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To expand the application field of the pulping industry, this study conducted a series of sample preparations for processing cellulose nanocrystals (CNCs) from a dry hardwood pulp to achieve optimal sulfuric acid hydrolysis. The properties of laboratory-prepared pulp CNCs (P-CNCs) were investigated with different preparation conditions including sulfuric acid concentrations, hydrolysis temperatures, and hydrolysis durations. Results showed a gradient of color changes observed with the increase of hydrolysis duration and temperature. Under certain conditions, the derived P-CNCs exhibited nanoscale dimensions, detected by transmission electron microscopy, and a crystallinity index similar to commercial products. In addition, the surface sulfate groups were assumed to be contributed by sulfuric acid hydrolysis. However, a high acid concentration and long hydrolysis processing duration introduced more sulfate groups on the derived P-CNCs, which may have acted as flame retardants and, thus, increased the amount of char residue.

With the proliferation of image-capturing and display-enabled IoT devices, ensuring the authenticity and integrity of visual data has become increasingly critical, especially in light of emerging cybersecurity threats and powerful generative AI tools. One of the major challenges in such sensor-based systems is the ability to protect privacy while maintaining data usability. Reversible data hiding has attracted growing attention due to its reversibility and ease of implementation, making it a viable solution for secure image communication in IoT environments. In this paper, we propose reversible data hiding techniques tailored to the content characteristics of images. Our approach leverages subsampling and quadtree partitioning, combined with multi-stage prediction schemes, to generate a predicted image aligned with the original. Secret information is embedded by analyzing the difference histogram between the original and predicted images, and enhanced through multi-round rotation techniques and a multi-level embedding strategy to boost capacity. By employing both subsampling and quadtree decomposition, the embedding strategy dynamically adapts to the inherent characteristics of the input image. Furthermore, we investigate the trade-off between embedding capacity and marked image quality. Experimental results demonstrate improved embedding performance, high visual fidelity, and low implementation complexity, highlighting the method’s suitability for resource-constrained IoT applications.

Over the last decade, the number of patients treated with open repair for TAAAD in Taiwan has dramatically increased. This study aims to assess the hospital-volume relationship with surgical outcomes of type A acute aortic dissection (TAAAD) across hospitals in Taiwan. Using the Taiwan National Health Insurance (NHI) Research Database (NHIRD), we include only the patients who underwent first open repair for TAAAD from 01/01/2005, to 31/12/2020, in Taiwan. A total of 8,059 patients in 77 hospitals were eligible for the analysis. Hospitals were categorized based on their 16-year cumulative volume of TAAAD open repair surgeries, and patients were grouped into quartiles accordingly. Ascending aortic replacement (55.7%) and partial/total arch replacement (38.8%) were the most common methods of open aortic repair. In-hospital mortality was 22% and decreased from 28% in 2005 to 20% in 2020. Greater volume (per 5 annual surgeries) was associated with lower risks of in-hospital mortality (odd ratio 0.90, 95% confidence interval [CI] 0.87-0.92) and mortality after discharge (hazard ratio 0.97, 95% CI 0.95-0.99). Operative volume inversely correlates to in-hospital mortality and postoperative complications. The volume-outcome effect extends after discharge and reflects better long-term survival. Hospital referral to high-volume centers should be considered in patients needing complex open repair for TAAAD.

The fracture theory of fiber-reinforced polymer (FRP) composites is complicated compared to that of homogeneous materials. Textile FRPs need to consider crimp, fiber off-axis and various weaving parameters in a two-dimensional scale, which makes research of failure and fracture difficult. The objective and main contribution of the present research lie in taking textile bamboo FRP as an example and using tools such as toughness, load and deflection curves analysis, energy analysis, and first-order derivative signals to establish the preliminary information needed for fracture theory. This is followed by observing the fracture characteristics of the material under bending. The identification of fracture modes, corresponding energy, and energy dissipation are all prerequisites for developing fracture models in the future. Differences in the direction of force, weaving method, and number of laminates will cause the amount and direction of fibers to vary, which makes the type and progression of fracture different. Combining signal analysis, fracture images and energy dissipation curves, there are different modes of fracture between various groups due to different energy storage forms and crack types, which ultimately lead to different energy dissipation behaviors.

Aquazol [poly(2-ethyl-2-oxazoline)] is a widely used polymeric material for conservation because of its high reversibility and excellent compatibility with various types of material. However, it is hydrophilic and not recommended for use in weight-bearing applications. The objective of this study is to introduce cellulose nanocrystals (CNCs) and cellulose nanofibers (CNFs) into Aquazol to evaluate the physicomechanical properties of the resultant composites. Several nanocellulose addition formulations involving two types of nanocellulose were designed at various addition levels. Water sorption investigations revealed that the addition of CNCs or CNFs reduced the maximum moisture content of the resultant composites when compared to the unfilled Aquazol. The tensile test results showed that the critical addition level of CNF (2 wt%) is lower than that of CNC (10 wt%) for the nanocellulose to start acting effectively as a mechanically reinforcing agent. Notably, compared with using a single type of nanocellulose for reinforcement, greater reinforcement was observed when both CNCs and CNFs were combinedly added. Field emission scanning electron microscopy indicated that these strong reinforcement outcomes were probably a result of branch-like structures forming among the mixed fillers. The addition of nanocellulose in general resulted in composites having marginally lower thermal stability and optical transparency. In this study, we demonstrated the increased retention of mechanical properties in variously filled composites exposed to anticipated service conditions (55% RH; 23 °C). Crucially, the discoveries in this study indicate that mixed CNC and CNF fillers could be a reasonable option for future applications where lower levels of nanocellulose are desired for optical transparency considerations.

Background In-hospital cardiac arrest (IHCA) poses a considerable threat to hospitalized patients, leading to high mortality rates and severe neurological deficits among survivors. Despite the advancements in resuscitation practices, the prognosis of IHCA remains poor, and comprehensive studies exploring nationwide trends and long-term survival are scarce, particularly in the Asian populations. Methods Utilizing data from the Taiwan National Health Insurance Research Database, we conducted a nationwide cohort study to analyze the IHCA events among adult patients between 2003 and 2020. The outcomes of interest in this study included the temporal trend in the IHCA incidence, in-hospital mortality, and median survival after discharge for overall hospitalizations. Results Over the 18-year period, the IHCA incidence in Taiwan declined by 70%, from an annual incidence of 7.1 per 1,000 admissions to a lower rate in 2020, accompanied by a 14% reduction in the in-hospital mortality rate, with an average of 86.5%. The overall long-term survival rate for discharged survivors was 63.9%. We observed a substantial 125% increase in the median survival duration of discharged survivors, rising from 1.56 years in 2003 to 3.51 years in 2015. Favorable in-hospital survival rates and extended life expectancy were notably seen in the patients with shockable rhythms, those with a cardiac primary diagnosis, women, and younger patients. Conclusions Our study data revealed significant declines in the IHCA incidence and in-hospital mortality in Taiwan, along with improved long-term survival among survivors, particularly among specific subgroups. Women exhibited significantly better long-term survival as compared to men, underscoring the need to avoid sex-based treatment biases. Improvements in discharge survival rates and life expectancy were less pronounced in older survivors, indicating that age alone may not be sufficient to guide IHCA management decisions. Proactive resuscitation should be carefully considered for older patients, particularly those with mild frailty and potentially reversible conditions. Trial registration the institutional review board of Chang Gung Memorial Hospital approved all data usage and the study protocol (Registration number: 202301625B0, Registered 7 November 2023)

ObjectivesOutcomes of sex differences in major cardiac surgery remain controversial. A comprehensive understanding of sex differences in major adult cardiac surgery could provide better knowledge of risk factors, management strategy and short-term or long-term outcomes. The present study aimed to investigate sex differences in the risks of outcomes of major cardiac surgeries and subgroup analyses of different valve types.DesignPopulation-based nationwide cohort study.SettingData were obtained from National Health Insurance Research Database (NHIRD) in Taiwan.ParticipantsA total of 66 326 adult patients (age ≥20 years; 30.3% women) who underwent a first major cardiac surgery (isolated coronary artery bypass graft (CABG), isolated valve or concomitant bypass/valve) from 2000 to 2013 were identified via Taiwan NHIRD.Main outcome measuresOutcomes of primary interest were in-hospital death and all-cause mortality during follow-up period. Propensity score matching was conducted as a secondary analysis for the sensitivity test.ResultsWomen who underwent isolated CABG tended to have greater risks of both in-hospital (OR 1.37; 95% CI 1.26 to 1.49) and late outcomes (HR 1.26; 95% CI 1.22 to 1.31). Women after concomitant CABG/valve also had a greater in-hospital (OR 1.19; 95% CI 1.01 to 1.40) and long-term mortality (HR 1.14; 95% CI 1.05 to 1.24). Women after isolated mitral valve repair have a non-favourable outcome of in-hospital mortality (OR 1.70; 95% CI 1.01 to 2.87). Women who did not receive an isolated aortic valve replacement had more favourable all-cause mortality outcome (HR 0.90; 95% CI 0.84 to 0.96). Secondary analysis in the propensity score-matching cohort demonstrated results similar to the primary analysis.ConclusionsFemale patients who underwent procedures involving CABG (with or without concurrent valvular intervention) had generally worse outcomes. However, the results of isolated valve surgery were variable on the basis of the type of intervened valve.

Background The impact of sex-related differences in patients receiving extracorporeal membrane oxygenation support (ECMO) support is still inconclusive. This population-based study aimed to investigate sex differences in short- or long-term outcomes in order to improve clinical practice. Methods Patients who received ECMO between 2001 to 2017 were identified from the Taiwan National Health Insurance Research Database. Propensity score matching with a 1:1 ratio was conducted in female-to-male groups, to reduce confounding of baseline covariates. Outcomes included in-hospital mortality, all-cause mortality, all-cause readmission, and ECMO-related complications. Logistic regression analysis, Cox proportional hazard model, and join point regression were used to compare sex differences in both short- or long-term outcomes. Results In total, 7,010 matched patients from 11,734 ECMO receivers were included for analysis. The use of ECMO increased dramatically in past years, although the proportion of females was still lower than males. There was a decreasing trend of females undergoing ECMO over time. Female patients have lower risks of in-hospital mortality (64.08% in females vs 66.48% in males; P  = 0.0352) and ECMO-related complications compared with males. Furthermore, females also had favorable long-term late outcomes such as all-cause mortality (73.35% in females vs 76.98% in males; P  = 0.009) and readmission rate (6.99% in females vs 9.19% in males; P  = 0.001). Conclusions Female patients had more favorable in-hospital and long-term survival outcomes. Despite improvement in modern ECMO technique and equipment, ECMO remains underutilized in eligible female patients. Thus, females should undergo ECMO treatment if available and indicated. Trial registration The institutional review board of Chang Gung Memorial Hospital approved all data usage and the study protocol (registration number: 202100151B0C502; date of registration: 23/08/2021).

ObjectivesAdministrative database research is pivotal for developing guidelines in cardiovascular surgery and valvular heart disease. However, validation studies specific to Asia are lacking. This study validated the coding of valvular heart repair and replacement surgeries in Taiwan’s National Health Insurance (NHI) Research Database using International Classification of Diseases, Clinical Modification (ICD-CM) codes.MethodsThis retrospective observational study used data from the Chang Gung Research Database between 2015 and 2018, identifying 1171 patients using Taiwanese NHI reimbursement codes. The gold standard was defined as a blinded retrospective review of operation notes. Claims data, including ICD diagnostic codes, ICD procedural codes and NHI supply codes for surgical materials, were validated. Positive predictive values (PPVs) were calculated as the number of true positives divided by the total claims data.ResultsThe PPVs (95% CI) for aortic valve (AV) surgery aetiologies were as follows: infectious endocarditis (IE), 94.1% (87.6%–97.7%); rheumatic heart disease (RHD), 88.2% (67.3%–97.5%); bicuspid AV, 93.3% (83.3%–98.1%); and degeneration, 91.7% (85.3%–95.8%). For mitral valve surgery, the surgery aetiologies and PPVs were IE, 93.2% (87.9%–96.6%); RHD, 94.9% (88.3%–98.2%); ischaemic mitral regurgitation, 87.5% (73.0%–95.6%); and degeneration, 88.4% (83.9%–92.0%). Surgical types generally exhibited higher PPVs, except for mechanical prostheses (<90%). The accuracy of mechanical prosthesis identification improved with the inclusion of supply codes along with ICD procedural codes.ConclusionsThe PPVs for both aetiologies and surgical types of valvular heart disease were generally satisfactory. The inclusion of supply codes for mechanical valve replacements enhanced accuracy but led to fewer eligible patients being included in the sample. This study provides a potentially optimal framework for future research on valve diseases and surgeries using claims databases.

To investigate the effect of fluctuating temperatures on the creep strain of wood–plastic composites, a full-scale, long-term creep test was conducted in an unconditioned environment. However, the effect of elevating temperature caused unexpected additional increases in strain. In this study, the previously developed stress–temperature incorporated creep model and the proposed temperature-induced strain superposition method were employed in combination. The temperature-induced additional strain was successfully simulated, indicating that the creep test under an ambient environment could successfully simulate long-term creep with increasing temperatures. This approach and the concept can be applied to comparable future studies.