below the state Grade V level. The fecal microbial biomass of some urban river sections increased from 103 MPN·L-1 to 106MPN·L-1 after the rainfall event, indicating an obvious change of fecal microbial pollution during the rainfall process. For the Beiyun River, the exposure risk of the fecal microbial biomass was mainly between 0.015-0.035, while the Lianhua River, Macao River, lower reaches of Qinghe River, and lower reaches of Wenyu River were hotspots for contamination. Greater attention should be paid to these areas.

[Generalized science of Chinese material medica-from preventive treatment of disease to Chinese medicine health industry].

Based on the systematic summary of the results of the fourth general survey of traditional Chinese medicine resources, the cultivation of large varieties of Chinese material medica and the latest research on health industrial development, the novel concepts and scientific connotations of generalized science of Chinese material medica are put forward, and the basic ideas and methods of a new Chinese medicine academic system, the cultivation system of large varieties of Chinese medicinal materials and the application system of the large health industry are constructed. This kind of generalized science of Chinese material medica, rooted in the traditional Chinese culture and the theory of "preventive treatment of disease", can avoid the narrow prospect induced by the increasing specialization and refinement of knowledge of science of Chinese material medica. It will play an important role in the modernization, industrialization, internationalization of traditional Chinese medicine.

Urban-rural disparities in office-based dermatological services in Taiwan - a nationwide survey.

INTRODUCTION: Shortages and maldistribution of dermatology services have negative impacts on the quality of care for patients with skin problems. Only a limited amount of literature is available regarding the current state of dermatologic services in Taiwan. The aim of this study was to examine the urban-rural distribution of dermatologists and office-based dermatology services in Taiwan. METHODS: Data regarding dermatology workforce and their geographic distribution were collected from the Taiwan Medical Association, Taiwan Dermatological Association, and Department of Household Registration, Ministry of the Interior, while data on the locations and opening hours of dermatologic clinics were sourced from the National Health Insurance Administration. The locations and opening times of dermatologic clinics were stratified by urbanisation levels. RESULTS: There were 4.27 dermatologists per 100 000 persons in Taiwan. Taipei City was the most dermatologist-dense area (9.61 dermatologists per 100 000 people), while Lienchiang County had no dermatologists at all. Among the 444 office-based dermatologic clinics in Taiwan, the overwhelming majority were located in urban (77.5%) and suburban (20.9%) areas, with two-thirds of towns in Taiwan (67.1%, n=247) having no dermatologic clinics at all. On average, the clinics provided 14.9 service sessions per week (standard deviation 3.04). Altogether, only 57.1% of the rural clinics were open during any of Saturday evening, Sunday daytime and Sunday evening, while the corresponding percentage was 75.9% for urban areas. Statistical analysis shows that the open ratios in suburban areas were significantly lower than those in urban areas on Saturday evening, Sunday daytime and Sunday evening (p<0.001), while urban and rural areas had no significant difference in open ratios on these three sections. CONCLUSIONS: In Taiwan, dermatologists are unevenly geographically distributed, with most practising in urban areas. Also, there are remarkable urban-rural disparities in the availability of services on Saturday evening, Sunday daytime and Sunday evening.

A Doctor's Name as a Brand: A Nationwide Survey on Registered Clinic Names in Taiwan.

In countries where the private clinics of physicians can be freely named, registering a clinic with a physician's name is one way to make patients familiar with the physician. No previous study had investigated how clinics make use of this method of personal branding. Therefore, the current study analyzed 10,847 private physician Western medicine clinics in Taiwan. Of those clinics, 31.0% (n = 3363) were named with a physician's full name, 8.9% (n = 960) with a surname, and 8.1% (n = 884) with a given name. The proportion of clinics registered with a physician's name was lower in rural areas (37.3%) than in urban (48.5%) and suburban areas (49.2%), respectively. Among clinics with only one kind of specialist, a physician's name was used most frequently in clinics of obstetrics and gynecology (64.9%), otorhinolaryngology (64.1%), and dermatology (63.4%). In Taiwan, fewer than half of clinics used a physician's name as a brand. The sociocultural or strategic factors and real benefits of doing so could be further studied in the future for a better understanding of healthcare services management.

Highly efficient charge transfer in Co/Co2P Schottky junctions embedded in nitrogen-doped porous carbon for enhancing bioelectricity generation.

Exploration of noble-metal free catalysts with high oxygen reduction reaction (ORR) activity and durability as alternatives for platinum/carbon (Pt/C) in microbial fuel cells (MFCs) remains a great challenge. This study reports the preparation of nitrogen-doped cobalt/cobalt phosphide/carbon (Co/Co2P/NC) catalysts via an in situ simultaneous doping/reduction method by using residual cornstalks as carbon source. Effects of carbonization temperature on structural characteristics and catalytic activity of Co/Co2P/NC catalysts are investigated. Co/Co2P/NC-850 with regular network structure obtains the maximum power density of 972 ± 5mWm-2, which is higher than that of Pt/C (808 ± 5mWm-2). The highest Coulombic efficiency (23.1%) and the lowest charge transfer resistance (0.93Ω) are also obtained by Co/Co2P/NC (850°C). ORR catalyzed by Co/Co2P/NC-850 is mainly via 4e- reduction pathway. The better durability of Co/Co2P/NC (850°C) is detected from long-term operation of MFCs. The promising catalytic activity for ORR is attributed to the introduction of Co/Co2P nanoparticles/Schottky junctions and N species in porous carbon skeleton, which are served as active sites to trap and consume electrons. Biomass-derived carbon with good electrical conductivity can provide large specific surface area and abundant interconnected holes, which contribute to efficient permeation and transport of O2. The synergistic effects between porous structure and sufficient active sites can energetically boost catalytic activity to improve ORR efficiency. These Co/Co2P/NC catalysts with durable power outputs are expected to have more extensive applications in MFCs.

Image-Guided Percutaneous Radiofrequency Ablation of Central Renal Cell Carcinoma: Assessment of Clinical Efficacy and Safety in 31 Tumors.

PURPOSE: To assess clinical efficacy and safety of image-guided percutaneous radiofrequency (RF) ablation of central renal cell carcinoma with adjunctive pyeloperfusion. MATERIALS AND METHODS: Patients with central renal tumors who underwent percutaneous RF ablation between 2005 and 2010 were retrospectively evaluated. Thirty patients with 31 central renal tumors underwent 39 RF ablation sessions. Mean tumor diameter was 3.7 cm (range, 2-7 cm). Median distance between tumor and renal pelvis was 5 mm (range, 0-15 mm). Pyeloperfusion was performed in 27 patients (27/30; 90%). Contrast-enhanced CT or MR imaging was performed to evaluate treatment response. RESULTS: Technical success of RF ablation was achieved in 38/39 (97.4%) ablation sessions. Primary efficacy was 83.9% (26/31) on first follow-up imaging. One (3.2%) case of local tumor progression was detected 6 months after initial ablation. Secondary efficacy was 96.8% (30/31) after repeat RF ablation for residual tumor or local tumor progression. Median follow-up was 88 months (mean 82.6 mo ± 30.7; range, 9-121 mo). Major complications occurred in 5/39 (12.8%) RF ablation sessions. Complications were significantly higher for tumors located within 5 mm of the renal pelvis or 0 mm of a major calyx (28.6% vs 4.0%; P < .05). Overall survival was 96.0% (95% CI, 88.4%-100.0%), and progression-free survival at 5 years was 80.9% (95% CI, 65.8%-95.9%). CONCLUSION: Image-guided percutaneous RF ablation combined with pyeloperfusion has satisfactory clinical efficacy in treating central renal tumors. Although clinically effective, RF ablation of central tumors may also be associated with significant major complications.

Branding Palliative Care Units by Avoiding the Terms "Palliative" and "Hospice".

