Location selection for offshore wind power station using interval-valued intuitionistic fuzzy distance measure-RANCOM-WISP method

The development opportunities and high-performance capacity of offshore wind energy project depends on the selection of the suitable offshore wind power station (OWPS) location. The present study aims to introduce a decision-making model for assessing the locations for OWPS from multiple criteria and uncertainty perspectives. In this regard, the concept of interval-valued intuitionistic fuzzy set (IVIFS) is utilized to express uncertain information. To quantify the degree of difference between IVIFSs, an improved distance measure is proposed and further utilized for deriving the objective weights of criteria. Numerical examples are discussed to illustrate the usefulness of introduced IVIF-distance measure. The RANking COMparison (RANCOM) based on interval-valued intuitionistic fuzzy information is presented to determine the subjective weights of criteria. With the combination of objective and subjective weights of criteria, an integrated weighting tool is presented to find the numeric weights of criteria under IVIFS environment. Further, a hybrid interval-valued intuitionistic fuzzy Weighted integrated Sum Product (WISP) approach is developed to prioritize the OWPS locations from multiple criteria and uncertainty perspectives. This approach combines the benefits of two normalization tools and four utility measures, which approves the effect of beneficial and non-beneficial criteria by means of weighted sum and weighted product measures. Further, the developed approach is applied to the OWPS location selection problem of Gujarat, India. Sensitivity and comparative analyses are presented to confirm the robustness and stability of the present WISP approach. This study provides an innovative decision analysis framework, which makes a significant contribution to the OWPS locations assessment problem under uncertain environment.

Intuitionistic fuzzy fairly operators and additive ratio assessment-based integrated model for selecting the optimal sustainable industrial building options

In the past few years, the private sectors and industries have focused their attention on sustainable development goals to achieve the better and more sustainable future for all. To accomplish a sustainable community, one requires to better recognize the fundamental indicators and selects the most suitable sustainable policies in diverse regions of the community. Considering the huge impact of construction industry on sustainable development, very less research efforts have been made to obtain worldwide sustainable elucidations for this type of industry. As a large sector of construction industry, industrial buildings consume enormous amounts of energy and financial assets, and play a key character in job creation and life quality improvement in the community. In order to assess the sustainable industrial buildings by means of multiple indicators, the present study introduces a hybrid multi-criteria decision-making methodology which integrates the fairly aggregation operator, the MEthod based on the Removal Effects of Criteria (MEREC), the stepwise weight assessment ratio analysis (SWARA) and the additive ratio assessment (ARAS) methods with intuitionistic fuzzy set (IFS). In this respect, firstly new intuitionistic fuzzy weighted fairly aggregation operators are proposed and then employed to aggregate the decision information in the proposed hybrid method. This operator overcomes the limitations of basic intuitionistic fuzzy aggregation operators. To find the criteria weights, an integrated model is presented based on the MEREC for objective weights and the SWARA for subjective weights of indicators under IFS context. To rank the sustainable industrial buildings, an integrated ARAS method is employed from uncertain perspective. Further, a case study concerning sustainable industrial buildings evaluation is presented to illustrate the superiority and practicality of the developed methodology. The advantages of the developed approach are highlighted in terms of stability and reliability by comparison with some of the existing methods.

An extended DNMA-based multi-criteria decision-making method and its application in the assessment of sustainable location for a lithium-ion batteries' manufacturing plant

Lithium-ion battery (LiB), a leading residual energy resource for electric vehicles (EVs), involves a market presenting exponential growth with increasing global impetus towards electric mobility. To promote the sustainability perspective of the EVs industry, this paper introduces a hybridized decision support system to select the suitable location for a LiB manufacturing plant. In this study, single-valued neutrosophic sets (SVNSs) are considered to diminish the vagueness in decision-making opinions and evade flawed plant location assessments. This study divided into four phases. First, to combine the single-valued neutrosophic information, some Archimedean-Dombi operators are developed with their outstanding characteristics. Second, an innovative utilization of the Method based on the Removal Effects of Criteria (MEREC) and Stepwise Weight Assessment Ratio Analysis (SWARA) is discussed to obtain objective, subjective and integrated weights of criteria assessment with the least subjectivity and biasedness. Third, the Double Normalization-based Multi-Aggregation (DNMA) method is developed to prioritize the location options. Fourth, an illustrative study offers decision-making strategies for choosing a suitable location for a LiB manufacturing plant in a real-world setting. Our outcomes specify that Bangalore (L ₂), with an overall utility degree (0.7579), is the best plant location for LiB manufacturing. The consistency and robustness of the presented methodology are discussed with the comparative study and sensitivity investigation. This is the first study in the current literature that has proposed an integrated methodology on SVNSs to select the best LiB manufacturing plant location by estimating both the objective and subjective weights of criteria and by considering ambiguous, inconsistent, and inexact manufacturing-based information.

Clean energy selection for sustainable development by using entropy-based decision model with hesitant fuzzy information

Smart cities development is an ambitious project launched in India in 2015 with around 14 billion USD. Smart city mission program primarily aimed at reducing the carbon footprint and encouraging green and sustainable practices. Under this context, clean energy usage for demand fulfillment became the prime focus. India's geographic location gifts the nation with diverse clean energy sources (CES). Owing to the multiple sustainable criteria that are both conflicting and correlated, there is an urge for a multi-criteria decision approach. Previously, literatures on CES selection have not been able to grab the hesitation properly and handle uncertainty effectively. Since the human mind is dynamic, hesitation is an integral part of choice making. Hesitant fuzzy set (HFS) is a generic set that captures hesitation better. Driven by these claims, in this work, a new framework for CES selection is developed. Attitude-driven entropy measure is proposed for criteria weight assessment, and a mathematical model is formulated for ranking CESs. Together, these methods constitute a decision framework that (i) considers the attitude of experts and captures hesitation during rating process and (ii) acquires partial personal choices from experts before ranking CESs. To testify the framework, a case study from a smart city within Tamil Nadu (a state in India) is explained. Sensitivity analysis reveals the robustness of the framework, and comparison with other works showcases the novel innovations of the proposal.

A Novel Image Processing Approach to Enhancement and Compression of X-ray Images

At present, there is an increase in the capacity of data generated and stored in the medical area. Thus, for the efficient handling of these extensive data, the compression methods need to be re-explored by considering the algorithm’s complexity. To reduce the redundancy of the contents of the image, thus increasing the ability to store or transfer information in optimal form, an image processing approach needs to be considered. So, in this study, two compression techniques, namely lossless compression and lossy compression, were applied for image compression, which preserves the image quality. Moreover, some enhancing techniques to increase the quality of a compressed image were employed. These methods were investigated, and several comparison results are demonstrated. Finally, the performance metrics were extracted and analyzed based on state-of-the-art methods. PSNR, MSE, and SSIM are three performance metrics that were used for the sample medical images. Detailed analysis of the measurement metrics demonstrates better efficiency than the other image processing techniques. This study helps to better understand these strategies and assists researchers in selecting a more appropriate technique for a given use case.

Carbon dioxide (CO2) emissions and economic growth: A systematic review of two decades of research from 1995 to 2017

Understanding the nexus CO₂ emissions and economic growth helps economies in formulating energy policies and developing energy resources in sustainable ways. Although during recent years, numerous of the previous studies have been very thoroughly investigated the nexus between economic growth and CO₂ emissions, there is a lack of research regarding the qualitative systematic review and meta-analysis in these areas. The main purpose of this review paper is to present the comprehensive overview of the relationship between CO₂ emissions and economic growth. In this regard, the Web of Science database has been chosen and a qualitative systematic and meta-analysis method which called "Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)" has been proposed. Therefore, a review of 175 published articles appearing in 55 scholarly international journals between 1995 and 2017 has been achieved to reach a broad review of the nexus between economic growth and CO₂ emissions with other indicators. Consequently, the selected articles have been categorized by the author name, the year of publication, data duration, types of techniques, data analysis method, the name of indicators, country, scope (individual country and multi-countries), journals, results, and outcome in which they appeared. The results of this paper demonstrated that the nexus between CO₂ emissions and economic growth gives reasons for policy options that have to reduce emissions by imposing limiting factors on economic growth as well. Given the fact that bidirectional causality exists, as far as economic growth increases or decreases, further CO₂ emissions are stimulated in higher or lower levels and consequently, a potential reduction of the emissions should have an adverse influence on economic growth.

