Numerical Simulation of Tunneling Current in an Anisotropic Metal-Oxide-Semiconductor Capacitor

In this paper, we have developed a model of the tunneling current through a high- dielectric stack in MOS capacitors with anisotropic masses. The transmittance was numerically calculated by employing a transfer matrix method and including longitudinal-transverse kinetic energy coupling which is represented by an electron phase velocity in the gate. The transmittance was then applied to calculate tunneling currents in TiN/HfSiOxN/SiO2/p-Si MOS capacitors. The calculated results show that as the gate electron velocity increases, the transmittance decreases and therefore the tunneling current reduces. The tunneling current becomes lower as the equivalent oxide thickness (EOT) of HfSiOxN layer increases. When the incident electron passed through the barriers in the normal incident to the interface, the electron tunneling process becomes easier. It was also shown that the tunneling current was independent of the substrate orientation. Moreover, the model could be used in designing high speed MOS devices with low tunneling currents

Mechanical behavior of hybrid glass Fiber-Jute reinforced with polymer composite for the wall of the Acehnese boat 'Jalo Kayoh'

Hybrid fiber composites are widely used composites in engineering applications, especially for the frame and wall structure of Acehnese traditional boat Jalo Kayoh. The purpose of this study is to obtain a hybrid material which is a blend of natural jute fiber reinforced with the synthetic fibers E-glass and polyester as a matrix. The materials potential to become a material for the structure and walls in the traditional Acehnese boat Jalo Kayoh. The fabrication of the hybrid composites is carried out manually using an engineered press at a pressure of 25 kg/cm2 for 24 hours. The ratio of jute fiber and E-glass in the composites at each layer are (1:0), (1:1) and (2:1). Tensile testing of the hybrid composites refers to ASTM D 3039 - 00. The results show that the tensile strength of the hybrid composites tends to increase with the increase in the volume of the fiber, with the maximum tensile strength of 4.8 MPa. The increasing number of layers in the jute and E-glass is adding strength to the composites. This will be good to use in the initial material of the structure and walls in the traditional Acehnese boat Jalo Kayoh

Thermal analysis of a portable DSSC mini greenhouse for botanical drugs cultivation

Photovoltaic farms in Malaysia are being developed tremendously as a form of supporting fossil fuel setbacks in Malaysia power generation. An important parameter of the PV installation is the power (Watts) accumulated over sunlight retrieval. Considerable losses may arise from the conversion, where the efficiency is typically 15% to 23%, with the remainder becoming losses in the form of accumulated heat under the PV array or panel installations. PV heat dissipation is dependent on solar radiation, air convection and PV cell conduction. Dye Sensitized Solar Cell (DSSC) has been applied as a greenhouse shading element, having the ability of enabling specified spectrum of light color penetration during electric accumulation. Furthermore, only light of wavelength between 400 and 700 nm (PAR) is absorbed by the greenhouse plants which is essential for their growth and photosynthesis. A Portable DSSC Mini Greenhouse (PDMG) can provide simple, effective and suitable light source for botanical drugs. Light which is associated with increasing temperature and heat is critical to be measured. A measurement of average heat gain flowing into a building through building envelope (OTTV- Overall Thermal Transfer Value) is a well-known method adopted in green building design. In this paper, the OTTV approach is applied to calculate heat transfer properties, from outdoor surroundings to the PDMG structure, giving justification of the PDMG thermal conditions

Dye-Sensitized Solar Cell (DSSC): effects on light quality, microclimate, and growth of Orthosiphon stamineus in tropical climatic condition

The main challenge facing greenhouse designers is to achieve environment-appropriate greenhouses, especially in tropical regions. The excess radiant energy transmitted into the greenhouse predisposes plants to photo-inhibition and consequently reduces crop production. Lately, photovoltaic (PV) modules are equipped as a greenhouse rooftop to minimize the level of irradiation and air temperature in the greenhouse, simultaneously improving its energy consumption. Nevertheless, due to the low level of irradiation, denser conventional PV internal shading would influence the cultivated crops’ growth. Thus, Dye Sensitized Solar Cell (DSSC) possesses several attractive features such as transparent, sensitive to low light levels, and various color options that render DSSC a perfect choice able to serve substantially in energy buildings. This study assessed the microclimate conditions inside the greenhouse with semi-transparent DSSC mounted on top of it, describing the Photosynthetic Photon Flux Density (PPFD) (µmol m−2 s−1), Vapor Pressure Deficit VPD (kPa), relative humidity (%), and also temperature (°C). The Overall Thermal Transfer Value (OTTV), which indicates the average thermal energy transmission rate across the external layer of a structure envelope, is also presented. The effects of colored DSSC in altering the spectral of sunlight in reference to the Orthosiphon stamineus growth responses were determined. The information of the condition of DSSC greenhouse microclimate helps to identify the information for designing PV greenhouses and to produce income from both electric power and agronomic activity

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

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

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

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics