Contralateral transvenous left ventricular lead placement of an implantable device with pre-sternal tunneling in an ipsilateral chronically obstructed subclavian vein.

Multiple methods are used to tackle ipsilateral obstructed venous access in patients undergoing a device upgrade by implanting a new left ventricular lead. One feasible solution to tackle this is implantation of the upgrade lead contralaterally with pre-sternal tunnelization to the opposite side under conscious sedation.

A review of incidents related to health information technology in Swedish healthcare to characterise system issues as a basis for improvement in clinical practice.

This study examined health information technology-related incidents to characterise system issues as a basis for improvement in Swedish clinical practice. Incident reports were collected through interviews together with retrospectively collected incidents from voluntary incident databases, which were analysed using deductive and inductive approaches. Most themes pertained to system issues, such as functionality, design, and integration. Identified system issues were dominated by technical factors (74%), while human factors accounted for 26%. Over half of the incidents (55%) impacted on staff or the organisation, and the rest on patients - patient inconvenience (25%) and patient harm (20%). The findings indicate that it is vital to choose and commission suitable systems, design out "error-prone" features, ensure contingency plans are in place, implement clinical decision-support systems, and respond to incidents on time. Such strategies would improve the health information technology systems and Swedish clinical practice.

Analyzing the variation of greenhouse gas emissions from typical municipal wastewater treatment plants in Beijing during 2007-2021.

With the proposal of dual carbon goals and stringent effluent standards, the path of mitigating greenhouse gas (GHG) emissions from wastewater treatment plants (WWTPs) has gained significant research attention. Here, we evaluate the impact of season, elevated standards, operating parameters, and using clean energy on GHG emissions from 8 typical WWTPs in Beijing based on 180 monthly monitoring data. Coupled with the increasing demand for wastewater treatment and 77% more chemical oxygen demand being removed in 2017, total GHG emissions from 5 WWTPs increased by 89% compared to the status quo in 2007, and after energy structure reform total GHG emissions decreased by 17% in 2021. Scenario analysis reveals that energy recovery and clean energy utilization provide 64% and 48% mitigation potential by 2050, respectively. We argue stricter effluent standard leads to GHG emissions growth in WWTPs; meanwhile, process optimization, proper temperature and targeted policies at WWTPs can reduce GHG emissions.

The value of synthetic magnetic resonance imaging in the diagnosis and assessment of prostate cancer aggressiveness.

Background: Synthetic magnetic resonance imaging (SyMRI) is a fast, standardized, and robust novel quantitative technique that has the potential to circumvent the subjectivity of interpretation in prostate multiparametric magnetic resonance imaging (mpMRI) and the limitations of existing MRI quantification techniques. Our study aimed to evaluate the potential utility of SyMRI in the diagnosis and aggressiveness assessment of prostate cancer (PCA). Methods: We retrospectively analyzed 309 patients with suspected PCA who had undergone mpMRI and SyMRI, and pathologic results were obtained by biopsy or PCA radical prostatectomy (RP). Pathological types were classified as PCA, benign prostatic hyperplasia (BPH), or peripheral zone (PZ) inflammation. According to the Gleason Score (GS), PCA was divided into groups of intermediate-to-high risk (GS ≥4+3) and low-risk (GS ≤3+4). Patients with biopsy-confirmed low-risk PCA were further divided into upgraded and nonupgraded groups based on the GS changes of the RP results. The values of the apparent diffusion coefficient (ADC), T1, T2 and proton density (PD) of these lesions were measured on ADC and SyMRI parameter maps by two physicians; these values were compared between PCA and BPH or inflammation, between the intermediate-to-high-risk and low-risk PCA groups, and between the upgraded and nonupgraded PCA groups. The risk factors affecting GS grades were identified via univariate analysis. The effects of confounding factors were excluded through multivariate logistic regression analysis, and independent predictive factors were calculated. Subsequently, the ADC+Sy(T2+PD) combined models for predicting PCA risk grade or GS upgrade were constructed through data processing analysis. The diagnostic performance of each parameter and the ADC+Sy(T2+PD) model was analyzed. The calibration curve was calculated by the bootstrapping internal validation method (200 bootstrap resamples). Results: The T1, T2, and PD values of PCA were significantly lower than those of BPH or inflammation (P≤0.001) in both the PZ or transitional zone. Among the 178 patients with PCA, intermediate-to-high-risk PCA group had significantly higher T1, T2, and PD values but lower ADC values compared with the low-risk group (P<0.05), and the diagnostic efficacy of each single parameter was similar (P>0.05). The ADC+Sy(T2+PD) model showed the best performance, with an area under the curve (AUC) 0.110 [AUC =0.818; 95% confidence interval (CI): 0.754-0.872] higher than that of ADC alone (AUC =0.708; 95% CI: 0.635-0.774) (P=0.003). Among the 68 patients initially classified as PCA in the low-risk group by biopsy, PCA in the postoperative upgraded GS group had significantly higher T1, T2, and PD values but lower ADC values than did those in the nonupgraded group (P<0.01). In addition, the ADC+Sy(T2+PD) model better predicted the upgrade of GS, with a significant increase in AUC of 0.204 (AUC =0.947; 95% CI: 0.864-0.987) compared with ADC alone (AUC =0.743; 95% CI: 0.622-0.841) (P<0.001). Conclusions: Quantitative parameters (T1, T2, and PD) derived from SyMRI can help differentiate PCA from non-PCA. Combining SyMRI parameters with ADC significantly improved the ability to differentiate between intermediate-to-high risk PCA from low-risk PCA and could predict the upgrade of low-risk PCA as confirmed by biopsy.

