Present industrial decarbonization technologies require an active CO_(2)-concentration system,often based on lime reaction or amine binding reactions,which is energy intensive and carries a high CO_(2)-footprint.Here ...Present industrial decarbonization technologies require an active CO_(2)-concentration system,often based on lime reaction or amine binding reactions,which is energy intensive and carries a high CO_(2)-footprint.Here instead,an effective process without active CO_(2)concentration is demonstrated in a new process-termed IC2CNT(Insulationdiffusion facilitated CO_(2) to Carbon Nanomaterial Technology)decarbonization process.Molten carbonates such as Li_(2)CO_(3)(mp 723℃)are highly insoluble to industrial feed gas principal components(N2,O_(2),and H2O).However,CO_(2) can readily dissolve and react in molten carbonates.We have recently characterized high CO_(2) diffusion rates through porous aluminosilicate and calcium-magnesium silicate thermal insulations.Here,the CO_(2) in ambient feed gas passes through these membranes into molten Li_(2)CO_(3).The membrane also concurrently insulates the feed gas from the hot molten carbonate chamber,obviating the need to heat the(non-CO_(2))majority of the feed gas to high temperature.In this insulation facilitated decarbonization process CO_(2)is split by electrolysis in the molten carbonate producing sequestered,high-purity carbon nanomaterials(such as CNTs)and O_(2).展开更多
BACKGROUND A major cause of mortality in the coronavirus disease 2019(COVID-19)pandemic was acute respiratory distress syndrome(ARDS).Currently,moderate to severe ARDS induced by COVID-19(COVID ARDS)and other viral an...BACKGROUND A major cause of mortality in the coronavirus disease 2019(COVID-19)pandemic was acute respiratory distress syndrome(ARDS).Currently,moderate to severe ARDS induced by COVID-19(COVID ARDS)and other viral and non-viral etiologies are treated by traditional ARDS protocols that recommend 12-16 hours of prone position ventilation(PPV)with neuromuscular blocking agents(NMBA)and a trial of inhaled vasodilators(IVd)if oxygenation does not improve.However,debate on the efficacy of adjuncts to PPV and low tidal volume ventilation persists and evidence about the benefits of IVd/NMBA in COVID ARDS is sparse.In our multi-center retrospective review,we evaluated the impact of PPV,IVd,and NMBA on outcomes and lung mechanics in COVID ARDS patients with moderate to severe ARDS.AIM To evaluate the impact of PPV used alone or in combination with pulmonary IVd and/or NMBA in mechanically ventilated patients with moderate to severe ARDS during the COVID-19 pandemic.METHODS A retrospective study at two tertiary academic medical centers compared outcomes between COVID ARDS patients receiving PPV and patients in the supine position.PPV patients were divided based on concurrent use of ARDS adjunct therapies resulting in four subgroups:(1)PPV alone;(2)PPV and IVd;(3)PPV and NMBA;and(4)PPV,IVd,and NMBA.Primary outcomes were hospital and intensive care unit(ICU)length of stay(LOS),mortality,and venovenous extracorporeal membrane oxygenation(VV-ECMO)status.Secondary outcomes included changes in lung mechanics at 24-hour intervals for 7 days.RESULTS Total 114 patients were included in this study.Baseline respiratory parameters and Sequential Organ Failure Assessment scores were significantly worse in the PPV group.ICU LOS and LOS were significantly longer for patients who were proned,but no mortality benefit or difference in VV-ECMO status was found.Among the subgroups,no difference in primary outcomes were found.In the secondary analysis,PPV was associated with a significant improvement in arterial oxygen partial pressure(PaO_(2))/fractional inspired oxygen(FiO_(2))(P/F)ratio from day 1 to day 4(P<0.05)and higher driving pressures day 5 to day 7(P<0.05).The combination of PPV and IVd together resulted in improvements in P/F ratio from day 1 to day 7 and plateau pressure on day 4 and day 6(P<0.05).PPV with NMBA was not associated with improvements in any of the secondary outcomes.The use of all three rescue therapies together resulted in improvements in lung compliance on day 2(P<0.05)but no other improvements.CONCLUSION In mechanically ventilated patients diagnosed with moderate to severe COVID ARDS,PPV and PPV with the addition of IVd produced a significant and sustained increase in P/F ratio.The combination of PPV,IVd and NMBA improved compliance however this did not reach significance.Mortality and LOS did not improve with adjunct therapies.Further research is warranted to determine the efficacy of these therapies alone and in combination in the treatment of COVID ARDS.展开更多
