Influence of Hf Doping on the Oxygen Behaviors on ZrCo(110) Surface Using First-Principles Calculation.

ZrCo alloy is easily poisoned by impurity gases such as O2, CO, and CO2, resulting in a deterioration in hydrogen storage performance. In this study, we conducted a comprehensive investigation into the adsorption and dissociation characteristics of oxygen on the ZrCo(110) surface using first-principles calculations. Previous studies indicated that the anti-disproportionation properties of ZrCo alloy can be significantly improved by Hf substitution, but the effect of Hf doping on the anti-poisoning properties has not been reported. We also examined the effect of Hf doping on the adsorption, dissociation, and diffusion characteristics of oxygen. It is found that on the ZrCo(110) surface, O2 molecules are easily dissociated and then stably adsorbed at the hollow site. Oxygen atoms will fill the surface preferentially and then diffuse inward. The doping of Hf has an insignificant impact on the adsorption or dissociation behavior of oxygen in comparison to the pure ZrCo surface. However, a notable observation is that the doping of Hf resulted in a reduction in the diffusion barrier for oxygen from the surface to the subsurface by 0.61 eV. Consequently, our study suggests that doping Hf is not an advisable strategy for improving the ZrCo(110) surface's resistance to O2 poisoning because of improved oxygen permeability.

Genomic landscape and distinct molecular subtypes of primary testicular lymphoma.

Primary testicular lymphoma (PTL) is a rare lymphoma predominantly occurring in the elderly male population. It is characterized by a limited response to treatment and a heightened tendency towards relapse. Histologically, approximately 90% of PTL cases are classified as diffuse large B-cell lymphomas (DLBCL). Genetic features of PTL were delineated in a limited scope within several independent studies. Some of the articles which analyzed the genetic characterization of DLBCL have incorporated PTL samples, but these have been constrained by small sample sizes. In addition, there have been an absence of independent molecular typing studies of PTL. This report summarizes the common mutational features, copy number variations (CNVs) and molecular typing of PTL patients, based on whole-exome sequencing (WES) conducted on a cohort of 25 PTL patients. Among them, HLA, CDKN2A and MYD88 had a high mutation frequency. In addition, we found two core mutational characteristics in PTL including mutation in genes linked to genomic instability (TP53 and CDKN2A) and mutation in immune-related genes (HLA, MYD88, CD79B). We performed molecular typing of 25 PTL patients into C1 subtype with predominantly TP53 mutations and C2 subtype with predominantly HLA mutations. Notably, mutations in the TP53 gene predicted a poor outcome in most types of lymphomas. However, the C1 subtype, dominated by TP53 mutations, had a better prognosis compared to the C2 subtype in PTL. C2 subtype exhibited a worse prognosis, aligning with our finding that the mechanism of immune escape in PTL was primarily the deletions of HLA rather than PD-L1/PD-L2 alterations, a contrast to other DLBCLs. Moreover, we calculated the tumor mutation burden (TMB) and identified that TMB can predict prognosis and recurrence rate in PTL. Our study underscores the significance of molecular typing in PTL based on mutational characteristics, which plays a crucial role in prognostication and guiding therapeutic strategies for patients.

A robust web-based tool to predict viral shedding in patients with Omicron SARS-CoV-2 variants.