Stromal lymphocytes are associated with upgrade of B3 breast lesions.

Various histopathological, clinical and imaging parameters have been evaluated to identify a subset of women diagnosed with lesions with uncertain malignant potential (B3 or BIRADS 3/4A lesions) who could safely be observed rather than being treated with surgical excision, with little impact on clinical practice. The primary reason for surgery is to rule out an upgrade to either ductal carcinoma in situ or invasive breast cancer, which occurs in up to 30% of patients. We hypothesised that the stromal immune microenvironment could indicate the presence of carcinoma associated with a ductal B3 lesion and that this could be detected in biopsies by counting lymphocytes as a predictive biomarker for upgrade. A higher number of lymphocytes in the surrounding specialised stroma was observed in upgraded ductal and papillary B3 lesions than non-upgraded (p < 0.01, negative binomial model, n = 307). We developed a model using lymphocytes combined with age and the type of lesion, which was predictive of upgrade with an area under the curve of 0.82 [95% confidence interval 0.77-0.87]. The model can identify some patients at risk of upgrade with high sensitivity, but with limited specificity. Assessing the tumour microenvironment including stromal lymphocytes may contribute to reducing unnecessary surgeries in the clinic, but additional predictive features are needed.

Benefits of upgrading right ventricular to biventricular pacing in heart failure patients with atrial fibrillation.

AIMS: Recommendations on cardiac resynchronization therapy (CRT) in patients with atrial fibrillation or flutter (AF) are based on less robust evidence than those in sinus rhythm (SR). We aimed to assess the efficacy of CRT upgrade in the BUDAPEST-CRT Upgrade trial population by their baseline rhythm. METHODS AND RESULTS: Heart failure patients with reduced ejection fraction (HFrEF) and previously implanted pacemaker (PM) or implantable cardioverter defibrillator (ICD) and ≥20% right ventricular (RV) pacing burden were randomized to CRT with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). Primary [HF hospitalization (HFH), all-cause mortality, or <15% reduction of left ventricular end-systolic volume] and secondary outcomes were investigated. At enrolment, 131 (36%) patients had AF, who had an increased risk for HFH as compared with those with SR [adjusted hazard ratio (aHR) 2.99; 95% confidence interval (CI) 1.26-7.13; P = 0.013]. The effect of CRT-D upgrade was similar in patients with AF as in those with SR [AF adjusted odds ratio (aOR) 0.06; 95% CI 0.02-0.17; P < 0.001; SR aOR 0.13; 95% CI 0.07-0.27; P < 0.001; interaction P = 0.29] during the mean follow-up time of 12.4 months. Also, it decreased the risk of HFH or all-cause mortality (aHR 0.33; 95% CI 0.16-0.70; P = 0.003; interaction P = 0.17) and improved the echocardiographic response (left ventricular end-diastolic volume difference -49.21 mL; 95% CI -69.10 to -29.32; P < 0.001; interaction P = 0.21). CONCLUSION: In HFrEF patients with AF and PM/ICD with high RV pacing burden, CRT-D upgrade decreased the risk of HFH and improved reverse remodelling when compared with ICD, similar to that seen in patients in SR.

Synthesis of palladium-decorated defective tungsten oxide heterostructures with enhanced photothermal catalytic activity for hydrodeoxygenation of vanillin.

The selective hydrodeoxygenation (HDO) of sustainable lignocellulosic biomass plays a pivotal role in the conversion of biomass into high-value fuels and chemicals. Nevertheless, HDO for biomass upgrading always demands high temperatures and high hydrogen (H2) pressure. Photothermal catalysis has been recognized as an effective approach for boosting chemical reactions under mild conditions while maintaining superior selectivity. Herein, we report the design of palladium-decorated defective tungsten oxide (Pd/WO3-x) catalysts with enhanced photothermal catalytic performances for the efficient HDO of vanillin. Pd/WO3-x nanoflowers have been synthesized through a solvothermal/in-situ reduction two-step strategy, and they exhibit notable photoabsorption in a wide range (200-1100 nm), high photothermal conversion and efficient charge separation efficiency. Under simulated sunlight irradiation (0.3 W cm-2), Pd/WO3-x exhibits a maximum vanillin conversion up to 86.8 % with a 2-methoxy-4-methylphenol (MMP) selectivity of 100 %, which is obviously higher than that (vanillin conversion = 33.1 %, MMP selectivity = 100 %) in the oil bath at the same temperature. Such higher conversion efficiency and selectivity under sunlight should result from the synergistic integration of hot electrons and photothermal heating, both of which are derived from localized surface plasmon resonance (LSPR) in WO3-x. Importantly, Pd/WO3-x catalyst demonstrates good stability and high selectivity to MMP even after 5 cycles. This work may offer a novel viewpoint on the advancement of photothermal catalysts and the realization of photothermal catalytic biomass conversion under mild conditions.

Quality assurance of an established online adaptive radiotherapy program: patch and software upgrade.

Introduction: The ability to dynamically adjust target contours, derived Boolean structures, and ultimately, the optimized fluence is the end goal of online adaptive radiotherapy (ART). The purpose of this work is to describe the necessary tests to perform after a software patch installation and/or upgrade for an established online ART program. Methods: A patch upgrade on a low-field MR Linac system was evaluated for post-software upgrade quality assurance (QA) with current infrastructure of ART workflow on (1) the treatment planning system (TPS) during the initial planning stage and (2) the treatment delivery system (TDS), which is a TPS integrated into the delivery console for online ART planning. Online ART QA procedures recommended for post-software upgrade include: (1) user interface (UI) configuration; (2) TPS beam model consistency; (3) segmentation consistency; (4) dose calculation consistency; (5) optimizer robustness consistency; (6) CT density table consistency; and (7) end-to-end absolute ART dose and predicted dose measured including interruption testing. Differences of calculated doses were evaluated through DVH and/or 3D gamma comparisons. The measured dose was assessed using an MR-compatible A26 ionization chamber in a motion phantom. Segmentation differences were assessed through absolute volume and visual inspection. Results: (1) No UI configuration discrepancies were observed. (2) Dose differences on TPS pre-/post-software upgrade were within 1% for DVH metrics. (3) Differences in segmentation when observed were small in general, with the largest change noted for small-volume regions of interest (ROIs) due to partial volume impact. (4) Agreement between TPS and TDS calculated doses was 99.9% using a 2%/2-mm gamma criteria. (5) Comparison between TPS and online ART plans for a given patient plan showed agreement within 2% for targets and 0.6 cc for organs at risk. (6) Relative electron densities demonstrated comparable agreement between TPS and TDS. (7) ART absolute and predicted measured end-to-end doses were within 1% of calculated TDS. Discussion: An online ART QA program for post-software upgrade has been developed and implemented on an MR Linac system. Testing mechanics and their respective baselines may vary across institutions, but all necessary components for a post-software upgrade QA have been outlined and detailed. These outlined tests were demonstrated feasible for a low-field MR Linac system; however, the scope of this work may be applied and adapted more broadly to other online ART platforms.

Carbon performance analysis of upgraded wastewater treatment plants in key control areas of the Ziya River Basin in China.