Systolic anterior motion causing hemodynamic instability and pulmonary edema during bleeding

Systolic anterior motion (SAM) of mitral valve is the prolapse of a mitral leaflet into the left ventricle outflow tract (LVOT) during systole, causing LVOT obstruction and mitral valve regurgitation. We report the case of a patient who developed SAM-induced hemodynamic instability during bleeding with a clinical picture resembling pulmonary edema. A 77-year-old woman was admitted to our emergency room for abdominal bleeding in polycystic renal disease. Upon arrival, she was normotensive, despite being anuric and acidotic. After infusion of fluids and packed red blood cells (total 3 680 mL in 6 hours) she developed atrial fibrillation and clinical and radiological signs of pulmonary edema. Sedation and non-invasive ventilation brought to immediate severe hypotension. A transesophageal echocardiogram showed an "empty" hypertrophic hypercontractile left ventricle, SAM with LVOT obstruction (intraventricular gradient 154 mmHg) and moderate-to-severe mitral regurgitation. With further fluid infusion hemodynamic stability and sinus rhythm were recovered. SAM, LVOT obstruction and mitral regurgitation disappeared. SAM is a rare but dangerous cause of hemodynamic instability. It has been described in patients with and without left ventricular hypertrophy, in presence of hypovolemia and sympathetic stimulation. In our case it presented with a misleading clinical picture of pulmonary edema simulating fluid overload in an actually hypovolemic patient. In fact, SAM-associated mitral regurgitation together with diastolic dysfunction and tachycardia induced a pulmonary edema whose treatment worsened hypovolemia and precipitated LVOT obstruction and hypotension. Further fluid infusion was resolutive. Echocardiography was fundamental for diagnosis and treatment.

Diurnal and nocturnal shifts do not influence non-invasive ventilation outcome

AIM

The aim of this study was to assess if diurnal or nocturnal shifts were independent risk factors for non-invasive ventilation (NIV) failure.

METHODS

This was an observational study carried out on 18 patients of the general Intensive Care Unit in Rome. A total number of 189 consecutive patients needing mechanical ventilation for respiratory failure were prospectively enrolled: 82 were treated with NIV as a first line intervention. Of the 107 patients who were initially intubated, 59 patients were extubated; once extubation failed they were treated with NIV. NIV failure was assessed during both the day (between 7 am and 10 pm) and night shifts (between 10 pm and 7 am).

RESULTS

Of the 141 total patients who received NIV, 51 experienced failure during the day shifts and 18 during the night shifts. No difference in the median day and night shift TISS-28 values were observed in any patients who failed NIV during both day and night shifts. Causes of NIV failure were similar during both diurnal and nocturnal shifts. The inability to correct gas exchanges was the main reason for failure.

CONCLUSION

In a center with NIV expertise, notwithstanding nurse understaffing, diurnal and nocturnal shifts did not affect the rate of NIV failure.

Reliability of the North Star Ambulatory Assessment in a multicentric setting

The aim of this study was to investigate the suitability of the North Star Ambulatory Assessment as a possible outcome measure in multicentric clinical trials. More specifically we wished to investigate the level of training needed for achieving a good interobserver reliability in a multicentric setting. The scale was specifically designed for ambulant children with Duchenne Muscular Dystrophy and includes 17 items that are relevant for this cohort. Thirteen Italian centers participated in the study. In the first phase of the study we provided two training videos and an example of the scale performed on a child. After the first session of training, all the 13 examiners were asked to send a video with an assessment performed in their centre and to score all the videos collected. There were no difficulties in performing the items and in obtaining adequate videos with a hand held camera but the results showed a poor interobserver reliability (<.5). After a second training session with review and discussion of the videos previously scored, the same examiners were asked to score three new videos. The results of this session had an excellent interobserver reliability (.995). The level of agreement was maintained even when the same videos were rescored after a month, showing a significant intra-observer reliability (.95). Our results suggest that the NSAA is a test that can be easily performed, completed in 10 min and can be used in a multicentric setting, providing that adequate training is administered.

Good neurological recovery after cardiopulmonary resuscitation and thrombolysis in two old patients with pulmonary embolism

The use of thrombolysis as an emergency treatment for cardiac arrest (CA) due to massive pulmonary embolism (MPE) has been described. However, there are no reports of successful treatment of MPE-associated CA in patients over 77 years of age. We report two cases of successful cardiopulmonary resuscitation for an MPE-associated CA in two very old women (87 and 86 years of age). In both cases, typical signs of MPE were documented using emergency echocardiography, which showed an acute right ventricle enlargement and a paradoxical movement of the interventricular septum. Emergency thrombolysis was administered during resuscitation, which lasted 45 and 21 min, respectively. Despite old age and prolonged resuscitation efforts, both patients had good neurological recovery and one of them was alive and neurologically intact 1 year later. Thrombolysis is a potentially useful therapy in MPE-associated CA. A good neurological outcome can be obtained even in very old patients and after prolonged resuscitation.

