Managing the surge:A comprehensive review of the entire disposal framework for retired lithium-ion batteries from electric vehicles

Anticipating the imminent surge of retired lithium-ion batteries(R-LIBs)from electric vehicles,the need for safe,cost-effective and environmentally friendly disposal technologies has escalated.This paper seeks to offer a comprehensive overview of the entire disposal framework for R-LIBs,encompassing a broad spectrum of activities,including screening,repurposing and recycling.Firstly,we delve deeply into a thorough examination of current screening technologies,shifting the focus from a mere enumeration of screening methods to the exploration of the strategies for enhancing screening efficiency.Secondly,we outline battery repurposing with associated key factors,summarizing stationary applications and sizing methods for R-LIBs in their second life.A particular light is shed on available reconditioning solutions,demonstrating their great potential in facilitating battery safety and lifetime in repurposing scenarios and identifying their techno-economic issues.In the realm of battery recycling,we present an extensive survey of pre-treatment options and subsequent material recovery technologies.Particularly,we introduce several global leading recyclers to illustrate their industrial processes and technical intricacies.Furthermore,relevant challenges and evolving trends are investigated in pursuit of a sustainable end-of-life management and disposal framework.We hope that this study can serve as a valuable resource for researchers,industry professionals and policymakers in this field,ultimately facilitating the adoption of proper disposal practices.

Development of Localized Assessment of Municipal Wastewater Disposal Risks

A means to develop a comparative assessment of the risks of available wastewater effluent disposal options on a local scale needs to be developed to help local decision-makers make decisions on options such as direct or indirect potable reuse options. These options have garnered more interest as a result of water supply limitations in many urban areas. This risk assessment was developed from a risk assessment developed at the University of Miami in 2001 and Florida Atlantic University (FAU) in 2023. Direct potable reuse and injection wells were deemed to have the lowest risk in the most recent study by FAU. However, the injection well option may not be available everywhere. As a result, a more local means to assess exposure risk is needed. This paper outlines the process to evaluate the public health risks associated with available disposal alternatives which may be very limited in some areas. The development of exposure pathways can help local decision-makers define the challenges, and support later expert level analysis upon which public health decisions are based.

Corrosion techniques and strategies for used fuel containers with copper corrosion barriers under deep geological disposal conditions:A review

Safe emplacement of high-level nuclear waste(HLNW)arising from the utilization of nuclear power is a frequently en-countered and considerably challenging issue.The widely accepted and feasible approach for the permanent disposal of HLNW involves housing it in a corrosion-resistant container and subsequently burying it deep in a geologic repository.The focus lies on ensuring the dur-ability and integrity of the container in this process.This review introduces various techniques and strategies employed in controlling the corrosion of used fuel containers(UFCs)using copper(Cu)as corrosion barrier in the context of deep geological disposal.Overall,these corrosion prevention techniques and methods have been effectively implemented and employed to successfully mitigate the corrosion challenges encountered during the permanent disposal of Cu containers(e.g.,corrosion mechanisms and corrosion parameters)in deep geologic repositories.The primary objective of this review is to provide an extensive examination of the alteration in the corrosion envir-onment encountered by the UFCs when subjected to deep geologic repository conditions and focusing on addressing the potential corro-sion scenarios.

Study of the Management and Disposal Practices of Unused or Out-of-Date Medicines by Households in the Municipality of Ouagadougou, Burkina Faso

Introduction: Not all medicines that pass-through consumers’ hands are used, and some often expire in households. These health products can be sources of accidental risks and pollution when they are not properly disposed of. In Burkina Faso, there are as yet no guidelines for the disposal of unused medicines in households. The aim of this study was to estimate the extent of household possession of unused or expired medicines, and to describe attitudes and disposal practices. Methods: This was a descriptive cross-sectional study covering households in the Ouagadougou commune conducted from June to August 2021. Two-stage stratified sampling was used: selection of Enumeration Zones (EZs) and selection of households, with each EZ comprising several households. Data collection was based on direct interviews using a structured questionnaire. Data were processed using Epi Info software version 7.2.4.0. Results: In total, 417 household residents were surveyed out of the planned 423 households, corresponding to a completion rate of 98.58% compared with the initial sample. Among the respondents, 79.62% had unused and/or expired medicines in their household. A total of 2562 drug packaging units were counted, for a total weight of 121.90 kg. Nearly 75% were aware that improper disposal was a danger to the environment. Some respondents kept their unused medicines at home until they expired (43.41%), and disposed of them mainly by throwing them in the household garbage (75.58%). The majority (79%) were in favor of the government setting up a take-back program for these medicines. Conclusion: The introduction of a take-back program for unused or out-of-date medicines will ensure safer disposal of medicines, and better protection for households and the environment.

Patients’Knowledge, Attitude and Practices on Disposal Methods of Expired and Unused Medicines: Implication for Creation of Drug Take-Back Program

Background: Handling of medicines is a day-to-day activity by patients and many health care providers. However, multiple studies have brought to light inappropriate disposal methods for expired and unused medication (EUM). Improper disposal of expired and unused medicines is hazardous both to humans and the environment. Objective: This sought to measure patients’ knowledge, attitude, and practices on disposal methods of EUM. Methods: A cross-sectional study was carried out among 384 patients at three outpatient pharmacies at the University Teaching Hospitals (UTHs). The structured questionnaire was used to collect data and STAT version 15.1 was used to analyse the data. Results: 384 respondents participated in this study and, at some point, had EUM. In this study, 356 (92.7%) of the participants reported that they had never heard of a drug take-back system. Most of the participants 285 (74.2%) and 239 (62.2%) kept and donated their unused medicine, respectively. Additionally, 244 (63.5%), 212 (55.2%), and 176 (44.8%) of the participants disposed of expired medicines in the bin or garbage, flushed them in toilets or sinks, or burned them, respectively. Occupation was significantly associated with unsafe disposal of unused medicine [P-value = 0.019]. Conclusion and Relevance: Knowledge of safe disposal methods for EUM was good amongst most participants. However, used unsafe disposal methods. The majority of the participants exhibited positive attitude concerning safe disposal methods. This study highlights the need for drug-take-back program creation in Zambia.

International law obligations for the disposal of Fukushima nuclear-contaminated water under the principles of nuclear safety

The disposal of contaminated water from Japan’s Fukushima nuclear power plant is a significant international nuclear safety issue with considerable cross-border implications.This matter requires compliance not only with the law of the sea but also with the principles of nuclear safety under international law.These principles serve as the overarching tenet of international and China’s domestic nuclear laws,applicable to nuclear facilities and activities.The principle of safety in nuclear activities is fully recognized in international and domestic laws,carrying broad legal binding force.Japan’s discharge of nuclear-contaminated water into the sea violates its obligations under the principle of safety in nuclear activities,including commitments to optimum protection,as low as reasonably practicable,and prevention.The Japanese government and the International Atomic Energy Agency(IAEA)have breached the obligation of optimum protection by restricting the scope of assessments,substituting core concepts,and shielding dissenting views.In the absence of clear radiation standards,they have acted unilaterally without fulfilling the obligation as low as reasonably practicable principle.The discharge of Fukushima nuclear-contaminated water poses an imminent and unpredictable risk to all countries worldwide,including Japanese residents.Japan and the IAEA should fulfill their obligations under international law regarding disposal,adhering to the principles of nuclear safety,including optimum protection,the obligation as low as reasonably practicable,and prevention through multilateral cooperation.Specifically,the obligation to provide optimum protection should be implemented by re-evaluating the most reliable disposal technologies and methods currently available and comprehensively assessing various options.The standard of the obligation as low as reasonably practicable requires that the minimization of negative impacts on human health,livelihoods,and the environment should not be subordinated to considerations of cutting costs and expenses.Multilateral cooperation should be promoted through the establishment of sound multilateral long-term monitoring mechanisms for the discharge of nuclear-contaminated water,notification and consultation obligations,and periodic assessments.These obligations under international law were fulfilled after the accidents at the Three Mile Island and Chernobyl nuclear power plants.The implications of the principles of nuclear safety align with the concept of building a community of shared future for nuclear safety advocated by China.In cases of violations of international law regarding the disposal of nuclear-contaminated water that jeopardize the concept of a community of a shared future for nuclear safety,China can also rely on its own strength to promote the implementation of due obligations through self-help.

Production Practice of Solid Waste Desulfurizer Disposal in European Metallurgical Furnace

In order to realize the OY Smelting Furnace disposal of solid waste,municipal waste,form a model of steel enterprises and urban integration,through the production practice of smelting furnace,analyzes the mechanism of solid waste disposal,and proposed the disposal of solid waste desulfurization agent and disposal method:According to the theory to guide the actual production process,the test ton of iron with 10-15kg of desulfurizer in the production process does not affect the quality of molten iron and slag quality.

Activation of cerebral Ras-related C3 botulinum toxin substrate(Rac) 1 promotes post-ischemic stroke functional recovery in aged mice

Brain functional impairment after stroke is common;however,the molecular mechanisms of post-stroke recovery remain unclear.It is well-recognized that age is the most important independent predictor of poor outcomes after stroke as older patients show poorer functional outcomes following stroke.Mounting evidence suggests that axonal regeneration and angiogenesis,the major forms of brain plasticity responsible for post-stroke recovery,diminished with advanced age.Previous studies suggest that Ras-related C3 botulinum toxin substrate(Rac)1 enhances stroke recovery as activation of Rac1 improved behavior recovery in a young mice stroke model.Here,we investigated the role of Rac1 signaling in long-term functional recovery and brain plasticity in an aged(male,18 to 22 months old C57BL/6J)brain after ischemic stroke.We found that as mice aged,Rac1 expression declined in the brain.Delayed overexpression of Rac1,using lentivirus encoding Rac1 injected day 1 after ischemic stroke,promoted cognitive(assessed using novel object recognition test)and sensorimotor(assessed using adhesive removal tests)recovery on days 14–28.This was accompanied by the increase of neurite and proliferative endothelial cells in the periinfarct zone assessed by immunostaining.In a reverse approach,pharmacological inhibition of Rac1 by intraperitoneal injection of Rac1 inhibitor NSC23766 for 14 successive days after ischemic stroke worsened the outcome with the reduction of neurite and proliferative endothelial cells.Furthermore,Rac1 inhibition reduced the activation of p21-activated kinase 1,the protein level of brain-derived neurotrophic factor,and increased the protein level of glial fibrillary acidic protein in the ischemic brain on day 28 after stroke.Our work provided insight into the mechanisms behind the diminished plasticity after cerebral ischemia in aged brains and identified Rac1 as a potential therapeutic target for improving functional recovery in the older adults after stroke.

Is recovery enhancement after gastric cancer surgery really a safe approach for elderly patients?

BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery(ERAS)in elderly patients with gastric cancer(GC).AIM To evaluate the safety of ERAS in elderly patients with GC.METHODS The PubMed,EMBASE,and Cochrane Library databases were used to search for eligible studies from inception to April 1,2023.The mean difference(MD),odds ratio(OR)and 95%confidence interval(95%CI)were pooled for analysis.The quality of the included studies was evaluated using the Newcastle-Ottawa Scale scores.We used Stata(V.16.0)software for data analysis.RESULTS This study consists of six studies involving 878 elderly patients.By analyzing the clinical outcomes,we found that the ERAS group had shorter postoperative hospital stays(MD=-0.51,I2=0.00%,95%CI=-0.72 to-0.30,P=0.00);earlier times to first flatus(defecation;MD=-0.30,I²=0.00%,95%CI=-0.55 to-0.06,P=0.02);less intestinal obstruction(OR=3.24,I2=0.00%,95%CI=1.07 to 9.78,P=0.04);less nausea and vomiting(OR=4.07,I2=0.00%,95%CI=1.29 to 12.84,P=0.02);and less gastric retention(OR=5.69,I2=2.46%,95%CI=2.00 to 16.20,P=0.00).Our results showed that the conventional group had a greater mortality rate than the ERAS group(OR=0.24,I2=0.00%,95%CI=0.07 to 0.84,P=0.03).However,there was no statistically significant difference in major complications between the ERAS group and the conventional group(OR=0.67,I2=0.00%,95%CI=0.38 to 1.18,P=0.16).CONCLUSION Compared to those with conventional recovery,elderly GC patients who received the ERAS protocol after surgery had a lower risk of mortality.

