Robust, Bridge-less Ion-selective Electrodes with Significantly Reduced Need for Pre- and Post-application Handling

We are demonstrating robust, single-layer ion-selective electrode (ISE) utilizing simple Ag/AgCl electrode as solid support without the need for intermediate polymer layer. We have created and chemically linked a family of imidazolium ionic liquids (ILs) with poly (vinyl chloride) (PVC) using click chemistry, resulting in hybrid materials with tunable characteristics. The resultant material inherently contains chloride ion thus offering the ability to stabilize interfacial potential. This allowed us to construct very simple, single-layer membranes with significantly reduced need for conditioning as an added bonus compared to traditional sensors. Chemical immobilization of ISE membrane components also led to extended lifetime as the potential for material loss is reduced and detection limits are lowered. In our characterization we focused on perchlorate as a model ion. It\u27s levels of around 10−7 M could be repeatedly quantified over a 100 day period despite constant exposure of ISEs to aqueous solution over this time. Most importantly, the electrodes exhibited stable and reproducible signal with significantly simplified pre- and post-operation handling protocols. This offers potential for in situ applications as well as to advanced fabrication techniques and miniaturization. Simplicity of construction and operation, and low cost of the solid substrate allows for disposable ISE formats

Hypersonic flow simulation by the gas-kinetic bhatnagar-gross-krook scheme

The gas-kinetic Bhatnagar–Gross–Krook (BGK) scheme is extended to hypersonic flow simulations and thus shows that the compressible inviscid flow solutions of the simulations are efficiently and accurately obtained from the BGK scheme without the disastrous shock instability phenomenon that occurs in most hypersonic flow simulations involving strong shock waves. For this particular study, the effect of chemistry in hypersonic flows has not been taken into account. Hence, the assumption of calorically perfect gas is imposed in all simulations. The high-order resolution of the scheme is achieved by utilizing monotone upstream-centered schemes for conservation laws-type initial reconstruction. While, an implicit-type time-integration method known as the approximate factorization– alternating direction implicit is adopted for computing both steady and unsteady calculations. The gas-kinetic scheme is tested meticulously in four two-dimensional numerical examples, namely, the blunt-body problem, the double Mach reflection problem, the axisymmetric blunt-body problem, and the flow over a 15-deg ramp. The numerical results of the BGK scheme when compared with the other schemes and experimental data show that this numerical technique is robust, accurate, and stable for hypersonic flow

Application of the ANOVA method in the optimization of a thermoelectric cooler-based dehumidification system

© 2022 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).In recent studies, Thermo-Electric Coolers (TEC) have been utilized for dehumidification purposes, which is mainly based on the extraction of moisture from humid atmospheric air. The reviewed literature showed that the rate of water collection from the TEC-based system can be affected by various parameters such as the module’s input voltage, the heat sink orientation, and tilt angles. In this research, the analysis of variance (ANOVA) was used to examine the significance of these factors and their interaction within the system on the TEC-based dehumidification system. Four levels were investigated for both, the Peltier’s input voltage and the rotation angle, and three levels for the tilt angle. This study indicated the significance of the studied factors and their interactions within the dehumidification system along with performing an overall numerical optimization. The experiments were conducted under the same working conditions in an enclosed environment to minimize errors. According to the overall numerical optimization, which was validated experimentally, the optimum system performance was predicted to be obtained at approximately 6.8V Peltier input volt, 65° rotation angle, and 90° tilt angles, with predicted optimum productivities of 0.32278 L/kWh and 13.03 mL/hr. For the same set of parameters, the variation between the experiment and the numerical optimization was less than 4%. The experiments show that when optimizing water collection rates for thermoelectric cooling heat sinks​ under high humidity conditions, the orientation of the heat sink should be considered.Peer reviewe

Thermohydraulic analysis of covalent and noncovalent functionalized graphene nanoplatelets in circular tube fitted with turbulators

© The Author(s) 2022. This article is licensed under a Creative Commons Attribution 4.0 International. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.Covalent and non-covalent nanofluids were tested inside a circular tube fitted with twisted tape inserts with 45° and 90° helix angles. Reynolds number was 7000 ≤ Re ≤ 17,000, and thermophysical properties were assessed at 308 K. The physical model was solved numerically via a two-equation eddy-viscosity model (SST k-omega turbulence). GNPs-SDBS@DW and GNPs-COOH@DW nanofluids with concentrations (0.025 wt.%, 0.05 wt.% and 0.1 wt.%) were considered in this study. The twisted pipes' walls were heated under a constant temperature of 330 K. The current study considered six parameters: outlet temperature, heat transfer coefficient, average Nusselt number, friction factor, pressure loss, and performance evaluation criterion. In both cases (45° and 90° helix angles), GNPs-SDBS@DW nanofluids presented higher thermohydraulic performance than GNPs-COOH@DW and increased by increasing the mass fractions such as 1.17 for 0.025 wt.%, 1.19 for 0.05 wt.% and 1.26 for 0.1 wt.%. Meanwhile, in both cases (45° and 90° helix angles), the value of thermohydraulic performance using GNPs-COOH@DW was 1.02 for 0.025 wt.%, 1.05 for 0.05 wt.% and 1.02 for 0.1 wt.%.Peer reviewe

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks