Driven by the ever-growing awareness of sustainability and circular economy, renewable, biodegradable, and recyclable fiberbased packaging materials are emerging as alternatives to fossil-derived, nonbiodegradable single-use plastics for the packaging industry. However, without functional barrier coatings, the water/moisture vulnerability and high permeability of fiber-based packaging significantly restrain its broader application as primary packaging for food, beverages, and drugs. Herein, we develop waterborne complex dispersion barrier coatings consisting of natural, biodegradable polysaccharides (i.e., chitosan and carboxymethyl cellulose) through a scalable, one-pot mechanochemical pathway. By tailoring the electrostatic complexation, the key element to form a highly crosslinked and interpenetrated polymer network structure, we formulate complex dispersion barrier coatings with excellent film-forming property and adaptable solid-viscosity profiles suitable for paperboard and molded pulp substrates. Our complex dispersions enable the formation of a uniform, defect-free, and integrated coating layer, leading to a remarkable oil and grease barrier and efficient water/moisture sensitivity reduction while still exhibiting excellent recyclability profile of the resulting fiber-based substrates. This natural, biorenewable, and repulpable barrier coating is a promising candidate to serve as a sustainable option for fiber-based packaging intended for the food and food service packaging industry.

Assessing the risk of acute kidney injury (AKI) has been a challenging issue for clinicians in an intensive care unit (ICU) as AKI could lead to many complications and even fatality. However, several early signs of AKI are non-specific and the current clinical practice monitors only the level of serum creatinine and the volume of urine output. Therefore, it is of great medical merit to identify all possible risk factors of AKI. In recent years, a number of studies have reported the associations between several serum electrolytes and AKI. Nevertheless, the compound effects of serum creatinine, blood urea nitrogen (BUN), and clinically relevant serum electrolytes have not been comprehensively investigated. Accordingly, we initiated this study aiming to develop machine learning models that not only illustrate how these factors interact with each other but also provide new insights for developing new clinical practices to assess AKI risk. Our analyses reveal that among the factors investigated the levels of serum creatinine, chloride, and magnesium are the major risk factors associated with the development of AKI in ICUs.

Introduction: The patient outcome after OHCA is poor. Return to spontaneous circulation (ROSC) dramatically decreases with the duration of CPR. It has been proposed to implement extracorporeal membrane oxygenation in order to assist CPR (ECPR) in OHCA. Objective: To investigate the effects of ECPR in emergency (ED) for OHCA. Methods: A prospective 4-year observational database collected from a community-wide OHCA registry in an urban EMS was studied. The EMS ambulance staffs were capable with advanced airway, intravenous (iv) fluid skills, basic and advanced life support and AED techniques. Outcomes included 2-hour and 24-hour sustained ROSC, survival (SD) and cerebral performance category scale (CPC) at discharge. OHCA receiving ECPR were included and their pre-hospital (pre-H) and hospital (H) characteristics and outcomes were evaluated by regression analysis. Results: In the 4 years among a total of 7,220 OHCA resuscitated in ED, ECPR was used 88 times (90% male, median age 54 [IQR 44-63]), 90% non-traumatic, 58.6% arrest witnessed, 50.6% with bystander CPR, up to 72.6% initial AED rhythm showing shockable, 54% with LMA (laryngeal mask airway), 5.7% with endotracheal intubation, 18.2% with pre-H iv epinephrine, and 12.5% of them received therapeutic hypothermia. Pre-H time intervals (min:sec, median [IQR]) were 04:38 [03:30-06:08] for response, 13:00 [10:05-16:00] for scene, and 03:08 [02:09-05:00] for transport. Only 10.2% of cases presented pre-H ROSC and 9.1% got ROSC upon H arrival. Outcomes were 88.6% for 2-hr ROSC, 69.3% for 24-hr ROSC, 39.1% for SD, and 21% for good CPC 1or2 respectively. Patients with CPC 1or2 tended to be younger (median age 46.8 vs. 55.9, p=0.04) and less with LMA (29.4 vs. 61.9%, p=0.02). Conclusions: ECPR can lead to survival and good neurological outcome in selected OHCA regardless of positive ROSC at pre-H or upon H arrival after EMS resuscitation. Elder age and pre-H LMA may be adverse to neurological outcome for OHCA with ECPR.

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