Are Most Polluted Regions Most Active in Energy Transition Processes? A Case Study of Polish Regions Acquiring EU Funds for Local Investments in Renewable Energy Sources

The primary aim of this study was to assess the investment activity of basic local government units in the development of renewable energy sources co-financed by EU funds depending on CO2 emissions and other socio-economic conditions in terms of regions of Poland in the years 2007–2020. Empirical studies aimed at the verification of the research hypothesis that “the greatest investment activity in local projects co-financed from EU funds related to the development of renewable energy sources is observed for local government units in regions with highest CO2 emissions”. Empirical studies were conducted based on data from the Ministry of Investment and Economic Development in Poland, the Local Data Bank, and the National Centre for Emissions Management. Thus, the conducted analyses provide both cognitive and applicatory values for the establishment of an appropriate energy transition policy in individual regions of Poland, which may be implemented by local government authorities within the current financial framework. Data concerning CO2 emissions at the regional level were estimated by applying the original disaggregation method as modified by the authors, which made it possible to fill the research gap resulting from the lack of data on emissions at the regional level. In order to show the regional diversification in investment activity of local government units in terms of renewable energy sources, its multi-faceted analysis was conducted by applying the Ward method. Clusters of regions with similar investment activity of local government units were described based on characteristics included in the typological classification (so-called active characteristics) and selected indexes showing CO2 emission levels, as well as selected socio-economic indexes (so-called passive characteristics). Based on the empirical studies, the research hypothesis presented in this paper was negatively verified. Considering both multiannual financial frameworks, the EU financial support for the development of renewable energy sources was used primarily by local government units of a predominantly agricultural character, and less advanced in terms of their development but exhibiting conditions conducive to renewable energy development

Surgical treatment of acute appendicitis in older patients

Introduction: Acute appendicitis (AA) is the most common indication for emergency surgery and it occurs more often in children and young adults than in patients of advanced age. AA in older patients is a challenging surgical problem because of its atypical presentation. This study was performed to determine whether the age of a patient impacts the outcomes and whether laparoscopic appendectomy (LA) is a feasible method for treatment of patients > 65 years. Material and methods: We performed a retrospective study of 355 patients with AA who were admitted to the Department of General, Minimally Invasive and Elderly Surgery in Olsztyn from 2014 to 2017. The patients were divided into three age groups: 18 to 40, 41 to 65 and >65 years. The histopathological diagnoses were divided into three types: simple AA, phlegmonous AA, and gangrenous AA. Results. LA was performed in 96% of young adults and in 67% of older patients. The patients older than 65 years had higher preoperative white blood cell counts, higher C-reactive protein (CRP) levels and had a longer length of stay (LOS) than younger patients (P=0.05, P=0.03, and P=0.03, respectively). We found a positive correlation among the CRP levels, open appendectomy (OA), and gangrenous appendicitis. Conclusions: Patients older than 65 years more frequently underwent OA than LA, had higher preoperative CRP levels and had a longer LOS than younger patients. Higher CRP levels were associated with a greater risk of gangrenous appendicitis. LA is a safe and feasible treatment method for patients older than 65 years

Chirurgiczne leczenie ostrego zapalenia wyrostka robaczkowego u pacjentów w wieku podeszłym

Wprowadzenie: Ostre zapalenie wyrostka robaczkowego (AA) jest najczęstszym wskazaniem do nagłych operacji. Występuje częściej u dzieci i młodych dorosłych niż u pacjentów w wieku podeszłym. U starszych pacjentów stanowi problem chirurgiczny ze względu na jego nietypową prezentację. Nasze badanie przeprowadziliśmy w celu ustalenia: 1) czy wiek pacjenta wpływa na wyniki leczenia, 2) czy laparoskopowa appendektomia (LA) jest bezpieczną metodą leczenia pacjentów powyżej 65. roku życia. Materiał i metody: Przeprowadziliśmy retrospektywne badanie 355 chorych z AA, którzy byli pacjentami kliniki w latach 2014–2017. Chorzy zostali podzieleni na trzy grupy wiekowe: 18–40 lat, 41–65 lat i powyżej 65. roku życia. Rozpoznania histopatologiczne podzielono na trzy typy: prosty AA, ropowiczy AA i zgorzelinowy AA. Wyniki LA przeanalizowano u 96% młodszych pacjentów i u 67% starszych. Pacjenci w wieku powyżej 65. roku życia mieli wyższą przedoperacyjną liczbę białych krwinek, wyższe poziomy białka C-reaktywnego (CRP) i byli dłużej hospitalizowani niż młodsi pacjenci (p=0,05; p=0,03 i p=0,03). Odkryliśmy dodatnią korelację pomiędzy poziomami CRP, otwartą appendektomią (OA) i zgorzelowym zapaleniem wyrostka robaczkowego. Wnioski: Pacjenci powyżej 65. roku życia częściej byli poddawani otwartej appendektomii niż laparoskopowej appendektomii, mieli wyższy przedoperacyjny poziom CRP i byli dłużej hospitalizowani niż chorzy młodsi. Wyższe wartości CRP wiązały się z większym ryzykiem zgorzelinowego zapalenia wyrostka robaczkowego. Laparaskopowa appendektomia jest bezpieczną metodą leczenia pacjentów w wieku powyżej 65. roku życia