BACKGROUND Primary ciliary dyskinesia(PCD)is a rare condition characterised by dysmotile,immotile,or absent cilia.As a result of the impairment in respiratory mucociliary clearance,patients with PCD typically develop ...BACKGROUND Primary ciliary dyskinesia(PCD)is a rare condition characterised by dysmotile,immotile,or absent cilia.As a result of the impairment in respiratory mucociliary clearance,patients with PCD typically develop neonatal respiratory distress,nasal congestion,otitis media and recurrent respiratory infections leading to bronchiectasis and structural lung changes.These changes have been shown by chest computed tomography(CT)to develop in infancy and early childhood.Recent development and refinement of radiation-reducing CT techniques have allowed significant radiation dose reductions,with chest CT doses now in the range of chest radiography(CR).AIM To evaluate the efficacy of ultra-low dose CT(ULDCT)chest in identifying pulmonary changes within a PCD paediatric patient cohort.METHODS Paediatric patients with PCD who presented for routine clinical outpatient follow-up within the study period,were eligible for inclusion in the study.ULDCT and CR were performed on these patients and the results compared.Comparison metrics included radiation dose,subjective and objective image quality and disease severity.RESULTS Six paediatric patients(mean age 9 years)underwent clinically indicated ULDCT chest examinations and CR for surveillance of their PCD.The mean effective dose was 0.08±0.02 mSv,a dose that approximates that of a frontal and lateral chest radiograph.The average Brody II score across the entire cohort was 12.92,with excellent interrater reliability and intra-class correlation coefficient(ICC)of 0.98.The average Chrispin-Norman score on CR was 1 with excellent inter-rater reliability and ICC of 0.92.CONCLUSION ULDCT demonstrates superior diagnostic capabilities,minimal radiation dose penalty,and high interobserver reliability in comparison to CR.Thus,we advocate for ULDCT to be the preferred modality for surveillance imaging in paediatric PCD.展开更多
When a vehicle moves over a flexible pavement structure,it generates loading and unloading cycles that produce recoverable(resilient)and permanent(plastic)deformations in the granular base and subbase layers,which are...When a vehicle moves over a flexible pavement structure,it generates loading and unloading cycles that produce recoverable(resilient)and permanent(plastic)deformations in the granular base and subbase layers,which are made of unbound granular materials(UGMs).The primary parameter used to evaluate the resilient response of UGMs in pavements is the resilient modulus(MR).The MR is widely used in calculating stress-strain states for flexible pavement design and as a control parameter during the construction process.It is also employed to understand the progression of distresses,such as fatigue cracking and rutting.The main objective of this study was to conduct a literature review on the resilient behavior of UGMs.This manuscript presents and describes the MR and the factors that influence it.It also outlines the evolution of the mathematical equations most commonly used to estimate and predict this physical parameter.Conclusions and recommendations for future research are provided at the end of the article.Despite the large amount of research done on the subject,the resilient behavior of UGM has not yet been fully understood.This is since these materials are highly heterogeneous and show nonlinear-anisotropic behavior under different cyclic loading paths and water contents.Likewise,these materials undergo different behaviors depending on their macro and microscopic properties(gradation,density,porosity,texture,mineralogy,particle geometry and orientation,temperature,among others).On the other hand,the main limitation of the mathematical equations is that their parameters are difficult to determine experimentally and are not constants of the material(they are state variables that can change with multiple factors).Additionally,these equations do not consider the boundary conditions to which UGM in pavements are exposed.Moreover,they are obtained from repeated load triaxial(RLT)tests,which cannot simulate the three cyclic stress components(vertical,horizontal,and shear)to which UGMs are subjected in a pavement.In recent years,there has been an increase in studies evaluating the use of recycled aggregates and the effect of temperature(particularly at subzero temperatures),but more research is still needed to reach definitive conclusions.展开更多