The 2005 European Guidelines for cardiopulmonary resuscitation: major changes and rationale

During the 2005 International Consensus Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care Science, a rigorous evidence-based evaluation process was conducted. The consensus reached during that Conference constituted the basis of the current CPR guidelines of the European Resuscitation Council (ERC), published in December 2005. Those guidelines included many important changes, made on the basis of emerging evidence. For example, the compression-ventilation ratio for CPR in non-intubated patients was increased from 15:2 to 30:2 and a strong recommendation to minimize interruptions in chest compression was issued in order to maximise organ perfusion. Energy levels for monophasic defibrillation were increased and specific energy levels for biphasic defibrillation have been recommended, in order to maximise the efficacy of the first shock. New timing of defibrillation shocks is now advised: the three-stacked shock sequence has been replaced by high-energy single shocks followed by two-minute cycles of CPR, in order to reduce CPR interruptions. Timing for administration of drugs has been adapted to the new shock sequence and the advanced life support (ALS) universal algorithm has been modified. Some controversial topics are still a matter of investigation and debate, including the use of therapeutic hypothermia in non-shockable cardiac arrests, the efficacy of a period of CPR before defibrillation in long-lasting cardiac arrests, and the chest-compression-only CPR for first responders of out-of-hospital cardiac arrests.

Functional hemodynamic monitoring and dynamic indices of fluid responsiveness

Knowing whether or not a fluid infusion can improve cardiac output (fluid responsiveness) is crucial when treating hemodynamically unstable patients. Generally, cardiac filling pressures (central venous pressure, pulmonary artery occlusion [''wedge''] pressure) and volumes (end-diastolic left and right ventricular volume) are used, although they are not reliable predictors of fluid responsiveness. For this reason, new indices, the so-called dynamic indices of fluid responsiveness, have been recently introduced in clinical use. If stroke volume, or stroke volume-derived parameters (pulse pressure and aortic flow) show wide variation during mechanical ventilation, a good response to fluid therapy can be predicted. As these indices are based upon the effects of controlled mechanical ventilation on stroke volume, they can be used in deeply sedated or apneic patients whose cardiac rhythm is regular. To overcome these limitations, new dynamic indices have been introduced. Among them, variation of cardiac output induced by passive leg raising (PLR) has raised particular interest since it can identify fluid responders even among spontaneously breathing and non-sinus rhythm patients. Although promising, the dynamic indices of fluid responsiveness have been studied only retrospectively in a relatively small number of patients and evidence that clinical use of these indices can improve outcome is still limited. Further investigations are needed to confirm their clinical validity.

Enoximone in cardiac arrest caused by propranolol: two case reports

We report two clinical cases of cardiac arrest, the former due to an adverse effect of intravenous (i.v.) propranolol in a patient with systemic sclerosis, the latter from a propranolol suicidal overdose. In both cases, conventional advanced life support (ALS) was ineffective but both patients eventually responded to the administration of enoximone, a phosphodiesterase III (PDE III) inhibitor. After the arrest, both patients regained consciousness and were discharged home. The chronotropic and inotropic effects of PDE III inhibitors are due to inhibition of intracellular PDEIII and are therefore unaffected by beta-blockers. These cases suggest that PDEIII inhibitors may be useful in restoring spontaneous circulation in cardiac arrest associated with beta-blocker administration when standard ALS is ineffective.

Successful treatment with enoximone for severe poisoning with atenolol and verapamil: a case report

Combined poisoning with calcium channel blockers (CCBs) and beta-blockers is usually associated with severe hypotension and heart failure. Due to the block of the beta receptors, treatment with adrenergic agonists, even at high doses, can be insufficient, and beta-independent inotropes, such as glucagon, may be required. Phosphodiesterase III (PDEIII) inhibitors represent a possible alternative to glucagon in these cases as they have an inotropic effect which is not mediated by a beta receptor.

[An unusual case of orbital cellulitis and perforating scleromalacia]

We report the case of a diabetic patient with refractory anemia with excess blasts (RAEB) who developed bladder infection followed by orbital cellulitis and nodular skin lesions. After a short remission, the clinical aspect was complicated by corneal ulceration, scleromalacia, bulbar perforation and lens luxation.