Preparation and characterization of CVD-TiN-coated carbon fibers for applications in metal matrix composites

Preparation and characterization of CVD-TiN-coated carbon fibers for applications in metal matrix composites (MMC) are promising materials for lightweight applications. So far the application has been hindered by a lack wettability of carbon fibers by aluminum alloys and detrimental reactions like aluminum carbide (Al4C3) formation. Protective coatings prepared by chemical vapor deposition (CVD) could be a suitable way to overcome these problems. In this work carbon fiber based 3D-textile preforms were coated with titanium nitride (TiN). Coating thickness, homogeneity, layer structure and composition were determined. Furthermore oxidation resistance and tensile strength of coated fibers were investigated. The wettability by molten aluminum combined with an interface analysis is examined on TiN-coated graphite substrates. Finally the quality of MMC parts prepared by gas pressure infiltration (GPI) method are evaluated. The CVD process was performed with a gas mixture of TiCl4, N2 and H2. A homogeneous coating was achieved at moderate deposition temperatures in the range from 800° to 850°C and by proper adjustment of further process parameters as TiCl4 concentration and total pressure. A very thin TiN layer with a thickness between 30 nm and 35 nm improves the oxidation resistance and results in a moderate decrease of the tensile strength from 3.9 GPa to 2.2 GPa. TiN improves the wettability and acts as a protective coating. However because of the long infiltration time in the GPI process, interface reactions occur. SEM investigations of TiN coated 3D-textile preforms infiltrated with AlSi9Cu3 alloy (226D) showa completely dense composite with a strong reduction of the Al4C3 formation. TiN offers a good protective effect if the contact time with the melt is not too long

Frailty increases mortality among patients ≥ 80 years old treated in Polish ICUs

Background: The increasing population of very old intensive care patients (VIPs) is a major challenge currently faced by clinicians and policymakers. Reliable indicators of VIPs’ prognosis and purposefulness of their admission to the intensive care unit (ICU) are urgently needed. Methods: This is a report from the Polish sample of the VIP1 multicentre cohort study (NCT03134807). Patients ≥ 80 years of age admitted to the ICU were included in the study. Information on the type and reason for admission, demographics, utilisation of ICU procedures, ICU length of stay, organ dysfunction and the decision to apply end-of-life care was collected. The primary objective was to investigate the impact of frailty syndrome on ICU and 30-day survival of VIPs. Frailty was assessed with the Clinical Frailty Scale (≥ 5 points on a scale of 1–9). Results: We enrolled 272 participants with a median age of 84 (81–87) years. Frailty was diagnosed in 170 (62.5%) patients. The ICU and 30-day survival rates were equal to 54.6% and 47.3% respectively. Three variables were found to significantly increase the odds of death in the ICU in a multiple logistic regression model: SOFA score (OR = 1.16; 95%CI 1.16–1.24), acute mode of admission (OR = 5.1; 95%CI 1.67–15.57) and frailty (OR = 2.25; 95%CI 1.26–4.01). Conclusion: Measuring frailty in critically ill older adults can facilitate making more informed clinical decisions and help avoid futile interventions.Background: The increasing population of very old intensive care patients (VIPs) is a major challenge currently facedby clinicians and policymakers. Reliable indicators of VIPs’ prognosis and appropriateness of their admission to theintensive care unit (ICU) are urgently needed. Methods: This is a report from the Polish sample of the VIP1 multicentre cohort study (NCT03134807). Patients≥ 80 years of age admitted to the ICU were included in the study. Information on the type and reason for admission,demographics, utilisation of ICU procedures, ICU length of stay, organ dysfunction and the decision to apply end-of--life care was collected. The primary objective was to investigate the impact of frailty syndrome on ICU and 30-daysurvival of VIPs. Frailty was assessed with the Clinical Frailty Scale (≥ 5 points on a scale of 1–9). Results: We enrolled 272 participants with a median age of 84 (81–87) years. Frailty was diagnosed in 170 (62.5%)patients. The ICU and 30-day survival rates were equal to 54.6% and 47.3% respectively. Three variables were found tosignificantly increase the odds of death in the ICU in a multiple logistic regression model, namely: SOFA score (OR = 1.16;95% CI: 1.16–1.24); acute mode of admission (OR = 5.1; 95% CI: 1.67–15.57); and frailty (OR = 2.25; 95% CI: 1.26–4.01). Conclusion: Measuring frailty in critically ill older adults can facilitate making more informed clinical decisions andhelp avoid futile interventions

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival