Search

Background Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. Methods An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. Results The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder. Conclusions The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities., For patients with acute COVID-19 pneumonia who require oxygen support, the International Task Force made suggestions for remdesivir and dexamethasone, but against hydroxychloroquine. Post-discharge management of COVID-19 survivors is a research priority. https://bit.ly/32B96uI

In industrial applications, filter materials are often chosen according to cost as well as their processing and thermomechanical properties, but rarely in terms of their behavior during filtration, which is largely due to there being insufficient information available on the influence of filter materials and surface quality on filtration behavior. In this study, the manufacture of functionalized Al2O3 nanofilters was investigated, along with their filtration performance in short- and long-term filtration trials. In addition, sessile drop tests were performed to measure the contact angle of the nanofunctionalized materials, and yielded an approximately 10 deg (11 pct) higher contact angle for nanocoated materials sintered at 800 °C and 1250 °C than for those sintered at 1600 °C and an approximately 23 deg (23 pct) higher contact angle compared to surfaces without a nanocoating. The filtration mechanism was assessed by means of Porous Disk Filtration Analysis (PoDFA) and Liquid Metal Cleanliness Analyzer (LiMCA) monitoring systems, as well as by analysis of the used and infiltrated filters using Scanning Electron Microscopy and Energy Dispersive X-ray analysis (SEM/EDX) technology. Both short-term and long-term filtration trials showed that the filtration behaviors of the reference and nanocoated filters were comparable. It was therefore determined that nanocoating of such filters with Al2O3 does not provide any improvement with regard to filtration performance.

In this work, cement-free alumina castables with different fiber additives were produced. The effect of commercial polypropylene fibers was compared to that of magnesium borate precursor fibers produced by electrospinning. The drying behavior of different batches was monitored by means of thermogravimetry. Elastic moduli were estimated in dried, sintered and thermally-shocked samples through the impulse excitation technique. The mechanical strength as cold modulus of rupture (CMOR) was measured by three-point bending tests. The open porosity and bulk density after sintering were assessed by water immersion. The thermal shock resistance was evaluated by heating the samples up to 950 ∘C and then quenching with compressed air. After 1 or 5 thermal shock cycles, the residual CMOR was determined. The microstructure of fracture surfaces was analyzed by scanning electron microscopy (SEM). The possible formation of new phases during thermal treatment was also assessed by means of XRD. Finally, the refractoriness under load was measured.

The current paper focuses on the fabrication of yttria and magnesia stabilized zirconia nanofibers via electrospinning from zirconyl chloride octahydrate and polyvinylpyrrolidone precursors with minor additions of yttrium nitrate hexahydrate (3 mol.%) or magnesium nitrate hexahydrate (10 mol.%). The precursor materials were dissolved in an ethanol-water mixture in a ratio of 75:25. After successful fiber preparation, the thermal decomposition behavior of the starting materials and the subsequent phase evolution at elevated temperatures were studied. Pure tetragonal zirconia nanofibers were obtained for the composition stabilized with 3 mol.% yttria when the thermal treatment was conducted with a heating rate of 10 K/min up to 1100 °C. In future research work, these tetragonal zirconia nanofibers will be used as reinforcing material in metal matrix composites based on metastable austenitic steel. The combination of the TRIP/TWIP-effect in the steel matrix with the stress-assisted tetragonal to monoclinic phase transformation in the tetragonal stabilized zirconia will lead to a composite material with outstanding mechanical properties.

ImportanceData on the association of COVID-19 vaccination with intensive care unit (ICU) admission and outcomes of patients with SARS-CoV-2–related pneumonia are scarce.ObjectiveTo evaluate whether COVID-19 vaccination is associated with preventing ICU admission for COVID-19 pneumonia and to compare baseline characteristics and outcomes of vaccinated and unvaccinated patients admitted to an ICU.Design, Setting, and ParticipantsThis retrospective cohort study on regional data sets reports: (1) daily number of administered vaccines and (2) data of all consecutive patients admitted to an ICU in Lombardy, Italy, from August 1 to December 15, 2021 (Delta variant predominant). Vaccinated patients received either mRNA vaccines (BNT162b2 or mRNA-1273) or adenoviral vector vaccines (ChAdOx1-S or Ad26.COV2). Incident rate ratios (IRRs) were computed from August 1, 2021, to January 31, 2022; ICU and baseline characteristics and outcomes of vaccinated and unvaccinated patients admitted to an ICU were analyzed from August 1 to December 15, 2021.ExposuresCOVID-19 vaccination status (no vaccination, mRNA vaccine, adenoviral vector vaccine).Main Outcomes and MeasuresThe incidence IRR of ICU admission was evaluated, comparing vaccinated people with unvaccinated, adjusted for age and sex. The baseline characteristics at ICU admission of vaccinated and unvaccinated patients were investigated. The association between vaccination status at ICU admission and mortality at ICU and hospital discharge were also studied, adjusting for possible confounders.ResultsAmong the 10 107 674 inhabitants of Lombardy, Italy, at the time of this study, the median [IQR] age was 48 [28-64] years and 5 154 914 (51.0%) were female. Of the 7 863 417 individuals who were vaccinated (median [IQR] age: 53 [33-68] years; 4 010 343 [51.4%] female), 6 251 417 (79.5%) received an mRNA vaccine, 550 439 (7.0%) received an adenoviral vector vaccine, and 1 061 561 (13.5%) received a mix of vaccines and 4 497 875 (57.2%) were boosted. Compared with unvaccinated people, IRR of individuals who received an mRNA vaccine within 120 days from the last dose was 0.03 (95% CI, 0.03-0.04; P P P P P o2) and fraction of inspiratory oxygen (FiO2) at ICU admission (median [IQR]: 138 [100-180] vs 120 [90-158] mm Hg; P = .007). Factors associated with ICU and hospital mortality were higher age, premorbid heart disease, lower Pao2/FiO2 at ICU admission, and female sex (this factor only for ICU mortality). ICU and hospital mortality were similar between vaccinated and unvaccinated patients.Conclusions and RelevanceIn this cohort study, mRNA and adenoviral vector vaccines were associated with significantly lower risk of ICU admission for COVID-19 pneumonia. ICU and hospital mortality were not associated with vaccinated status. These findings suggest a substantial reduction of the risk of developing COVID-19–related severe acute respiratory failure requiring ICU admission among vaccinated people.

Calcium zirconate fibers were produced by electrospinning and characterized in this work. The solution was prepared from zirconium and calcium salts, using polyvinyl-pyrrolidone (PVP) as processing aid. The decomposition of the organic fraction and crystallization of calcium zirconate were followed by thermogravimetry and differential scanning calorimetry (TG/DSC). Raman Spectroscopy was used to measure the vibrational modes in the green as well as in the calcined fibers. The final phase composition was studied by means of X-ray diffraction (XRD). The fiber morphology was investigated by confocal laser scanning microscopy (CLS) and scanning electron microscopy (SEM). The formation reaction of calcium zirconate was observed at about 740 °C. Highly crystalline fibers were obtained already at 800 °C, but the crystallinity and calcium zirconate yield improved when the temperature was increased to 1000 °C.

New carbon-bonded alumina filters for steel melt filtration were developed. The carbonaceous matrix was based on a new, environmental friendly binder system based on lactose and tannin. The filter preparation was analogous to the production of conventional foam filters according to the Schwartzwalder process. The processing as well as the rheology of the slurries was investigated. An addition of n-Si increased the carbon yield and the cold crushing strength (CCS) of the samples. Higher values of CCS were obtained after coating of the filters with alumina. The material was characterized by scanning electron microscopy, X-ray diffraction and Raman spectroscopy. The applicability of these new filters was assessed in impingement tests with a steel melt, in which three out of four recipes survived the thermal shock.

In this paper, a unique nano-coating consisting of a mixture of graphene oxide and multi-walled carbon nanotubes was applied on carbon-bonded alumina substrates. Graphene oxide (GO) was prepared according to the modified Tour's method. GO in combination with carbon nanotubes (CNTs) and modified coal tar pitch was spray-coated on conventional carbon-bonded alumina material for investigations in contact with steel. Temperature and time-dependent experiments were performed in a hot stage microscope to analyze the wetting behavior. The microstructures of the substrates before and after heating were compared by scanning electron microscopy. The results showed that the coating containing both GO and CNTs delivered a fast stabilization of the wetting angle with low wettability towards the metal melt. Similar coatings may offer an innovative approach to improve purification of steel melts by filtration in the steel industry.

Aim Ventricular fibrillation amplitude spectral area (AMSA) and end-tidal carbon dioxide (ETCO2) are predictors of shock success, understood as restoration of an organized rhythm, and return of spontaneous circulation (ROSC). However, little is known about their combined use. We aimed to assess the prediction accuracy when combined, and to clarify if they are correlated in out of hospital cardiac arrest' victims. Materials and Methods Records acquired by external defibrillators in out-of-hospital cardiac arrest patients of the Lombardia Cardiac Arrest registry were processed. The 1-min pre-shock ETCO2 median value (METCO2) was computed from the capnogram and AMSA (2–48 mV.Hz range) computed applying the Fast Fourier Transform to a 2-second pre-shock filtered ECG interval (0.5−30 Hz). Support Vector Machine (SVM) predictive models based on METCO2, AMSA and their combination were fit; results were given as the area under the curve (AUC) of the receiver operating characteristic (ROC) curves. Results We considered 112 patients with 391 shocks delivered. METCO2 and AMSA were predictors of shock success [AUC (IQR) of the ROC curve: 0.59 (0.56−0.62); 0.68 (0.65−0.72), respectively] and of ROSC [0.56 (0.53−0.59); 0.74 (0.71−0.78),]. Their combination in a SVM model increased the accuracy for predicting shock success [AUC (IQR) of the ROC curve: 0.71 (0.68−0.75)] and ROSC [0.77 (0.73−0.8)]. AMSA and METCO2 were significantly correlated only in patients who achieved ROSC (rho = 0.33 p = 0.03). Conclusions AMSA and ETCO2 predict shock success and ROSC after every shock, and their predictive power increases if combined. Notably, they were correlated only in patients who achieved ROSC.

The “gold” standard radiological method for the diagnosis of the lung findings in COVID-19 patients is known to be the chest high-resolution computed tomography. However, in a mass casualty scenario, as in times of COVID-19 epidemics, in which emergency departments, intensive care units, and whole hospitals are massive overcrowded and continue to change their original configuration, a more rapid, flexible, and performant diagnostic approach is required. Moreover, the high contagiousness of these patients and the risk of transporting critical patients make chest computed tomography (CT) a limited option for them. Lung ultrasonography, a rapid, reliable, bedside, nonradiating and repeatable examination, with its sensitivity closed to chest CT and much higher than the chest X-ray for COVID patients, has proved to be in COVID-19 pandemic as crucial diagnostic and monitoring tool of patients with acute respiratory failure. It could be performed in the prehospital setting, in the emergency department (as part of the diagnostic approach), up to the normal wards and the intensive care unit. The aim of this article is to describe the central role of LUS in the management of COVID-19 critically ill patients with acute respiratory distress syndrome, as valid diagnostic and monitoring point-of-care technique.

The aim of this paper is to prepare nano-functionalized ceramic foam filters from carbon-bonded alumina. The carbon-bonded filters were produced via the Schwartzwalder process using a two-step approach. The prepared ceramic foam filters were further coated using graphene oxide. Graphene oxide was prepared by the modified Tour method. The C/O of the graphene oxide ratio was evaluated by XPS, EDS and elemental analysis (EA). The amount and type of individual oxygen functionalities were characterized by XPS and Raman spectroscopy. The microstructure was studied by TEM, and XRD was used to evaluate the interlayer distance. In the next step, filters were coated by graphene oxide using dip-coating. After drying, the prepared composite filters were used for the purification of the water containing lead, zinc and cadmium ions. The efficiency of the sorption was very high, suggesting the potential use of these materials for the treatment of wastewater from heavy metals.

The novel coronavirus (COVID-19) began in China in early December 2019 and rapidly has spread to many countries around the globe, with the number of confirmed cases increasing every day. An epidemic has been recorded since February 20 in a middle province in Northern Italy (Lodi province, in the low Po Valley). The first line hospital had to redesign its logistical and departmental structure to respond to the influx of COVID-19-positive patients who needed hospitalization. Logistical and structural strategies were guided by the crisis unit, managing in 8 days from the beginning of the epidemic to prepare the hospital to be ready to welcome more than 200 COVID-19-positive patients with different ventilatory requirements, keeping clean emergency access lines, and restoring surgical interventions and deferred urgent, routine activity.

Patients with COVID-19 present a broad spectrum of clinical presentation. Whereas hypoxaemia is the marker of severity, different strategies of management should be customised to five specific individual phenotypes. Many intubated patients present with phenotype 4, characterised by pulmonary hypoxic vasoconstriction, being associated with severe hypoxaemia with “normal” (>40 mL·cmH2O−1) lung compliance and likely representing pulmonary microvascular thrombosis. Phenotype 5 is often associated with high plasma procalcitonin and has low pulmonary compliance, Which is a result of co-infection or acute lung injury after noninvasive ventilation. Identifying these clinical phenotypes and applying a personalised approach would benefit the optimisation of therapies and improve outcomes., SARS-CoV-2 infections present different specific individual phenotypes. Applying a personalised approach would benefit in optimisation of therapies and outcome improvement. #COVID19 https://bit.ly/3akTSuf

Highlights • Simple mathematics for medical doctors and decision-makers under covid-19 emergency • Regression models describe the evolution of intensive care patients and fatalities • Proposed models allow predicting both short- and long-term horizon scenarios • Key values and dates of the Covid-19 phenomenon can be predicted easily • An Excel file is available in the supplement material for dynamic forecasts, The different stages of Covid-19 pandemic can be described by two key-variables: ICU patients and deaths in hospitals. We propose simple models that can be used by medical doctors and decision makers to predict the trends on both short-term and long-term horizons. Daily updates of the models with real data allow forecasting some key indicators for decision-making (an Excel file in the Supplemental material allows computing them). These are beds allocation, residence time, doubling time, rate of renewal, maximum daily rate of change (positive/negative), halfway points, maximum plateaus, asymptotic conditions, and dates and time intervals when some key thresholds are overtaken. Doubling time of ICU beds for Covid-19 emergency can be as low as 2-3 days at the outbreak of the pandemic. The models allow identifying the possible departure of the phenomenon from the predicted trend and thus can play the role of early warning systems and describe further outbreaks., Graphical Abstract Image, graphical abstract

This paper focused on the nano-functionalization of carbon-bonded alumina using graphene oxide (GO) and multi-walled carbon nanotubes (MWCNTs). GO was prepared according to the modified Tour's method. The rheology of suspensions containing GO, CNTs and both substances were analyzed and discussed. Xanthan proved to be a suitable stabilizer for the three systems. The spraying process of the suspensions was investigated with the aid of a high-speed camera. Al2O3-C filters and flat samples were spray coated, for investigations in contact with steel. The ceramic foam filters as well as the starting suspensions were analyzed by several analytic techniques to investigate the microstructure and other properties. Moreover, the hot stage microscope was used to study the steel/coating wetting behavior during operation at high temperatures. The results showed that the formulation containing both GO and CNTs delivered the best performance in contact with the melt. Similar coatings based on these nano-sized materials may offer an innovative route to improve purification of steel melts by filtration.

Carbon-bonded alumina refractories offer excellent thermal shock performance but are lacking in terms of mechanical strength. In the present contribution, the influence of the particle packing and the addition of graphene oxide (GO) to carbon-bonded alumina refractories on the physical and mechanical properties before and after thermal shock was investigated. Coarse tabular alumina grains were coated by a GO suspension and used to prepare dry-pressed compacts. The included graphite fraction (15 wt%) was either regarded as a lubricating matrix component or as a quasi-spherical component of a calculated density-optimized aggregate size distribution. During coking, the GO was reduced to thermally reduced graphene. The porosity, true density and thermal shock behavior in terms of the cold modulus of rupture (CMOR) and Young’s modulus were compared. Samples with a higher density were obtained when the irregularly shaped graphite was considered as the matrix component (lubricant). The results showed that the use of GO had a positive impact on the mechanical properties of the graphene-reinforced Al2O3–C refractories, especially in the case of a less optimized packing, due to the bridging of delamination gaps. In addition, the thermal shock only had a minor impact on the Young’s modulus and CMOR values of the samples. SEM investigation revealed very similar microstructures in coked as well as thermally shocked samples.

Full metal-ceramic composite beads containing different amounts of niobium and alumina, particularly 100 vol% alumina, 100 vol% niobium, and 95/5 vol% niobium/alumina, were produced by the alginate gelation process. The suspension for bead fabrication contained sodium alginate as gelling agent and was added dropwise into a calcium chloride solution to trigger the consolidation process. After debinding in air, sintering of the composite beads was performed under inert atmosphere. Samples in green and sintered state were analyzed by digital light microscopy and scanning electron microscopy equipped with energy dispersive X-ray spectroscopy. Investigations by mercury intrusion porosimetry revealed that pure alumina beads featured smaller pores compared to composite beads, although the open porosities were comparable. The fracture strength was evaluated on single beads. Contrary to the pure alumina, the composite beads showed a clear plastic deformation. Pure niobium beads showed a ductile behavior with very large deformations. XRD analyses revealed the presence of calcium hexaluminate and beta-alumina as minor phases in the alumina beads, while the composite ones contained about 25 wt% of impurities. The impurities comprised NbO arising from the oxidation, and β-Nb2C, from the reaction with the residual sodium alginate.

A substantial number of patients are at high-risk of intra- or post-operative complications or both. Most perioperative deaths are represented by patients who present insufficient physiological reserve to meet the demands of major surgery. Recognition and management of critical high-risk surgical patients require dedicated and effective teams, capable of preventing, recognize, start treatment with adequate support in time to refer patients to the satisfactory ICU level provision. The main task for health-care planners and managers is to identify and reduce this severe risk and to encourage patient’s safety practices. Inadequate tissue perfusion and decreased cellular oxygenation due to hypovolemia, heart dysfunction, reduced cardiovascular reserve, and concomitant diseases are the most common causes of perioperative complications. Hemodynamic, respiratory and careful sequential monitoring have become essential aspects of the clinical practice both for surgeons and intensivists. New monitoring techniques have changed significantly over the past few years and are now able to rapidly identify shock states earlier, define the etiology, and monitor the response to different therapies. Many of these techniques are now minimally invasive or non-invasive. Advanced hemodynamic and respiratory monitoring combines invasive, non-invasive monitoring skills. Non-invasive ultrasound has emerged during the last years as an essential operative and perioperative evaluation tool, and its use is now rapidly growing. Perioperative management guided by appropriate sequential clinical evaluation combined with respiratory and hemodynamic monitoring is an established tool to help clinicians to identify those patients at higher risk in the attempt to reduce the complications rate and potentially improve patient outcomes. This review aims to provide an update of currently available standard concepts and evolving technologies of the various respiratory and hemodynamic monitoring systems for the high-risk surgical patients, highlighting their potential usefulness when integrated with careful clinical evaluation.