The term "palliative care" has a negative connotation and may act as a barrier to early patient referrals. Rebranding has thus been proposed as a strategy to reduce the negative perceptions associated with palliative care. For example, using the term "supportive care" instead of "palliative care" in naming palliative care units has been proposed in several studies. In Taiwan, terms other than "palliative" and "hospice" are already widely used in the names of palliative care units. With this in mind, this study investigated the characteristics of palliative care unit names in order to better understand the role of naming in palliative care. Relevant data were collected from the Taiwan Academy of Hospice Palliative Medicine, the National Health Insurance Administration of the Ministry of Health and Welfare, and the open database maintained by the government of Taiwan. We found a clear phenomenon of avoiding use of the terms "palliative" and "hospice" in the naming of palliative care units, a phenomenon that reflects the stigma attached to the terms "palliative" and "hospice" in Taiwan. At the time of the study (September, 2016), there were 55 palliative care units in Taiwan. Only 20.0% (n = 11) of the palliative care unit names included the term "palliative," while 25.2% (n = 14) included the term "hospice." Religiously affiliated hospitals were less likely to use the terms "palliative" and "hospice" (χ2 = 11.461, P = .001). There was also a lower prevalence of use of the terms "palliative" and "hospice" for naming palliative care units in private hospitals than in public hospitals (χ2 = 4.61, P = .032). This finding highlights the strong stigma attached to the terms "palliative" and "hospice" in Taiwan. It is hypothesized that sociocultural and religious factors may partially account for this phenomenon.

Risk-standardized Acute Admission Rates Among Patients With Diabetes and Heart Failure as a Measure of Quality of Accountable Care Organizations: Rationale, Methods, and Early Results.

BACKGROUND: Population-based measures of admissions among patients with chronic conditions are important quality indicators of Accountable Care Organizations (ACOs), yet there are challenges in developing measures that enable fair comparisons among providers. METHODS: On the basis of consensus standards for outcome measure development and with expert and stakeholder input on methods decisions, we developed and tested 2 models of risk-standardized acute admission rates (RSAARs) for patients with diabetes and heart failure using 2010-2012 Medicare claims data. Model performance was assessed with deviance R; score reliability was tested with intraclass correlation coefficient. We estimated RSAARs for 114 Shared Savings Program ACOs in 2012 and we assigned ACOs to 3 performance categories: no different, worse than, and better than the national rate. RESULTS: The diabetes and heart failure cohorts included 6.5 and 2.6 million Medicare Fee-For-Service beneficiaries aged 65 years and above, respectively. Risk-adjustment variables were age, comorbidities, and condition-specific severity variables, but not socioeconomic status or other contextual factors. We selected hierarchical negative binomial models with the outcome of acute, unplanned hospital admissions per 100 person-years. For the diabetes and heart failure measures, respectively, the models accounted for 22% and 12% of the deviance in outcomes and score reliability was 0.89 and 0.81. For the diabetes measure, 51 (44.7%) ACOs were no different, 45 (39.5%) were better, and 18 (15.8%) were worse than the national rate. The distribution of performance for the heart failure measure was 61 (53.5%), 37 (32.5%), and 16 (14.0%), respectively. CONCLUSION: Measures of RSAARs for patients with diabetes and heart failure meet criteria for scientific soundness and reveal important variation in quality across ACOs.

Variation in US hospital emergency department admission rates by clinical condition.

BACKGROUND: Variation in hospitalization rates have been described for decades, yet little is known about variation in emergency department (ED) admission rates across clinical conditions. We sought to describe variation in ED risk-standardized admission rates (RSAR) and the consistency between condition-specific ED admission rates within hospitals. METHODS: Cross-sectional analysis of the 2009 National Emergency Department Sample, an all-payer administrative, claims dataset. We identify the 15 most frequently admitted conditions using Clinical Classification Software. To identify conditions with the highest ED RSAR variation, we compared both the ratio of the 75th percentile to the 25th percentile hospital and coefficient of variation between conditions. We calculate Spearman correlation coefficients to assess within-hospital correlation of condition-specific ED RSARs. RESULTS: Of 21,885,845 adult ED visits, 4,470,105 (20%) resulted in admission. Among the 15 most frequently admitted conditions, the 5 with the highest magnitude of variation were: mood disorders (ratio of 75th:25th percentile, 6.97; coefficient of variation, 0.81), nonspecific chest pain (2.68; 0.66), skin and soft tissue infections (1.82; 0.51), urinary tract infections (1.58; 0.43), and chronic obstructive pulmonary disease (1.57; 0.33). For these 5 conditions, the within-hospital RSAR correlations between each pair of conditions were >0.4, except for mood disorders, which was poorly correlated with all other conditions (r<0.3). CONCLUSIONS: There is significant condition-specific variation in ED admission rates across US hospitals. This variation appears to be consistent between conditions with high variation within hospitals.

