The maturation of emergency medicine (EM) as a specialty has coincided with dramatic increases in emergency department (ED) visit rates, both in the United States and around the world. ED crowding has become a public health problem where periodic supply and demand mismatches in ED and hospital resources cause long waiting times and delays in critical treatments. ED crowding has been associated with several negative clinical outcomes, including higher complication rates and mortality. This article describes emergency care systems and the extent of crowding across 15 countries outside of the United States: Australia, Canada, Denmark, Finland, France, Germany, Hong Kong, India, Iran, Italy, The Netherlands, Saudi Arabia, Catalonia (Spain), Sweden, and the United Kingdom. The authors are local emergency care leaders with knowledge of emergency care in their particular countries. Where available, data are provided about visit patterns in each country; however, for many of these countries, no national data are available on ED visits rates or crowding. For most of the countries included, there is both objective evidence of increases in ED visit rates and ED crowding and also subjective assessments of trends toward higher crowding in the ED. ED crowding appears to be worsening in many countries despite the presence of universal health coverage. Scandinavian countries with robust systems to manage acute care outside the ED do not report crowding is a major problem. The main cause for crowding identified by many authors is the boarding of admitted patients, similar to the United States. Many hospitals in these countries have implemented operational interventions to mitigate crowding in the ED, and some countries have imposed strict limits on ED length of stay (LOS), while others have no clear

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Polymers derived from renewable resources are now considered as promising alternatives to traditional petro-polymers as they mitigate current environmental concerns (raw renewable materials/biodegradability). d-limonene can be found in a variety of citrus, indeed is the main component of citrus oils and one of most important contributors to citrus flavor. The incorporation of limonene in PLA matrix was evaluated and quantified by Pyrolysis Gas Chromatography Mass Spectrometry (Py-GC/MS). Transparent films were obtained after the addition of the natural compound. Mechanical properties were evaluated by tensile tests. The effect of limonene on mechanical properties of PLA films was characterized by an increase in the elongation at break and a decrease in the elastic modulus. The fracture surface structure of films was evaluated by scanning electron microscopy (SEM), and homogeneous surfaces were observed in all cases. Barrier properties were reduced due to the increase of the chain mobility produced by the d-limonene.

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In this work, different materials for three-dimensional (3D)-printing were studied, which based on polycaprolactone with two natural additives, gum rosin, and beeswax. During the 3D-printing process, the bed and extrusion temperatures of each formulation were established. After, the obtained materials were characterized by mechanical, thermal, and structural properties. The results showed that the formulation with containing polycaprolactone with a mixture of gum rosin and beeswax as additive behaved better during the 3D-printing process. Moreover, the miscibility and compatibility between the additives and the matrix were concluded through the thermal assessment. The mechanical characterization established that the addition of the mixture of gum rosin and beeswax provides greater tensile strength than those additives separately, facilitating 3D-printing. In contrast, the addition of beeswax increased the ductility of the material, which makes the 3D-printing processing difficult. Despite the fact that both natural additives had a plasticizing effect, the formulations containing gum rosin showed greater elongation at break. Finally, Fourier-Transform Infrared Spectroscopy assessment deduced that polycaprolactone interacts with the functional groups of the additives.

This study presents the valorization of cotton waste from the textile industry for the development of sustainable and cost-competitive biopolymer composites. The as-received linter of recycled cotton was first chopped to obtain short fibers, called recycled cotton fibers (RCFs), which were thereafter melt-compounded in a twin-screw extruder with partially bio-based polyethylene terephthalate (bio-PET) and shaped into pieces by injection molding. It was observed that the incorporation of RCF, in the 1–10 wt% range, successfully increased rigidity and hardness of bio-PET. However, particularly at the highest fiber contents, the ductility and toughness of the pieces were considerably impaired due to the poor interfacial adhesion of the fibers to the biopolyester matrix. Interestingly, RCF acted as an effective nucleating agent for the bio-PET crystallization and it also increased thermal resistance. In addition, the overall dimensional stability of the pieces was improved as a function of the fiber loading. Therefore, bio-PET pieces containing 3–5 wt% RCF presented very balanced properties in terms of mechanical strength, toughness, and thermal resistance. The resultant biopolymer composite pieces can be of interest in rigid food packaging and related applications, contributing positively to the optimization of the integrated biorefinery system design and also to the valorization of textile wastes.

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