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Vascular surgeons are often called upon to provide emergent surgical assistance to other specialties for iatrogenic complications, both intraoperatively and in the inpatient setting. The management of iatrogenic vascular injury remains a critical role of the vascular surgeon, especially in the context of the increasing adoption of percutaneous procedures by other specialties. This study aims to characterize consultation timing, management, and outcomes for iatrogenic vascular injuries. This study identified patients for whom vascular surgery was consulted for iatrogenic vascular complications from February 1, 2022, to May 12, 2023. Patient information, including demographic information, injury details, and details of any operative intervention, was retrospectively collected from February 1, 2022, to October 13, 2022, and prospectively collected for the remainder of the study period. Analyses were performed with R (version 2022.02.03). There were 87 patients with consultations related to iatrogenic vascular injury. Of these, 42 (46%) were female and the mean age was 59 years (±18 years). The most common consulting services were cardiology (32%), cardiothoracic surgery (26%), general surgery (8%), and neurointerventional radiology (10%). Reasons for consultation included hemorrhage (36%), limb ischemia (36%), and treatment of pseudoaneurysm (23%). A total of 24% of consults were intraoperative, 20% of consults related to extracorporeal membrane oxygenation cannulation, and 16% of consults related to ventricular assist devices including left ventricular assist device and intra-aortic balloon pump. The majority of these consult requests (60%) occurred during evening and night hours (5 PM to 7 AM). Emergent intervention was required in 62% of cases and consisted of primary open surgical repair of arterial injury (54%), endovascular intervention (21%), and open thromboembolectomy (15%). Overall, in-hospital mortality for the patient cohort was 20% and the reintervention rate was 23%, reflecting the underlying complexity of the illness and nature of the vascular injury in this patient group. Vascular surgeons play an essential role in managing emergent life-threatening hemorrhagic and ischemic iatrogenic vascular complications in the hospitalized setting. The complications require immediate bedside or intraoperative consult and often emergent open surgical or endovascular intervention. Furthermore, many of these require urgent management in the evening or overnight hours, and therefore the high frequency of these events represents a potential significant resource utilization and workforce issue to the vascular surgery workforce. [ABSTRACT FROM AUTHOR]

• OS-P formed more amorphous charcoal-like graphite microcrystalline structure at 600℃. • The pyrolysis treatment could make the speciation of heavy metals more stabilized. • The environmental risks and ecological safety of OS-P are controllable. • OS-P can be considered as agricultural sludge. Solid-phase residues from pyrolysis of oily wastes (OS) are widely used due to their rich pore structure and strong adsorption capacity. In this study, pyrolysis residues (OS-P) were obtained from the pyrolysis treatment of four typical OS in Karamay, Xinjiang. The results indicate that the crystalline substances in OS-P mainly were SiO 2 , BaSO 4 , and graphite. The heavy metals of OS-P were higher than that of OS in the following order: Zn > Cu > Ni > Cr > Pb > Cd. The results of the improvement of Community Bureau of Reference (BCR) sequential extraction showed that the proportion of Cu, Ni and Cr in OS1-P in the residual fraction was higher than that of the other three OS. The residual fraction of Cu, Ni, and Cr in OS1-P increased from 16.0 %, 30.0 %, and 11.0 % to 66.1 %, 81.9 %, and 89.2 %, respectively. After pyrolysis treatment, the leaching concentration of heavy metals in the residue was reduced. Referring to the requirements for heavy metal control limits (GB 4284–2018), all heavy metals in OS-P showed low risk. Their potential ecological risk indices were 4.11, 3.13, 4.87 and 5.35, respectively, indicating that the potential ecological hazards of heavy metals from OS-P were slight. There was no significant effect on the histopathological changes of kidney, lung, liver, ovary and testis of mice, showing that the rational use of OS-P in production will not produce toxic effects on target animals. Based on risk assessment and safety evaluation, the application of OS-P is controllable, safe and reliable for resource utilization. [ABSTRACT FROM AUTHOR]

Compared to conventional cardiac troponin (cTn), the high-sensitivity cardiac troponin (hs-cTn) assay is associated with improved detection of myocardial infarction (MI). We performed a descriptive retrospective analysis of resource utilization at Rush University Medical Center over the transition period (July 1, 2021) from a cTn to a hs-cTn assay. Inclusion criteria included emergency department (ED) encounters between January 1 to December 31, 2021, with chief complaints of "chest pain" or "dyspnea" with associated troponin orders. The primary endpoint was the percentage of ED discharges. Secondary endpoints included the number of cardiac studies ordered. Univariable comparisons of these endpoints were performed using Student's t -test for continuous variables and Chi-square tests for binary/categorical variables. A total of 5113 encounters were analyzed. Hs-cTn was associated with an overall increase in ED patient discharges with negative troponin tests (44.1% vs. 29.9%, P < 0.01). In terms of cardiac testing per encounter, hs-cTn was associated with significant increases in the number of troponin tests (1.9 vs. 1.6, P < 0.01), electrocardiograms (3.0 vs. 2.9, P = 0.01), and echocardiograms (0.5 vs. 0.4, P < 0.01). There was a significant decrease in the utilization of stress testing (0.21 vs. 0.26, P < 0.01). There was a significant increase in total coronary angiography use during the hs-cTn period compared to cTn (227/2471 (9.2%) vs. 195/2642 (7.4%), P = 0.02). Transitioning from cTn to hs-cTn was associated with significantly increased ED discharges and an increase in troponin tests, ECG, echocardiograms, and coronary angiograms. There was a decrease in the number of stress tests. [ABSTRACT FROM AUTHOR]

Evidence continues to mount for the deleterious effects of preoperative opioid use in the setting of total shoulder arthroplasty (TSA). Tramadol, a synthetic opioid with concomitant neurotransmitter effects, has become a popular alternative to traditional opioids, but it has not been well studied in the preoperative setting of TSA. The purpose of this study is to evaluate postsurgical outcomes in TSA for patients with preoperative tramadol use compared with patients using traditional opioids and those who were opioid naïve. Using the IBM Watson Health MarketScan databases, a retrospective cohort study was performed for patients who underwent TSA from 2009 to 2018. Filled pain prescriptions were collected, and prescribing trends were analyzed. Outcomes were compared between 4 patient cohorts defined by preoperative analgesia use—opioid naïve, tramadol, traditional opioids, and combination (opioids and tramadol). Multivariate analysis was used to account for small variations in cohort demographics and comorbidities. Analysis focused on resource utilization and complications. Revision rates at 1 and 3 years postoperatively were also compared. A total of 29,454 TSA patients were studied, with 8959 available for 3-year postoperative follow-up. Of these, 10,462 (35.5%) were prescribed traditional opioids and 2214 (7.5%) tramadol only. From 2009 to 2018, prescribing trends in the United States demonstrated a significant decrease in the number of patients prescribed preoperative narcotics, whereas the number of patients prescribed preoperative tramadol and those who were opioid naïve significantly increased. Compared with opioid-naïve patients, the traditional opioid cohort had significantly increased odds of resource utilization and complications, whereas the tramadol cohort did not. Specifically, the traditional opioid cohort had an increased risk of prosthetic joint infection compared with both opioid-naïve and tramadol cohorts. The traditional opioid cohort had higher revision rates than opioid-naïve patients at 1 and 3 years, whereas the tramadol cohort did not. Despite a decrease in opioid prescriptions over the study period, many patients in the United States remain on opioids. Although tramadol is not without its own risks, our results suggest that patients taking preoperative tramadol as an alternative to traditional opioids for glenohumeral arthritic pain had a lesser postoperative risk profile, comparable with opioid-naïve patients. [ABSTRACT FROM AUTHOR]

Docosahexaenoic acid (DHA) is a high-value polyunsaturated fatty acid. The industrial development of microbial DHA was restricted due to high medium cost. Kitchen wastewater was always rich in nitrogen, phosphorous, carbohydrates, which can be used for microorganism growth. This study developed of a primitive low-cost culture medium for a new isolated high-production DHA strain using kitchen wastewater. The results showed that, a total of 66 strains were isolated from mangrove habitats. The highest DHA-producing strain N6 was identified as Aurantiochytrium sp. (GenBank accession number OL455742) with a DHA production of 6.56 g/L. Then the optimization of kitchen wastewater medium was designed by Response Surface Methodology, and 7.14 ∼ 7.23 g/L of DHA production was obtained. At the same time, the lipid content in Aurantiochytrium sp. N6 was as high as 75.68%, which contributed to the increase of DHA production in optimal kitchen wastewater medium. Finally, the substrate cost of kitchen wastewater medium was reduced by 43.95%. Meanwhile, the dissolved organic carbon (DOC), dissolved nitrogen (DN) and dissolved phosphorus (DP) in kitchen wastewater were utilized by Aurantiochytrium sp. N6 more than 90%. This work enriched the competitive candidate DHA-producing microbes, and provided a perceptive idea for both the medium substrate cost reducing and kitchen wastewater recycling. [Display omitted] [ABSTRACT FROM AUTHOR]

Anaerobic digestion technology has gained significant attention as an organic solid waste treatment method due to its favorable economic and environmental benefits. However, after digestion, the digestate still contains a significant amount of underutilized organic matter. Sustainable management and resource utilization of digestate plays a crucial role in achieving resource circularity and implementing a circular economy. Previous reviews have mainly focused on improving the operational efficiency and stability of anaerobic digestion, with limited exploration of sustainable management and resource utilization of digestate. To address this gap, this review provides a systematic summary of the sustainable management and resource utilization of digestate. First, the basic characteristics of digestate are outlined. Then, based on a visual analysis of literature on digestate management from the past decade, the review highlights the hotspots in sustainable management and circular utilization of digestate. Finally, it summarizes the relevant policies on digestate management in different regions and outlines the challenges in digestate treatment and disposal. The challenges in digestate management remain a significant issue that requires further exploration and solutions. This review aims to promote the standardization of digestate management, provide direction for further in-depth research on digestate, and contribute to the continued development of resource cycling of anaerobic fermentation products. [Display omitted] [ABSTRACT FROM AUTHOR]

• Fly ash (FA) is a hazardous waste with the potential to cause environmental harm. • Fluidization-melting of fuel/FA uses released heat and fuel ash for melting FA. • Utilizing 72% rice husk and 28% FA as mixed fuel, achieve fluidization-melting. • Fuel/FA fluidization-melting makes FA attain standard limit for safe disposal. • Slag's low glass content and high Ni leaching fail resource utilization criteria. Fly ash (FA) from municipal solid waste incineration contains hazardous substances such as dioxins, furans, and heavy metals. Melting FA has proved to be an effective method for reducing volume and mass, while also rendering the waste harmless. However, during the melting process, the addition of a fluxing agent with calorific value is currently necessary to increase melting capacity and reduce energy consumption, which presents a challenge. To tackle this issue, a fluidization-melting technology for a fuel/FA mixture is proposed, wherein a fuel source is employed in the melting process, producing ash that can serve as a fluxing agent. To test this approach, rice husk (RH) was utilized as fuel in a small-scale fluidization-melting test. The objective of this study was to examine the operation parameters of the platform and the characteristics of the resulting product, and to evaluate the harm reduction effect of the slag and its potential for resource utilization. The operating temperature was set at 690 °C in the thermal modification unit and at 1450 °C in the melting furnace, resulting in stable operation and continuous liquid slag discharge. The leaching toxicity of heavy metals in the obtained slag was lower than the standard limit, achieving harmless disposal of FA. However, the resource utilization potential of the obtained slag is limited due to its failure to meet the criteria of vitrified substance and environmental quality requirements. These limitations could be addressed by promoting the combustion of carbon in the melting furnace and accelerating the cooling rate of the slag in the quenching unit. [ABSTRACT FROM AUTHOR]

Considerable variability exists in emergency physicians' (EPs) rates of resource utilization, which may cluster in distinct patterns. However, previous studies have focused on academic and tertiary care centers, and it is unclear whether similar patterns exist in community practice. Our aim was to examine whether EPs practicing in community emergency departments (EDs) have practice patterns similar to those of academic EDs. Secondarily, we sought to investigate the effects of shared visits with advanced practice professionals and residents. This was a retrospective study of two community EDs affiliated with an academic network. There were 62,860 visits among 50 EPs analyzed from October 1, 2018 through January 31, 2020 for rates of advanced imaging, admission, and shared visits. To classify practice patterns, we used a Gaussian Mixture Model (GMM), with groups and covariance determined by Bayesian Information Criteria. Our GMM revealed three groups. The largest had homogeneous patterns of resource use (n = 28; 50% were female; years of experience: 7; interquartile range [IQR] 2–11; advanced imaging: 28%; admission: 19%; shared: 34%), a small group with lower resource use (n = 4; 0% were female; years of experience: 6; IQR 4–10; advanced imaging: 28%; admission: 16%; shared: 8%), and a modest high-resource group (n = 18; 28% female; years of experience: 5; IQR 2–16; advanced imaging: 34%; admission: 23%; shared: 43%). Rates of shared visits had little direct correlation with imaging (r 2 = 0.045) or admission (r 2 = 0.093), and rates of imaging and admission were weakly correlated (r 2 = 0.242). Our data suggest that community EPs may have multiple patterns of resource use, similar to those in academic EDs. [ABSTRACT FROM AUTHOR]

To address the environmental pollution and resource wastage caused by the massive stockpiling of coal gasification slag (CGS), in this study, chlorine salt (CaCl 2 , CC) was adopted to stimulate the potential volcanic ash activity of CGS and to prepare a new modified CGS-based cementitious backfill material (MC-CPB). The optimum CC admixture was determined by comparing the compressive strength, and the effect of different admixtures on the strength of the MC-CPB was investigated. The effects of the CC content on the hydration properties and the composition and the micro-morphology of the hydration products of the MC-CPB were analyzed using hydration heat, X-ray diffraction (XRD), scanning electron microscopy (SEM), and thermogravimetry (TG) analyses. It was found that the addition of CC promoted the early and mid-strength of the MC-CPB, but an excessive amount of CC (>1%) inhibited the development of the strength in the later stages. A concentration of 1% CC had the best effect on the strength of the MC-CPB in the entire age range, increasing the compressive strength from 3 to 90 days by 65.8%, 56.1%, 80.6%, 30.9%, and 31% compared to the control group. The CC accelerated the hydration reaction process of the MC-CPB by shortening the durations of the induction and acceleration periods, and it enhanced the hydration reaction intensity of the MC-CPB by increasing the second release heat peak and forming a third release heat peak. The MC-CPB sample containing CC generated a new hydration product, Friedel's salt, which increased the compactness of the matrix and thus improved the compressive strength of the sample. However, excessive addition of CC reduced the amount of Ettringite (AFt) generated in the later stage, leading to a decrease in the strength of the high CC content samples in the later stage. The results of this study promote the large-scale and resourceful use of CGS in mine backfill and provide a theoretical basis for the field proportioning design and industrial application of MC-CPB for backfill. [Display omitted] [ABSTRACT FROM AUTHOR]

The age-adjusted modified frailty index (aamFI) has been demonstrated to effectively predict postoperative complications and healthcare resource utilization in patients undergoing primary total joint arthroplasty. The purpose of this study was to evaluate the applicability of aamFI in patients undergoing aseptic revision total hip (rTHA) and knee arthroplasty (rTKA). A national database was queried for patients undergoing aseptic rTHA and rTKA from 2015 to 2020. A total of 13,307 rTHA and 18,762 rTKA cases were identified. The aamFI was calculated by adding 1 additional point for age ≥73 years to the previously described 5-item modified frailty index (mFI-5). The area under the curve was calculated and compared to compare predictive accuracy between mFI-5 and aamFI. Logistic regression was used to investigate the relationship between aamFI and 30-day complications. The incidence of incurring any (≥1) complication increased from 15% for aamFI 0 to 45% for aamFI ≥5 after rTHA and from 5 to 55% after rTKA. Patients who had an aamFI ≥3 (reference aamFI = 0) had increased odds (rTHA: odds ratio (OR) 3.5, 95% confidence interval (CI) 2.9 to 4.1, P <.001; rTKA: OR 4.2, 95% CI 4.4 to 5.1, P <.001) of incurring at least 1 complication. The aamFI, compared to mFI-5, was a more accurate predictor of any complication (rTHA P <.001; rTKA P <.001) and 30-day mortality (rTHA P <.001; rTKA P <.003). The aamFI is an excellent predictor of complications in patients undergoing rTHA and rTKA. The addition of chronological age to the previously described mFI-5 improves the predictive value of this simple metric. [ABSTRACT FROM AUTHOR]

The increasing complexity of ED physician performance measures has resulted in significant challenges, including duplicative and conflicting measures that fail to account for different ED settings. We performed a cross sectional analysis of correlations between measures to characterize their relationships and determine if differences exist between academic versus non-academic ED settings. Pearson correlations were calculated for 12 measures among 220 ED physicians at 11 EDs. Higher admission rate was strongly correlated with higher CT utilization rate (R = 0.7, p < 0.01) and longer room to discharge time (R = 0.7, p < 0.01). Higher patients per hour was strongly correlated with shorter room to doctor time (R = −0.7, p < 0.01). Stronger measure correlations were found in the academic setting compared to the non-academic setting. Strong correlations between ED measures imply opportunities to reduce competing performance demands on clinicians. Differences in correlations at academic versus non-academic settings suggest that it may be inappropriate to apply the same performance standards across settings. [ABSTRACT FROM AUTHOR]

Chromite ore processing residue (COPR) and copper slag (CS) are industrial waste slags that cause environmental pollution and require effective treatment. This study proposes a new strategy for the co-treatment and resource utilization of COPR and CS. Under the optimal conditions (liquid-solid ratio of 9.99; H 2 SO 4 concentration of 0.85 M; the CS/COPR mass ratio of 9.98%; temperature of 88.20 ℃; and duration of 60 min), the reduction efficiency of Cr(VI) reached 99.48%, and the total Cr leaching concentration of residue reached 1.35 mg/L, which was below the USEPA regulatory limit of 5 mg/L. In addition, the detoxicated slag containing 61.44 wt% Fe 2 O 3 can be used as a raw material in the steel industry. Through kinetic, characterization, and DFT analyses, the effective remediation of Cr(VI) in COPR by CS is a combination of adsorption and reduction. The unreacted shrinkage nuclear reaction model under the control of the surface chemical reaction is the most suitable model to describe the process, and when the apparent activation energy is 63.90 kJ/mol, the apparent rate equation is: 1-(1-x)1/3= 1·371×107[CS/COPR]2·35004 [H 2 SO 4 ]2·3945 [L/S]1·95338 exp(–63·90/RT) This is an important study for waste-waste co-treatment and resource utilization of industrial waste. [Display omitted] [ABSTRACT FROM AUTHOR]

Whether frailty impacts total hip arthroplasty (THA) patients of different races or sex equally is unknown. This study aimed to assess the influence of frailty on outcomes following primary THA in patients of differing race and sex. This is a retrospective cohort study utilizing a national database (2015-2019) to identify frail (≥2 points on the modified frailty index-5) patients undergoing primary THA. One-to-one matching for each frail cohort of interest (race: Black, Hispanic, Asian, versus White (non-Hispanic), respectively; and sex: men versus women) was performed to diminish confounding. The 30-day complications and resource utilizations were then compared between cohorts. There was no difference in the occurrence of at least 1 complication (P >.05) among frail patients of differing race. However, frail Black patients had increased odds of postoperative transfusion (odds ratio [OR]: 1.34, 95% confidence interval [CI]: 1.02-1.77), deep vein thrombosis (OR: 2.61, 95% CI: 1.08-6.27), as well as >2-day hospitalization and nonhome discharge (P <.001). Frail women had higher odds of having at least 1 complication (OR: 1.67, 95% CI: 1.47-1.89), nonhome discharge, readmission, and reoperation (P <.05). Contrarily, frail men had higher 30-day cardiac arrest (0.2% versus 0.0%, P =.020) and mortality (0.3 versus 0.1%, P =.002). Frailty appears to have an overall equitable influence on the occurrence of at least 1 complication in THA patients of different races, although different rates of some individual, specific complications were identified. For instance, frail Black patients experienced increased deep vein thrombosis and transfusion rates relative to their non-Hispanic White counterparts. Contrarily, frail women, relative to frail men, have lower 30-day mortality despite increased complication rates. [ABSTRACT FROM AUTHOR]

Malrotation with midgut volvulus is a surgical emergency commonly encountered in pediatric surgical practice. Outcomes are excellent with timely diagnosis and treatment, but the development of bowel ischemia is associated with many negative consequences. The Nationwide Readmissions Database was used to identify patients 0–18 years (excluding newborns) with malrotation and midgut volvulus from 2010 to 2014. Demographics, procedures, and outcomes were compared by income group (highest quartile vs. lowest quartile) using standard statistical tests. Results were weighted for national estimates. Emergency surgery for midgut volvulus was performed in 572 patients. The majority (86%) underwent Ladd's procedure, while 14% required bowel resection and/or ostomy. Patients in the lowest income quartile were more likely to require bowel resection (18% vs. 8%, p = 0.03) or ostomy (9% vs. 2%, p = 0.015) compared to those in the highest income quartile. Low-income patients were more likely to experience prolonged hospital stay (8 [5-13] days vs. 6 [4-8] days, p <0.001) and experience complications including infections (19% vs. 5%, p = 0.002), endotracheal intubation (18% vs. 4%, p <0.001), and blood transfusions (13% vs. 3%, p = 0.003). Income disparity represents a major factor in surgical outcomes in children with midgut volvulus. A broad spectrum of clinical outcomes following surgery for midgut volvulus exists. Patients from lower-income communities are at significantly higher risk for numerous complications, negative outcomes, and higher resource utilization. These findings support additional investigations of practices to mitigate risk for low-income patients. Level III: Retrospective comparative study [ABSTRACT FROM AUTHOR]

In recent years, small celestial bodies (SCBs) exploration missions have attracted extensive attention. For the purposes of space resource exploitation and earth defense, revealing the formation and evolution of the solar system and exploring the origin of life, sampling return and in situ resource utilization (ISRU) have become the focus of SCBs exploration missions. Based on this background, this paper attempts to comprehensively illustrate the advances in SCBs resources utilization and exploitation technologies. First, the status of the utilization and exploitation of SCBs is summarized. The classification and resource distribution of SCBs are introduced later and focus on the utilization prospects of SCBs resources. From the four aspects of resource prospecting, exploitation, extraction and storage, transfer and transportation, the technical progress of SCBs mining is discussed. Some typical sampling technologies, such as siliceous aerogel, impact projectile, auger drill and excavating mechanism, pneumatic apparatus and wheel brush sampler, cutter and abrasive tool, laser and electromagnetic device, as well as bionic mining technologies inspired by some animals and plants, are reviewed in detail. According to the research of space mining, the critical points and legal issues involved in the utilization and exploitation of SCBs resources are presented, and future development trends are proposed. Finally, the full paper is summarized. • The status of the utilization and exploitation of SCBs is summarized. • The classification and utilization prospects of SCBs resources are introduced. • The technical progress of SCBs sampling and mining is discussed. • The critical points and issues are presented. • Future development trends are proposed. [ABSTRACT FROM AUTHOR]

• Oxygen-filled ball milling remarkably promotes the remediation of PCS. • Expose more functional components onto soil surface to adsorb metals. • Generate more 1O 2 and accelerate electron transfer to enhance PDS oxidation. • The recovered metals improve PDS activation efficiency and reusability. • Simultaneously realize efficient remediation and sequential reuse of PCS. Ball milling is an environmentally friendly technology for the remediation of petroleum-contaminated soil (PCS), but the cleanup of organic pollutants requires a long time, and the post-remediation soil needs an economically viable disposal/reuse strategy due to its vast volume. The present paper develops a ball milling process under oxygen atmosphere to enhance PCS remediation and reuse the obtained carbonized soil (BCS-O) as wastewater treatment materials. The total petroleum hydrocarbon removal rates by ball milling under vacuum, air, and oxygen atmospheres are 39.83%, 55.21%, and 93.84%, respectively. The Langmuir and pseudo second-order models satisfactorily describe the adsorption capacity and behavior of BCS-O for transition metals. The Cu2+, Ni2+, and Mn2+ adsorbed onto BCS-O were mainly bound to metal carbonates and metal oxides. Furthermore, BCS-O can effectively activate persulfate (PDS) oxidation to degrade aniline, while BCS-O loaded with transition metal (BCS-O-Me) shows better activation efficiency and reusability. BCS-O and BCS-O-Me activated PDS oxidation systems are dominated by 1 O 2 oxidation and electron transfer. The main active sites are oxygen-containing functional groups, vacancy defects, and graphitized carbon. The oxygen-containing functional groups and vacancy defects primarily activate PDS to generate 1 O 2 and attack aniline. Graphitized carbon promotes aniline degradation by accelerating electron transfer. The paper develops an innovative strategy to simultaneously realize efficient remediation of PCS and sequential reuse of the post-remediation soil. [Display omitted] [ABSTRACT FROM AUTHOR]

This study, a method was proposed under room temperature, atmospheric pressure, additive-free, and ultrasound was used as a strengthening method to promote the original gehlenite in municipal solid waste incineration fly ash (MSWI FA) to fix soluble chromium (Cr). At the same time, CO 2 was captured, and calcium salts were recovered by using the washing solution's alkaline and high calcium ion properties. Firstly, the reaction time (t), ultrasonic power (w), magnetic stirring rate (rpm), and liquid-solid ratio (L/S) of ultrasonic-assisted water washing were studied by single factor experiment. The results shown that the ultrasonic power had the most significant effect on the fixation effect of Cr, and the optimal parameters are 50 min, 800w, 500 rpm, and 8 L / kg, respectively. The fixation rate of Cr was more than 99.64%. Subsequent carbonation experiments on the washing waste liquid showed that under the flow rate of 200 ml/min of carbon dioxide gas flow, the calcium ions in the solution can be recovered in the form of calcium salts. This study provides an effective MSWI FA treatment process, which can realize the resource utilization of MSWI FA and has the potential to adsorb CO 2 and recover calcium salts efficiently. [Display omitted] [ABSTRACT FROM AUTHOR]

