Improved approach to Fowler-Nordheim plot analysis

This article introduces an improved approach to Fowler-Nordheim (FN) plot analysis, based on a new type of intercept correction factor. This factor is more cleanly defined than the factor previously used. General enabling theory is given that applies to any type of FN plot of data that can be fitted using a FN-type equation. Practical use is limited to emission situations where slope correction factors can be reliably predicted. By making a series of well-defined assumptions and approximations, it is shown how the general formulas reduce to provide an improved theory of orthodox FN-plot data analysis. This applies to situations where the circuit current is fully controlled by the emitter characteristics, and tunneling can be treated as taking place through a Schottky-Nordheim (SN) barrier. For orthodox emission, good working formulas make numerical evaluation of the slope correction factor and the new intercept correction factor quick and straightforward. A numerical illustration, using simulated emission data, shows how to use this improved approach to derive values for parameters in the full FN-type equation for the SN barrier. Good self-consistency is demonstrated. The general enabling formulas also pave the way for research aimed at developing analogous data-analysis procedures for non-orthodox emission situations.Comment: Paper is extended version of poster presented at the 25th International Vacuum Nanoelectronics Conference, Jeju island, South Korea, July 2012. Third version includes small changes made at proof correction stag

Illustrating field emission theory by using Lauritsen plots of transmission probability and barrier strength

This technical note relates to the theory of cold field electron emission (CFE). It starts by suggesting that, to emphasize common properties in relation to CFE theory, the term 'Lauritsen plot' could be used to describe all graphical plots made with the reciprocal of barrier field (or the reciprocal of a quantity proportional to barrier field) on the horizontal axis. It then argues that Lauritsen plots related to barrier strength (G) and transmission probability (D) could play a useful role in discussion of CFE theory. Such plots would supplement conventional Fowler-Nordheim (FN) plots. All these plots would be regarded as particular types of Lauritsen plot. The Lauritsen plots of -G and lnD can be used to illustrate how basic aspects of FN tunnelling theory are influenced by the mathematical form of the tunnelling barrier. These, in turn, influence local emission current density and emission current. Illustrative applications used in this note relate to the well-known exact triangular and Schottky-Nordheim barriers, and to the Coulomb barrier (i.e., the electrostatic component of the electron potential energy barrier outside a model spherical emitter). For the Coulomb barrier, a good analytical series approximation has been found for the barrier-form correction factor; this can be used to predict the existence (and to some extent the properties) of related curvature in FN plots.Comment: Based on a poster presented at the 25th International Vacuum Nanoelectronics Conference, Jeju, S. Korea, July 2012. Version 3 incorporates small changes made at proof stag

Numerical testing by a transfer-matrix technique of Simmons' equation for the local current density in metal-vacuum-metal junctions

We test the consistency with which Simmons' model can predict the local current density obtained for flat metal-vacuum-metal junctions. The image potential energy used in Simmons' original papers had a missing factor of 1/2. Besides this technical issue, Simmons' model relies on a mean-barrier approximation for electron transmission through the potential-energy barrier between the metals. In order to test Simmons' expression for the local current density when the correct image potential energy is included, we compare the results of this expression with those provided by a transfer-matrix technique. This technique is known to provide numerically exact solutions of Schrodinger's equation for this barrier model. We also consider the current densities provided by a numerical integration of the transmission probability obtained with the WKB approximation and Simmons' mean-barrier approximation. The comparison between these different models shows that Simmons' expression for the local current density actually provides results that are in good agreement with those provided by the transfer-matrix technique, for a range of conditions of practical interest. We show that Simmons' model provides good results in the linear and field-emission regimes of current density versus voltage plots. It loses its applicability when the top of the potential-energy barrier drops below the Fermi level of the emitting metal.Comment: Paper accepted for publication in Jordan Journal of Physic

Implementation of the orthodoxy test as a validity check on experimental field emission data

In field electron emission (FE) studies, it is important to check and analyse the quality and validity of experimental current-voltage data, which is usually plotted in one of a small number of standard forms. These include the so-called Fowler-Nordheim (FN), Millikan-Lauritsen (ML) and Murphy-Good (MG) plots. The Field Emission Orthodoxy Test is a simple quantitative test that aims to check for the reasonableness of the values of the parameter "scaled field" that can be extracted from these plots. This is done in order to establish whether characterization parameters extracted from the plot will be reliable or, alternative, likely to be spurious. This paper summarises the theory behind the orthodoxy test, for each of the plot forms, and confirms that it is easy to apply it to the newly developed MG plot. A simple web tool has been developed that extracts scaled-field values from any of these three plot forms, and tests for lack of field emission orthodoxy.Comment: 14 typescript pages, 2 figure

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

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

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030