Earthquake-induced fracture displacements and transmissivity changes in a 3D fracture network of crystalline rock for spent nuclear fuel disposal

During the long service period of a nuclear waste repository in crystalline rock,large earthquake(s)may occur nearby the repository site and coseismically alter the local stress field around pre-existing fractures within the geological formation.The resulting fracture normal/shear displacements may lead to fracture opening and further promote the transport of leaked radionuclides into the groundwater system.Thus,it is of central importance to analyze the consequences of potential future earthquake(s)on the hydrogeological properties of a repository site for spent nuclear fuel disposal.Based on the detailed site characterization data of the repository site at Forsmark,Sweden,we conduct a three-dimensional(3D)seismo-hydro-mechanical simulation using the 3Dimensional Distinct Element Code(3DEC).We explicitly represent a primary seismogenic fault zone and its surrounding secondary fracture network associated with a power-law size scaling and a Fisher orientation distribution.An earthquake with a magnitude of M_(w)=5.6 caused by the reactivation of the primary fault zone is modeled by simulating its transient rupture propagating radially outwards from a predefined hypocenter at a specified rupture speed,with the faulting dynamics controlled by a strength weakening law.We model the coseismic response of the off-fault fracture network subject to both static and dynamic triggering effects.We further diagnose the distribution of fracture hydro-mechanical properties(e.g.mechanical/hydraulic aperture,hydraulic transmissivity)before and after the earthquake in order to quantify earthquakeinduced hydraulic changes in the fracture network.It is found that earthquake-induced fracture transmissivity changes tend to follow a power-law decay with the distance to the earthquake fault.Our simulation results and insights obtained have important implications for the long-term performance assessment of nuclear waste repositories in fractured crystalline rocks.

Transplantation of fibrin-thrombin encapsulated human induced neural stem cells promotes functional recovery of spinal cord injury rats through modulation of the microenvironment

Recent studies have mostly focused on engraftment of cells at the lesioned spinal cord,with the expectation that differentiated neurons facilitate recovery.Only a few studies have attempted to use transplanted cells and/or biomaterials as major modulators of the spinal cord injury microenvironment.Here,we aimed to investigate the role of microenvironment modulation by cell graft on functional recovery after spinal cord injury.Induced neural stem cells reprogrammed from human peripheral blood mononuclear cells,and/or thrombin plus fibrinogen,were transplanted into the lesion site of an immunosuppressed rat spinal cord injury model.Basso,Beattie and Bresnahan score,electrophysiological function,and immunofluorescence/histological analyses showed that transplantation facilitates motor and electrophysiological function,reduces lesion volume,and promotes axonal neurofilament expression at the lesion core.Examination of the graft and niche components revealed that although the graft only survived for a relatively short period(up to 15 days),it still had a crucial impact on the microenvironment.Altogether,induced neural stem cells and human fibrin reduced the number of infiltrated immune cells,biased microglia towards a regenerative M2 phenotype,and changed the cytokine expression profile at the lesion site.Graft-induced changes of the microenvironment during the acute and subacute stages might have disrupted the inflammatory cascade chain reactions,which may have exerted a long-term impact on the functional recovery of spinal cord injury rats.

Multidisciplinary approach toward enhanced recovery after surgery for total knee arthroplasty improves outcomes

Knee osteoarthritis is a degenerative disorder of the knee,which leads to joint pain,stiffness,and inactivity and significantly affects the quality of life.With an increased prevalence of obesity and greater life expectancies,total knee arthroplasty(TKA)is now one of the major arthroplasty surgeries performed for knee osteoarthritis.When enhanced recovery after surgery(ERAS)was introduced in TKA,clinical outcomes were enhanced and the economic burden on the healthcare system was reduced.ERAS is an evidence-based scientific protocol aimed at ameliorating the surgical stress response.ERAS aims to enhance the recovery phase,which encompasses multidisciplinary strategies at every step of perioperative care,including the rehabilitation phase.Implementation of ERAS in TKA aids in reducing the length of hospital stay,improving pain management,reducing perioperative complications,and enhancing patient satisfaction.Multidisciplinary collaboration,integrating the expertise of anesthesiologists,orthopedic surgeons,nursing personnel,and other healthcare professionals,is the cornerstone of ERAS in patients undergoing TKA.

