Revealing dislocation structure around and underneath indentations in (001) strontium titanate single crystals at room temperature and 350o C

Many crystalline materials exhibit an indentation size effect, i.e., an intrinsic change in hardness with changes in sampled material volume. During indentation testing, the material underneath the indenter is heavily deformed, introducing high local dislocation densities and density gradients. In the present work, dislocation structures around and underneath the Vickers and Berkovich indentations performed at room temperature and 350oC have been resolved in (001) oriented strontium titanate (STO) single crystal via a sequential polishing, etching, and imaging technique. Laser and atomic force microscopy were used to image dislocation etch-pit patterns which were then digitized for calculating dislocation densities, plastic zone sizes, and dislocation spacing at multiple depths within the material. In addition, a simple model for estimating lattice friction stresses from digitized dislocation etch-pit images has been modified to work at large applied loads [1]. At high loads, images consistently exhibited etch-pit arms extending from the indentation aligned along the {010} and {110} directions, regardless of indenter symmetry. However, the size, shape, and density of etch-pits was found to strongly depend on applied load at lower indentation loads, consistent with the idea of a size effect. Interestingly, slip was documented at depths well below indentation depth, where slip was favored. Load-displacement data combined with dislocation etch-pit techniques revealed that incipient plasticity (manifested as sudden indenter displacement bursts) was strongly influenced by pre-existing dislocations. Furthermore, there was a significant decrease in the indentation size effect with an increase in temperature. Results from the model show a significant change in lattice friction stresses between room temperature and 350oC for and slip planes, consistent with compression testing. The above-mentioned results show that STO provides a unique opportunity as a reference material for understanding size effects in crystalline materials. In addition, the sequential polishing, etching, and imaging technique combined with modeling gives rise to estimates of lattice friction stresses from an indentation test

Indentation size effect and 3D dislocation structure evolution in (001) oriented SrTiO3: HR‐ EBSD and etch‐pit analysis

Most crystalline materials exhibit an indentation size effect (ISE), i.e., an intrinsic increase in hardness with decreasing penetration depth. During indentation testing, the material underneath the indenter is heavily deformed, introducing strain gradients in the materials, causing high local dislocation densities. In the present work, the three-dimensional (3D) dislocation structure evolution and ISE in (001) oriented Strontium Titanate (STO) have been studied by direct observation of dislocations using chemical etching and high-resolution electron backscattered diffraction (HR-EBSD) analysis. The sequential polishing, etching and imaging technique was used to reveal the 3D dislocation etch-pit structure at various sub-surface depths using confocal laser and scanning electron microscopy (Fig. 1). The 3D dislocation etch-pit analysis of spherical indentations confirm that, at the early stage of plastic deformation, the dislocation pile-ups were aligned in \u3c100\u3e directions, lying on {110}45 planes, inclined at 45° to the (001) surface. At higher mean contact pressure and larger indentation depth, however, dislocation pile-ups along \u3c110\u3e directions appeared, lying on {110}90 planes, perpendicular to the (001) surface. These observations were qualitatively confirmed by corresponding direct Molecular Dynamics Simulations. Please click Additional Files below to see the full abstract

Thermal Performance Analysis of Various Heat Sinks Based on Alumina NePCM for Passive Cooling of Electronic Components: An Experimental Study

In the modern digital world, electronic devices are being widely employed for various applications where thermal performance represents a significant technical challenge due to continued miniaturization, high heat generated in the system, and non-uniform high-temperature causing failure. Phase change materials (PCMs) owing to the immense heat of fusion are primarily considered for thermal management, but their insulating properties hedge their applications in electronics cooling. Nano-enhanced phase change materials (NePCMs) have the ability to improve the thermal conductivity of PCM, decrease system temperature and escalate the operating time of devices. Accordingly, the current study focused on the experimental investigations for the thermal performance of three heat sinks (HS) with different configurations such as a simple heat sink (SHS), a square pin-fins heat sink (S pfHS), and Cu foam integrated heat sink (Cu fmHS) with various alumina nanoparticles mass concentrations (0.15, 0.20 and 0.25 wt%) incorporated in PCM (RT-54HC) and at heat flux (0.98–2.94 kW/m 2). All HSs reduced the base temperature with the insertion of NePCM compared to the empty SHS. The experimental results identified that the thermal performance of Cu fmHS was found to be superior in reducing base temperature and enhancing working time at two different setpoint temperatures (SPTs). The maximum drop in base temperature was 36.95%, and a 288% maximum working time enhancement was observed for Cu fmHS. Therefore, NePCMs are highly recommended for the thermal management of the electronic cooling system

Graphene oxide incorporated polyether sulfone nanocomposite antifouling ultrafiltration membranes with enhanced hydrophilicity

In this study, the polyether sulfone (PES) based membranes containing various concentrations of graphene oxide (GO), polyvinylpyrrolidone (PVP), and polyethylene glycol (PEG) were synthesized via the phase immersion method. This study aims to evaluate the effect of GO addition on the structural properties and performance of the membranes. The membranes were analyzed by x-ray diffraction (XRD), scanning electron microscopy (SEM), and Fourier transforms infrared spectroscopy (FTIR). The FTIR-ATR spectra indicated the presence of hydroxyl and carboxylic acid groups on the surface of GO-incorporated membranes, which improved their dispersion in the polymeric matrix and hydrophilicity. The SEM analysis of the GO-containing PES membranes confirmed the formation of a well-defined finger-like porous structure presenting adequate water flux (95 l.m(-2).h(-1)) and salt rejection (72%) compared to the pristine PES membranes (46 l.m(-2).h(-1) and similar to 35%, respectively). In addition, the significantly large wettability and considerably improved antibacterial characteristic (against S. aureus and E. coli strains) of the GO-PES membranes are considered impressive features.National University of Sciences and Technology (NUST) Research Directorate; HEC; NRPU [6020]6020; Higher Education Commission, Pakistan, HEC; National University of Sciences and Technology, NUS

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

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

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

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

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries