Decoupling economic growth from construction waste generation: Comparative analysis between the EU and China.

The reduction and management of construction waste is crucial for the sustainable development of the construction industry. This research aims to explore a comparative analysis on decoupling relationship between economic growth and construction waste generation on European Union (EU) and Chi et al., 2020 to 2020 in the construction industry, through an integrated method framework of "Tapio + Kaya + LMDI". The research results indicate that there are significant differences in construction waste generation among different countries. The growth rates of construction waste in the EU and China from 2004 to 2020 were 2.47 % and 10.5 %, respectively, showing an upward trend. The economic growth of the construction industry in most EU countries is in a decoupling and negative decoupling state with significant regional differences in decoupling status. The construction waste generation in China is mainly in a weak decoupling state. Economic and demographic factors are the main factors promoting the increase in construction waste generation, while technological factors are the main factors inhibiting construction waste generation in EU and China. However, the impact of each factor on construction was generation varies from EU countries. The research reveals the decoupling effect mechanism between construction waste generation and economic growth, and improves the theory of construction waste management, promotes sustainable development. These findings have feasible inspiration for construction waste management in developing countries with different economic growth levels.

Pixel-Domain Just Noticeable Difference Modeling with Heterogeneous Color Features.

With the rapidly emerging user-generated images, perception compression for color image is an inevitable mission. Whilst in existing just noticeable difference (JND) models, color-oriented features are not fully taken into account for coinciding with HVS perception characteristics, such as sensitivity, attention, and masking. To fully imitate the color perception process, we extract color-related feature parameters as local features, including color edge intensity and color complexity, as well as region-wise features, including color area proportion, color distribution position and color distribution dispersion, and inherent feature irrelevant to color content called color perception difference. Then, the potential interaction among them is analyzed and modeled as color contrast intensity. To utilize them, color uncertainty and color saliency are envisaged to emanate from feature integration in the information communication framework. Finally, color and uncertainty saliency models are applied to improve the conventional JND model, taking the masking and attention effect into consideration. Subjective and objective experiments validate the effectiveness of the proposed model, delivering superior noise concealment capacity compared with start-of-the-art works.

Tracking Key Industrial Sectors for CO2 Mitigation through the Driving Effects: An Attribution Analysis.

The heavy pressure to improve CO2 emission control in industry requires the identification of key sub-sectors and the clarification of how they mitigate CO2 emissions through various actions. Focusing on 30 Chinese provincial regions, this study quantifies the contribution of each industrial sector to regional CO2 mitigation by combining the logarithmic mean Divisia index with attribution analysis and extract the key sectors of CO2 mitigation for each region. Results indicate that during 2010-2019, significant emission reduction was achieved through energy intensity (74%) in Beijing, while emission reductions were attained through industrial structure changes for Anhui (50%), Henan (45%), and Chongqing (45%). The contribution to emission reduction through energy structures is not significant. The production and supply of power and heat (PSPH) is a central factor in CO2 mitigation through all three inhibitive factors. Petroleum processing and coking (PPC) generally contributes to emission reduction through energy structures, while the smelting and pressing of ferrous metals (SPMF) through changes in industrial structures and energy intensity. PSPH and SPMF, in most regions, have not achieved the emission peak. Except in the case of coal mining and dressing (CMD), CO2 emissions in other key sectors have almost been decoupled from industrial development. CMD effectively promotes CO2 mitigation in Anhui, Henan, and Hunan, with larger contribution of PPC in Tianjin, Xinjiang, Heilongjiang, and that of smelting and pressing of nonferrous metals in Yunnan and Guangxi. The findings help to better identify key sectors across regions that can mitigate CO2 emissions, while analyzing the critical emission characteristics of these sectors, which can provide references to formulating region- and sector-specific CO2 mitigation measures for regions at different levels of development.

Machine-Learning Classification of Pulse Waveform Quality.