Background: Data on viral kinetics and variants affecting the duration of viral shedding were limited. Our objective was to determine viral shedding in distinct severe acute respiratory syndrome coronavirus 2 variants, including Omicron BA.4/5 and BF.7, and to identify the relevant influencing factors. Methods: We carried out a longitudinal cohort study at Beijing Xiaotangshan Fangcang shelter hospital from May to June 2022 (Omicron BA.4/5) and from November to December 2022 (Omicron BF.7). Nucleocapsid protein (N) and open reading frame (ORF) genes were considered as the target genes of the reverse transcription PCR. The daily results of cycle threshold (CT), including lowest ORF1ab-CT values for days 1-3 post-hospitalisation and lowest N-CT values for days 1-3 post-hospitalisation (CT3minN) and demographic and clinical characteristics were collected. Results: 1433 patients with coronavirus disease 2019 (COVID-19) were recruited from the Fangcang shelter hospital, in which 278 patients were diagnosed with Omicron BA.4/5 and 1155 patients with Omicron BF.7. Patients with BF.7 infection showed a longer duration of viral shedding. The duration of viral shedding was associated with the variants age, alcohol use, the severity of COVID-19 and CT3minN. Moreover, the nomogram had excellent accuracy in predicting viral shedding. Conclusions: Our results indicated that patients with Omicron BF.7 had a longer period of contagiousness than those with BA.4/5. The duration of viral shedding was affected by a variety of factors and the nomogram may become an applicable clinical instrument to predict viral shedding. Furthermore, we developed a new COVID-19 viral shedding predicting model that can accurately predict the duration of viral shedding for COVID-19, and created a user-friendly website to apply this prediction model (https://puh3.shinyapps.io/CVSP_Model/).

Impact of Lianhua Qingwen on viral shedding in omicron mild/asymtomatic patients: a real-world study.

Background: Lianhuaqingwen (LHQW), a traditional Chinese medicine comprised of 13 herbal extracts renowned for their robust heat-clearing and detoxifying properties, has gained widespread utilization in China but has yet to garner similar recognition abroad. It is believed to exhibit efficacy in ameliorating symptoms in individuals afflicted with coronavirus disease 2019 (COVID-19). However, the precise impact of LHQW on viral shedding (VS), particularly in the context of mild or asymptomatic infections caused by the Omicron BF.4/5 or BF.7 variants of COVID-19, remained inadequately elucidated. Consequently, a real-world study was conducted, involving patients diagnosed with COVID-19, with the primary objective of ascertaining the effectiveness of LHQW in this specific clinical context. Methods: We conducted an investigation on Omicron-infected patients through a single-center, propensity score-matched real-world study conducted at Xiaotangshan Fangcang Hospital from May to November 2022. A total of 3,368 COVID-19 patients were enrolled in the study, all of whom presented mild or asymptomatic infections caused by either BF.4/5 or BF.7 strains of the virus. Demographic and clinical data were systematically collected from medical records. Patients were allocated to receive treatment with LHQW (designated as the treatment group) or received no LHQW treatment (designated as the not-treated/no-treatment group). Viral load was quantified utilizing quantitative real-time PCR (qPCR), and the duration of VS was defined as the time interval between the initial negative test result and the date of COVID-19 diagnosis or symptom onset. Results: The study encompassed a cohort of 3,368 patients, and following propensity score matching, a subset of 296 patients was meticulously chosen for subsequent analysis. Notably, baseline characteristics exhibited disparities between the treatment and not-treated/no-treatment groups. However, post-matching, these characteristics achieved a commendable level of comparability. Our findings unequivocally demonstrated that there existed no statistically significant disparity in VS. This holds true when comparing patients subjected to LHQW treatment against those not administered LHQW, as well as when contrasting individuals presenting asymptomatic and mild COVID-19 manifestations. Conclusion: No statistically significant difference in VS was observed between patients who underwent LHQW treatment and those who did not. Additional investigations are imperative to provide a comprehensive assessment of LHQW's efficacy, particularly in patients afflicted with severe COVID-19 or those infected with viral strains distinct from BF.4/5 or BF.7.

Suppressing gas swelling in self-assembled Li4Ti5O12 (400) for high-performance rechargeable batteries.

Lithium titanate is a promising anode material for lithium-ion batteries due to its high-rate capability and long-cycle duration. However, gas swelling during electrochemical reactions has hindered its industrial application. Here, we synthesize self-assembled (400)-orientation lithium titanate (SA-LTONF) with ultrafine nanoparticles using a feasible thermal method. The SA-LTONF with an organic carbon coating exhibited superior electrochemical performance. To understand such high-rate capability, we perform density functional theory (DFT) calculations which elucidate the orientation-dependent electrochemical mechanism of hydrogen evolution and the atomically dynamic mechanism of lithium-ion migration in Li4Ti5O12 and Li7Ti5O12. Our findings provide a unique insight into the gas generation and ultrafast lithium-ion transportation in lithium titanate and offer guidance for nanoarchitecture construction and materials design of lithium titanate for commercial applications.

Palladium-Phosphide-Modified Three-Dimensional Phospho-Doped Graphene Materials for Hydrogen Storage.

The development of efficient hydrogen storage materials is crucial for advancing hydrogen-based energy systems. In this study, we prepared a highly innovative palladium-phosphide-modified P-doped graphene hydrogen storage material with a three-dimensional configuration (3D Pd3P0.95/P-rGO) using a hydrothermal method followed by calcination. This 3D network hindering the stacking of graphene sheets provided channels for hydrogen diffusion to improve the hydrogen adsorption kinetics. Importantly, the construction of the three-dimensional palladium-phosphide-modified P-doped graphene hydrogen storage material improved the hydrogen absorption kinetics and mass transfer process. Furthermore, while acknowledging the limitations of primitive graphene as a medium in hydrogen storage, this study addressed the need for improved graphene-based materials and highlighted the significance of our research in exploring three-dimensional configurations. The hydrogen absorption rate of the material increased obviously in the first 2 h compared with two-dimensional sheets of Pd3P/P-rGO. Meanwhile, the corresponding 3D Pd3P0.95/P-rGO-500 sample, which was calcinated at 500 °C, achieved the optimal hydrogen storage capacity of 3.79 wt% at 298 K/4 MPa. According to molecular dynamics, the structure was thermodynamically stable, and the calculated adsorption energy of a single H2 molecule was -0.59 eV/H2, which was in the ideal range of hydrogen ad/desorption. These findings pave the way for the development of efficient hydrogen storage systems and advance the progress of hydrogen-based energy technologies.

FAM46C-mediated tumor heterogeneity predicts extramedullary metastasis and poorer survival in multiple myeloma.

Cancers originate from a single cell according to Nowell's theory of clonal evolution. The enrichment of the most aggressive clones has been developed and the heterogeneity arises for genomic instability and environmental selection. Multiple myeloma (MM) is a multiple relapse plasma cell cancer generated from bone marrow. Although there were accumulating researches in multiple myeloma pathogenesis, the heterogeneity remains poorly understood. The participants enrolled in this study were 4 EMP+ (EMP, Extramedullary plasmacytoma) and 2 EMP- primarily untreated MM patients. Single cell RNA sequencing and analysis were conducted for the single cell suspension, which was sorted by flow cytometry from peripheral blood mononuclear cells or bone marrow cells. In our research, the results of single cell RNA sequencing show that FAM46C determines MM tumor heterogeneity predicting extramedullary metastasis by influencing RNA stability. Further, we integrated and analyzed 2280 multiple myeloma samples from 7 independent datasets, which uncover that FAM46C mediated tumor heterogeneity predicts poorer survival in multiple myeloma.

Hydrogen Absorption Performance and O2 Poisoning Resistance of Pd/ZrCo Composite Film.

In order to enhance the hydrogen absorption performance and poisoning resistance of ZrCo to O2, Pd/ZrCo composite films were prepared by direct current magnetron sputtering. The results show that the initial hydrogen absorption rate of the Pd/ZrCo composite film increased significantly due to the catalytic effect of Pd compared with the ZrCo film. In addition, the hydrogen absorption properties of Pd/ZrCo and ZrCo were tested in poisoned hydrogen mixed with 1000 ppm O2 at 10-300 °C, where the Pd/ZrCo films maintained a better resistance to O2 poisoning below 100 °C. The mechanism of poisoning was investigated jointly by first-principles calculation combined with SEM-EDS elemental mapping tests. It is shown that the poisoned Pd layer maintained the ability to promote the decomposition of H2 into hydrogen atoms and their rapid transfer to ZrCo.

Weighted gene co-expression network analysis identifies dysregulated B-cell receptor signaling pathway and novel genes in pulmonary arterial hypertension.

Background: Pulmonary arterial hypertension (PAH) is a devastating cardio-pulmonary vascular disease in which chronic elevated pulmonary arterial pressure and pulmonary vascular remodeling lead to right ventricular failure and premature death. However, the exact molecular mechanism causing PAH remains unclear. Methods: RNA sequencing was used to analyze the transcriptional profiling of controls and rats treated with monocrotaline (MCT) for 1, 2, 3, and 4 weeks. Weighted gene co-expression network analysis (WGCNA) was employed to identify the key modules associated with the severity of PAH. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to explore the potential biological processes and pathways of key modules. Real-time PCR and western blot analysis were used to validate the gene expression. The hub genes were validated by an independent dataset obtained from the Gene Expression Omnibus database. Results: A total of 26 gene modules were identified by WGCNA. Of these modules, two modules showed the highest correlation with the severity of PAH and were recognized as the key modules. GO analysis of key modules showed the dysregulated inflammation and immunity, particularly B-cell-mediated humoral immunity in MCT-induced PAH. KEGG pathway analysis showed the significant enrichment of the B-cell receptor signaling pathway in the key modules. Pathview analysis revealed the dysregulation of the B-cell receptor signaling pathway in detail. Moreover, a series of humoral immune response-associated genes, such as BTK, BAFFR, and TNFSF4, were found to be differentially expressed in PAH. Additionally, five genes, including BANK1, FOXF1, TLE1, CLEC4A1, and CLEC4A3, were identified and validated as the hub genes. Conclusion: This study identified the dysregulated B-cell receptor signaling pathway, as well as novel genes associated with humoral immune response in MCT-induced PAH, thereby providing a novel insight into the molecular mechanisms underlying inflammation and immunity and therapeutic targets for PAH.

Hierarchal Porous Graphene-Structured Electrocatalysts with Fe-N5 Active Sites Modified with Fe Clusters for Enhanced Performance Toward Oxygen Reduction Reaction.

The local coordination environment around the active centers has a major impact on tuning the intrinsic activity of M-N-C catalysts. Herein, a porous graphene with Fe-N5 active sites modified with Fe clusters is successfully fabricated by using Fe3+-SCN- and NaHCO3 as the metal precursor and pore-forming agent, respectively. The unique Fe-N5 configuration accompanying Fe clusters and the improved ORR activity are confirmed by various characterization techniques and theoretical calculations. Benefiting from the pores, mass and electron transfer channels are successfully constructed, making more active sites accessible and facilitating the ORR process. As a consequence, the as-prepared catalyst has an excellent ORR activity with a half-wave potential of 0.89 V, comparable selectivity, and superior stability. In addition, a homemade primary zinc-air battery using this material as the cathode catalyst has a maximum power density of 0.205 W/cm2, revealing the potential of the as-constructed CSA-Fe-N-C catalyst to replace precious Pt catalysts.

Li-Ion Conductivity Enhancement of LiBH4·xNH3 with In Situ Formed Li2O Nanoparticles.

Interfacial engineering is an efficient approach to improve the ionic conductivity of solid-state electrolytes. In the present study, we report the enhancement of in situ formed nanocrystalline Li2O on the thermal stability and electrochemical properties of amide lithium borohydride, LiBH4·xNH3 (x = 0.67-0.8). LiBH4·xNH3-Li2O composites with different amounts of Li2O are prepared by a one-step synthesis process by ball milling the mixture of LiBH4, LiNH2, and LiOH in molar ratios of 1:n:n (n = 1, 2, 3, 4). Owing to the strong interfacial effect with nanocrystalline Li2O, LiBH4·xNH3 is converted to the amorphous state in the presence of 78 wt % Li2O at n = 4. Consequently, the ionic conductivity of LiBH4·xNH3 at 20 °C is improved by orders of magnitude up to 5.4 × 10-4 S cm-1, the NH3 desorption temperature is increased by more than 20 °C, and the electrochemical window is widened from 0.5 to 3.8 V.

Heterostructured Ni3S2-Ni3P/NF as a Bifunctional Catalyst for Overall Urea-Water Electrolysis for Hydrogen Generation.

Urea oxidation reaction (UOR) has been proposed to replace the formidable oxygen evolution reaction (OER) to reduce the energy consumption for producing hydrogen from electrolysis of water owing to its much lower thermodynamic oxidation potential compared to that of the OER. Therefore, exploring a highly efficient and stable hydrogen evolution and urea electrooxidation bifunctional catalyst is the key to achieve economical and efficient hydrogen production. In this paper, we report a heterostructured sulfide/phosphide catalyst (Ni3S2-Ni3P/NF) synthesized via one-step thermal treatment of Ni(OH)2/NF, which allows the simultaneous occurrence of phosphorization and sulfuration. The obtained Ni3S2-Ni3P/NF catalyst shows a sheet structure with an average sheet thickness of ∼100 nm, and this sheet is composed of interconnected Ni3S2 and Ni3P nanoparticles (∼20 nm), between which there are a large number of accessible interfaces of Ni3S2-Ni3P. Thus, the Ni3S2-Ni3P/NF exhibits superior performance for both UOR and hydrogen evolution reaction (HER). For the overall urea-water electrolysis, to achieve current densities of 10 and 100 mA cm-2, cell voltage of only 1.43 and 1.65 V is required using this catalyst as both the anode and the cathode. Moreover, this catalyst also maintains fairly excellent stability after a long-term testing, indicating its potential for efficient and energy-saving hydrogen production. The theoretical calculation results show that the Ni atoms at the interface are the most efficient catalytically active site for the HER, and the free energy of hydrogen adsorption is closest to thermal neutrality, which is only 0.16 eV. A self-driven electron transfer at the interface, making the Ni3S2 sides become electron donating while Ni3P sides become electron withdrawing, may be the reason for the enhancement of the UOR activity. Therefore, this work shows an easy treatment for enhancing the catalytic activity of Ni-based materials to achieve high-efficiency urea-water electrolysis.

Preparation, characterization and antibacterial mechanism of the chitosan coatings modified by Ag/ZnO microspheres.

BACKGROUND: To improve the physicochemical and antibacterial properties of coatings, the chitosan (CS) coatings were respectively prepared by a casting method with zinc oxide (ZnO) and silver (Ag)/ZnO microspheres as modifiers. The chemical structures and micromorphology of ZnO, Ag/ZnO microspheres and CS coatings were characterized by X-ray diffraction, Fourier-transform infrared spectroscopy, scanning electron microscopy, transmission electron microscopy and energy dispersive X-ray spectroscopy. Furthermore, using the dominant spoilage bacteria of aquatic products, Shewanella putrefaciens and Pseudomonas aeruginosa, as objects, the antibacterial activities and mechanism of the CS coatings were investigated. RESULTS: The results show that ZnO and Ag/ZnO microspheres are dispersed homogeneously in the CS coatings. After modified by ZnO and Ag/ZnO microspheres, the mechanical properties and antibacterial abilities of the CS coatings are improved, and that of 0.5% Ag/ZnO-CS coating is the optimal. For pure CS coating, the bacterial cell membrane is damaged slightly because of the electrostatic interaction between NH3+ of CS and the negative charge on bacterial surface. After treated by ZnO-CS composite coating, the bacterial cell membrane is destroyed badly on account of the earlier-mentioned ion interaction and disturbing the synthesis of high molecular weight total protein. CONCLUSION: With regard to Ag/ZnO-CS composite coating, the bacterial cell membrane is damaged seriously and cell contents are completely released due to ion interaction, disturbing the synthesis of high molecular weight total protein and low molecular weight membrane protein. Hence, Ag/ZnO-CS composite coatings are antimicrobial materials and food preservative materials with great potential application. © 2020 Society of Chemical Industry.

Improving patient safety during intrahospital transportation of mechanically ventilated patients with critical illness.

AIM: Intrahospital transportation (IHT) of patients under mechanical ventilation (MV) significantly increases the risk of patient harm. A structured process performed by a well-prepared team with adequate communication among team members plays a vital role in enhancing patient safety during transportation. DESIGN AND IMPLEMENTATION: We conducted this quality improvement programme at the intensive care units of a university-affiliated medical centre, focusing on the care of patients under MV who received IHT for CT or MRI examinations. With the interventions based on the analysis finding of the IHT process by healthcare failure mode and effects analysis, we developed and implemented strategies to improve this process, including standardisation of the transportation process, enhancing equipment maintenance and strengthening the teamwork among the transportation teammates. In a subsequent cycle, we developed and implemented a new process with the practice of reminder-assisted briefing. The reminders were printed on cards with mnemonics including 'VITAL' (Vital signs, Infusions, Tubes, Alarms and Leave) attached to the transportation monitors for the intensive care unit nurses, 'STOP' (Secretions, Tubes, Oxygen and Power) attached to the transportation ventilators for the respiratory therapists and 'STOP' (Speak-out, Tubes, Others and Position) attached to the examination equipment for the radiology technicians. We compared the incidence of adverse events and completeness and correctness of the tasks deemed to be essential for effective teamwork before and after implementing the programme. RESULTS: The implementation of the programme significantly reduced the number and incidence of adverse events (1.08% vs 0.23%, p=0.01). Audits also showed improved teamwork during transportation as the team members showed increased completeness and correctness of the essential IHT tasks (80.8% vs 96.5%, p<0.001). CONCLUSION: The implementation of reminder-assisted briefings significantly enhanced patient safety and teamwork behaviours during the IHT of mechanically ventilated patients with critical illness.

Maximal expiratory pressure is associated with reinstitution of mechanical ventilation after successful unassisted breathing trials in tracheostomized patients with prolonged mechanical ventilation.

OBJECTIVE: Reinstitution of mechanical ventilation (MV) for tracheostomized patients after successful weaning may occur as the care setting changes from critical care to general care. We aimed to investigate the occurrence, consequence and associated factors of MV reinstitution. METHODS: We analyzed the clinical data and physiological measurements of tracheostomized patients with prolonged MV discharged from the weaning unit to general wards after successful weaning to compare between those with and without in-hospital MV reinstitution within 60 days. RESULTS: Of 454 patients successfully weaned, 116 (25.6%) reinstituted MV at general wards within 60 days; at hospital discharge, 42 (36.2%) of them were eventually liberated from MV, 51 (44.0%) remained MV dependent, and 33 (28.4%) died. Of the 338 patients without reinstitution within 60 days, only 3 (0.9%) were later reinstituted with MV before discharge (on day 67, 89 and 136 at general wards, respectively), and 322 (95.2%) were successfully weaned again at discharge, while 13 (3.8%) died. Patients with MV reinstitution had a significantly lower level of maximal expiratory pressure (PEmax) before unassisted breathing trial compared to those without reinstitution. Multivariable Cox regression analysis showed fever at RCC discharge (hazard ratio [HR] 14.00, 95% confidence interval [CI] 3.2-61.9) chronic obstructive pulmonary disease (HR 2.37, 95% CI 1.34-4.18), renal replacement therapy at the ICU (HR 2.29, 95% CI 1.50-3.49) and extubation failure before tracheostomy (HR 1.76, 95% CI 1.18-2.63) were associated with increased risks of reinstitution, while PEmax > 30 cmH2O (HR 0.51, 95% CI 0.35-0.76) was associated with a decreased risk of reinstitution. CONCLUSIONS: The reinstitution of MV at the general ward is significant, with poor outcomes. The PEmax measured before unassisted breathing trial was significantly associated with the risk of reinstituting MV at the general wards.

In Vitro Evaluation of Aerosol Performance and Delivery Efficiency During Mechanical Ventilation Between Soft Mist Inhaler and Pressurized Metered-Dose Inhaler.

BACKGROUND: Soft mist inhalers (SMIs) generate aerosols with a smaller particle size than pressurized metered-dose inhalers (pMDIs). However, the whole-span particle size distribution (PSD) of SMIs and the optimal delivery method of SMIs during mechanical ventilation have not been fully investigated. This study aimed to measure the PSD of the SMI alone and the SMI coupled to an inhalation aid (eg, a spacer, a valved holding chamber), as well as the delivery efficiency of SMI in different actuation timings and circuit positions during mechanical ventilation. As a suitable comparison, the pMDI was chosen for the same measurement. METHODS: SMIs (2.5 µg/actuation of tiotropium) were compared with pMDIs (100 µg/actuation of salbutamol). A microorifice uniform deposit impactor was utilized for the particle sizing of drug aerosols generated by inhalers alone, inhalers with a spacer, and inhalers with a valved holding chamber. To optimize the delivery efficiency of both inhalers during mechanical ventilation, the operating parameters included the circuit positions and actuation timings in the ventilator circuit. Particle sizes and inhaled doses were measured with an optical particle sizer and filters used to collect and quantify the drug, respectively. RESULTS: The SMI generated a smaller mass medium aerodynamic diameter (MMAD) than that from the pMDI. The extrafine-particle fraction (EFPF, < 1 µm) of the SMI was significantly higher than that of the pMDI. With the use of either inhalation aid, the MMAD of both inhalers decreased, and both inhalers with inhalation aid showed significant increases in EFPF. During mechanical ventilation, the optimum way to deliver the SMI and pMDI was at 15 cm from the Y-piece and actuated at the end of expiration and the onset of inspiration, respectively. CONCLUSIONS: The SMI with an inhalation aid showed marginal improvement on the PSD. The inhaler type, actuation timing, and position within the circuit also played important roles in delivery efficiency during mechanical ventilation.

The Modification of In Situ SiOx Chitosan Coatings by ZnO/TiO2 NPs and Its Preservation Properties to Silver Carp Fish Balls.

The composite chitosan coatings were prepared and characterized to evaluate their preservation properties for silver carp fish balls, and the microstructures and physicochemical properties of the coatings were improved by in situ nano silicon oxide (SiOx) and zinc oxide/titania (ZnO/TiO2 ) nano-particles (NPs). In the chitosan coatings, when the chitosan combines with NPs by chemical bonds, the crystal lattice is slightly changed due to the modification of NPs. The chitosan coatings modified by NPs showed few cracks, among which sodium hexametaphosphate (SHMP) modified ZnO/TiO2 /SiOx-chitosan (ZTS-CS) coating is proved to be the optimal one. The change of the freshness index and the texture of the fish balls are delayed by the coatings due to their gas permeability and antibacterial properties. The preservation properties of the chitosan coatings for Silver Carp fish balls are improved by in situ SiOx, and further improved by co-modification of ZnO/TiO2 NPs. Furthermore, the surface modification of ZnO/TiO2 NPs enhances the preservation properties of the chitosan coating. PRACTICAL APPLICATION: In our previous study, in situ SiOx was found to improve antibacterial and preservation properties of chitosan coating, leading to extending shelf time of Sciaenops ocellatus. In order to further improve properties of chitosan coatings, we added nontoxic edible nano materials to the in situ SiOx chitosan coatings. In situ SiOx modified by ZnO/TiO2 NPs were synthesized, measured, and characterized in this study, and were applied for the preservation of silver carp fish balls. It could serve as a potential preservation material due to the increasing mechanical preservation properties. Through the results, the ZnO/TiO2 /SiOx-chitosan (ZTS-CS) coatings have potential as application in the food industry to guarantee food quality and extend shelf life of products.

Incidence of patient safety events and process-related human failures during intra-hospital transportation of patients: retrospective exploration from the institutional incident reporting system.

BACKGROUND: Intra-hospital transportation (IHT) might compromise patient safety because of different care settings and higher demand on the human operation. Reports regarding the incidence of IHT-related patient safety events and human failures remain limited. OBJECTIVE: To perform a retrospective analysis of IHT-related events, human failures and unsafe acts. SETTING: A hospital-wide process for the IHT and database from the incident reporting system in a medical centre in Taiwan. PARTICIPANTS: All eligible IHT-related patient safety events between January 2010 to December 2015 were included. MAIN OUTCOME MEASURES: Incidence rate of IHT-related patient safety events, human failure modes, and types of unsafe acts. RESULTS: There were 206 patient safety events in 2 009 013 IHT sessions (102.5 per 1 000 000 sessions). Most events (n=148, 71.8%) did not involve patient harm, and process events (n=146, 70.9%) were most common. Events at the location of arrival (n=101, 49.0%) were most frequent; this location accounted for 61.0% and 44.2% of events with patient harm and those without harm, respectively (p<0.001). Of the events with human failures (n=186), the most common related process step was the preparation of the transportation team (n=91, 48.9%). Contributing unsafe acts included perceptual errors (n=14, 7.5%), decision errors (n=56, 30.1%), skill-based errors (n=48, 25.8%), and non-compliance (n=68, 36.6%). Multivariate analysis showed that human failure found in the arrival and hand-off sub-process (OR 4.84, p<0.001) was associated with increased patient harm, whereas the presence of omission (OR 0.12, p<0.001) was associated with less patient harm. CONCLUSIONS: This study shows a need to reduce human failures to prevent patient harm during intra-hospital transportation. We suggest that the transportation team pay specific attention to the sub-process at the location of arrival and prevent errors other than omissions. Long-term monitoring of IHT-related events is also warranted.

Effect of Tracheostomy on Weaning Parameters in Difficult-to-Wean Mechanically Ventilated Patients: A Prospective Observational Study.

BACKGROUND AND OBJECTIVE: Weaning parameters are commonly measured through an endotracheal tube in mechanically ventilated patients recovering from acute respiratory failure, however this practice has rarely been evaluated in tracheostomized patients. This study aimed to investigate changes in weaning parameters measured before and after tracheostomy, and to explore whether the data measured after tracheostomy were associated with weaning outcomes in difficult-to-wean patients. METHODS: In a two-year study period, we enrolled orotracheally intubated patients who were prepared for tracheostomy due to difficult weaning. Weaning parameters were measured before and after the conversion to tracheostomy and compared, and the post-tracheostomy data were tested for associations with weaning outcomes. RESULTS: A total of 86 patients were included. After tracheostomy, maximum inspiratory pressure (mean difference (Δ) = 4.4, 95% CI, 2.7 to 6.1, P<0.001), maximum expiratory pressure (Δ = 5.4, 95% CI, 2.9 to 8.0, P<0.001) and tidal volume (Δ = 33.7, 95% CI, 9.0 to 58.5, P<0.008) significantly increased, and rapid shallow breathing index (Δ = -14.6, 95% CI, -25.4 to -3.7, P<0.009) and airway resistance (Δ = -4.9, 95% CI, -5.8 to -4.0, P<0.001) significantly decreased. The patients who were successfully weaned within 90 days of the initiation of mechanical ventilation had greater increments in maximum inspiratory pressure (5.9 vs. 2.4, P = 0.04) and maximum expiratory pressure (8.0 vs. 2.0, P = 0.02) after tracheostomy than those who were unsuccessfully weaned. CONCLUSIONS: In conclusion, the conversion from endotracheal tube to tracheostomy significantly improved the measured values of weaning parameters in difficult-to-wean patients who subsequently weaned successfully from the mechanical ventilator. The change was significant only for airway resistance in patients who failed weaning. TRIAL REGISTRATION: ClinicalTrials.gov NCT01312142.