A binder-free cobalt phosphate hydrate (Co3(PO4)2·8H2O) multilayer nano/microflake structure is synthesized on nickel foam (NF) via a facile hydrothermal process. Four different concentrations (2.5, ...5, 10, and 20 mM) of Co2+ and PO4 –3 were used to obtain different mass loading of cobalt phosphate on the nickel foam. The Co3(PO4)2·8H2O modified NF electrode (2.5 mM) shows a maximum specific capacity of 868.3 C g–1 (capacitance of 1578.7 F g–1) at a current density of 5 mA cm–2 and remains as high as 566.3 C g–1 (1029.5 F g–1) at 50 mA cm–2 in 1 M NaOH. A supercapattery assembled using Co3(PO4)2·8H2O/NF as the positive electrode and activated carbon/NF as the negative electrode delivers a gravimetric capacitance of 111.2 F g–1 (volumetric capacitance of 4.44 F cm–3). Furthermore, the device offers a high specific energy of 29.29 Wh kg–1 (energy density of 1.17 mWh cm–3) and a specific power of 4687 W kg–1 (power density of 187.5 mW cm–3).
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IJS, KILJ, NUK, PNG, UL, UM
This perspective reviews recent advances in inverse opal structures, how they have been developed, studied and applied as catalysts, catalyst support materials, as electrode materials for batteries, ...water splitting applications, solar-to-fuel conversion and electrochromics, and finally as photonic photocatalysts and photoelectrocatalysts. Throughout, we detail some of the salient optical characteristics that underpin recent results and form the basis for light-matter interactions that span electrochemical energy conversion systems as well as photocatalytic systems. Strategies for using 2D as well as 3D structures, ordered macroporous materials such as inverse opals are summarized and recent work on plasmonic-photonic coupling in metal nanoparticle-infiltrated wide band gap inverse opals for enhanced photoelectrochemistry are provided.
The risk of permanent pacemaker implantation (PPI) after cardiac valve replacement surgery is thought to be highest in the postoperative period. Long-term risks are uncertain.
The purpose of this ...study was to determine rates and timing of PPI after cardiac valve replacement surgery.
We compared PPI rates of patients undergoing aortic valve replacement (AVR; n = 111,674), mitral valve replacement (MVR; n = 18,402), AVR + MVR (n = 5166), AVR + MVR + tricuspid valve replacement (TVR; n = 114), or coronary artery bypass surgery (CABG) without valve replacement (n = 249,742).
Over a period of 14 years (median 3.9 years; interquartile range 1.1-7.4 years), cumulative PPI rates were 3.07-7.6 times higher (P < .001 for all) than after CABG, depending on the number of valves replaced. PPI risks after AVR were higher that those after MVR (hazard ratio HR 1.22; 95% confidence interval CI 1.16-1.28), AVR + MVR (HR 1.52; 95% CI 1.40-1.65), and AVR + MVR + TVR (HR 2.22; 95% CI 1.40-3.53), independent of known confounders. Cumulative PPI hazard rates from the postoperative period to 10 years after surgery increased after AVR (4.22%-14.4%), MVR (4.38%-15.6%), AVR + MVR (5.59%-18.3%), and AVR + MVR + TVR (7.89%-25.9%) (P < .001 for all). Age, male sex, emergency admission, and preexisting diabetes mellitus, renal impairment, and heart failure were independent predictors of PPI (P < .001 for all).
Valve replacement surgery was associated with a long-term risk of PPI. This was particularly high after dual and triple valve replacements. Age, male sex, emergency admission, and preexisting diabetes mellitus, heart failure, and renal impairment were independent predictors of PPI.
Plasmonic photocatalysis has facilitated rapid progress in enhancing photocatalytic efficiency under visible light irradiation. Poor visible‐light‐responsive photocatalytic materials and low ...photocatalytic efficiency remain major challenges. Plasmonic metal–semiconductor heterostructures where both the metal and semiconductor are photosensitive are promising for light harvesting catalysis, as both components can absorb solar light. Efficiency of photon capture can be further improved by structuring the catalyst as a photonic crystal. Here, the synthesis of photonic crystal plasmonic photocatalyst materials using Au nanoparticle‐functionalized inverse opal (IO) photonic crystals is reported. A catalyst prepared using a visible‐light‐responsive semiconductor (V2O5) displayed over an order of magnitude increase in reaction rate under green light excitation (λ = 532 nm) compared to no illumination. The superior performance of Au‐V2O5 IO is attributed to spectral overlap of the electronic bandgap, localized surface plasmon resonance, and incident light source. For the Au‐TiO2 catalyst, despite coupling of the LSPR and excitation source at λ = 532 nm, this is not as effective in enhancing photocatalytic activity compared to carrying out the reaction under broadband visible light, which is attributed to improved photon adsorption in the visible by the presence of a photonic bandgap, and exploiting slow light in the photonic crystal to enhance photon absorption to create this synergistic type of photocatalyst.