Wastewater treatment plants (WWTPs) are one of the largest sources of greenhouse gas (GHG) emissions, and they are also one of the largest energy consumption industries in urban systems. With the progression of upgrading and standard-rising, WWTPs both directly and indirectly increase carbon emissions from the increased investments in facilities and usages in electricity as well as chemical agents. Here, we collected operational data from 15 WWTPs in the key control areas of the Ziya River Basin in North China and accounted for the changes in carbon performance at different technical upgrade methods. Results showed that the average carbon emission performance increased by 0.487 kg CO2/m3 after the upgrade. Carbon emissions from electricity consumption, chemical usage, biochemical process and sludge treatment accounted for 42%, 17%, 24%, and 17% of the total improvement in carbon emission performance, respectively. Reducing energy consumption, regulating chemical use and sludge comprehensive utilization are the key to carbon emission reduction. It further proposes that the development of wastewater treatment discharge standards should fully consider the comprehensive utilization of water quality classification. Regions with favorable natural conditions should make full use of their advantages by adopting economically feasible, low-energy-consuming technologies such as constructed wetlands, which offer carbon sequestration and landscaping benefits. This study provides guidance on the selection of technological pathways for pollution reduction and carbon mitigation in the wastewater treatment industry and on achieving sustainable water resource utilization.

Radial sclerosing lesions found on core needle biopsy: excision can be safely avoided.

AIMS: Radial sclerosing lesions (RSLs) are benign breast lesions composed of glandular and epithelial proliferations with stellate architecture and fibro-elastotic stroma, which can mimic invasive carcinoma on imaging. Surgical management following a core biopsy diagnosis of RSLs remains controversial. METHODS AND RESULTS: We retrospectively identified core biopsies with RSLs without atypia who underwent subsequent surgical excision between 2015 and 2021. All core biopsy slides were reviewed to confirm the diagnosis. Imaging was reviewed to determine radiological-pathological concordance. An upgrade was defined as invasive carcinoma or ductal carcinoma in situ (DCIS) in the excision. The final cohort consisted of 130 core biopsies from 124 women (median age = 52 years, range = 27-76). The imaging modality was mammogram in 52 (40%) cases, MRI in 52 (40%) and ultrasound in 26 (20%). One hundred and seven (82%) core biopsies were vacuum-assisted and 23 (18%) were ultrasound-guided without vacuum assistance. The median lesion size on imaging was 9 mm (range = 2-41). Overall, two (1%) cases were upgraded at excision, including one microinvasive lobular carcinoma and one 2 mm focus of invasive mammary carcinoma with associated DCIS. In both cases, the upgraded foci of carcinoma were not closely associated with the biopsy site and were considered incidental upgrades. CONCLUSIONS: This study adds to the body of literature supporting observation, rather than routine excision of radial sclerosing lesions without atypia.

Predictive Performance of Radiomic Features Extracted from Breast MR Imaging in Postoperative Upgrading of Ductal Carcinoma in Situ to Invasive Carcinoma.

PURPOSE: To investigate the predictive performance of radiomic features extracted from breast MRI for upgrade of ductal carcinoma in situ (DCIS) to invasive carcinoma. METHODS: This retrospective study included 71 women with DCIS lesions diagnosed preoperatively by biopsy. All women underwent breast dynamic contrast-enhanced (DCE) MRI of the breast, which included pre-contrast and five post-contrast phases continuously with a time resolution of 60s. Lesion segmentation was performed manually, and 144 radiomic features of the lesions were extracted from T2-weighted images (T2WI), pre-contrast T1-weighted images (T1WI), and post-contrast 1st, 2nd, and 5th phase subtraction images on DCE-MRI. Qualitative features of mammography, ultrasound, and MRI were also assessed. Clinicopathological features were evaluated using medical records. The least absolute shrinkage and selection operator (LASSO) algorithm was applied for features selection and model building. The predictive performance of postoperative upgrade to invasive carcinoma was assessed using the area under the receiver operating characteristic curve. RESULTS: Surgical specimens revealed 13 lesions (18.3%) that were upgraded to invasive carcinoma. Among clinicopathological and qualitative features, age was the only significant predictive variable. No significant radiomic features were observed on T2WI and post-contrast 2nd phase subtraction images on DCE-MRI. The area under the curves (AUCs) of the LASSO radiomics model integrated with age were 0.915 for pre-contrast T1WI, 0.862 for post-contrast 1st phase subtraction images, and 0.833 for post-contrast 5th phase subtraction images. The AUCs of the 200-times bootstrap internal validations were 0.885, 0.832, and 0.775. CONCLUSION: A radiomics approach using breast MRI may be a promising method for predicting the postoperative upgrade of DCIS. The present study showed that the radiomic features extracted from pre-contrast T1WI and post-contrast subtraction images in the very early phase of DCE-MRI were more predictable.

Surfactant Directionally Assembled at the Electrode-Electrolyte Interface for Facilitating Electrocatalytic Aldehyde Hydrogenation.

Electrocatalytic hydrogenation of unsaturated aldehydes to unsaturated alcohols is a promising alternative to conventional thermal processes. Both the catalyst and electrolyte deeply impact the performance. Designing the electrode-electrolyte interface remains challenging due to its compositional and structural complexity. Here, we employ the electrocatalytic hydrogenation of 5-hydroxymethylfurfural (HMF) as a reaction model. The typical cationic surfactant, cetyltrimethylammonium bromide (CTAB), and its analogs are employed as electrolyte additives to tune the interfacial microenvironment, delivering high-efficiency hydrogenation of HMF and inhibition of the hydrogen evolution reaction (HER). The surfactants experience a conformational transformation from stochastic distribution to directional assembly under applied potential. This oriented arrangement hampers the transfer of water molecules to the interface and promotes the enrichment of reactants. In addition, near 100 % 2,5-bis(hydroxymethyl)furan (BHMF) selectivity is achieved, and the faradaic efficiency (FE) of the BHMF is improved from 61 % to 74 % at -100 mA cm-2. Notably, the microenvironmental modulation strategy applies to a range of electrocatalytic hydrogenation reactions involving aldehyde substrates. This work paves the way for engineering advanced electrode-electrolyte interfaces and boosting unsaturated alcohol electrosynthesis efficiency.

When and how to perform venoplasty for lead placement.

Because of the increasing use of cardiac implantable electronic devices (CIEDs) with one or more intracardiac electrodes, the rate of lead failure is increasing. Moreover, upgrade of the CIED frequently is indicated for cardiac resynchronization therapy or other reasons. Both these situations require a new intervention, preferably using ipsilateral venous access. However, venous obstruction after CIED insertion occurs in 10%-20% of patients and poses a major obstacle for implantation of additional leads. Possible solutions include lead extraction, contralateral lead insertion, and venoplasty. Preprocedural venoplasty is associated with the lowest short- and long-term risks. Here we describe a step-by-step approach to this technique, which can be introduced and safely performed in most interventional catheterization laboratories.

Digital carbon neutrality: evidence of carbon emission reduction based on digital inclusive finance.

As a powerful engine for economic reform and curbing carbon emissions, digital inclusive finance provides solid support for achieving the goal of digital carbon neutrality. This study reveals the positive effect of digital inclusive finance on carbon emission reduction and the deeper reasons behind it by digging deeper into the panel data of 213 cities in China. The study adopts advanced empirical analysis methods to rigorously test the association between digital inclusive finance and carbon emissions. The results show that there is a strong positive correlation between the booming development of digital inclusive finance and the significant decline in carbon emissions. This finding remains solid after several rounds of robustness tests, which fully proves the reliability of the research results. Further mechanism analysis reveals the multiple paths of digital financial inclusion on carbon emission reduction. First, it promotes the optimization and upgrading of industrial structure by optimizing the allocation of financial resources, thus reducing the proportion of high-carbon emission industries. Second, digital inclusive finance attracts more foreign capital inflows and introduces advanced low-carbon technologies and management experience, further promoting the development of low-carbon economy. In addition, the study also found that the differences between different cities in terms of geographic location and city size have a significant impact on the carbon emission reduction effect of digital inclusive finance. In particular, the carbon emission reduction effect of digital inclusive finance is particularly significant in western regions, central cities, and first-tier cities. In response to these findings, this paper proposes a series of targeted policy recommendations. First, the financial service system should be further optimized to increase the coverage and penetration of digital inclusive finance, especially in less developed regions and small- and medium-sized cities. Second, regional policy synergies should be strengthened to form a strong synergy to promote the development of a low-carbon economy. In addition, it should guide capital flows to low-carbon industries and encourage enterprises to increase green technology research and development and application, while actively promoting low-carbon consumption concepts and guiding consumers to form green consumption habits. Through the implementation of these measures, it is expected that the potential of digital inclusive finance in the development of a low-carbon economy will be further stimulated, making a greater contribution to the realization of the goals of carbon peaking and carbon neutrality.