Synthesis of iron oxide/partly graphitized carbon composites as a high-efficiency and low-cost cathode catalyst for microbial fuel cells.

Waste cornstalks and pomelo skins are used as carbon resources for preparing nanocomposites of iron oxide and partly graphitized carbon (Fe3O4/PGC-CS and Fe3O4/PGC-PS). The results showed that Fe3O4 with a face-centered cubic structure is uniformly dispersed on the skeleton of Fe3O4/GC, and the highest SBET values of Fe3O4/PGC-CS (476.5 m(2) g(-1)) and Fe3O4/PGC-PS (547.7 m(2) g(-1)) are obtained at 1000 °C. The electrical conductivity and density of catalytic active sites are correspondingly improved by the introduction of Fe species. Microbial fuel cells (MFCs) with a mixed composite (Fe3O4/PGC-CS:Fe3O4/PGC-PS = 1:1) cathode (three-dimensional structures) generate the highest power density of 1502 ± 30 mW m(-2), which is 26.01% higher than that of Pt/C (1192 ± 33 mW m(-2)) and only declines by 7.12% after 18 cycles. The Fe3O4/PGC-CS cathode has the highest Coulombic efficiency (24.3 ± 0.7%). The Fe3O4/PGC composites exhibit high oxygen reduction reactivity, low charge transfer resistances, and long-term stability and can be used as a low-cost and high-efficiency catalyst for MFCs.

[The assessment of wall invasion of rectal carcinoma: correlation of endoluminal ultrasonographic and pathologic findings].

OBJECTIVE: To evaluate the accuracy of endoluminal ultrasonography (ELUS) in the preoperative assessment of wall invasion of rectal carcinoma and analyze its influencing factors. METHODS: ELUS was performed preoperatively in 117 patients with rectal carcinoma, in which no preoperative treatment was given. The results of ELUS were correlated with operative and pathologic findings according to the TNM classification. We observed the following factors and analyzed their impact on the accuracy of ELUS: tumor location, the depth of the tumor invasion, and the inflammatory cell infiltration and fibrosis peritumor. RESULTS: The overall accuracy of ELUS in T stage was 76.9% (90/117). The sensitivity of ELUS for pT(1), pT(2), pT(3) and pT(4) carcinoma was 87.5% (7/8), 51.7% (15/29), 85.7% (60/70), 80% (8/10), respectively. Misdiagnosis occurred in 27 cases, of which 14 cases were overstaged and 13 cases were understaged. The sensitivity for pT(2) carcinoma was the lowest; 14 cases were misdiagnosed, of them 13 cases were overstaged. Overstaging with ELUS for pT(2) carcinoma occurred mainly in these cases in which inflammatory cell infiltration, fibrosis or tumor involved more than one-third of muscularis propria. 13 cases were understaged, of which tumors in 7 cases were located in superior segment of rectum and 4 cases with obviously rectal stenosis. When tumor was located in middle or lower segment of rectum, misdiagnostic rate was 18.5% (17/92); while tumor was located in superior segment of rectum, misdiagnostic rate was 40% (10/25), and differences were statistically significant between two groups in misdiagnostic rate (P = 0.024). CONCLUSION: Although ELUS in the preoperative assessment of wall invasion of rectal carcinoma is useful, it is difficult to avoid overstaging and understaging of ELUS. The overstaging is an important unfavourable factor in assessing the invasion depth of pT(2) carcinoma with ELUS, and the depth of tumor invasion muscularis propria, and the depth of inflammatory cell infiltration and fibrosis might be responsible for overstaging. Obviously rectal stenosis and tumor being located in the superior segment of rectum might cause understaging.