Magnesium borate fibers were prepared by electrospinning technique (and following calcination) from sol–gel precursors, using polyvinyl-pyrrolidone (PVP) as processing aid. Phase-pure fibers of about 6 μm in diameter were obtained by high temperature calcination of the inorganic–organic composite mats. The samples thus prepared were characterized by means of SEM, XRD and FT-IR, respectively. The concentration of the initial solution influenced only the fiber diameter in the green samples, while the final dimension after ceramization was related to the formation of new porous fibers in a preferential direction. This phenomenon resulted from some orientation already present in the green mats, and from the softening and densification of the fibers after decomposition of the PVP. An incomplete crystallization of the samples was observed after heat treatment at 800 °C, with a residual glassy phase due to the Mg modification of the B2O3 network. Fully crystalline fibers were obtained from the mats calcined at 1000 °C.

Despite numerous descriptions of body abscesses produced by Streptococcus milleri group bacteria, lung abscesses caused by this group remain under-reported and the clinical and laboratory features have yet to be fully characterised. We present the case of a patient admitted with lung multiple abscesses produced by Streptococcus constellatus.

The influence of different heating rates as well as different atmospheres on magnesium borate fibers produced by electrospinning was investigated in this work. The green fibers were prepared from sol–gel precursors, using polyvinyl-pyrrolidone (PVP) as processing aid. Crystalline fibers with the typical necklace structure and average diameter in the range 300–500 nm were produced when heating up to 900 °C in air. The main phase detected by XRD analysis was in this case Mg2B2O5. On the other hand, the fibers slowly heated in reducing atmosphere to 800 °C exhibited similar dimension but a different morphology. The crystalline grains were presumably smaller, hence the necklace effect was absent. This sample also revealed a much higher specific surface area in comparison to the samples calcined in air. Mg3B2O6 was here the main crystalline phase, while a part of boron was lost during the thermal treatment.

Yttrium silicate and oxonitridosilicate ceramic powders have been successfully prepared by heat treatment, at 1300–1400 °C, of a silicone resin embedding Y 2 O 3 nano-sized particles as reactive fillers. Nano-sized RE-oxides (Eu 2 O 3 , CeO 2 ), used as secondary additives, promoted the development of apatite phase, in both air and N 2 atmosphere. For treatments in nitrogen, the only crystal phase consisted of yttrium nitrogen apatite, mixed with amorphous silicon oxycarbide (SiOC). Eu-doped and Ce-doped yttrium silicates were characterized by means of UV–visible luminescence and ion beam induced luminescence (IBIL). Strong luminescence features were observed, depending on the conditions of thermal treatment.

Ceramic foam filters (CFFs) have been used by steel foundries for several years to remove non-metallic inclusions from the metal castings. In order to improve their filtration efficiency, promising approaches which involve “active” and “reactive” coatings applied on the filters have recently been proposed. In this work, a new coating system containing multi-walled carbon nanotubes (MWCNTs) is presented. A special water-based dispersing technique for carbon nanotubes was developed. Xanthan gum was used both as a dispersing agent and as a rheology modifier for the spraying slurries. The synthetic coal tar pitch Carbores® P was added as a binder for the carbon nanotubes. The coatings were cold-applied on 10 pores per inch (ppi) carbon-bonded alumina filters previously manufactured via the Schwartzwalder process. After drying, the samples were heat treated at 800 °C. The performance of the coated filters was investigated with the aid of a special steel casting simulator in fully-controlled atmosphere.

Carbon-bonded ceramic foam filters with different functional coatings are immersed in a 42CrMo4 steel melt within a steel casting simulator. The solidified steel is analyzed with respect to the size distribution and the chemical composition of the remaining nonmetallic inclusions (NMI). Cyclic loading and quasi-static tests are performed to determine the fatigue limit, the strength, deformability, and toughness of the steel after filter immersion. The immersion of filter with calcium hexaluminate (CA6) coating significantly reduces the population of small (4–20 μm) NMIs. This leads to an increased deformability and, thus, ability for energy dissipation during deformation. However, the maximum size of NMIs is increased from 100 to 150 μm, which results in fatigue limit reduction, despite the decrease in NMIs total density. The majority of inclusions are found to be pure alumina. Large (up to 150 μm) plate-like alumina inclusions introduce most of the detrimental effects on cyclic strength, whereas significant effect on quasi-static strength is not found.