Fluorescent, Thermoresponsive Oligo(ethylene glycol) Methacrylate/9-(4-Vinylbenzyl)-9<i>H</i>-carbazole Copolymers Designed with Multiple LCSTs via Nitroxide Mediated Controlled Radical Polymerization

9-(4-Vinylbenzyl)-9<i>H</i>-carbazole (VBK) was used as the “controlling” comonomer for nitroxide mediated polymerization with 10 mol % SG1 free nitroxide relative to BlocBuilder initiator at 80 °C of oligo­(ethylene glycol) methyl ether methacrylate (8–9 ethylene glycol (EG) units) (OEGMA_8–9), 2-(2-methoxyethoxy)­ethyl methacrylate (MEO₂MA) and for an OEGMA_8–9/MEO₂MA-mixed feed. The synthesis of MEO₂MA/VBK and OEGMA_8–9/VBK copolymers and MEO₂MA/OEGMA_8–9/VBK terpolymers exhibited linear increases in number-average molecular weight (<i>M̅</i>_n) versus conversion <i>X</i>, up until <i>X</i> = 0.6, with final copolymers characterized by relatively narrow, monomodal molecular weight distributions (<i>M̅</i>_w/<i>M̅</i>_n < 1.4, in most cases). A series of MEO₂MA/OEGMA_8–9/VBK terpolymers were synthesized and by varying the OEGMA_8–9:MEO₂MA feed ratios, the terpolymers exhibited tunable lower critical solution temperatures in water (28 °C < LCST<i>s</i> < 81 °C). MEO₂MA/OEGMA_8–9/VBK terpolymers were deemed sufficiently pseudo-“living” to reinitiate a second batch of MEO₂MA/OEGMA_8–9/VBK, with few apparent dead chains, as indicated by the monomodal shift in the GPC chromatograms. The resulting MEO₂MA/OEGMA_8–9/VBK block copolymers were designed so that each block exhibited a distinct LCST, which was confirmed by UV–vis and dynamic light scattering. In addition to controlling the terpolymerization, the VBK units imparted thermo-responsive fluorescence into the final copolymers

Investigating and understanding the effects of multiple femtosecond

The majority of studies performed on the formation of surface features by femtosecond laser radiation focuses on single scan procedures, i.e. manipulating the laser beam once over the target area to fabricate different surface topographies. In this work, the effect of scanning stainless steel 304 multiple times with femtosecond laser pulses is thoroughly investigated over a wide range of fluences. The resultant laser-induced surface topographies can be categorized into two different regimes. In the low fluence regime (FΣline,max < 130 J/cm2), ellipsoidal cones (randomly distributed surface protrusions covered by several layers of nanoparticles) are formed. Based on chemical, crystallographic, and topographical analyses, we conclude that these ellipsoidal cones are composed of unablated steel whose conical geometry offers a significant degree of fluence reduction (35–52%)..

Reducing Ice Adhesion on Nonsmooth Metallic Surfaces: Wettability and Topography Effects

The effects of ice formation and accretion on external surfaces range from being mildly annoying to potentially life-threatening. Ice-shedding materials, which lower the adhesion strength of ice to its surface, have recently received renewed research attention as a means to circumvent the problem of icing. In this work, we investigate how surface wettability and surface topography influence the ice adhesion strength on three different surfaces: (i) superhydrophobic laser-inscribed square pillars on copper, (ii) stainless steel 316 Dutch-weave meshes, and (iii) multiwalled carbon nanotube-covered steel meshes. The finest stainless steel mesh displayed the best performance with a 93% decrease in ice adhesion relative to polished stainless steel, while the superhydrophobic square pillars exhibited an increase in ice adhesion by up to 67% relative to polished copper. Comparisons of dynamic contact angles revealed little correlation between surface wettability and ice adhesion. On the other hand, by considering the ice formation process and the fracture mechanics at the ice–substrate interface, we found that two competing mechanisms governing ice adhesion strength arise on nonplanar surfaces: (i) mechanical interlocking of the ice within the surface features that enhances adhesion, and (ii) formation of microcracks that act as interfacial stress concentrators, which reduce adhesion. Our analysis provides insight toward new approaches for the design of ice-releasing materials through the use of surface topographies that promote interfacial crack propagation

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine