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Background: Physical examination and computed tomography angiography (CTA) are used for diagnosing arterial injury in extremity trauma. In recent years, CTA has been overused to obtain more objective data. Our study aimed to investigate the effect of using CTA for the management of patients with extremity penetrating injuries, specifically in cases where vascular injury was not detected during initial examination. Methods: This retrospective study included patients with penetrating trauma who underwent CTA of the extremities. The demographic data, mechanism of injury, the side of injury, initial vascular exam (normal, soft signs, and hard signs), radiological results, and any orthopedic and vascular intervention performed were recorded. The χ2 test was used for independent variables. A significance level of p < 0.05 was used. We compared the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) for physical exam and CTA for identifying arterial injury requiring intervention. Results: Of the 252 patients included in the study, 29 (21.5%) had abnormal vascular physical examination while 26 (10.3%) had an abnormal CTA. The NPV of the hard sign for identifying vascular injury was 95.4%, while the sensitivity was 57.7%, specificity was 100%, and PPV was 100%. The NPV of routine physical examination to determine the requirement for vascular intervention was 100%. The sensitivity and PPV of the soft sign in determining the need for vascular intervention were 65.4% and 77.3%, respectively. Conclusion: Vascular injury was present in all cases that had positive hard signs. CTA imaging and vascular intervention are not necessary in patients who exhibit no hard and/or soft indicators during a thorough physical examination. [ABSTRACT FROM AUTHOR]

A net zero transition is likely to generate substantial and irreversible economic transformation. High-carbon industries and their related occupations will disappear, while new low-carbon industries and occupations will be created. In the aggregate, the impact of the transition on GDP and employment is commonly projected to be relatively moderate. However, such estimates hide drastic distributional issues that are sectorally and regionally concentrated. We use three sectorally detailed and regionally disaggregated macroeconomic models to explore the possible levels and impacts of structural change in a well below 2°C scenario. In addition to the expected decline in the carbon-intensive industries, we observe secondary impacts, particularly in the services sectors, that vary significantly between models. The risks entailed with structural change involve worsening economic disparity and societal division that could exacerbate existing socioeconomic and political polarisation. Impact assessments of decarbonisation should consider such distributional issues to avoid post-industrial decline and widening socioeconomic inequalities. [ABSTRACT FROM AUTHOR]

Energy Service Companies (ESCos) can help energy users, companies, industries, and commercial sectors in improving the efficiency of equipment by providing energy service (energy performance and/or credit risk). ESCos were implemented quite successfully for promoting energy efficiency (EE) in many European countries and other developed countries such as the USA, Canada, and Japan. However, developing countries should improve ESCo implementation. This raised the question of potential barriers to use ESCo for energy efficiency programs in developing countries. To successfully implement and operate ESCo in developing countries like Indonesia, it is crucial to study and understand the opportunities and challenges encountered in running energy efficiency program. The aims of this study are to understand and verify the strengths, weaknesses, opportunities and threats of developing markets for energy service companies in Indonesia. This is achieved by surveying the key stakeholders in the industry, financial institution and policymakers and identifying significant factors such as regulatory, financial, and awareness aspects for decision-makers. The key findings of the research are that strong policy regulation and financial incentives can improve the development of ESCos due to huge investment opportunities for energy efficiency projects in Indonesia. • The development of ESCOs is in great demand as countries strive to achieve energy efficiency. • ESCOs would help the promotion of Energy efficiency in Indonesia. • Strong policy regulation and financial incentives can improve the development of ESCOs in Indonesia. [ABSTRACT FROM AUTHOR]