933 research outputs found
Processing and Properties of Bar-Shaped Single-Seeded and Multi-Seeded YBCO Bulk Superconductors by a Top-Seeded Melt Growth Technique
© 2016 The Author(s)The fabrication of (RE)-Ba-Cu-O bulk superconductors, where RE is a rare-earth element such as Y, Gd and Sm, is both time consuming and expensive due to the complexity of the melt process and the slow growth rate of large, single grains. In this study, different approaches to the fabrication of bar-shaped, bulk YBCO superconductors are investigated and compared using single- and multiple-seeding techniques via top-seeded melt growth (TSMG). Both the microstructural and superconducting properties of the bulk samples are investigated, including trapped field, critical current density, critical temperature and levitation force. The results of this study indicate that, in general, the superconducting properties of YBCO fabricated by a single-seeded process are significantly better than those of samples fabricated by a four-seeded process for non-bridge seeds. The differences between the samples are less pronounced in the levitation force measurements, however. In this paper, we attempt to explain the reasons for the similarities and differences observed between bulk samples fabricated by the different single- and multi-seeded processes.This work was supported by the King Abdulaziz City for Science and Technology (KACST)
Hospital bed capacity and usage across secondary healthcare providers in England during the first wave of the COVID-19 pandemic: a descriptive analysis
OBJECTIVE: In this study, we describe the pattern of bed occupancy across England during the peak of the first wave of the COVID-19 pandemic. DESIGN: Descriptive survey. SETTING: All non-specialist secondary care providers in England from 27 March27to 5 June 2020. PARTICIPANTS: Acute (non-specialist) trusts with a type 1 (ie, 24 hours/day, consultant-led) accident and emergency department (n=125), Nightingale (field) hospitals (n=7) and independent sector secondary care providers (n=195). MAIN OUTCOME MEASURES: Two thresholds for 'safe occupancy' were used: 85% as per the Royal College of Emergency Medicine and 92% as per NHS Improvement. RESULTS: At peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough there were 8.7% (8508) fewer general and acute beds across England, but occupancy never exceeded 72%. The closest to full occupancy of general and acute bed (surge) capacity that any trust in England reached was 99.8% . For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust=1, range: 1-17). However, only three sustainability and transformation partnerships (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds. CONCLUSIONS: Throughout the first wave of the pandemic, an adequate supply of all bed types existed at a national level. However, due to an unequal distribution of bed utilisation, many trusts spent a significant period operating above 'safe-occupancy' thresholds despite substantial capacity in geographically co-located trusts, a key operational issue to address in preparing for future waves
The association between mechanical ventilator compatible bed occupancy and mortality risk in intensive care patients with COVID-19: a national retrospective cohort study
BACKGROUND:
The literature paints a complex picture of the association between mortality risk and ICU strain.
In this study, we sought to determine if there is an association between mortality risk in intensive care units (ICU) and occupancy of beds compatible with mechanical ventilation, as a proxy for strain.
METHODS:
A national retrospective observational cohort study of 89 English hospital trusts (i.e. groups of hospitals functioning as single operational units). Seven thousand one hundred thirty-three adults admitted to an ICU in England between 2 April and 1 December, 2020 (inclusive), with presumed or confirmed COVID-19, for whom data was submitted to the national surveillance programme and met study inclusion criteria. A Bayesian hierarchical approach was used to model the association between hospital trust level (mechanical ventilation compatible), bed occupancy, and in-hospital all-cause mortality. Results were adjusted for unit characteristics (pre-pandemic size), individual patient-level demographic characteristics (age, sex, ethnicity, deprivation index, time-to-ICU admission), and recorded chronic comorbidities (obesity, diabetes, respiratory disease, liver disease, heart disease, hypertension, immunosuppression, neurological disease, renal disease).
RESULTS:
One hundred thirty-five thousand six hundred patient days were observed, with a mortality rate of 19.4 per 1000 patient days. Adjusting for patient-level factors, mortality was higher for admissions during periods of high occupancy (> 85% occupancy versus the baseline of 45 to 85%) [OR 1.23 (95% posterior credible interval (PCI): 1.08 to 1.39)]. In contrast, mortality was decreased for admissions during periods of low occupancy (< 45% relative to the baseline) [OR 0.83 (95% PCI 0.75 to 0.94)].
CONCLUSIONS:
Increasing occupancy of beds compatible with mechanical ventilation, a proxy for operational strain, is associated with a higher mortality risk for individuals admitted to ICU. Further research is required to establish if this is a causal relationship or whether it reflects strain on other operational factors such as staff. If causal, the result highlights the importance of strategies to keep ICU occupancy low to mitigate the impact of this type of resource saturation
The disproportionate excess mortality risk of COVID-19 in younger people with diabetes warrants vaccination prioritisation
This is the final version. Available on open access from Springer via the DOI in this recordData availability:
CHESS data cannot be shared publicly as it was collected by Public Health England as part of their statutory responsibilities, which allows them to process patient confidential data without explicit patient consent. Data utilised in this study were made available through an agreement between the University of Warwick and Public Health England. Individual requests for access to CHESS data are considered directly by Public Health England (contact via [email protected]).Diabetes U
The implications of an incidental chronic lymphocytic leukaemia in a resection specimen for colorectal adenocarcinoma
<p>Abstract</p> <p>Background</p> <p>Colorectal cancer and B cell chronic lymphocytic leukaemia (CLL) have a significant incidence, which are increasing with the aging population. Evidence has been presented in the literature to suggest that the synchronous presentation of colorectal cancer and B cell CLL may be more than simply coincidental for these two common malignancies. We report an unusual case of a presumed B cell CLL diagnosed on the basis of histological analysis of lymph nodes recovered from a resection specimen for rectal adenocarcinoma. We considered aetiological factors which may have linked the synchronous diagnosis of the two malignancies and the potential implications for the natural history of the two malignancies on one another.</p> <p>Case presentation</p> <p>A 70-year-old male underwent low anterior resection with total mesorectal excision for a rectal adenocarcinoma. His co-morbid conditions were chronic obstructive airways disease and ischaemic heart disease. General examination revealed no lymphadenopathy. Full blood count, urea and electrolytes and liver function tests were all within normal limits. As well as confirming a pT3 N1 adenocarcinoma, histological analysis showed lymph nodes with an infiltrate of small lymphoid cells. Immunohistochemical studies showed these cells to be in keeping with B cell CLL.</p> <p>Conclusion</p> <p>Whilst unable to identify any common aetiological factors in the two malignancies in our patient, immunosuppression and genetic abnormalities have been identified as possible bases for an observed epidemiological association between colorectal cancer and haematological malignancies. Examples such as our case of synchronous diagnosis of two malignancies in a patient are likely to increase with the aging population. The potential affects of one malignancy on the natural history of the other warrants further study. In our case, we considered that slow progression of the B cell CLL may increase the risk of recurrent rectal adenocarcinoma.</p
Epidemic infectious gastrointestinal illness aboard U.S. Navy ships deployed to the Middle East during peacetime operations – 2000–2001
BACKGROUND: Infectious gastrointestinal illness (IGI) outbreaks have been reported in U.S. Navy ships and could potentially have an adverse mission impact. Studies to date have been anecdotal. METHODS: We conducted a retrospective analysis of weekly reported disease and non-battle injury health data collected in 2000 – 2001 from 44 U.S. Navy ships while sailing in the 5(th )Fleet (Persian Gulf and nearby seas). RESULTS: During this period, 11 possible IGI outbreaks were identified. Overall, we found 3.3 outbreaks per 100 ship-weeks, a mean outbreak duration of 4.4 weeks, and a mean cumulative ship population attack rate of 3.6%. Morbidity, represented by days lost due to personnel being placed on sick-in-quarters status, was higher during outbreak weeks compared to non-outbreak weeks (p = 0.002). No clear seasonal distribution was identified. CONCLUSION: Explosive outbreaks due to viruses and bacteria with the potential of incapacitating large proportions of the crew raise serious concerns of mission impact and military readiness
Optoelectronic Characterization and Properties of Single-walled Carbon Nanotubes in a Liquid Dispersion Form
Carbon nanotubes (CNTs) are very promising
nanodevices due to their extraordinary electrical, thermal, and optical
properties. However, as-grown single-walled CNTs (SWCNTs) contain a mixture of
semiconducting and metallic species with great features versatility and
variation. Solution-based processing of this nanomaterial is vital for further
implementation in applicable platforms. In this paper, important optoelectronic
intrinsic properties of SWCNTs in dispersions are studied applying a
semi-empirical approach of optical characterization and Tauc/Davis-Mott
relation and Max-Planck equations. SWCNTs are found to have a direct bandgap of
2.20 eV, an indirect bandgap of 0.27 eV, an optical conductivity of about 107
S cm-1, and exhibited a metamaterial behavior ascribed to the high
negative permittivity. In addition, the optimum parameters for the dispersion
of SWCNTs, and the separation of the semiconducting species using simple
mechanical methods of ultrasonication and density gradient ultracentrifugation,
respectively, without using surfactants are also presented
Hospital bed capacity and usage across secondary healthcare providers in England during the first wave of the COVID-19 pandemic: a descriptive analysis
Objective In this study, we describe the pattern of bed occupancy across England during the peak of the first wave of the COVID-19 pandemic. Design Descriptive survey. Setting All non-specialist secondary care providers in England from 27 March27to 5 June 2020. Participants Acute (non-specialist) trusts with a type 1 (ie, 24 hours/day, consultant-led) accident and emergency department (n=125), Nightingale (field) hospitals (n=7) and independent sector secondary care providers (n=195). Main outcome measures Two thresholds for ‘safe occupancy’ were used: 85% as per the Royal College of Emergency Medicine and 92% as per NHS Improvement. Results At peak availability, there were 2711 additional beds compatible with mechanical ventilation across England, reflecting a 53% increase in capacity, and occupancy never exceeded 62%. A consequence of the repurposing of beds meant that at the trough there were 8.7% (8508) fewer general and acute beds across England, but occupancy never exceeded 72%. The closest to full occupancy of general and acute bed (surge) capacity that any trust in England reached was 99.8% . For beds compatible with mechanical ventilation there were 326 trust-days (3.7%) spent above 85% of surge capacity and 154 trust-days (1.8%) spent above 92%. 23 trusts spent a cumulative 81 days at 100% saturation of their surge ventilator bed capacity (median number of days per trust=1, range: 1–17). However, only three sustainability and transformation partnerships (aggregates of geographically co-located trusts) reached 100% saturation of their mechanical ventilation beds. Conclusions Throughout the first wave of the pandemic, an adequate supply of all bed types existed at a national level. However, due to an unequal distribution of bed utilisation, many trusts spent a significant period operating above ‘safe-occupancy’ thresholds despite substantial capacity in geographically co-located trusts, a key operational issue to address in preparing for future waves
Type 2 Diabetes and COVID-19-Related Mortality in the Critical Care Setting: A National Cohort Study in England, March-July 2020
This is the author accepted manuscript. The final version is available from the American Diabetes Association via the DOI in this recordOBJECTIVE: To describe the relationship between type 2 diabetes and all-cause mortality among adults with coronavirus disease 2019 (COVID-19) in the critical care setting. RESEARCH DESIGN AND METHODS: This was a nationwide retrospective cohort study in people admitted to hospital in England with COVID-19 requiring admission to a high dependency unit (HDU) or intensive care unit (ICU) between 1 March 2020 and 27 July 2020. Cox proportional hazards models were used to estimate 30-day in-hospital all-cause mortality associated with type 2 diabetes, with adjustment for age, sex, ethnicity, obesity, and other major comorbidities (chronic respiratory disease, asthma, chronic heart disease, hypertension, immunosuppression, chronic neurological disease, chronic renal disease, and chronic liver disease). RESULTS: A total of 19,256 COVID-19-related HDU and ICU admissions were included in the primary analysis, including 13,809 HDU (mean age 70 years) and 5,447 ICU (mean age 58 years) admissions. Of those admitted, 3,524 (18.3%) had type 2 diabetes and 5,077 (26.4%) died during the study period. Patients with type 2 diabetes were at increased risk of death (adjusted hazard ratio [aHR] 1.23 [95% CI 1.14, 1.32]), and this result was consistent in HDU and ICU subsets. The relative mortality risk associated with type 2 diabetes decreased with higher age (age 18-49 years aHR 1.50 [95% CI 1.05, 2.15], age 50-64 years 1.29 [1.10, 1.51], and age ≥65 years 1.18 [1.09, 1.29], P value for age-type 2 diabetes interaction = 0.002). CONCLUSIONS: Type 2 diabetes may be an independent prognostic factor for survival in people with severe COVID-19 requiring critical care treatment, and in this setting the risk increase associated with type 2 diabetes is greatest in younger people.Research EnglandEngineering and Physical Sciences Research Council (EPSRC)University of WarwickNational Institute for Health Research (NIHR)Wellcome Trus
Stochastic population growth in spatially heterogeneous environments
Classical ecological theory predicts that environmental stochasticity
increases extinction risk by reducing the average per-capita growth rate of
populations. To understand the interactive effects of environmental
stochasticity, spatial heterogeneity, and dispersal on population growth, we
study the following model for population abundances in patches: the
conditional law of given is such that when is small the
conditional mean of is approximately , where and are the abundance and per
capita growth rate in the -th patch respectivly, and is the
dispersal rate from the -th to the -th patch, and the conditional
covariance of and is approximately . We show for such a spatially extended population that if
is the total population abundance, then ,
the vector of patch proportions, converges in law to a random vector
as , and the stochastic growth rate equals the space-time average per-capita growth rate
\sum_i\mu_i\E[Y_\infty^i] experienced by the population minus half of the
space-time average temporal variation \E[\sum_{i,j}\sigma_{ij}Y_\infty^i
Y_\infty^j] experienced by the population. We derive analytic results for the
law of , find which choice of the dispersal mechanism produces an
optimal stochastic growth rate for a freely dispersing population, and
investigate the effect on the stochastic growth rate of constraints on
dispersal rates. Our results provide fundamental insights into "ideal free"
movement in the face of uncertainty, the persistence of coupled sink
populations, the evolution of dispersal rates, and the single large or several
small (SLOSS) debate in conservation biology.Comment: 47 pages, 4 figure
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