Pulse measurements made using wearable devices can aid the monitoring of human physiological condition. Accurate estimation of waveforms is often difficult for nonexperts; motion artifacts may occur during tonometry measurements when the skin-sensor contact pressure is insufficient. An alternative approach is to extract only high-quality pulses for use in index calculations. The present study aimed to determine the effectiveness of using machine-learning analysis in discriminating between high-quality and low-quality pulse waveforms induced by applying different contact pressures. Radial blood pressure waveform (BPW) signals were measured noninvasively in healthy young subjects using a strain-gauge transducer. One-minute-long trains of pulse data were measured when applying the appropriate contact pressure (67.80 ± 1.55 mmHg) and a higher contact pressure (151.80 ± 3.19 mmHg). Eight machine-learning algorithms were employed to evaluate the following 40 harmonic pulse indices: amplitude proportions and their coefficients of variation and phase angles and their standard deviations. Significant differences were noted in BPW indices between applying appropriate and higher skin-surface contact pressures. The present appropriate contact pressure could not only provide a suitable holding force for the wearable device but also helped to maintain the physiological stability of the underlying tissues. Machine-learning analysis provides an effective method for distinguishing between the high-quality and low-quality pulses with excellent discrimination performance (leave-one-subject-out test: random-forest AUC = 0.96). This approach will aid the development of an automatic screening method for waveform quality and thereby improve the noninvasive acquisition reliability. Other possible interfering factors in practical applications can also be systematically studied using a similar procedure.

Association of Tocilizumab and Invasive Aspergillosis in Critically Ill Patients with Severe COVID-19 Pneumonia and Acute Respiratory Distress Syndrome.

Coronavirus disease-2019 (COVID-19) causes severe pneumonia and acute respiratory distress syndrome. According to the current consensus, immunosuppressants, such as dexamethasone and anti-interleukin-6 receptor monoclonal antibodies, are therapeutic medications in the early stages of infection. However, in critically ill patients, viral, fungal, and bacterial coinfection results in higher mortality. We conducted a single-center, retrospective analysis of 29 mechanically ventilated patients with artificial airways. Patients were adults with confirmed COVID-19 infection and severe pneumonia. Acute respiratory distress syndrome was diagnosed according to the Kigali modification of the Berlin definition. Six patients had invasive pulmonary aspergillosis coinfection based on elevated serum galactomannan levels and/or bronchoalveolar lavage fluid. We present two cases with brief histories and available clinical data. We also conducted a literature review to determine whether immunosuppressants, such as tocilizumab, increase infection risk or invasive aspergillosis in patients with COVID-19. There is no conclusive evidence to suggest that tocilizumab increases coinfection risk. However, further studies are needed to determine the optimal dose, between-dose interval, and timing of tocilizumab administration in patients with COVID-19.

Swelling-Resistant, Crosslinked Polyvinyl Alcohol Membranes with High ZIF-8 Nanofiller Loadings as Effective Solid Electrolytes for Alkaline Fuel Cells.

The present work investigates the direct mixing of aqueous zeolitic imidazolate framework-8 (ZIF-8) suspension into a polyvinyl alcohol (PVA) and crosslinked with glutaraldehyde (GA) to form swelling-resistant, mechanically robust and conductivity retentive composite membranes. This drying-free nanofiller incorporation method enhances the homogeneous ZIF-8 distributions in the PVA/ZIF-8/GA composites to overcome the nanofiller aggregation problem in the mixed matrix membranes. Various ZIF-8 concentrations (25.4, 40.5 and 45.4 wt.%) are used to study the suitability of the resulting GA-crosslinked composites for direct alkaline methanol fuel cell (DAMFC). Surface morphological analysis confirmed homogeneous ZIF-8 particle distribution in the GA-crosslinked composites with a defect- and crack-free structure. The increased ionic conductivity (21% higher than the ZIF-free base material) and suppressed alcohol permeability (94% lower from the base material) of PVA/40.5%ZIF-8/GA resulted in the highest selectivity among the prepared composites. In addition, the GA-crosslinked composites' selectivity increased to 1.5−2 times that of those without crosslink. Moreover, the ZIF-8 nanofillers improved the mechanical strength and alkaline stability of the composites. This was due to the negligible volume swelling ratio (<1.4%) of high (>40%) ZIF-8-loaded composites. After 168 h of alkaline treatment, the PVA/40.5%ZIF-8/GA composite had almost negligible ionic conductivity loss (0.19%) compared with the initial material. The maximum power density (Pmax) of PVA/40.5%ZIF-8/GA composite was 190.5 mW cm−2 at 60 °C, an increase of 181% from the PVA/GA membrane. Moreover, the Pmax of PVA/40.5%ZIF-8/GA was 10% higher than that without GA crosslinking. These swelling-resistant and stable solid electrolytes are promising in alkaline fuel cell applications.

Clinical efficacy and safety of peroral endoscopic myotomy for esophageal achalasia: A multicenter study in Taiwan.

BACKGROUND/OBJECTIVE: Peroral endoscopic myotomy (POEM), a novel minimally invasive treatment for esophageal achalasia, is becoming more popular globally because of its efficacy and safety. We aimed to clarify the technical concerns, efficacy, and safety of POEM for treating esophageal achalasia in Taiwan. METHODS: We conducted a retrospective study on consecutive patients with achalasia who underwent POEM between October 2016 and May 2021 at three medical centers in Taiwan. All patients underwent a comprehensive work-up before POEM, including symptom questionnaires, esophagogastroduodenoscopy, timed barium esophagogram (TBE), and high-resolution impedance manometry (HRIM), and were re-evaluated three months after POEM. We compared procedure variables, adverse events, and clinical responses, including Eckardt score ≤3 and TBE and HRIM findings. RESULTS: We analyzed 92 patients in total (54 men; mean age 49.5 years [range: 20-87]; type I/II/III/unclassified: 24/51/1/16). The mean POEM procedure duration was 89.5 ± 38.2 min, though it was significantly longer in patients with prior treatment or sigmoid-type achalasia. In total, 91 patients (98.9%) showed immediate technical success, and the overall clinical success rate at three months after POEM was 95.7%. Nearly 60% of patients experienced adverse events during POEM, but most of these were mild and none required further endoscopic or surgical intervention. During a follow-up period of up to five years (median 25 months), only four patients (4.3%) showed symptomatic recurrence, but none required further treatment. CONCLUSION: POEM is a very effective and safe treatment for Taiwanese patients with achalasia, irrespective of their achalasia subtype or prior treatment failure.

Collagen-Alginate Composite Hydrogel: Application in Tissue Engineering and Biomedical Sciences.

Alginate (ALG), a polysaccharide derived from brown seaweed, has been extensively investigated as a biomaterial not only in tissue engineering but also for numerous biomedical sciences owing to its wide availability, good compatibility, weak cytotoxicity, low cost, and ease of gelation. Nevertheless, alginate lacks cell-binding sites, limiting long-term cell survival and viability in 3D culture. Collagen (Col), a major component protein found in the extracellular matrix (ECM), exhibits excellent biocompatibility and weak immunogenicity. Furthermore, collagen contains cell-binding motifs, which facilitate cell attachment, interaction, and spreading, consequently maintaining cell viability and promoting cell proliferation. Recently, there has been a growing body of investigations into collagen-based hydrogel trying to overcome the poor mechanical properties of collagen. In particular, collagen-alginate composite (CAC) hydrogel has attracted much attention due to its excellent biocompatibility, gelling under mild conditions, low cytotoxicity, controllable mechanic properties, wider availability as well as ease of incorporation of other biomaterials and bioactive agents. This review aims to provide an overview of the properties of alginate and collagen. Moreover, the application of CAC hydrogel in tissue engineering and biomedical sciences is also discussed.

Prevalence and factors associated with anxiety and depressive symptoms among patients hospitalized with hematological malignancies after chimeric antigen receptor T-cell (CAR-T) therapy: A cross-sectional study.

BACKGROUND: We conducted a survey to investigate the prevalence and factors associated with anxiety and depressive symptoms among patients hospitalized with hematological malignancies after chimeric antigen receptor T-cell (CAR-T) therapy. METHODS: In total, 130 eligible patients completed the Self-Rating Anxiety Scale and Self-Rating Depression Scale at week 4 after CAR-T cell infusion. We collected sociodemographic information during the same period. We studied factors associated with anxiety and depressive symptoms using logistic regression analysis. RESULTS: The prevalence of anxiety and depressive symptoms at week 4 after infusion were 13.8% and 40.0%, respectively. A cutoff value of 50 or above indicates significantly anxiety and depressive symptoms. Binary logistic regression analysis showed that high school education and above (OR = 0.22, 95% CI = 0.06-0.78) and middle age (OR = 0.16, 95% CI = 0.03-0.90) were associated with lower risk of anxiety symptoms, and increased odds of depressive symptoms was associated with old age (OR = 11.39, 95% CI = 2.50-51.88), non-manual occupations before illness (OR = 3.72, 95% CI = 1.20-11.58), and higher healthcare expenditure (OR = 3.93, 95% CI = 1.50-10.33), while lower risk of depressive symptoms was associated with rural household location (OR = 0.25, 95% CI = 0.08-0.76) and being cared for by spouse (OR = 0.12, 95% CI = 0.02-0.63). CONCLUSIONS: Patients receiving CAR-T therapy with lower education background, old ages, urban household location, or who used to work as non-manual workers require more attention and psychological care. Support from a spouse and medical expense deductions from the government may help patients develop positive attitudes.

Incidence and management of metabolic acidosis with sodium bicarbonate in the ICU: An international observational study.

BACKGROUND: Metabolic acidosis is a major complication of critical illness. However, its current epidemiology and its treatment with sodium bicarbonate given to correct metabolic acidosis in the ICU are poorly understood. METHOD: This was an international retrospective observational study in 18 ICUs in Australia, Japan, and Taiwan. Adult patients were consecutively screened, and those with early metabolic acidosis (pH < 7.3 and a Base Excess < -4 mEq/L, within 24-h of ICU admission) were included. Screening continued until 10 patients who received and 10 patients who did not receive sodium bicarbonate in the first 24 h (early bicarbonate therapy) were included at each site. The primary outcome was ICU mortality, and the association between sodium bicarbonate and the clinical outcomes were assessed using regression analysis with generalized linear mixed model. RESULTS: We screened 9437 patients. Of these, 1292 had early metabolic acidosis (14.0%). Early sodium bicarbonate was given to 18.0% (233/1292) of these patients. Dosing, physiological, and clinical outcome data were assessed in 360 patients. The median dose of sodium bicarbonate in the first 24 h was 110 mmol, which was not correlated with bodyweight or the severity of metabolic acidosis. Patients who received early sodium bicarbonate had higher APACHE III scores, lower pH, lower base excess, lower PaCO2, and a higher lactate and received higher doses of vasopressors. After adjusting for confounders, the early administration of sodium bicarbonate was associated with an adjusted odds ratio (aOR) of 0.85 (95% CI, 0.44 to 1.62) for ICU mortality. In patients with vasopressor dependency, early sodium bicarbonate was associated with higher mean arterial pressure at 6 h and an aOR of 0.52 (95% CI, 0.22 to 1.19) for ICU mortality. CONCLUSIONS: Early metabolic acidosis is common in critically ill patients. Early sodium bicarbonate is administered by clinicians to more severely ill patients but without correction for weight or acidosis severity. Bicarbonate therapy in acidotic vasopressor-dependent patients may be beneficial and warrants further investigation.

Rapid-onset acute respiratory distress syndrome after mastectomy in a breast cancer patient: A case report and review of literature.

RATIONALE: Postoperative acute respiratory distress syndrome (ARDS) often results in severe morbidity and mortality in surgical patients. The etiology of this condition is complex, especially in cancer patients. PATIENT CONCERNS: We encountered a 53-year-old woman with left breast cancer, cT1cN2M0, stage IIIA with left axillary lymph node metastasis. She had received chemotherapy with 4 cycles of doxorubicin plus cyclophosphamide, and 4 cycles of trastuzumab plus docetaxel within a span of 6 months. Subsequently, she underwent left simple mastectomy and axillary lymph node dissection, shortly after which she developed respiratory distress with progressive desaturation and hemoptysis. DIAGNOSIS: ARDS was diagnosed using the Berlin criteria. Her arterial blood gas analysis revealed profound hypoxemia and her chest imaging was suggestive of pulmonary edema. She developed diffuse alveolar hemorrhage (DAH) that was confirmed with bronchoscopy and hemorrhagic samples on bronchoalveolar lavage. INTERVENTIONS: She was mechanically ventilated with lung protective measures for management of ARDS. In addition to antibiotic cover with amoxicillin sodium-potassium clavulanate for occult infections during her stay in the intensive care unit, we administered epinephrine inhalations, intravenous treatment with tranexamic acid, and methylprednisolone for DAH. OUTCOMES: Her clinical course improved; she was extubated successfully on day 7 and discharged home on day 11. LESSONS SUBSECTIONS: Chemotherapeutic agents may cause pulmonary toxicity through a direct cytotoxic effect or immune-mediated reactions and result in an increased risk of development of ARDS. Furthermore, surgery may trigger a systemic inflammatory response syndrome that can also induce ARDS. In our patient, the development of ARDS was attributed to the combined effects of surgery and chemotherapeutic agents (trastuzumab or docetaxel). When patients undergo major surgery after receiving chemotherapeutic agents, careful consideration is necessary to prevent the development of ARDS.

Self-pinning of silica suspension droplets on hydrophobic surfaces.

HYPOTHESIS: Self-pinning induced by the aggregation of particles at the edge of a pinned drop is a pre-requisite for the coffee ring formation. The edge (three-phase contact line) of a suspension drop on a hydrophobic surface would depin and shrink in the early stage of evaporation process. It is plausible to conjecture that the self-pinning of silica suspension drops depends on the particle size and surface property. EXPERIMENTS: Two substrate materials, the alkylsilane coated surfaces and the polydimethylsiloxane surfaces, and three different sizes of silica particles are used to explore the criterion of self-pinning of silica suspension drops on these hydrophobic surfaces. The evaporation process of droplets is recorded and further analyzed. FINDINGS: The pinning concentration of silica suspensions of a fixed size linearly depends on the receding contact angle of the surface, irrelevant to the substrate material and initial particle concentration. The pinning concentration decreases along with an increase in particle size. In addition, the pinning concentrations of bi-dispersed silica (e.g. 400 + 1000 nm) suspensions have an excellent agreement with that of larger size (1000 nm) particle system. That implies that the larger particle dominates the system of bi-dispersed silica suspensions to initiate the self-pinning, further verified by SEM images.

Highly Zeolite-Loaded Polyvinyl Alcohol Composite Membranes for Alkaline Fuel-Cell Electrolytes.

Having a secure and stable energy supply is a top priority for the global community. Fuel-cell technology is recognized as a promising electrical energy generation system for the twenty-first century. Polyvinyl alcohol/zeolitic imidazolate framework-8 (PVA/ZIF-8) composite membranes were successfully prepared in this work from direct ZIF-8 suspension solution (0⁻45.4 wt %) and PVA mixing to prevent filler aggregation for direct methanol alkaline fuel cells (DMAFCs). The ZIF-8 fillers were chosen for the appropriate cavity size as a screening aid to allow water and suppress methanol transport. Increased ionic conductivities and suppressed methanol permeabilities were achieved for the PVA/40.5% ZIF-8 composites, compared to other samples. A high power density of 173.2 mW cm-2 was achieved using a KOH-doped PVA/40.5% ZIF-8 membrane in a DMAFC at 60 °C with 1⁻2 mg cm-2 catalyst loads. As the filler content was raised beyond 45.4 wt %, adverse effects resulted and the DMAFC performance (144.9 mW cm-2) was not improved further. Therefore, the optimal ZIF-8 content was approximately 40.5 wt % in the polymeric matrix. The specific power output was higher (58 mW mg-1) than most membranes reported in the literature (3⁻18 mW mg-1).

Rotura traqueal yatrogénica tras una intubación de urgencia / Iatrogenic tracheal rupture after emergent intubation

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Glycemic control and radiographic manifestations of tuberculosis in diabetic patients.

BACKGROUND: Radiographic manifestations of pulmonary tuberculosis (TB) in patients with diabetes mellitus (DM) have previously been reported, with inconsistent results. We conducted a study to investigate whether glycemic control has an impact on radiographic manifestations of pulmonary TB. METHODS: Consecutive patients with culture-positive pulmonary TB who had DM in three tertiary care hospitals from 2005-2010 were selected for review and compared with a similar number without DM. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C). A pre-treatment chest radiograph was read independently by two qualified pulmonologists blinded to patients' diabetic status. Films with any discordant reading were read by a third reader. RESULTS: 1209 culture positive pulmonary TB patients (581 with DM and 628 without DM) were enrolled. Compared with those without DM, TB patients with DM were significantly more likely to have opacity over lower lung fields, extensive parenchymal lesions, any cavity, multiple cavities and large cavities (>3 cm). The relative risk of lower lung field opacities was 0.80 (95% CI 0.46-1.42) for those with DM with A1C<7%, 2.32 (95% CI 1.36 - 3.98) for A1C 7%-9%, and 1.62 (95% CI 1.12-2.36) for A1C>9%; and that of any cavity over no cavity was 0.87 (95% CI 0.46-1.62) for patients with DM with A1C<7%, 1.84 (95% CI 1.20-2.84) for A1C 7%-9%, and 3.71 (95% CI 2.64-5.22) for A1C>9%, relative to patients without DM. CONCLUSIONS: Glycemic control significantly influenced radiographic manifestations of pulmonary TB in patients with DM.