The objective was to explore the hospital-level relationship between routine pre-discharge WBC utilization (RPD-WBC) and outcomes in children with complicated appendicitis. Multicenter analysis of NSQIP-Pediatric data from 14 consortium hospitals augmented with RPD-WBC data. WBC were considered routine if obtained within one day of discharge in children who did not develop an organ space infection (OSI) or fever during the index admission. Hospital-level observed-to-expected ratios (O/E) for 30-day outcomes (antibiotic days, imaging utilization, healthcare days, and OSI) were calculated after adjusting for appendicitis severity and patient characteristics. Spearman correlation was used to explore the relationship between hospital-level RPD-WBC utilization and O/E's for each outcome. 1528 children were included. Significant variation was found across hospitals in RPD-WBC use (range: 0.7–100%; p < 0.01) and all outcomes (mean antibiotic days: 9.9 [O/E range: 0.56–1.44, p < 0.01]; imaging: 21.9% [O/E range: 0.40–2.75, p < 0.01]; mean healthcare visit days: 5.7 [O/E 0.74–1.27, p < 0.01]); OSI: 14.1% [O/E range: 0.43–3.64, p < 0.01]). No correlation was found between RPD-WBC use and antibiotic days (r = +0.14, p = 0.64), imaging (r = −0.07, p = 0.82), healthcare days (r = +0.35, p = 0.23) or OSI (r = −0.13, p = 0.65). Increased RPD-WBC utilization in pediatric complicated appendicitis did not correlate with improved outcomes or resource utilization at the hospital level. III. Clinical Research [ABSTRACT FROM AUTHOR]

Resource shortages and metal demand continuously increase, and the massive quantities of waste printed circuit boards (WPCB) generated make resource recycling and environmental sustainability necessary paths. Pyrolysis is a practicable and promising pathway to lessen the environmental burden through the conversion of WPCB into high value-added products. In this study, the characteristics of WPCB are first analyzed, and the types of pyrolysis reactors for WPCB and the characteristics of pyrolysis products are introduced. Then, we summarize and compare the conventional and advanced pyrolysis technologies applied to the treatment of WPCB for the scientific management and sustainable recovery of WPCB. In addition, we present an overview of possible pathways for the subsequent treatment of pyrolysis products. Furthermore, we discuss the prospects of WPCB pyrolysis, emphasize the imperatives and significance of establishing a circular economy for WPCB, and discuss the economic feasibility and future challenges of WPCB pyrolysis. Pyrolysis of WPCB has been proven at the laboratory scale; however, more effort and time are required for industrialization. [Display omitted] [ABSTRACT FROM AUTHOR]

Vanadium (V) is widely used and is an important strategic resource due to its superior physicochemical properties. Securing the sustainability of vanadium production is crucial due to the rising global demand for the metal. The primary raw material used in vanadium extraction is vanadium slag, which is produced during the smelting of vanadium titanomagnetite (VTM). Resources and the environment both benefit from the recovery of vanadium resources from vanadium slag. This review summarizes the sources and characteristics of vanadium slag, and comprehensively compares and discusses various treatment methods of vanadium slag, including roasting, leaching, precipitation and strengthened vanadium extraction process. Finally, the prospects and challenges of recovering vanadium from slag are assessed. Literature review shows that the roasting assisted leaching process is the most effective way to extract vanadium from vanadium slag. Some promising methods offer the advantages of high selectivity and environmental friendliness and deserve further research in this field in the future. The purpose of this paper is to provide some reasonable development directions for a completely harmless treatment of vanadium slag. [ABSTRACT FROM AUTHOR]

Hospital administrators are often challenged with overcrowding at hospitals. The study hospital receives referred patients; however, they have to wait in long queues even for getting registered. This was a cause of concern for hospital administrators. The study was undertaken to find an amicable solution to the queues at registration using Queuing Theory. This observational and interventional study was carried out in a tertiary care ophthalmic hospital. In the first phase, data of service time and arrival rate was collected. The queuing model was built using the coefficient of variation (CoV) of the observed times. Server utilization for new patient registration was found to be 1.21 and was 0.63 for revisit patients. Scenario-based simulation carried out using free software for optimal utilization of both types of servers. Recommendations made to combine the registration process and to increase one server were implemented. In the second phase, after one year, patient registration data were collected and compared for the number of patients registered using SPSS 17. Number of patients registered within the registration timings increased whereas the number of patients registered after the registration timings decreased significantly at 95% CI with a p-value of less than 0.001. Queues finished early and more number of patients were registered in the same time. Using queuing theory, the bottleneck of the systems can be identified. Scenario and software-based simulations provide solutions to the problem of queues. The study is an application of Queuing Theory with a focus on efficient resource utilization. It can be replicated in an organization with limited resources facing the challenge of queues. [ABSTRACT FROM AUTHOR]

The acidic wastewater and red gypsum generated by the titanium dioxide (TiO 2) industry pose a great threat to humans and the environment. In order to achieve low-cost and high-benefit resource utilization of acidic wastewater and red gypsum, a harmless process for the self-treatment of acidic wastewater and red gypsum as well as for the recovery of valuable resources such as Ti, Fe, Ca, and S is proposed in this study. Acidic wastewater was innovatively used to purify red gypsum while reducing its acidity. The results showed that Fe, Ti, Al, Mn, and Mg impurities in red gypsum could be leached efficiently by the acidic wastewater, resulting in the calcium sulfate products, which can be used as a substitute for natural gypsums in industrial production. Subsequently, phosphoric acid was directly added to the Ti-rich filtrate and stirred at 85 ℃ for 45 min, so that the titanium was converted into titanium phosphate precipitation, with an optimal titanium recovery ratio of 94.86%. After recovering Ti, the filtrate was used again to purify red gypsum. Finally, the pH of the low acidity solution was treated by oxidation and precipitation, and filtered to obtain the Fe-rich filter residue and ammonium sulfate solution. The Fe-rich filter residue could be used in the metallurgical industry, and the ammonium sulfate solution was evaporated and crystallized to obtain the (NH 4) 2 SO 4 product. The harmless self-treatment process not only facilitated the resource utilisation of acidic wastewater and red gypsum, but also solved the pollution problems caused by wastewater and solid waste in the TiO 2 industry. [ABSTRACT FROM AUTHOR]

The existence of a "weekend effect" in heart transplantation (HTx) is understudied. The present study sought to determine whether the odds of (HTx) offer acceptance differed for adult and pediatric candidates depending upon the day on which the offer occurred. United Network for Organ Sharing data were used to identify all HTx offers to adult (listing age ≥18) and pediatric candidates from 2000-2019. Odds of offer acceptance were studied, comparing weekends, holidays, and conferences (Society of Thoracic Surgeons [STS], American Association for Thoracic Surgery [AATS], International Society for Heart and Lung Transplantation [ISHLT]) to "baseline" (all other days). Multivariable binary logistic regression analyses were performed to determine independent predictors of offer nonacceptance, controlling for the impacts of program transplant volume, region, and candidate characteristics. A total of 323,953 offers occurred – 298,405 to adults and 25,548 to pediatric candidates. Clinically significant differences did not exist in donor or candidate characteristics between baseline or other events. The number of offers per day was stable throughout the year for both adults (p = 0.191) and pediatrics (p = 0.976). In adults, independently lower odds of acceptance existed on weekends (OR 0.88 [95% CI 0.84-0.92]), conferences in aggregate (0.86 [0.77-0.95]), and holidays in aggregate (0.81 [0.72-0.91]). In children, independently lower odds of acceptance were seen on weekends (0.88 [0.79-0.98]), during STS (0.46 [0.25-0.83], and during Christmas (0.32 [0.14-0.76]). The day on which a HTx offer occurs significantly impacts its likelihood of acceptance. Further work can determine the impacts of human behavior or resource distribution, but knowledge of this phenomenon can inform efforts to ensure ideal organ allocation throughout the year. [ABSTRACT FROM AUTHOR]

Assess whether changing an emergency department (ED) chest pain pathway from utilizing the Thrombolysis in Myocardial Infarction (TIMI) score for risk stratification to an approach utilizing the History, EKG, Age, Risk, Troponin (HEART) score was associated with reductions in healthcare resource utilization. A retrospective, quasi-experimental study using difference-in-differences and interrupted time series specifications evaluated all ED patients with a chest pain encounter from 8/2015 to 7/2019 at a large academic medical center. We included patients age ≥ 18 with negative troponin testing discharged from the ED. Our standardized care pathway utilized TIMI for risk stratification until 09/2017 and HEART thereafter. We evaluated patients undergoing hospital-based cardiac diagnostic testing (CDT), length of stay (LOS), and 30-day Major Adverse Cardiovascular Events (MACE) at the intervention site before and after the pathway change and compared these outcomes to a similar control site within the health system for the difference-in-differences specification. During the study period, 6.3% (450 of 7117) of patients in the TIMI cohort and 7.2% (546 of 7623) in the HEART cohort among 400,965 total ED visits underwent CDT. In a multivariable analysis, transition to the HEART pathway was associated with greater odds of receiving CDT (odds ratio 2.88 [95% CI 1.21 to 6.86]), a reduction in LOS of 34 min (95% CI 2.2 to 67.6), and no significant difference in 30-day MACE. The transition from TIMI to HEART was associated with mixed consequences for healthcare resource utilization, including increased CDT but reduced length of stay. [ABSTRACT FROM AUTHOR]

Acid mine drainage (AMD) contains high concentrations of heavy metals and sulfates with strong acidity. AMD exists in several major coal-producing countries such as China, the United States, Canada, etc., and it poses significant threaten to the environment and human health owing to it exists in nature for a long time and continues to cause harm after mining. In China, about 3.5 billion tons of AMD was produced annually and their negative effects on the ecological environment and human health in mining area cannot be ignored. Herein, the formation mechanism and environmental impact of AMD are discussed thoroughly. Additionally, the principles and applications of several AMD treatment technologies are discussed in detail and the limitations of the practical application of AMD in China are summarized. On this basis, the current status and importance of the resource utilization of AMD are further discussed. Finally, the future direction of AMD treatment is proposed. In principle, this review will provide useful implications in guiding the treatment and resource utilization of AMD. [Display omitted] • Several acid mine drainage (AMD) treatment technologies are discussed in detail. • The limitations of the practical application of AMD in China are summarized. • New material development and waste utilization is one of the future directions. • Resource utilization offers the possibility of sustainable management of AMD. • The integrated use of integrated processes is a promising approach to AMD treatment. [ABSTRACT FROM AUTHOR]

Frailty is a well-established risk factor in patients undergoing total knee arthroplasty (TKA). How age modifies the impact of frailty on outcomes in these patients, however, remains unknown. In this study, we aimed to describe and evaluate the applicability of a novel risk stratification tool—the age-adjusted modified Frailty Index (aamFI)—in patients undergoing TKA. A national database was queried for all patients undergoing primary TKA from 2015 to 2019. There were 271,271 patients who met inclusion criteria for this study. First, outcomes were compared between chronologically young and old frail patients. In accordance with previous studies, the 75th percentile of age of all included patients (73 years) was used as a binary cutoff. Then, frailty was classified using the novel aamFI, which constitutes the 5-item mFI with the addition of 1 point for patients ≥73 years. Multivariable logistic regressions were then used to investigate the relationship between aamFI and postoperative outcomes. Frail patients ≥73 years had a higher incidence of complications compared to frail patients <73 years. There was a strong association between aamFI and complications. An aamFI of ≥3 (reference aamFI of 0) was associated with an increased odds of 30-day mortality (odds ratio [OR] 8.6, 95% CI 5.0-14.8), any complication (OR 3.1, 95% CI 2.9-3.3), deep vein thrombosis (OR 1.5, 95% CI 1.2-1.8), and nonhome discharge (OR 6.1, 95% CI 5.8-6.4; all P <.001). Although frailty negatively influences outcomes following TKA in patients of all ages, chronologically old, frail patients are particularly vulnerable. The aamFI accounts for this and represents a simple, but powerful tool for stratifying risk in patients undergoing primary TKA. [ABSTRACT FROM AUTHOR]

Medicaid payer status has been shown to affect risk-adjusted patient outcomes and health care utilization across multiple medical specialties and orthopedic procedures. However, there is a paucity of data regarding the impact of Medicaid payer status on 90-day morbidity and resource utilization following primary shoulder arthroplasty (reverse total shoulder arthroplasty [rTSA], anatomic total shoulder arthroplasty [aTSA], and hemiarthroplasty [HA]). The purpose of this study was to examine 90-day readmission and reoperation rates, hospital length of stay (LOS), and direct cost following primary shoulder arthroplasty in the Medicaid population. The National Readmission Database was queried for all patients undergoing primary aTSA, rTSA, and HA from 2011 to 2016. Medicaid or non-Medicaid payer status was determined. Patient demographic characteristics and comorbidities, along with 90-day readmission, 90-day reoperation, LOS, and inflation-adjusted cost, were queried. Propensity score matching was used to control for baseline differences in cohorts that could be acting as confounders in the exposure-outcome relationship. This was achieved with 1-to-1 propensity score matching between Medicaid and non-Medicaid patients. Odds ratios (ORs) and 95% confidence intervals (CIs) for 90-day readmission and reoperation rates were calculated, and a comparison of LOS and cost was performed between the propensity score–matched cohorts. A total of 4667 Medicaid and 161,147 non-Medicaid patients were identified from the 2011-2016 National Readmission Databases. Propensity score analysis was performed, and 4637 Medicaid patients were matched to 4637 non-Medicaid patients; each group comprised 1504 rTSAs (32.4%), 1934 aTSAs (41.7%), and 1199 HAs (25.9%). Patients with Medicaid payer status yielded significant increases in the 90-day all-cause readmission rate of 11.6% vs. 9.3% (P <.001; OR, 1.28 [95% CI, 1.12-1.46]), 90-day shoulder-related readmission rate of 3.3% vs. 2.3% (P =.004; OR, 1.44 [95% CI, 1.12-1.85]), and 90-day reoperation rate of 2.0% vs. 1.3% (P =.008; OR, 1.54 [95% CI, 1.12-1.94]). Furthermore, there was an increased risk of an extended LOS (ie, LOS > 2 days) (28.4% vs. 25.7%; P =.004; OR, 1.14 [95% CI, 1.04-1.25]) along with increased direct cost (median, $17,612 vs. $16,775; P <.001). This study demonstrates that Medicaid payer status is independently associated with increased 90-day readmission and reoperation rates, LOS, and direct cost following primary shoulder arthroplasty. Providers may have a disincentive to treat patient populations who require increased resource utilization following surgery. Risk adjustment models accounting for Medicaid payer status will be necessary to ensure good access to care for this patient population by avoiding penalties for physicians and hospital systems. [ABSTRACT FROM AUTHOR]

To describe utilization of mental health services in a standard of care group of traumatic and non-traumatic spinal cord injury (SCI) patients with mild to moderate depressive symptoms following inpatient rehabilitation discharge within one year of injury. Single center, controlled, block randomized clinical trial. Community-setting in California. Twenty-nine adults with SCI and mild to moderate depressive symptoms (Patient Health Questionnaire 9 [PHQ-9] total scores between 5-14) and with Montreal Cognitive Assessment (MoCA) full scores ≥ 25 or MoCA Blind ≥ 18 were randomized into the standard of care group in a clinical trial. Participants were followed via phone to collect information on resources utilized after being discharged from acute inpatient rehabilitation over the course of 26 weeks. Not Applicable. Clinical utilization survey of mental health services, antidepressant use, and other self-reported health conditions. The average age was 40 [SD]=17.1 and the majority were male (79.3%), traumatic etiologies (58.6%), with tetraplegia (51.7%), Caucasian (62.1%), and non-Hispanic (79.3%). The following general clinical utilizations were reported by the 29 participants: 96.6% had physician visits, 27.6% had ER visits, and 20.7% were hospitalized. Participants self-reported the following general health issues: 55.2% pain, 44.8% sleep disorders, 13.8% pressure sores, 10.3% Autonomic Dysreflexia, and 3.4% pneumonia. In terms of mental health utilizations, four participants reported at least 1 visit with a psychologist only, one participant had a visit with a psychiatrist only, and one participant had a visit with both. Participants also self-reported the following mental health related problems: sleep disorders (44.8%), depression (30.9%), and psychiatric disorders (6.9%). A total of 48.3% of participants reported anti-depression medication use. In this sample less than 20% of participants utilized mental health services and under 50% used anti-depression medication post-discharge even though they endorsed mild to moderate depressive symptoms on the PHQ-9. Further research needs to be conducted to determine barriers or reasons for the lack of utilization of mental health services in individuals with SCI and generate alternatives they may be utilizing. None. [ABSTRACT FROM AUTHOR]

[Display omitted] Many replication protocols, which can be used in various distributed applications such as distributed databases, collaborative applications, and distributed agenda, sacrifice strong consistency to achieve lower latency and higher throughput. This paper describes the design, specification, implementation, and evaluation of Unidirectional and Multidirectional Replication, which challenge this inflexible tradeoff. By propagating the resulting states parallelly, as in Primary-Backup Replication, but with fewer messages, while having a head that processes write requests and a tail that processes read requests, as in Chain Replication, Unidirectional Replication improves the latency and throughput of the two protocols without compromising strong consistency. To improve the utilization of computing and communication resources of Unidirectional Replication, Multidirectional Replication divides objects into several logical shards and runs an instance of Unidirectional Replication on each logical shard. We have accomplished the proposed protocols in three steps: (1) merging Primary-Backup Replication and Chain Replication into Unidirectional Replication; (2) merging Unidirectional Replication and logical sharding into Multidirectional Replication; and (3) implementation and evaluation. Empirical results show that, compared to Primary-Backup Replication, when handling read requests with write-read conflicts, Unidirectional Replication shows an improvement of roughly 66% in latency; compared to Chain Replication, when handling write requests with basic settings, Unidirectional Replication shows an improvement of roughly 59% in throughput; and compared to Unidirectional Replication, Multidirectional Replication shows an improvement of 150% in the number of clients that it can handle. [ABSTRACT FROM AUTHOR]

• A modest delay in time to operation does not increase disease severity in acute appendicitis. • QI initiatives are likely more effective than expediting urgency at decreasing hospital resource utilization. • Institutions are recommended to focus on standardization of workflow and same day discharge for nonperforated appendicitis. Controversy exists regarding how operative timing affects patient safety and resource utilization for acute appendicitis. Over 3 years, our institution trialed efforts to optimize appendectomy workflow. Our aim is to describe the ramifications of expediting appendectomy and implementing standardized protocols relative to historic controls. Patient records at a freestanding children's hospital were reviewed from synchronized 6-month periods from 2019 to 2021. During Year 1 (historic), no standardized workflows existed. In Year 2 (expedited), appendicitis management was protocoled using a clinical quality improvement bundle, which included performing appendectomies within two hours of diagnosis. In Year 3 (QI), operative timing was relaxed to the same calendar day while all prior QI initiatives continued. Descriptive statistics were performed, using hospital length of stay (LOS) as the primary outcome. 298 patients underwent appendectomy for acute appendicitis. The median expedited workflow LOS was 15.3 hours shorter (p = 0.003) than historic controls; however, this was sustained despite relaxation of surgical urgency in the QI workflow. No differences in perforation rates were observed. During the expedited workflow, OR overtime staffing expense increased by $90,000 with no significant change in hospital costs. In multivariate regression, perforation was the only variable associated with LOS. Hospital LOS can be shortened by expediting appendectomy. However, in our institution this did not decrease hospital costs and was furthermore balanced by higher personnel expenses. A sustained decrease in LOS after relaxing operative urgency standards implies that concurrent QI initiatives represent a more effective and cost-efficient strategy to decrease hospital resource utilization. Level III [ABSTRACT FROM AUTHOR]

Hospital length of stay (HLOS) after traumatic brain injury (TBI) is an important metric of injury severity, resource utilization, and access to post-acute care services. Risk factors for protracted HLOS after TBI require further characterization. Data regarding adult inpatients admitted to a single U.S. level 1 trauma center with a diagnosis of acute TBI between August 1, 2019, and April 1, 2022, were extracted from the electronic health record. Patients with extreme HLOS (XHLOS, >99th percentile of institutional TBI HLOS) were compared with those without XHLOS. Socioeconomic status (SES), clinical/injury factors, and discharge disposition were analyzed. In 1638 patients, the median HLOS was 3 days (interquartile range [IQR]: 2–8 days). XHLOS threshold was >70 days (N = 18; range: 72–146 days). XHLOS was associated with younger age (XHLOS/non-XHLOS: 50.4/59.6 years; P = 0.042) and greater proportions with severe TBI (55.6%/11.4%; P < 0.001), low SES (72.2%/31.4%; P < 0.001), and Medicaid insurance (77.8%/30.1%; P < 0.001). XHLOS patients were more likely to die in hospital (22.2%/8.1%) and discharge to post-acute facility (77.8%/16.3%; P < 0.001). No XHLOS patients were discharged to home. In XHLOS patients alive at discharge, medical stability was documented at median 39 days (IQR: 28–58 days) and were hospitalized for another 56 days (IQR: 26.5–78.5 days). XHLOS patients were more likely to have severe injuries, low SES, and Medicaid. XHLOS is associated with in-hospital mortality and need for post-acute placement. XHLOS patients often demonstrated medical stability long before placement, underscoring complex relationships between SES, health insurance, and outcome. These findings have important implications for quality improvement and resource utilization at acute care hospitals and await validation from larger trials. [ABSTRACT FROM AUTHOR]

The black soldier fly (BSF , Hermetia illucens) is a resource insect that can utilize livestock and poultry feces. However, BSFs may also increase the risk of transmission of antibiotic resistance genes (AGRs) that are widespread in livestock and poultry farm environments. Therefore, we aimed to evaluate the biosecurity risks of different BSF treatments in the laying chicken food chain using the "chicken manure-BSF-laying hens" model. Our results indicated that different BSF treatments significantly affected antibiotic residue, ARGs, MGEs, bacterial antibiotic resistance, and bacterial microbial community composition in the food chain of laying hens fed BSFs. These risks can be effectively reduced through starvation treatment and high-temperature grinding treatment. Comprehensive risk assessment analysis revealed that starvation combined with high-temperature milling (Group H) had the greatest effect. [ABSTRACT FROM AUTHOR]

Cloud computing has emerged as a cornerstone technology for modern computational paradigms due to its scalability and flexibility. One critical aspect of cloud computing is efficient task scheduling, which directly impacts system performance and resource utilization. In this paper, we propose an enhanced optimization algorithm tailored for task scheduling in cloud environments. Building upon the foundation of the Jaya algorithm and Synergistic Swarm Optimization (SSO), our approach integrates a Levy flight mechanism to enhance exploration-exploitation trade-offs and improve convergence speed. The Jaya algorithm's ability to exploit the current best solutions is complemented by the SSO's collaborative search strategy, resulting in a synergistic optimization framework. Moreover, the incorporation of Levy flights injects stochasticity into the search process, enabling the algorithm to escape local optima and navigate complex solution spaces more effectively. We evaluate the proposed algorithm against state-of-the-art approaches using benchmark task scheduling problems in cloud environments. Experimental results demonstrate the superiority of our method in terms of solution quality, convergence speed, and scalability. Overall, our proposed Improved Jaya Synergistic Swarm Optimization Algorithm offers a promising solution for optimizing TSCC (TSCC), contributing to enhanced resource utilization and system performance in cloud-based applications. The proposed method got 88 % accuracy overall and 10 % enhancement compared to the original method. • JSSOA optimizes cloud task scheduling by integrating fitness-distance balance and Lévy flight. • Efficient cloud task scheduling is achieved with JSSOA. • JSSOA excels in empirical evaluations, outperforming Jaya and SSOA algorithms. • JSSOA showcases its prowess in advancing cloud computing efficiency. [ABSTRACT FROM AUTHOR]

The resource utilization of waste bagasse (SB) is a green and effective solution to reduce environmental pollution. However, traditional methods for recycling of bagasse have the technical bottlenecks, including, secondary pollution, low efficiency, high cost and small production scale. Here, we develop a novel mechanical activation technology to convert SB in situ into zinc oxide-tannic acid-SB (ZnO-TA-SB) with antibacterial activity as multifunctional additives for packaging films. Unlike traditional methods that demand harsh reaction conditions, this novel strategy for the resource utilization of SB is convenient, green, efficient and large-scale. The results show that the bactericidal activities of ZnO-TA-SB against E. coli and S. aureus are >99 %, confirming the strong spectral antibacterial activity of ZnO-TA-SB. With the addition of ZnO-TA-SB to carboxymethyl cellulose (CMC) film, the tensile strength, elongation at break, O 2 barrier property of ZnO-TA-SB/CMC film are increased by 1.43, 2.49, 2.09 times compared with CMC film, respectively. Furthermore, ZnO-TA-SB/CMC film effectively keeps the appearance and freshness of strawberries for more than 18 days. Notably, ZnO-TA-SB/CMC film is easily degraded in soil and used as a nutrient for crop growth without secondly pollution. Therefore, this work develops a new strategy for the resource utilization of waste biomass, and obtains green, clean and high-value products from waste biomass. [Display omitted] • A green, efficient and sustainable strategy for the resource utilization of waste bagasse. • Waste bagasse is converted into high-value ZnO-TA-SB by mechanical activation. • The ZnO-TA-SB is used as multifunctional additive for packaging film. • The good biodegradable performance of ZnO-TA-SB/CMC will not cause environmental pollution. [ABSTRACT FROM AUTHOR]

[Display omitted] • Recovering Rb from carnallite decomposition mother liquor is of great significance. • Waste brines generated at each chemical stage were successively recycled and utilized. • The overall utilization efficiency of carnallite was significantly enhanced. • The cost of large-scale Mg-LDHs preparation was effectively reduced. Resource scarcity and environmental degradation pose formidable challenges for the sustainable development of human society. Although enhancing resource utilization efficiency represents a viable solution to these challenges, many strategic resources still suffer from substantial waste and environmental pollution owing to their single utilization form and non-environmentally friendly technologies. In this study, by employing salt lake carnallite as a representative example, we proposed an eco-friendly closed-loop strategy that integrated various chemical processes to maximize resource utilization. This innovation enables successive recycling and utilization of the waste brine generated at each chemical stage, resulting in minimized resource wastage and maximized eco-environmental benefits. Compared with the conventional carnallite utilization method, our strategy enhanced the KCl yield from 55.48% to 89.25%, achieved nearly 100% utilization efficiency of Mg, and improved the Rb recovery efficiency from 0% to 81.28%. Consequently, the overall utilization efficiency of carnallite increased from 20.91% to 87.37%. Additionally, this approach offers the added benefit of significantly improving the overall utilization of mineral resources and substantially reducing the cost of large-scale sample preparation. This work helps to construct a more sustainable and cost-effective utilization system for various mineral and brine resources. [ABSTRACT FROM AUTHOR]

Cyanobacteria, as organic matter with a high protein content, have great potential as feed additives, and the use of black soldier fly larvae (BSFL) to convert organic waste into biomass that is rich in protein and fat is a proven process. Accordingly, the study evaluated the beneficial effects of microbial inoculation (Bacillus subtilis , yeast, Lactobacillus plantarum , and a mixture of those three microorganisms) on the growth performance, and nutrient accumulation of BSFL based on utilizing cyanobacteria as feedstock. The mixed microorganism addition group showed the most significant increase in the BSFL biotransformation efficiency compared to the control group, with a 16.73% increase in larvae weight, a 9.33% increase in dry matter reduction rate, a 16.90% increase in bioconversion rate, and also a reduction in developmental time. The amino acid content of all microorganism-added groups was increased, bring the larvae amino acid composition closer to that of soybean meal. Furthermore, microbial addition also resulted in a significant enrichment in larvae lauric acid (>40%) and a decrease (<33%) in unsaturated fatty acid. Microbial addition altered the structure of the larvae gut microbial community, resulting in an increase and a decrease in the abundances of Actinobacteria and Proteobacteria , respectively. Metabolomic analyses demonstrated that the addition of microorganisms improved the ability of larvae to utilize nutrients and increased the accumulation of short-chain fatty acid metabolites. The study advances a new approach to the utilization of cyanobacteria and provides guidance for establishing an efficient process for the conversion of organic solid waste by BSFL. [Display omitted] • Beneficial microorganisms resulted in better growth performance of BSFL. • The addition of beneficial microorganisms caused enrichment of lauric acid. • The amino acid profile of BSFL was similar to that of soybean meal. • Beneficial microorganisms alter the BSFL intestinal microbiota. • Beneficial microorganisms alter expression of short-chain fatty acid metabolites. [ABSTRACT FROM AUTHOR]

Limited cycling life and outdated recycling modes will inevitably cause an explosive surge in spent lithium-ion batteries (LIBs). The recycling and reutilization of these spent LIBs play a vital role in environmental conservation and resource circulation. In recent years, deep eutectic solvents (DESs), recognized as green solvents, have attracted the public's attention for their outstanding environmental friendliness, recyclability, tunability, and ability to dissolve metal oxides, which has resulted in significant practical value in the realm of recycling spent LIBs, offering enormous economic feasibility for the large-scale recovery and utilization of spent LIBs. This paper offers a comprehensive overview of recycling technologies within the recent DESs system, focusing on the separation of cathode active materials (CAMs) and current collectors, as well as the extraction of metals from CAMs. Firstly, this review systematically expounds on the distinctions in the separation principles of DESs when separating CAMs and current collectors. Secondly, the leaching system is preliminarily categorized, considering the composition of DESs. It methodically delineates and compares the advantages, challenges, and leaching mechanisms of different DES leaching systems from perspectives on viscosity, acidity, reducibility, and coordination ability. On this basis, a preliminary proposal for an efficient, low-cost, green, and sustainable spent LIBs recycling process under the DESs system is introduced, offering a reference for improving spent LIBs recycling technology under the DESs system. Finally, the current challenges of DESs in recycling spent LIBs are discussed, and relevant suggestions for the future direction in this field are proposed. [ABSTRACT FROM AUTHOR]

The aim of this study is to explore the feasibility of applying bipolar membrane electrodialysis (BMED) to treat coal chemical waste salt with different pretreatments of organic pollutants. The organic content in the real waste salt reached 0.6 ± 0.1 % with a weight averaged molecular weight of 641 g/mol. Only 26.5 % of the total COD in a 250 g/L waste salt solution could be removed by the coagulation pretreatment, resulting in no apparent improvement in BMED performance. Thermal pretreatment at 850 °C for 180 min completely removed organics from the waste salt, resulting in efficient control of membrane fouling in the BMED. At the current density of 50 mA/cm2 and 250 g/L waste salt solution, the base concentration in the BMED with 850 °C pretreatment of waste salt was higher than that with 550 °C pretreatment and without any pretreatment (58.2 ± 1.0 vs. 56.0 ± 2.4 and 53.6 ± 2.0 g/L) within 180 min, respectively. The average current efficiency based on base productions with 850 °C pretreatment of the waste salt reached 91 ± 5 % in the BMED within 180 min. Our results should be useful for the resource utilization of coal chemical waste salt. [Display omitted] • Resource utilization of coal chemical waste salt was realized in this study. • Organics in the waste salt caused AEM fouling in BMED without any pretreatment. • Thermal pretreatment at 850 °C completely removed the organics in the waste salt. • Thermal pretreatment of waste salt resulted in low energy consumption of BMED. [ABSTRACT FROM AUTHOR]

[Display omitted] • Battery-grade FePO 4 ·2H 2 O was prepared by copper slag resource utilization. • FePO 4 ·2H 2 O was synthesized by selective sediment in the leachate. • Adding Na 2 HPO 4 ·12H 2 O without extra pH adjustment. • The battery performance of synthetic LFP/C is effective. • Life cycle assessment indicates that the technology is environmentally friendly. Copper slag (CS) contains a high content of valuable iron, the stockpile of CS occupies a large amount of land and leads to a waste of secondary resources. This study proposed producing battery-grade FePO 4 ·2H 2 O from CS through selective leaching, synthesis, and purification. The combined acid leaching/evaporation method was used to leach out Fe and inhibit Si from fayalite selectively, and then FePO 4 ·2H 2 O was formed by adding Na 2 HPO 4 ·12H 2 O without extra pH adjustment. The purity of FePO 4 ·2H 2 O obtained by using a reactor heated for 5 h at 180 ℃ with an HCl concentration of 2.5 M was 99.47 %, and the impurities were all by the industry standard for battery-grade FePO 4 ·2H 2 O (HG/T 4701–2021). The LiFePO 4 /C material was further synthesized and tested for battery performance. Under the test current of 0.1C, the charging-specific capacity of the battery in the first week was 175.8 mAh/g, and the discharge-specific ability was 159.3 mAh/g, which was close to the theoretical specific capacity and effective. Life cycle assessment (LCA) indicated that for each 1 kg of iron phosphate produced, the carbon emission of this study was reduced by 4.71 kg CO 2 eq compared with the traditional technology. [ABSTRACT FROM AUTHOR]

Datacenters receive dynamic workloads with disparate specifications to be scheduled on virtual machines (VMs). These unpredictable, alarmingly growing workloads with varying resource specifications may bring down the servers of datacenters into an imbalanced state. Thus, resulting in low resource utilization and high energy consumption among the servers. To cater to the need of fluctuating on-demand resource provisioning, it is essential to scale up the ability and capacityof existing infrastructure through virtualization. Moreover, due to the involvement of conflicting scheduling constraints, load scheduling in cloud computing fall under NP-hard problem. An effective scheduling mechanism in amalgamation with a load balancing strategy based on binary JAYA is implemented to alleviate the challenges as mentioned above. This technique not only improves resource utilization but also brings down the degree of energy consumption and makespan while keeping the whole system balanced. At first, it focuses on evoking a load balancing procedure to uniformly disperse the loads among VMs based on the compatibility between the tasks and VMs and secondly, JAYA algorithm is executed to find the best possible mapping of tasks onto VMs. In order to appraise the efficacy of the proposed algorithm, the scheduling of independent and non-preemptive tasks is simulated in CloudSim using a benchmark parallel workload by NASA-iPSC. Experiments are conducted in both homogenous and heterogeneous environments. The proposed algorithm is statistically validated using the Friedman test, followed by a Holm's test. The proposed approach is compared over other algorithms such as Round Robin (RR), binary Particle Swarm Optimization (PSO) and Genetic Algorithm (GA). The simulation results show a notable amelioration over other mentioned algorithms by an increase of resource utilization with 18.47% (GA), 12.65% (BPSO) and 4.18% (GA), 2.51% (BPSO) and a reduction of makespan by 6.47% (GA), 4.35% (BPSO) and 4.17% (GA), 2.20% (BPSO) with an increasing number of tasks and VMs in two different test cases respectively. [ABSTRACT FROM AUTHOR]

The present aim was to estimate direct health care costs of patients suffering from post-traumatic trigeminal neuropathy (PTTN) and to compare the use of health care services, medications, and costs between temporary and persistent (>3 months) PTTN cohorts. A pre-existing clinical dataset of PTTN patients visiting a tertiary orofacial pain clinic in Belgium was utilized, including symptoms and quality of life measurements. Cost and resource utilization data were obtained by Belgium's largest health insurance provider for a period of 5 years after onset. Data from 158 patients was analyzed. The average cost per patient in the first year after injury was €2353 (IQR 1426–4499) with an out-of-pocket expense of 25% of the total cost. Hospitalization and technical interventions were the main drivers of cumulative costs, followed by consultation costs. For each cost category, expenditure was significantly higher in patients with persistent PTTN than in those with temporary PTTN (median 5-year total costs in persistent PTTN patients yielded €8866 (IQR 4368–18191) versus €4432 (IQR 2156–9032) in temporary PTTN, p <0.001) PTTN patients received repeated and frequent head and neck imaging (mean number of imaging investigations per patient was 10 ± 12). Medication consumption was high, with an unwarranted higher use of opioids and antibiotics in persistent PTTN patients. Within the limitations of this study, it seems there is a need for informing patients in detail on the inherent risks of nerve damage during dental and oromaxillofacial procedures. Every surgery should be preceded by a risk-benefit assessment in order to avoid unnecessary nerve damage. [ABSTRACT FROM AUTHOR]

In cloud computing environment tasks are allocated among virtual machines (VMs) having different length, starting time and execution time. Therefore, balancing these loads among VM is a key factor. Load balancing has to be carried out in such a manner that all VMs should have balanced to achieve optimal utilization of its capabilities and improve the system performance. In this paper, we proposed a load balancing technique by using modified PSO task scheduling (LBMPSO) to schedule tasks over the available cloud resources that minimizes the makespan and maximizes resource utilization. This is achieved by having proper information among the tasks and resources within the datacenter. Our proposed scheduling algorithm is implemented by using CloudSim simulator. Simulation results clearly shows that proposed scheduling algorithm performs better in reducing makespan and increases the resource utilization than other existing techniques. [ABSTRACT FROM AUTHOR]

• The International Classification of Disease Critical Care Severity Score (ICASS) is a resource-based severity of injury metric. • ICASS, scored on a 0–100 point scale, is highly predictive of actual critical care utilization. • ICASS can be calculated from existing administrative data, without requiring a trauma registry. • ICASS captures burden of injury in children more fully than existing mortality-based metrics. • Resource-based metrics can help evaluate triage tools in regional pediatric trauma systems. Resource-based severity of injury (SOI) measures, such as the International Classification of Disease (ICD) Critical Care Severity Score (ICASS), may characterize traumatic burden better than standard mortality-based measures. The purpose of this study was to validate the ICASS in a representative national-level trauma cohort and compare SOI measures between children and adults. The National Trauma Databank was used to derive (2008–12) and validate (2013–15) ICASS and ICD Injury Severity Scores (ICISS, standard mortality-based SOI measure). SOI metrics and outcomes were compared between pediatric, adult, and elderly age groups. Logistic regression modeling evaluated predictors of critical care resource utilization. Derivation and validation cohorts consisted of 3.90 and 1.97 million patients, respectively. ICASS strongly predicted actual critical care utilization (OR 1.04, 95% CI 1.04–1.04, p <0.0001). Mean ICASS was 24.4 for children and 33.0 for adults (ratio 0.74), indicating predicted critical care utilization in children was three-quarters that of adults. In contrast, predicted pediatric mortality was less than half that of adults. Mortality-based SOI measures underestimate pediatric burden of injury. This study validates ICASS and demonstrates that pediatric resource-based SOI is more similar to that of adults. ICASS is easily calculated without a trauma registry and complements mortality-based measures. Level of evidence III, retrospective comparative study [ABSTRACT FROM AUTHOR]

Background: Patients with burn injuries cause significant healthcare economic burden, often utilising extra-hospital resources, caregiving, and specialized care.Methods: We present a retrospective cohort analysis of the hospitalized patients in the USA with a primary diagnosis of burn injury. Opioid dependence was identified using ICD-10 CM codes. The 30-day all-cause readmission rate was the main outcome while secondary outcomes were inhospital mortality rate, resource utilization which included hospital length of stay, total hospitalization costs and charges and surgical procedures for burn injury treatment as well as the most important five principal diagnoses for admission and readmission.Results: Out of 22,348 patients included in the study, 597 had opioid dependence. Older patients (43 years, range: 38.6-47.2 years) as well as males (70.8%) were more likely to be opioid dependent. Opioid dependence was associated with higher 30-day readmission rates (aOR: 1.83, 95% confidence interval (CI): 1.30-2.57, p-value: <0.01), higher total hospitalization costs (aMD: $14,981, CI: $3820-$26,142, p-value: 0.01), total hospitalization charges (aMD: $47,078, CI: -$5093 to $89,063, p-value: 0.03), and a shorter mean length of stay (aMD: 5.13 days, CI: 2.60-7.66, p-value: <0.01). However, patients with and without opioid dependence had similar in-hospital mortality rates (aOR: 0.27, CI: 0.06-1.28, p-value: 0.10).Conclusion: We are the first to our knowledge to report the association of treatment outcomes and opioid dependence in patients hospitalized at the national level with a burn injury. We show that there were higher 30-day all-cause readmission rates and in-hospital resource utilization among patients with opioid-dependence. [ABSTRACT FROM AUTHOR]

Background: Frailty and increasing age are well-established risk factors in patients undergoing total hip arthroplasty (THA). However, these variables have only been considered independently. This study assesses the interplay between age and frailty and introduces a novel age-adjusted modified frailty index (aamFI) for more refined risk stratification of THA patients.Methods: The American College of Surgeons National Surgical Quality Improvement Program database was queried from 2015 to 2019 for patients undergoing primary THA. First, outcomes were compared between chronologically younger and older frail patients. Then, to establish the aamFI, one additional point was added to the previously described mFI-5 for patients aged ≥73 years (the 75th percentile for age in our study population). The association of aamFI with postoperative complications and resource utilization was then analyzed categorically.Results: A total of 165,957 THA patients were evaluated. Older frail patients had a higher incidence of complications than younger frail patients. Regression analysis demonstrated a strong association between aamFI and complications. For instance, an aamFI of ≥3 (compared to aamFI of 0) was associated with an increased odds of mortality (OR: 22.01, 95% confidence interval [CI] 11.62-41.68), any complication (OR: 3.50, 95% CI 3.23-3.80), deep vein thrombosis (OR: 2.85, 95% CI 2.03-4.01), and nonhome discharge (OR 9.61, 95% CI 9.04-10.21; all P < .001).Conclusion: Chronologically, older patients are impacted more by frailty than younger patients. The aamFI accounts for this and outperforms the mFI-5 in prediction of postoperative complications and resource utilization in patients undergoing primary THA. [ABSTRACT FROM AUTHOR]

Ascites and hyponatremia are important milestones of worsening portal hypertension in those with cirrhosis. The objective of our study was to evaluate the differences in clinical characteristics, resource utilization, and disposition of hospitalized cirrhotic patients with ascites with and without hyponatremia. The National Inpatient Sample (NIS) database was used to identify all adult hospitalized patients with a diagnosis of cirrhosis and ascites with or without hyponatremia from 2016 to 2017 using ICD-10 codes. During the study period, 10,187 (7.6%) hospitalized patients with cirrhosis had ascites and hyponatremia and 34,555 (24.3%) had ascites but no hyponatremia. Elixhauser comorbidity score, excluding liver disease, was higher in hyponatremic patients (median 21 vs. 12, P < 0.001). Acute kidney injury (50.3% vs. 32.8%, P < 0.001) and sepsis (16.8% vs. 11.8%, P < 0.001) were more common in hyponatremic patients compared to those without hyponatremia. Similarly, acute respiratory failure, coagulopathy, hepatorenal syndrome, spontaneous bacterial peritonitis, acute (on chronic) liver failure, and liver cancer were more common in hyponatremic patients. Hyponatremia patients had a higher number of inpatient procedures, longer (6 days vs. 4 days, P < 0.001) hospital stay, and had higher hospital charges ($97,327 vs. $72,278, P < 0.01) than those without hyponatremia. Inpatient mortality was 38% higher in hyponatremic patients (9.8% vs. 7.1%, P < 0.001) compared to those without hyponatremia. Additionally, hyponatremic patients were less likely to have routine home discharges with self-care. In conclusion, using a large and diverse national cohort of unselected patients, we were able to show that hyponatremia in patients with cirrhosis and ascites is associated with poor clinical outcomes and increased resource utilization. [ABSTRACT FROM AUTHOR]