Thermomechanical treatment of austempered ductile iron

The production of lightweight ferrous castings with increased strength properties became unavoidable facing the serious challenge of lighter aluminum and magnesium castings. The relatively new ferrous casting alloy ADI offers promising strength prospects, and the thermo-mechanical treatment of ductile iron may suggest a new route for production of thin-wall products. This work aims at studying the influence of thermomechanical treatment, either by ausforming just after quenching and before the onset of austempering reaction or by cold rolling after austempering. In the first part of this work, ausforming of ADI up to 25% reduction in height during a rolling operation was found to add a mechanical processing component compared to the conventional ADI heat treatment, thus increasing the rate of ausferrite formation and leading to a much finer and more homogeneous ausferrite product. The kinetics of ausferrite formation was studied using both metallographic as well as XRD-techniques. The effect of ausforming on the strength was quite dramatic (up to 70% and 50% increase in the yield and ultimate strength respectively). A mechanism involving both a refined microstructural scale and an elevated dislocation density was suggested. Nickel is added to ADI to increase hardenability of thick section castings, while ausforming to higher degrees of deformation is necessary to alleviate the deleterious effect of alloy segregation on ductility. In the second part of this work, the influence of cold rolling (CR) on the mechanical properties and structural characteristics of ADI was investigated. The variation in properties was related to the amount of retained austenite (γr) and its mechanically induced ransformation. In the course of tensile deformation of ADI, transformation induced plasticity (TRIP) takes place, indicated by the increase of the instantaneous value of strain-hardening exponent with tensile strain. The amount of retained austenite was found to decrease due to partial transformation of γr to martensite under the CR strain. Such strain-induced transformation resulted in higher amounts of mechanically generated martensite. The strength and hardness properties were therefore increased, while ductility and impact toughness decreased with increasing CR reduction

Application of emulsified acids on sandstone formation at elevated temperature conditions: an experimental study

Emulsified acid has attracted considerable attention of the oil and gas industry due to its delayed nature that allows deeper penetration of acid into the formation which essentially facilitate further enhancing the well productivity, and at the same time minimizes the corrosion issues. However, emulsified acid has only been extensively studied and applied on carbonate formations. Considering more than half of the reservoirs worldwide are sandstone reservoirs, studying the effects of emulsified acid on sandstone under high-temperature conditions would unlock the potential of emulsified acid and help generate more value for the oil and gas industry by improving the well productivity from sandstone reservoirs. To ensure the applicability of the emulsified acid on the real sandstone reservoir, which usually has a temperature higher than ambient conditions, the stability of emulsified acids is investigated under 300 °F. Then, the stable emulsified acid samples are developed and their impact on the properties of Berea sandstone core samples, including porosity, pore-size distribution, permeability and wettability, are investigated. The core samples have undergone pre-flush (10% HCl:5% CH3COOH) before the main flush (emulsified acid). The emulsified acids are prepared using hydrofluoric acid, hydrochloric acid, phosphoric acid, cationic surfactant and chelating agent. Fourteen core samples are saturated with different emulsified acids under vacuum conditions for 3 days to ensure maximum saturation. The porosity, permeability and wettability of each core sample are measured before and after the reaction with acid. Nuclear magnetic resonance analysis has been applied to evaluate the change in pore size distribution. This study has demonstrated that the emulsified acids are capable of improving the porosity and permeability of Berea sandstone core sample. The pore size distribution has also been affected by the application of emulsified acid, where more large pores have been evolved to the core samples due to the reaction of acids with the sandstone which ultimately helps in improving the productivity of hydrocarbons. This indicates less precipitation of the secondary reaction products resulting better enhancement in sandstone flow properties. These results demonstrate the potential of emulsified acid during sandstone acidizing as emulsified acid significantly improved the sandstone properties which can essentially enhance the well productivity

Higher ethical objective (Maqasid al-Shari'ah) augmented framework for Islamic banks : assessing the ethical performance and exploring its determinants.

This study utilises higher objectives postulated in Islamic moral economy or the maqasid al-Shari’ah theoretical framework’s novel approach in evaluating the ethical, social, environmental and financial performance of Islamic banks. Maqasid al-Shari’ah is interpreted as achieving social good as a consequence in addition to well-being and, hence, it goes beyond traditional (voluntary) social responsibility. This study also explores the major determinants that affect maqasid performance as expressed through disclosure analysis. By expanding the traditional maqasid al-Shari’ah,, we develop a comprehensive evaluation framework in the form of a maqasid index, which is subjected to a rigorous disclosure analysis. Furthermore, in identifying the main determinants of the maqasid disclosure performance, panel data analysis is used by including several key variables alongside political and socio-economic environment, ownership structures, and corporate and Shari’ah governance-related factors. The sample includes 33 full-fledged Islamic banks from 12 countries for the period of 2008–2016. The findings show that although during the nine-year period the disclosure of maqasid performance of the sampled Islamic banks has improved, this is still short of ‘best practices’. Through panel data analysis, this study finds that the Muslim population indicator, CEO duality, Shari’ah governance, and leverage variables positively impact the disclosure of maqasid performance. However, the effect of GDP, financial development and human development index of the country, its political and civil rights, institutional ownership, and a higher share of independent directors have an overall negative impact on the maqasid performance. The findings reported in this study identify complex and multi-faceted relations between external market realities, corporate and Shari’ah governance mechanisms, and maqasid performance

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

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

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

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 variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Flow Behaviour of Alkali, Surfactant, and Xanthan Solutions Used for Enhanced Oil Recovery Fluidité des solutions d'alcali, de tensio-actif et de xanthane utilisées pour la récupération assistée du pétrole

An experimental study was conducted to examine the effects of various alkalis, surfactants and brines on the viscosity of dilute aqueous solutions of two xanthan materials containing medium and high pyruvate content, over a wide range of parameters. The effect of alkalis on the flow curves of xanthan solutions depended on alkali type and concentration, shear rate and pyruvate content of xanthan. Strong alkalis caused partial degradation of the xanthan molecules. As a result, a fast and significant reduction in apparent viscosity occurred, especially with the high pyruvate xanthan. This drop was only noticeable at low shear rates. Buffered alkalis were less detrimental to the viscosity of xanthan solutions. Triton X-100 up to 10 wt% had no significant effect on the flow curves of both xanthan materials. Neodol 25-3S caused noticeable changes only in the flow curves of the high pyruvate xanthan. Triton X-100 up to 10 wt% in the presence of alkali had no significant effect on the flow curves of either xanthan material. The addition of anionic surfactants at low concentrations slightly decreased the viscosity of alkali/xanthan solutions. A significant viscosity enhancement was observed at higher surfactant concentrations over a narrow range of alkali concentrations. This behaviour was only observed with anionic surfactants and was due to the formation of surfactant aggregates. The effect of sodium chloride on the apparent viscosity of xanthan solutions depended on polymer concentration and the pyruvate content of xanthan. Only the high pyruvate polymer at high polymer concentrations (= 1 wtO/o) showed a dramatic increase in the apparent viscosity upon the addition of sodium chloride. At low polymer concentrations, calcium chloride had a more detrimental effect on the viscosity of the high pyruvate xanthan than sodium chloride. <br> Une étude expérimentale a été effectuée pour examiner les effets de divers alcalis, tensioactifs et saumures sur la viscosité de solutions aqueuses diluées de deux produits à base de xanthane, à teneur en pyruvate moyenne (polymère Statoil) ou élevée (Flocon 4800), avec une large gamme de paramètres. L'effet des alcalis sur la viscosité des solutions de xanthane dépend du type et de la concentration de l'alcali, du gradient de cisaillement, et de la teneur en pyruvate. L'influence des alcalis sur la courbe de viscosité du xanthane n'est repérable que pour de faibles gradients de cisaillement. Les alcalis forts (hydroxyde de sodium par exemple) provoquent une dégradation partielle des molécules de xanthane, d'où une réduction rapide et importante de la viscosité apparente, surtout avec une forte teneur en pyruvate. Les alcalis en solution-tampon (carbonate de sodium par exemple) sont moins nocifs pour la viscosité des solutions de xanthane. Par conséquent, dans les procédés à l'alcali/ polymère ou à l'alcali/tensioactif/polymère utilisant la gomme de xanthane, il serait extrêmement avantageux, du point de vue économique, de préférer un alcali tampon plutôt qu'un alcali fort. L'effet des tensioactifs sur les courbes de viscosité des solutions de xanthane dépend du type et de la concentration du produit tensioactif. L'influence du Triton X-100 (tensioactif non ionique) sur les courbes des deux produits à base de xanthane n'est pas significative jusqu'à 10 % en poids. Le Néodol 25-3S, tensioactif anionique, ne provoque de modifications de viscosité notables que pour le xanthane à forte teneur en pyruvate. Le Triton X-100, jusqu'à 10 % en poids, en présence d'alcali, n'a pas d'effet marqué sur les courbes de viscosité des deux produits à base de xanthane. L'addition de Néodol 25-3S à faible concentration diminue légèrement la viscosité des solutions alcali/xanthane. On a constaté un renforcement notable de la viscosité des solutions alcali/xanthane pour de plus fortes concentrations en tensioactif, sur une gamme étroite de concentrations en alcali. Ce comportement n'a été observé que pour les tensioactifs anioniques, et il est dû à la formation d'agrégats de tensioactif qui résulte de l'effet électrolytique sur la formation de micelles dans les tensioactifs anioniques. L'effet du chlorure de sodium sur la viscosité apparente des solutions de xanthane dépend de la concentration en polymère et de la teneur en pyruvate. Pour de faibles concentrations en polymère, < ou = 4000 ppm, la viscosité apparente tombe lors de l'addition de sels. Cette chute est due à l'effet d'écran de la charge. Pour de fortes concentrations en polymère (= 1 % en poids), seul le polymère à forte teneur en pyruvate subit une importante augmentation de sa viscosité apparente lors de l'addition de chlorure de sodium. Cette augmentation est due à l'association des molécules de polymère. Pour de faibles concentrations de polymère, le chlorure de calcium nuit plus que le chlorure de sodium à la viscosité du xanthane à forte teneur en pyruvate