Synergistic anionic/zwitterionic mixed surfactant system with high emulsification efficiency for enhanced oil recovery in low permeability reservoirs

Emulsification is one of the important mechanisms of surfactant flooding. To improve oil recovery for low permeability reservoirs, a highly efficient emulsification oil flooding system consisting of anionic surfactant sodium alkyl glucosyl hydroxypropyl sulfonate(APGSHS) and zwitterionic surfactant octadecyl betaine(BS-18) is proposed. The performance of APGSHS/BS-18 mixed surfactant system was evaluated in terms of interfacial tension, emulsification capability, emulsion size and distribution, wettability alteration, temperature-resistance and salt-resistance. The emulsification speed was used to evaluate the emulsification ability of surfactant systems, and the results show that mixed surfactant systems can completely emulsify the crude oil into emulsions droplets even under low energy conditions. Meanwhile,the system exhibits good temperature and salt resistance. Finally, the best oil recovery of 25.45% is achieved for low permeability core by the mixed surfactant system with a total concentration of 0.3 wt%while the molar ratio of APGSHS:BS-18 is 4:6. The current study indicates that the anionic/zwitterionic mixed surfactant system can improve the oil flooding efficiency and is potential candidate for application in low permeability reservoirs.

Problem identification and revitalization strategies for the recovery and reconstruction of traditional villages in the Ms 6.8 Luding Earthquake

Post-disaster reconstruction is a topic of global concern,and traditional villages have special heritage attributes and need to face more requirements and obstacles in post-disaster reconstruction.This paper summarizes four concepts based on the research on post-disaster reconstruction both domestically and internationally,as well as the recovery and reconstruction of cultural heritage.Through a field survey of traditional villages in the Ms 6.8 Luding earthquake-stricken area,it is found that there are problems such as insufficient awareness of heritage value,misalignment of scientific reconstruction technology,and insufficient protection of reconstruction elements during the reconstruction process.Traditional villages face the risk of declining or even loss of heritage value.In order to effectively protect traditional villages and inherit the carrier of regional culture,four targeted reconstruction response strategies are proposed,i.e.,to"establish special planning for traditional village preservation","emphasize recovery of the authenticity of village heritage","ensure elements for village heritage recovery"and"promote the activation and utilization of village heritage",based on the problems discovered during the survey and the four concepts summarized in the research on post-disaster reconstruction of traditional villages.The research results hope to provide useful reference for ancient cultural areas affected by earthquakes on how to protect cultural heritage during the post-disaster reconstruction process.

Surgical intervention combined with weight-bearing walking training promotes recovery in patients with chronic spinal cord injury:a randomized controlled study

For patients with chronic spinal cord injury,the co nventional treatment is rehabilitation and treatment of spinal cord injury complications such as urinary tract infection,pressure sores,osteoporosis,and deep vein thrombosis.Surgery is rarely perfo rmed on spinal co rd injury in the chronic phase,and few treatments have been proven effective in chronic spinal cord injury patients.Development of effective therapies fo r chronic spinal co rd injury patients is needed.We conducted a randomized controlled clinical trial in patients with chronic complete thoracic spinal co rd injury to compare intensive rehabilitation(weight-bearing walking training)alone with surgical intervention plus intensive rehabilitation.This clinical trial was registered at ClinicalTrials.gov(NCT02663310).The goal of surgical intervention was spinal cord detethering,restoration of cerebrospinal fluid flow,and elimination of residual spinal cord compression.We found that surgical intervention plus weight-bearing walking training was associated with a higher incidence of American Spinal Injury Association Impairment Scale improvement,reduced spasticity,and more rapid bowel and bladder functional recovery than weight-bearing walking training alone.Overall,the surgical procedures and intensive rehabilitation were safe.American Spinal Injury Association Impairment Scale improvement was more common in T7-T11 injuries than in T2-T6 injuries.Surgery combined with rehabilitation appears to have a role in treatment of chronic spinal cord injury patients.

Correlation linking illness perception,negative emotions,and the post-operative recovery effect in patients with perianal disease

BACKGROUND Improvements in the standard of living have led to increased attention to perianal disease.Although surgical treatments are effective,the outcomes of postoperative recovery(POR)are influenced by various factors,including individual differences among patients,the characteristics of the disease itself,and the psychological state of the patient.Understanding these factors can help healthcare providers develop more personalized and effective post-operative care plans for patients with perianal disease.AIM To investigate the effect of illness perception(IP)and negative emotions on POR outcomes in patients with perianal disease.METHODS A total of 146 patients with perianal disease admitted to the First People's Hospital of Changde City from March to December 2023 were recruited.We employed a general information questionnaire,the Brief Illness Perception Questionnaire(B-IPQ),and the Hospital Anxiety and Depression Scale(HADS).We used the 15-item Quality of Recovery Score(QoR-15)to measure patients’recovery effects.Finally,we conducted Pearson’s correlation analysis to examine the relationship between pre-operative IP and anxiety and depression levels with POR quality.RESULTS Fifty-three(36.3%)had poor knowledge of their disease.Thirty(20.5%)were suspected of having anxiety and 99(67.8%)exhibited symptoms.Forty(27.4%)were suspected of having depression and 102(69.9%)displayed symptoms.The B-IPQ,HADS-A,HADS-D,and QoR-15 scores were 46.82±9.97,12.99±3.60,12.58±3.36,and 96.77±9.85,respectively.There was a negative correlation between pre-operative IP,anxiety,and depression with POR quality.The influence of age and disease course on post-operative rehabilitation effect are both negative.The impact of B-IPQ,HADS-A,and HADS-D on POR was negative.Collectively,these variables accounted for 72.6%of the variance in POR.CONCLUSION The quality of POR in patients with perianal disease is medium and is related to age,disease course,IP,anxiety,and depression.

Research on revision of relevant provisions of high-speed railway emergency disposal in the regulations on railway technical management(RRTM)

Purpose–This study aims to improve the rules and regulations system of high-speed rail emergency disposal.Design/methodology/approach–Based on the analysis of the demands,rules and regulations of China concerning on-site high-speed rail emergency disposal,basic principles for revising the regulations on railway technical management(RRTM)are proposed and suggestions and evaluation methods according to the main clauses are put forward.Findings–Basic principles for revising the RRTM are proposed,namely“to meet the actual needs of on-site high-speed railway emergency disposal,standardize the emergency disposal process,improve the efficiency of emergency disposal and keep the consistency between provisions of emergency disposal”.Existing provisions related to emergency disposal efficiency,scenarios,safety and service quality are made up for the deficiencies.To make up for the deficiencies of the existing provisions related to emergency disposal efficiency,improvement of emergency disposal scenarios and guarantee of emergency disposal safety and quality,this paper puts forward suggestions on revising 15 emergency disposal provisions of the RRTM with regard to earthquake monitoring and warning,in-station foreign body invasion warning,air conditioning failure of EMU trains and forced parking of trains in sections.A fuzzy comprehensive evaluation model based on the analytic hierarchy process(AHP)is constructed to evaluate the proposed revision scheme and suggestions,which has been highly recognized by experts.Originality/value–This study implements the goal of high-quality railway development.

Enhanced recovery after surgery in elderly patients with non-small cell lung cancer who underwent video-assisted thoracic surgery