Chronic diseases,or NCDs(noncommunicable diseases),constitute a major global health challenge,causing millions of deaths and imposing substantial economic burdens annually.This paper introduces the Health Score,a comp...Chronic diseases,or NCDs(noncommunicable diseases),constitute a major global health challenge,causing millions of deaths and imposing substantial economic burdens annually.This paper introduces the Health Score,a comprehensive framework for assessing chronic disease risk by integrating diverse determinants of health,including social,economic,environmental,behavioral,treatment,culture,and nature factors.The Health Score,ranging from 0 to 850,quantifies indivi dual and population-level health risks while identifying protective factors through a structured methodology that supports targeted interventions at individual,corporate,and community scales.The paper highlights the rising prevalence of chronic diseases in the United States,projecting that nearly half of the population will be affected by 2030,alongside a global economic burden expected to reach trillions of dollars.Existing surveillance tools,such as the CDS(Chronic Disease Score)and CDIs(Chronic Disease Indicators),are examined for their roles in monitoring health disparities.The Health Score advances a holistic,proactive approach,emphasizing lifestyle modifications,equitable healthcare access,economic opportunities,social support,nature exposure,cu ltural awareness,and community engagement.By elucidating the complex interplay of health determinants,this framework equips stakeholders with actionable insights to implement effective prevention strategies,ultimately fostering healthier,more resi lient populations.展开更多
In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,com...In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,commonly due to periprosthetic loosening.Revision procedures are associated with significantly increased healthcare costs;therefore,timely and accurate diagnostics are critical for clinicians and patients.Loosening,which may be septic or aseptic,remains a challenge and requires thorough clinical examination and multimodal imaging evaluation.Plain radiographs remain an essential diagnostic tool but advanced imaging modalities such as computed tomography,magnetic resonance imaging and nuclear medicine are playing an increasingly important role.This comprehensive review,through outlining the available radiological modalities,their respective strengths and weaknesses and the pertinent imaging findings,may help radiologists and orthopaedic surgeons make more informed decisions in the management of periprosthetic loosening.展开更多
The term disorders of gut-brain interaction(DGBIs)encompasses gastrointestinal disorders that globally affect more than one third of all people.The Rome IV criteria replaced the former term“functional gastrointestina...The term disorders of gut-brain interaction(DGBIs)encompasses gastrointestinal disorders that globally affect more than one third of all people.The Rome IV criteria replaced the former term“functional gastrointestinal disorders.”DGBIs can seriously challenge health and quality of life(QoL).A traditional but outdated approach differentiated“organic”vs“functional”disorders,seen by some as real vs psychiatric or undefined ones.This traditional distinction did not help patients whose health and QoL are seriously affected.DGBIs include motility disturbance;visceral hypersensitivity;altered mucosal and immune function;altered central nervous system processing,and more.Several DGBIs affect both children and adolescents.DGBIs are characterized by clusters of symptoms.Their pathophysiology relates to combinations of altered motility,visceral sensitivity,mucosal immune function,and more.Routine investigations find no structural abnormality that would easily explain the symptoms.Symptom-based criteria were developed to better understand patients where no mechanistic explanation was available for clinical practice and inclusion into clinical trials.To understand DGBIs and to find ways to treat them,these rigid mechanistic views fall short.展开更多
Today’s youth in rich and poor countries faces comparable health risks and challenges.There is the temptation to enjoy too much food that is advertised as delicious and to eat too little healthier food.An increasingl...Today’s youth in rich and poor countries faces comparable health risks and challenges.There is the temptation to enjoy too much food that is advertised as delicious and to eat too little healthier food.An increasingly sedentary lifestyle makes physical activity voluntary,no longer based on the daily need for physical activity in rural production.This is a serious medical problem,as today’s young people are threatened tomorrow(and sometimes,already today)by cardiova-scular disease and type 2 diabetes mellitus,later by further challenges including arthritis,stroke,and more.But this is a challenge far beyond medicine.Young people need to be empowered to distinguish between good and bad lifestyles and be strengthened in their willingness to make an effort for future health.It may not seem very sexy to eat mostly fruits and high-fiber traditional foods instead of hamburgers,snacks,sweets,or to eat in posh restaurants.Everyone needs a certain resistance to advertising today,whether they grow up in Nigeria,Europe or anywhere else.Medical doctors,teachers,and many other professionals with responsibilities for young people have a key role in this endeavour.展开更多