Understanding microplastic presence in different wastewater treatment processes: Removal efficiency and source identification.

Municipal effluents discharged from wastewater treatment plants (WWTPs) are a considerable source of microplastics in the environment. The dynamic profiles of microplastics in treatment units in WWTPs with different treatment processes remain unclear. This study quantitatively analyzed microplastics in wastewater samples collected from different treatment units in two tertiary treatment plants with distinct processes. The influents contained an average of 15.5 ± 3.5 particles/L and 38.5 ± 2.5 particles/L in the two WWTPs with in the oxidation ditch process and the integrated fixed-film activated sludge process, respectively. Interestingly, microplastic concentrations in the influent were more influenced by the population density in the served area than sewage volume or served population equivalent. Throughout the treatment process, concentrations were reduced to 1.5 ± 0.5 particles/L and 1.0 ± 1.0 particles/L in the final effluents, representing an overall decrease of 90% and 97%, in WWTPs with the oxidation ditch process and integrated fixed-film activated sludge process, respectively. A significant proportion of the microplastics were removed during the primary treatment stage in both WWTPs, with better performance for foam, film, line-shaped and large-sized microplastics. Most microplastics were accumulated in activated sludge, indicating its key role as the primary sink in WWTPs. The multiple correspondence analysis identified laundry washing and daily necessities such as packaging and containers as the major contributors to microplastics in WWTPs. The study proposed recommendations for upgrading WWTPs, modifying designs, and implementing strategies to reduce microplastic sources, aiming to minimize the release of microplastics into the environment. These findings can shed lights on the sources of microplastics in WWTPs, and advance our understanding of the mechanisms for more effective microplastic removals in wastewater treatment technologies in future applications.

Upgrading anode graphite from retired lithium ion batteries via solid-phase exfoliation by mechanochemical strategy.

Vast quantities of anode graphite from waste lithium ion batteries (LIBs), as a type of underrated urban mine, has enormous potential to be exploited for resource recovery. Herein, we propose a benign process integrating low-temperature pyrolysis and mechanochemical techniques to upcycle spent graphite (SG) from end-of-life LIBs. Pyrolysis at 500 °C leads to about 82.2 % PVDF dissociation in thermal treated graphite (TG). Solid-phase exfoliation via ball milling assisted by urea successfully produces abundant graphite flakes and a small amount of monolayer graphene nanosheet at the edge of mechanochemically processed graphite (MG). Subsequent rinsing removes the residual LiF salts. High purity and unique edge structural features of the as-prepared MG offer more active sites and storage reservoir for intercalation and de-intercalation of lithium ions, resulting in enhanced lithium-ion diffusion kinetics, excellent reversible specific capacity and desirable rate capability. Inspiringly, MG exhibits a remarkably enhanced initial specific charge capacity of 521.3 mAh g-1 during the first charge-discharge, and only declines from 569.9 mAh g-1 to 538 mAh g-1 with slight attenuation after 50 consecutive cycles at 0.1 A/g, indicating satisfactory cycle stability. Additionally, the purification and reconstruction mechanism for MG have been illustrated in detail. This study offers a green strategy to reconstruct and upgrade anode graphite from LIBs, which can realize sustainable waste management.

Parameters optimization for decontamination and fine physical regeneration pathways of polypropylene plastics from waste lunchboxes.

Due to the development of the food delivery industry, a large amount of waste lunchboxes made of homo polypropylene (PP) plastic have been generated. This study developed a new technological strategy to effectively regenerate PP from waste lunchboxes. Through response surface curve analysis, it was found that under the optimal process conditions of hot alkali washing at 80 â„ƒ, 30 min, and pH 13, the optimal contact angle was 65.55°, indicating a good oil stain removal effect. By identifying and analyzing the characteristics of impurities in waste lunchboxes, a physical sorting and granulation regeneration process was constructed. And through large-scale statistical analysis and data collection, it was further verified that recycled PP plastics maintained their physical stability and excellent processing performance. The quality stability of recycled PP plastics in terms of impurities content was also verified. By designing different formulations specifically, recycled PP was mixed with different virgin PP and antioxidants in appropriate proportions, and extruded into particles under 150-300 mesh filtration conditions to obtain modified recycled PP. Modified recycled PP was applied in textiles, clothing, and injection molded products. In conclusion, we achieve the up-cylcing of waste PP lunchboxes instead of down-cylcing.

Patient characteristics, predictors and outcome of pacemaker patients upgraded to an implantable cardioverter defibrillator.

AIMS: Pacemaker (PM) patients may require a subsequent upgrade to an implantable cardioverter defibrillator (ICD). Limited data exists on this patient population. We sought to characterize this population, to assess predictors for ICD upgrade, and to report the outcome. METHODS: From our prospective PM and ICD implantation registry, all patients who underwent PM and/or ICD implantations at our center were analyzed. Patient characteristics and outcomes of PM patients with subsequent ICD upgrade were compared to age- and sex-matched patients with de novo ICD implantation, and to PM patients without subsequent upgrade. RESULTS: Of 1'301 ICD implantations, 60 (5%) were upgraded from PMs. Median time from PM implantation to ICD upgrade was 2.6 years (IQR 1.3-5.4). Of 2'195 PM patients, 28 patients underwent subsequent ICD upgrades, corresponding to an estimated annual incidence of an ICD upgrade of at least 0.33%. Lower LVEF (p = .05) and male sex (p = .038) were independent predictors for ICD upgrade. Survival without death, transplant and LVAD implantation were worse both for upgraded ICD patients compared to matched patients with de novo ICD implantation (p = .05), as well as for PM patients with subsequent upgrade compared to matched PM patients not requiring an upgrade (p = .036). CONCLUSIONS: One of 20 ICD implantations are upgrade of patients with a PM. At least one of 30 PM patients will require an ICD upgrade in the following 10 years. Predictors for ICD upgrade are male sex and lower LVEF at PM implantation. Upgraded patients have worse outcomes.

History of NHTSA's upgrade of FMVSS 208 addressing airbag induced fatalities and serious injuries.

OBJECTIVE: The objective of this paper is to provide a history of the National Highway Traffic Safety Administration's (NHTSA's) extensive efforts of incorporating advanced airbag technology capability beyond that available in first-generation airbag systems into FMVSS No. 208. METHODS: In the paper, NHTSA's actions and their collaborative efforts with automakers, automaker suppliers, insurance industry, academia, and other Federal agencies were reviewed, and the key efforts have been highlighted. Through their efforts, NHTSA developed its strategy by first undertaking near term actions and then undertaking the strategy for longer term actions. Rulemaking was undertaken in three steps. Then, as sufficient data became available, NHTSA documented the effectiveness of the rulemakings. RESULTS: The approach taken by NHTSA with the goal of preserving the safety benefits of the first-generation of frontal airbags while minimizing their danger to children and at-risk adults paved the way for the advanced airbags final rule and an interim final rule issued on May 12, 2000 (see Federal Register Notice 65 FR 30680). A follow-up final rule was issued on August 31, 2006, to change the test speed of the belted 5th percentile female dummy from 48 km/h to 56 km/h (30 mph to 35 mph). The final rule was updated on November 2, 2007, to permit manufacturers to earn advance credits for vehicles that are certified in compliance with the new higher speed requirement one year in advance of the regulatory requirements. CONCLUSION: NHTSA engagement in efforts with multiple partners toward identifying the safety issues, was an integral part of NHTSA's strategy in addressing the problem, arriving at immediate actions that NHTSA took, and detailing a comprehensive look at the longer-term approach required to resolve the safety issues. The approach taken by NHTSA paved the way for the advanced airbags final rule and an interim final rule issued on May 12, 2000 (Federal Register Notice 65 FR 30680). NHTSA had undertaken a successful collaboration of the Federal Government, the automobile industry, equipment suppliers, insurance companies, traffic safety advocates, law enforcement agencies from across the country, and the media to solve the airbag related safety issue.