The Flexi Planar Fuel Cell

The Flexi Planar fuel cell is a new type of lightweight polymer electrolyte fuel cell design. The approach utilises standard, reliable and low cost printed circuit board fabrication processes. An iterative approach is adopted and feasibility along with excellent test characteristics for short modules have been successfully demonstrated

Strategies for living well with hormone-responsive advanced prostate cancer—a qualitative exploration

Purpose: Due to recent treatment advances, men are increasingly living longer with advanced prostate cancer (PCa). This study sought to understand men’s experiences of living with and adjusting to advanced hormone-responsive PCa and how this influenced their quality of life (QoL), in order to highlight how support could be optimized. / Methods: Participants were recruited through a UK wide survey—the ‘Life After Prostate Cancer Diagnosis’ study. In-depth telephone interviews were conducted with 24 men (aged 46–77 years) with advanced (stage IV) hormone-responsive PCa diagnosed 18–42 months previously. Thematic analysis was undertaken using a framework approach. / Results: Most participants perceived their QoL to be relatively good, which was influenced by the following factors (enablers to ‘living well’ with PCa): a sense of connectedness to others, engagement in meaningful activities, resources (social, cognitive, financial), ability to manage uncertainty, utilization of adjustment strategies and support, communication and information from health professionals. Barriers to ‘living well’ with PCa were often the converse of these factors. These also included more troublesome PCa-related symptoms and stronger perceptions of loss and restriction. / Conclusions: In our study, men living with advanced hormone-responsive PCa often reported a good QoL. Exploring the influences on QoL in men with advanced PCa indicates how future interventions might improve the QoL of men who are struggling. Further research is required to develop and test interventions that enhance QoL for these men

Effect of clamping pressure on ohmic resistance and compression of gas diffusion layers for polymer electrolyte fuel cells

This paper describes the use of an in situ analytical technique based on simultaneous displacement and resistance measurement of gas diffusion layers (GDLs) used in polymer electrolyte fuel cells (PEFCs), when exposed to varying compaction pressure. In terms of the losses within fuel cells, the ohmic loss makes up a significant portion. Of this loss, the contact resistance between the GDL and the bipolar plate (BPP) is an important constituent. By analysing the change in thickness and ohmic resistance of GDLs under compression, important mechanical and electrical properties are obtained. Derived parameters such as the ‘displacement factor’ are used to characterise a representative range of commercial GDLs. Increasing compaction pressure leads to a non-linear decrease in resistance for all GDLs. For Toray paper, compaction becomes more irreversible with pressure with no elastic region observed. Different GDLs have different intrinsic resistance; however, all GDLs of the same class share a common compaction profile (change in resistance with pressure). Cyclic compression of Toray GDL leads to progressive improvement in resistance and reduction in thickness that stabilises after ∼10 cycles

Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock. The VANISH Randomized Clinical Trial

IMPORTANCE: Norepinephrine is currently recommended as the first-line vasopressor in septic shock; however, early vasopressin use has been proposed as an alternative. OBJECTIVE: To compare the effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock. DESIGN, SETTING, AND PARTICIPANTS: A factorial (2×2), double-blind, randomized clinical trial conducted in 18 general adult intensive care units in the United Kingdom between February 2013 and May 2015, enrolling adult patients who had septic shock requiring vasopressors despite fluid resuscitation within a maximum of 6 hours after the onset of shock. INTERVENTIONS: Patients were randomly allocated to vasopressin (titrated up to 0.06 U/min) and hydrocortisone (n = 101), vasopressin and placebo (n = 104), norepinephrine and hydrocortisone (n = 101), or norepinephrine and placebo (n = 103). MAIN OUTCOMES AND MEASURES: The primary outcome was kidney failure-free days during the 28-day period after randomization, measured as (1) the proportion of patients who never developed kidney failure and (2) median number of days alive and free of kidney failure for patients who did not survive, who experienced kidney failure, or both. Rates of renal replacement therapy, mortality, and serious adverse events were secondary outcomes. RESULTS: A total of 409 patients (median age, 66 years; men, 58.2%) were included in the study, with a median time to study drug administration of 3.5 hours after diagnosis of shock. The number of survivors who never developed kidney failure was 94 of 165 patients (57.0%) in the vasopressin group and 93 of 157 patients (59.2%) in the norepinephrine group (difference, -2.3% [95% CI, -13.0% to 8.5%]). The median number of kidney failure-free days for patients who did not survive, who experienced kidney failure, or both was 9 days (interquartile range [IQR], 1 to -24) in the vasopressin group and 13 days (IQR, 1 to -25) in the norepinephrine group (difference, -4 days [95% CI, -11 to 5]). There was less use of renal replacement therapy in the vasopressin group than in the norepinephrine group (25.4% for vasopressin vs 35.3% for norepinephrine; difference, -9.9% [95% CI, -19.3% to -0.6%]). There was no significant difference in mortality rates between groups. In total, 22 of 205 patients (10.7%) had a serious adverse event in the vasopressin group vs 17 of 204 patients (8.3%) in the norepinephrine group (difference, 2.5% [95% CI, -3.3% to 8.2%]). CONCLUSIONS AND RELEVANCE: Among adults with septic shock, the early use of vasopressin compared with norepinephrine did not improve the number of kidney failure-free days. Although these findings do not support the use of vasopressin to replace norepinephrine as initial treatment in this situation, the confidence interval included a potential clinically important benefit for vasopressin, and larger trials may be warranted to assess this further. TRIAL REGISTRATION: clinicaltrials.gov Identifier: ISRCTN 20769191

First principles simulations of liquid Fe-S under Earth's core conditions

First principles electronic structure calculations, based upon density functional theory within the generalized gradient approximation and ultra-soft Vanderbilt pseudopotentials, have been used to simulate a liquid alloy of iron and sulfur at Earth's core conditions. We have used a sulfur concentration of $\approx 12$wt, in line with the maximum recent estimates of the sulfur abundance in the Earth's outer core. The analysis of the structural, dynamical and electronic structure properties has been used to report on the effect of the sulfur impurities on the behavior of the liquid. Although pure sulfur is known to form chains in the liquid phase, we have not found any tendency towards polymerization in our liquid simulation. Rather, a net S-S repulsion is evident, and we propose an explanation for this effect in terms of the electronic structure. The inspection of the dynamical properties of the system suggests that the sulfur impurities have a negligible effect on the viscosity of Earth's liquid core.Comment: 24 pages (including 8 figures

ICES Viewpoint background document: Impact from exhaust gas cleaning systems (scrubbers) on the marine environment (Ad hoc).

Shipping is a diverse industry that connects the world. The distribution and intensity of commercial shipping is increasing and there is a growing need to assess and mitigate the impacts of vessel activities on the marine environment. New global standards on sulphur content in marine fuels have led to an increasing number of ships installing exhaust gas cleaning systems (EGCS), also known as scrubbers, to reduce their emissions of sulphur oxides to the atmosphere. Ships equipped with a scrubber can continue to use heavy fuel oil, and the process results in discharges of large volumes of acidified water that contain a mix of contaminants, such as heavy metals, polycyclic aromatic hydrocarbons (PAHs), oil residues, and nitrates. For the most common type of scrubber, open loop, this polluted water is directly discharged back to the sea, trading reductions in air pollution for increased water pollution. The scrubber discharge mixture has demonstrated toxic effects in laboratory studies, causing immediate mortality in plankton and exhibiting negative synergistic effects. The substances found in scrubber discharge water are likely to have further impacts in the marine environment through bioaccumulation, acidification and eutrophication. The impacts of scrubber discharge water can be completely avoided through the use of alternative fuels, such as distilled low sulphur fuels. Distilled fuels have the added benefit that they remove the threat of heavy fuel oil spills from shipping activities. If the use of alternative fuels is not adopted, and scrubbers continue to be considered an equivalent method to meet the sulphur emissions limits, then there is urgent need for:1) significant investment in technological advances and port reception facilities to allow zero discharge closed loop scrubber systems;2) improved protocols and standards for measuring, monitoring and reporting on scrubber discharge water acidity and pollutants;3) evidence-based regulations on scrubber water discharge limits that consider the full suite of contaminants

Bright emission from a random Raman laser

Random lasers are a developing class of light sources that utilize a highly disordered gain medium as opposed to a conventional optical cavity. Although traditional random lasers often have a relatively broad emission spectrum, a random laser that utilizes vibration transitions via Raman scattering allows for an extremely narrow bandwidth, on the order of 10 cm(−1). Here we demonstrate the first experimental evidence of lasing via a Raman interaction in a bulk three-dimensional random medium, with conversion efficiencies on the order of a few percent. Furthermore, Monte Carlo simulations are used to study the complex spatial and temporal dynamics of nonlinear processes in turbid media. In addition to providing a large signal, characteristic of the Raman medium, the random Raman laser offers us an entirely new tool for studying the dynamics of gain in a turbid medium

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