BACKGROUND This study was designed to investigate the clinical outcomes of enhanced recovery after surgery(ERAS)in the perioperative period in elderly patients with nonsmall cell lung cancer(NSCLC).AIM To investigate the potential enhancement of video-assisted thoracic surgery(VATS)in postoperative recovery in elderly patients with NSCLC.METHODS We retrospectively analysed the clinical data of 85 elderly NSCLC patients who underwent ERAS(the ERAS group)and 327 elderly NSCLC patients who received routine care(the control group)after VATS at the Department of Thoracic Surgery of Peking University Shenzhen Hospital between May 2015 and April 2017.After propensity score matching of baseline data,we analysed the postoperative stay,total hospital expenses,postoperative 48-h pain score,and postoperative complication rate for the 2 groups of patients who underwent lobectomy or sublobar resection.RESULTS After propensity score matching,ERAS significantly reduced the postoperative hospital stay(6.96±4.16 vs 8.48±4.18 d,P=0.001)and total hospital expenses(48875.27±18437.5 vs 55497.64±21168.63 CNY,P=0.014)and improved the satisfaction score(79.8±7.55 vs 77.35±7.72,P=0.029)relative to those for routine care.No significant between-group difference was observed in postoperative 48-h pain score(4.68±1.69 vs 5.28±2.1,P=0.090)or postoperative complication rate(21.2%vs 27.1%,P=0.371).Subgroup analysis showed that ERAS significantly reduced the postoperative hospital stay and total hospital expenses and increased the satisfaction score of patients who underwent lobectomy but not of patients who underwent sublobar resection.CONCLUSION ERAS effectively reduced the postoperative hospital stay and total hospital expenses and improved the satisfaction score in the perioperative period for elderly NSCLC patients who underwent lobectomy but not for patients who underwent sublobar resection.

Composting of Disposal Organic Wastes: Resource Recovery for Agricultural Sustainability

One of the major problems of agricultural soils in the tropical regions of the Pacific is the low organic matter content.Because of the hot and humid environment,the soil organic matter(SOM)is minimal due to rapid decomposition.Composted organic material is being applied on agricultural fields as an amendment to provide nutrients and enhance the organic matter content for improving the physical and chemical properties of the cultivated soils.In addition land application of composted material as a fertilizer source effectively disposes of wastes that otherwise are buried in landfills.In our soil program at the University of Guam,we are evaluating the use of organic material as an alternative to synthetic fertilizers.Its goal is to develop management strategies and use available resources for improving crop production while conserving resources and preserving environmental quality.Our case study project is designed to improve soil fertility status by using composted organic wastes and assessing how the nitrogen and other essential nutrients contribute to long-term soil fertility and crop productivity without application of synthetic fertilizers.In our pilot project,compost is produced from wood chips,grinded typhoon debris mixed with animal manure,fish feed,shredded paper and other organic wastes.Mature compost is then applied on the field at the rates of 0,5,10 and 20 t/ha as a soil amendment on the eroded cobbly soils of southern Guam.Corn is planted and monitored for growth performance and yield.The effect of land application of composted material on the SOM content and overall soil quality indices are being evaluated in this pilot study.

Risk Factors Asscociated with Hypokalemia during Postanesthesia Recovery and Its Impact on Outcomes in Gynecological Patients:A Propensity Score Matching Study

Objective:This study aimed to explore the risk factors and outcomes of hypokalemia during the recovery period from anesthesia in the gynecological population.Methods:This retrospective cohort study included 208 patients who underwent gynecological surgery at our institution between January 2021 and March 2022.Data were collected for each patient,including demographics,disease status,surgical data,and clinical information.Preoperative bowel preparation,postoperative gastrointestinal function,and electrolyte levels were compared between the two groups using propensity score matching(PSM).Results:The incidence of hypokalemia(serum potassium level<3.5 mmol/L)during the recovery period from anesthesia was approximately 43.75%.After PSM,oral laxative use(96.4%vs.82.4%,P=0.005),the number of general enemas(P=0.014),and the rate of≥2 general enemas(92.9%vs.77.8%,P=0.004)were identified as risk factors for hypokalemia,which was accompanied by decreased PaCO_(2) and hypocalcemia.There were no significant differences in postoperative gastrointestinal outcomes,such as the time to first flatus or feces,the I-FEED score(a scoring system was created to evaluate impaired postoperative gastrointestinal function),or postoperative recovery outcomes,between the hypokalemia group and the normal serum potassium group.Conclusion:Hypokalemia during postanesthesia recovery period occurred in 43.75%of gynecological patients,which resulted from preoperative mechanical bowel preparation;however,it did not directly affect clinical outcomes,including postoperative gastrointestinal function,postoperative complications,and length of hospital stay.