文摘Present industrial decarbonization technologies require an active CO_(2)-concentration system,often based on lime reaction or amine binding reactions,which is energy intensive and carries a high CO_(2)-footprint.Here instead,an effective process without active CO_(2)concentration is demonstrated in a new process-termed IC2CNT(Insulationdiffusion facilitated CO_(2) to Carbon Nanomaterial Technology)decarbonization process.Molten carbonates such as Li_(2)CO_(3)(mp 723℃)are highly insoluble to industrial feed gas principal components(N2,O_(2),and H2O).However,CO_(2) can readily dissolve and react in molten carbonates.We have recently characterized high CO_(2) diffusion rates through porous aluminosilicate and calcium-magnesium silicate thermal insulations.Here,the CO_(2) in ambient feed gas passes through these membranes into molten Li_(2)CO_(3).The membrane also concurrently insulates the feed gas from the hot molten carbonate chamber,obviating the need to heat the(non-CO_(2))majority of the feed gas to high temperature.In this insulation facilitated decarbonization process CO_(2)is split by electrolysis in the molten carbonate producing sequestered,high-purity carbon nanomaterials(such as CNTs)and O_(2).
文摘BACKGROUND A major cause of mortality in the coronavirus disease 2019(COVID-19)pandemic was acute respiratory distress syndrome(ARDS).Currently,moderate to severe ARDS induced by COVID-19(COVID ARDS)and other viral and non-viral etiologies are treated by traditional ARDS protocols that recommend 12-16 hours of prone position ventilation(PPV)with neuromuscular blocking agents(NMBA)and a trial of inhaled vasodilators(IVd)if oxygenation does not improve.However,debate on the efficacy of adjuncts to PPV and low tidal volume ventilation persists and evidence about the benefits of IVd/NMBA in COVID ARDS is sparse.In our multi-center retrospective review,we evaluated the impact of PPV,IVd,and NMBA on outcomes and lung mechanics in COVID ARDS patients with moderate to severe ARDS.AIM To evaluate the impact of PPV used alone or in combination with pulmonary IVd and/or NMBA in mechanically ventilated patients with moderate to severe ARDS during the COVID-19 pandemic.METHODS A retrospective study at two tertiary academic medical centers compared outcomes between COVID ARDS patients receiving PPV and patients in the supine position.PPV patients were divided based on concurrent use of ARDS adjunct therapies resulting in four subgroups:(1)PPV alone;(2)PPV and IVd;(3)PPV and NMBA;and(4)PPV,IVd,and NMBA.Primary outcomes were hospital and intensive care unit(ICU)length of stay(LOS),mortality,and venovenous extracorporeal membrane oxygenation(VV-ECMO)status.Secondary outcomes included changes in lung mechanics at 24-hour intervals for 7 days.RESULTS Total 114 patients were included in this study.Baseline respiratory parameters and Sequential Organ Failure Assessment scores were significantly worse in the PPV group.ICU LOS and LOS were significantly longer for patients who were proned,but no mortality benefit or difference in VV-ECMO status was found.Among the subgroups,no difference in primary outcomes were found.In the secondary analysis,PPV was associated with a significant improvement in arterial oxygen partial pressure(PaO_(2))/fractional inspired oxygen(FiO_(2))(P/F)ratio from day 1 to day 4(P<0.05)and higher driving pressures day 5 to day 7(P<0.05).The combination of PPV and IVd together resulted in improvements in P/F ratio from day 1 to day 7 and plateau pressure on day 4 and day 6(P<0.05).PPV with NMBA was not associated with improvements in any of the secondary outcomes.The use of all three rescue therapies together resulted in improvements in lung compliance on day 2(P<0.05)but no other improvements.CONCLUSION In mechanically ventilated patients diagnosed with moderate to severe COVID ARDS,PPV and PPV with the addition of IVd produced a significant and sustained increase in P/F ratio.The combination of PPV,IVd and NMBA improved compliance however this did not reach significance.Mortality and LOS did not improve with adjunct therapies.Further research is warranted to determine the efficacy of these therapies alone and in combination in the treatment of COVID ARDS.
