192 research outputs found

    The impact of COVID-19 on anaesthesia and critical care services in the UK: a serial service evaluation

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    Between October 2020 and January 2021, we conducted three national surveys to track anaesthetic, surgical and critical care activity during the second COVID-19 pandemic wave in the UK. We surveyed all NHS hospitals where surgery is undertaken. Response rates, by round, were 64%, 56% and 51%. Despite important regional variations, the surveys showed increasing systemic pressure on anaesthetic and peri-operative services due to the need to support critical care pandemic demands. During Rounds 1 and 2, approximately one in eight anaesthetic staff were not available for anaesthetic work. Approximately one in five operating theatres were closed and activity fell in those that were open. Some mitigation was achieved by relocation of surgical activity to other locations. Approximately one-quarter of all surgical activity was lost, with paediatric and non-cancer surgery most impacted. During January 2021, the system was largely overwhelmed. Almost one-third of anaesthesia staff were unavailable, 42% of operating theatres were closed, national surgical activity reduced to less than half, including reduced cancer and emergency surgery. Redeployed anaesthesia staff increased the critical care workforce by 125%. Three-quarters of critical care units were so expanded that planned surgery could not be safely resumed. At all times, the greatest resource limitation was staff. Due to lower response rates from the most pressed regions and hospitals, these results may underestimate the true impact. These findings have important implications for understanding what has happened during the COVID-19 pandemic, planning recovery and building a system that will better respond to future waves or new epidemics

    Ferroelectric Sm-doped BiMnO3 thin films with ferromagnetic transition temperature enhanced to 140 K.

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    A combined chemical pressure and substrate biaxial pressure crystal engineering approach was demonstrated for producing highly epitaxial Sm-doped BiMnO(3) (BSMO) films on SrTiO(3) single crystal substrates, with enhanced magnetic transition temperatures, TC up to as high as 140 K, 40 K higher than that for standard BiMnO(3) (BMO) films. Strong room temperature ferroelectricity with piezoresponse amplitude, d(33) = 10 pm/V, and long-term retention of polarization were also observed. Furthermore, the BSMO films were much easier to grow than pure BMO films, with excellent phase purity over a wide growth window. The work represents a very effective way to independently control strain in-plane and out-of-plane, which is important not just for BMO but for controlling the properties of many other strongly correlated oxides.This research was funded by the Engineering and Physical Sciences Research Council, (EP/P50385X/1), the European Research Council (ERC-2009-AdG 247276 NOVOX). The TEM work at Texas A&M University was funded by the U.S. National Science Foundation (NSF-1007969).This is the final published manuscript. It is available online through ACS in Applied Materials and Interfaces here: http://pubs.acs.org/doi/abs/10.1021/am501351c

    Peri‐operative cardiac arrest in children as reported to the 7th National Audit Project of the Royal College of Anaesthetists

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    The 7th National Audit Project of the Royal College of Anaesthetists studied peri‐operative cardiac arrest. An activity survey estimated UK paediatric anaesthesia annual caseload as 390,000 cases, 14% of the UK total. Paediatric peri‐operative cardiac arrests accounted for 104 (12%) reports giving an incidence of 3 in 10,000 anaesthetics (95%CI 2.2–3.3 per 10,000). The incidence of peri‐operative cardiac arrest was highest in neonates (27, 26%), infants (36, 35%) and children with congenital heart disease (44, 42%) and most reports were from tertiary centres (88, 85%). Frequent precipitants of cardiac arrest in non‐cardiac surgery included: severe hypoxaemia (20, 22%); bradycardia (10, 11%); and major haemorrhage (9, 8%). Cardiac tamponade and isolated severe hypotension featured prominently as causes of cardiac arrest in children undergoing cardiac surgery or cardiological procedures. Themes identified at review included: inappropriate choices and doses of anaesthetic drugs for intravenous induction; bradycardias associated with high concentrations of volatile anaesthetic agent or airway manipulation; use of atropine in the place of adrenaline; and inadequate monitoring. Overall quality of care was judged by the panel to be good in 64 (62%) cases, which compares favourably with adults (371, 52%). The study provides insight into paediatric anaesthetic practice, complications and peri‐operative cardiac arrest

    Self-assembled oxide films with tailored nanoscale ionic and electronic channels for controlled resistive switching.

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    Resistive switches are non-volatile memory cells based on nano-ionic redox processes that offer energy efficient device architectures and open pathways to neuromorphics and cognitive computing. However, channel formation typically requires an irreversible, not well controlled electroforming process, giving difficulty to independently control ionic and electronic properties. The device performance is also limited by the incomplete understanding of the underlying mechanisms. Here, we report a novel memristive model material system based on self-assembled Sm-doped CeO2 and SrTiO3 films that allow the separate tailoring of nanoscale ionic and electronic channels at high density (∼10(12) inch(-2)). We systematically show that these devices allow precise engineering of the resistance states, thus enabling large on-off ratios and high reproducibility. The tunable structure presents an ideal platform to explore ionic and electronic mechanisms and we expect a wide potential impact also on other nascent technologies, ranging from ionic gating to micro-solid oxide fuel cells and neuromorphics.This work was supported by the European Research Council (ERC) (Advanced Investigator grant ERC-2009-AdG-247276-NOVOX) and the Cambridge Commonwealth, European & International Trust. We further acknowledge funding from ERC grant InsituNANO, 279342, (S.T. and S.H.) and the Engineering and Physical Sciences Research Council (EPSRC), EP/P005152/1 (S.H.). Sandia National Laboratories is a multi-program laboratory managed and operated by Sandia Corporation, a wholly owned subsidiary of Lockheed Martin Corporation, for the US Department of Energy’s National Nuclear Security Administration under contract DE-AC04-94AL85000. The work at Los Alamos was supported by the U.S. Department of Energy through the LDRD program and performed, in part, at the Center for Integrated Nanotechnologies (CINT), a U.S. Department of Energy, Office of Basic Energy Sciences user facility.This is the final version of the article. It first appeared from Nature Publishing Group via https://www.nature.com/articles/ncomms1237

    Reaction method control of impurity scattering in C-doped MgB2: proving the role of defects besides C substitution level

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    In this study, Si and C were incorporated into polycrystalline MgB 2 via in situ reaction of Mg and B with either SiC or with separate Si and C (Si+C). The electrical transport and magnetic properties of the two series of samples were compared. The corrected resistivity at 40 K, ρA(40 K), is higher for the samples reacted with SiC regardless of the carbon (C) substitution level, indicating larger intragrain scattering because of the simultaneous reaction between Mg and SiC and carbon substitution during the formation of MgB2. In addition, because of the cleaner reaction route for the samples reacted with SiC, the calculated active area that carries current, AF, is twice that of the (Si+C) samples. On the other hand, the upper critical field, Hc2, was similar for both sets of samples despite their different C substitution levels, which proves the importance of defect scattering in addition to C substitution level. Hence, the form of the precursor reactants is critical for tuning the form of Hc2(T)

    Nanoengineering room temperature ferroelectricity into orthorhombic SmMnO₃ films

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    Orthorhombic RMnO3 (R = rare-earth cation) compounds are type-II multiferroics induced by inversion-symmetry-breaking of spin order. They hold promise for magneto-electric devices. However, no spontaneous room-temperature ferroic property has been observed to date in orthorhombic RMnO3. Here, using 3D straining in nanocomposite films of (SmMnO3)0.5((Bi,Sm)2O3)0.5, we demonstrate room temperature ferroelectricity and ferromagnetism with TC,FM ~ 90 K, matching exactly with theoretical predictions for the induced strain levels. Large in-plane compressive and out-of-plane tensile strains (−3.6% and +4.9%, respectively) were induced by the stiff (Bi,Sm)2O3 nanopillars embedded. The room temperature electric polarization is comparable to other spin-driven ferroelectric RMnO3 films. Also, while bulk SmMnO3 is antiferromagnetic, ferromagnetism was induced in the composite films. The Mn-O bond angles and lengths determined from density functional theory explain the origin of the ferroelectricity, i.e. modification of the exchange coupling. Our structural tuning method gives a route to designing multiferroics
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