文摘BACKGROUND Primary ciliary dyskinesia(PCD)is a rare condition characterised by dysmotile,immotile,or absent cilia.As a result of the impairment in respiratory mucociliary clearance,patients with PCD typically develop neonatal respiratory distress,nasal congestion,otitis media and recurrent respiratory infections leading to bronchiectasis and structural lung changes.These changes have been shown by chest computed tomography(CT)to develop in infancy and early childhood.Recent development and refinement of radiation-reducing CT techniques have allowed significant radiation dose reductions,with chest CT doses now in the range of chest radiography(CR).AIM To evaluate the efficacy of ultra-low dose CT(ULDCT)chest in identifying pulmonary changes within a PCD paediatric patient cohort.METHODS Paediatric patients with PCD who presented for routine clinical outpatient follow-up within the study period,were eligible for inclusion in the study.ULDCT and CR were performed on these patients and the results compared.Comparison metrics included radiation dose,subjective and objective image quality and disease severity.RESULTS Six paediatric patients(mean age 9 years)underwent clinically indicated ULDCT chest examinations and CR for surveillance of their PCD.The mean effective dose was 0.08±0.02 mSv,a dose that approximates that of a frontal and lateral chest radiograph.The average Brody II score across the entire cohort was 12.92,with excellent interrater reliability and intra-class correlation coefficient(ICC)of 0.98.The average Chrispin-Norman score on CR was 1 with excellent inter-rater reliability and ICC of 0.92.CONCLUSION ULDCT demonstrates superior diagnostic capabilities,minimal radiation dose penalty,and high interobserver reliability in comparison to CR.Thus,we advocate for ULDCT to be the preferred modality for surveillance imaging in paediatric PCD.
文摘When a vehicle moves over a flexible pavement structure,it generates loading and unloading cycles that produce recoverable(resilient)and permanent(plastic)deformations in the granular base and subbase layers,which are made of unbound granular materials(UGMs).The primary parameter used to evaluate the resilient response of UGMs in pavements is the resilient modulus(MR).The MR is widely used in calculating stress-strain states for flexible pavement design and as a control parameter during the construction process.It is also employed to understand the progression of distresses,such as fatigue cracking and rutting.The main objective of this study was to conduct a literature review on the resilient behavior of UGMs.This manuscript presents and describes the MR and the factors that influence it.It also outlines the evolution of the mathematical equations most commonly used to estimate and predict this physical parameter.Conclusions and recommendations for future research are provided at the end of the article.Despite the large amount of research done on the subject,the resilient behavior of UGM has not yet been fully understood.This is since these materials are highly heterogeneous and show nonlinear-anisotropic behavior under different cyclic loading paths and water contents.Likewise,these materials undergo different behaviors depending on their macro and microscopic properties(gradation,density,porosity,texture,mineralogy,particle geometry and orientation,temperature,among others).On the other hand,the main limitation of the mathematical equations is that their parameters are difficult to determine experimentally and are not constants of the material(they are state variables that can change with multiple factors).Additionally,these equations do not consider the boundary conditions to which UGM in pavements are exposed.Moreover,they are obtained from repeated load triaxial(RLT)tests,which cannot simulate the three cyclic stress components(vertical,horizontal,and shear)to which UGMs are subjected in a pavement.In recent years,there has been an increase in studies evaluating the use of recycled aggregates and the effect of temperature(particularly at subzero temperatures),but more research is still needed to reach definitive conclusions.
文摘Chronic diseases,or NCDs(noncommunicable diseases),constitute a major global health challenge,causing millions of deaths and imposing substantial economic burdens annually.This paper introduces the Health Score,a comprehensive framework for assessing chronic disease risk by integrating diverse determinants of health,including social,economic,environmental,behavioral,treatment,culture,and nature factors.The Health Score,ranging from 0 to 850,quantifies indivi dual and population-level health risks while identifying protective factors through a structured methodology that supports targeted interventions at individual,corporate,and community scales.The paper highlights the rising prevalence of chronic diseases in the United States,projecting that nearly half of the population will be affected by 2030,alongside a global economic burden expected to reach trillions of dollars.Existing surveillance tools,such as the CDS(Chronic Disease Score)and CDIs(Chronic Disease Indicators),are examined for their roles in monitoring health disparities.The Health Score advances a holistic,proactive approach,emphasizing lifestyle modifications,equitable healthcare access,economic opportunities,social support,nature exposure,cu ltural awareness,and community engagement.By elucidating the complex interplay of health determinants,this framework equips stakeholders with actionable insights to implement effective prevention strategies,ultimately fostering healthier,more resi lient populations.
文摘In response to an ageing global population,the primary hip and knee arthroplasty rate continues to increase.Although an effective treatment,up to 25%patients may require revision arthroplasty during their lifetime,commonly due to periprosthetic loosening.Revision procedures are associated with significantly increased healthcare costs;therefore,timely and accurate diagnostics are critical for clinicians and patients.Loosening,which may be septic or aseptic,remains a challenge and requires thorough clinical examination and multimodal imaging evaluation.Plain radiographs remain an essential diagnostic tool but advanced imaging modalities such as computed tomography,magnetic resonance imaging and nuclear medicine are playing an increasingly important role.This comprehensive review,through outlining the available radiological modalities,their respective strengths and weaknesses and the pertinent imaging findings,may help radiologists and orthopaedic surgeons make more informed decisions in the management of periprosthetic loosening.
文摘The term disorders of gut-brain interaction(DGBIs)encompasses gastrointestinal disorders that globally affect more than one third of all people.The Rome IV criteria replaced the former term“functional gastrointestinal disorders.”DGBIs can seriously challenge health and quality of life(QoL).A traditional but outdated approach differentiated“organic”vs“functional”disorders,seen by some as real vs psychiatric or undefined ones.This traditional distinction did not help patients whose health and QoL are seriously affected.DGBIs include motility disturbance;visceral hypersensitivity;altered mucosal and immune function;altered central nervous system processing,and more.Several DGBIs affect both children and adolescents.DGBIs are characterized by clusters of symptoms.Their pathophysiology relates to combinations of altered motility,visceral sensitivity,mucosal immune function,and more.Routine investigations find no structural abnormality that would easily explain the symptoms.Symptom-based criteria were developed to better understand patients where no mechanistic explanation was available for clinical practice and inclusion into clinical trials.To understand DGBIs and to find ways to treat them,these rigid mechanistic views fall short.
文摘Today’s youth in rich and poor countries faces comparable health risks and challenges.There is the temptation to enjoy too much food that is advertised as delicious and to eat too little healthier food.An increasingly sedentary lifestyle makes physical activity voluntary,no longer based on the daily need for physical activity in rural production.This is a serious medical problem,as today’s young people are threatened tomorrow(and sometimes,already today)by cardiova-scular disease and type 2 diabetes mellitus,later by further challenges including arthritis,stroke,and more.But this is a challenge far beyond medicine.Young people need to be empowered to distinguish between good and bad lifestyles and be strengthened in their willingness to make an effort for future health.It may not seem very sexy to eat mostly fruits and high-fiber traditional foods instead of hamburgers,snacks,sweets,or to eat in posh restaurants.Everyone needs a certain resistance to advertising today,whether they grow up in Nigeria,Europe or anywhere else.Medical doctors,teachers,and many other professionals with responsibilities for young people have a key role in this endeavour.