An inverse opal photonic crystal‐structured metal oxide becomes a very efficient photocatalyst when the surface plasmon absorption of surface immobilized gold nanoparticles, slow photon effect from the photonic crystal, semiconductor bandgap absorption, and reduced reflectivity from the photonic bandgap are all tuned to work together to maximize electron transfer for photocatalysis.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
NHS England (NHSE) advocates 'reason to reside' (R2R) criteria to support discharge planning. The proportion of patients without R2R and their rate of discharge are reported daily by acute hospitals ...in England. R2R has no interoperable standardised data model (SDM), and its performance has not been validated. We aimed to understand the degree of intercentre and intracentre variation in R2R-related metrics reported to NHSE, define an SDM implemented within a single centre Electronic Health Record to generate an electronic R2R (eR2R) and evaluate its performance in predicting subsequent discharge.
Retrospective observational cohort study using routinely collected health data.
122 NHS Trusts in England for national reporting and an acute hospital in England for local reporting.
6 602 706 patient-days were analysed using 3-month national data and 1 039 592 patient-days, using 3-year single centre data.
Variability in R2R-related metrics reported to NHSE. Performance of eR2R in predicting discharge within 24 hours.
There were high levels of intracentre and intercentre variability in R2R-related metrics (p<0.0001) but not in eR2R. Informedness of eR2R for discharge within 24 hours was low (J-statistic 0.09-0.12 across three consecutive years). In those remaining in hospital without eR2R, 61.2% met eR2R criteria on subsequent days (76% within 24 hours), most commonly due to increased NEWS2 (21.9%) or intravenous therapy administration (32.8%).
Reported R2R metrics are highly variable between and within acute Trusts in England. Although case-mix or community care provision may account for some variability, the absence of a SDM prevents standardised reporting. Following the development of a SDM in one acute Trust, the variability reduced. However, the performance of eR2R was poor, prone to change even when negative and unable to meaningfully contribute to discharge planning.
BackgroundStudies suggest that certain black and Asian minority ethnic groups experience poorer outcomes from COVID-19, but these studies have not provided insight into potential reasons for this. We ...hypothesised that outcomes would be poorer for those of South Asian ethnicity hospitalised from a confirmed SARS-CoV-2 infection, once confounding factors, health-seeking behaviours and community demographics were considered, and that this might reflect a more aggressive disease course in these patients.MethodsPatients with confirmed SARS-CoV-2 infection requiring admission to University Hospitals Birmingham NHS Foundation Trust (UHB) in Birmingham, UK between 10 March 2020 and 17 April 2020 were included. Standardised admission ratio (SAR) and standardised mortality ratio (SMR) were calculated using observed COVID-19 admissions/deaths and 2011 census data. Adjusted HR for mortality was estimated using Cox proportional hazard model adjusting and propensity score matching.ResultsAll patients admitted to UHB with COVID-19 during the study period were included (2217 in total). 58% were male, 69.5% were white and the majority (80.2%) had comorbidities. 18.5% were of South Asian ethnicity, and these patients were more likely to be younger and have no comorbidities, but twice the prevalence of diabetes than white patients. SAR and SMR suggested more admissions and deaths in South Asian patients than would be predicted and they were more likely to present with severe disease despite no delay in presentation since symptom onset. South Asian ethnicity was associated with an increased risk of death, both by Cox regression (HR 1.4, 95% CI 1.2 to 1.8), after adjusting for age, sex, deprivation and comorbidities, and by propensity score matching, matching for the same factors but categorising ethnicity into South Asian or not (HR 1.3, 95% CI 1.0 to 1.6).ConclusionsThose of South Asian ethnicity appear at risk of worse COVID-19 outcomes. Further studies need to establish the underlying mechanistic pathways.
Background Women are underrepresented in cardiac resynchronization therapy (CRT) trials. Some studies suggest that women fare better than men after CRT. We sought to explore clinical outcomes in ...women and men undergoing CRT-defibrillation or CRT-pacing in real-world clinical practice. Methods and Results A national database (Hospital Episode Statistics for England) was used to quantify clinical outcomes in 43 730 patients (women: 10 890 24.9%; men: 32 840 75.1%) undergoing CRT over 7.6 years, (median follow-up 2.2 years, interquartile range, 1-4 years). In analysis of the total population, the primary end point of total mortality (adjusted hazard ratio aHR, 0.73; 95% CI, 0.69-0.76) and the secondary end point of total mortality or heart failure hospitalization (aHR, 0.79, 95% CI 0.75-0.82) were lower in women, independent of known confounders. Total mortality (aHR, 0.73; 95% CI, 0.70-0.76) and total mortality or heart failure hospitalization (aHR, 0.79; 95% CI, 0.75-0.82) were lower for CRT-defibrillation than for CRT-pacing. In analyses of patients with (aHR, 0.89; 95% CI, 0.80-0.98) or without (aHR, 0.70; 95% CI, 0.66-0.73) a myocardial infarction, women had a lower total mortality. In sex-specific analyses, total mortality was lower after CRT-defibrillation in women (aHR, 0.83;
=0.013) and men (aHR, 0.69;
<0.001). Conclusions Compared with men, women lived longer and were less likely to be hospitalized for heart failure after CRT. In both sexes, CRT-defibrillation was superior to CRT-pacing with respect to survival and heart failure hospitalization. The longest survival after CRT was observed in women without a history of myocardial infarction.
Germanium (Ge) nanowires were fabricated directly on stainless steel current collectors for Li-ion batteries without any additional catalytic seeds. Substrates of stainless steel are unconventional ...materials for the direct growth of nanowires for battery applications. Stainless steel substrates were activated for nanowire growth by annealing them in air at a temperature of 450 °C to form a catalytic iron oxide surface layer. Large yields of Ge nanowires were obtained from oxidized stainless steel via a liquid-injection chemical vapor deposition process, with diphenylgermane (DPG) as a Ge precursor. Fabricated Ge nanowires have uniform morphology and are single-crystalline. The capacity retention from a nanowire anode tested at 0.2 C is very stable, highlighted by reversible capacities of ∼1014 and 894 mAh/g after the 50th and 250th cycles, respectively. The large specific capacity values are one of the highest achieved for binder-free Ge nanomaterial-based anode materials. The high specific capacity values, good capacity retention, and voltage stability observed resulted from the excellent adhesion of the nanowires to the stainless steel current collectors, ensuring good electrical contact and electrical conductivity. Achieving such electrochemical performance from Ge nanowires grown via a significantly simplified direct growth process on a functional conductive substrate demonstrates the potential of directly grown Ge nanowires as a high-performing anode material for Li-ion batteries.
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Suspected urinary tract infection (UTI) syndromes are a common reason for empirical antibiotics to be prescribed in the Emergency Department (ED), but differentiating UTI from other conditions with a ...similar presentation is challenging. We investigated how often an ED diagnosis of UTI is confirmed clinically/microbiologically, and described conditions which present as UTI syndromes.
Observational study using electronic health records from patients who attended the ED with suspected UTI and had a urine sample submitted for culture. We compared the ED diagnosis to diagnosis at discharge from hospital (ICD-10 codes), and estimated the proportion of cases with clinical/microbiological evidence of UTI.
Two hundred eighty nine patients had an ED diagnosis of UTI syndrome comprising: lower UTI (191), pyelonephritis (56) and urosepsis (42). In patients admitted to hospital with an ED diagnosis of lower UTI, pyelonephritis or urosepsis, clinical/microbiological evidence of UTI was lacking in 61/103, 33/54 and 31/42 cases respectively. The ED diagnosis was concordant with the main reason for admission in less than 40% of patients with UTI syndromes, and antibiotics were stopped within 72 h in 37/161 patients.
Clinical/microbiological evidence of UTI was lacking in 60-70% of patients, suggesting scope to revise empirical prescribing decisions for UTI syndromes in light of microbial culture and clinical progression.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Improved recognition of factors influencing graft survival has led to better short-term kidney transplant outcomes. However, efforts to prevent long-term graft decline and improve graft survival have ...seen more modest improvements. The adoption of electronic health records has enabled better recording and identification of donor-recipient factors through the use of modern statistical techniques. We have previously shown in a prevalent renal transplant population that episodes of rapid deterioration are associated with graft loss.
Estimated glomerular filtration rates (eGFR) between 3 and 27 months after transplantation were collected from 310 kidney transplant recipients. We utilised a Bayesian approach to estimate the most likely eGFR trajectory as a smooth curve from an average of 10,000 Monte Carlo samples. The probability of having an episode of rapid deterioration (decline greater than 5 ml/min/1.73 m
per year in any 1-month period) was calculated. Graft loss and mortality data was collected over a median follow-up period of 8 years. Factors associated with having an episode of rapid deterioration and associations with long-term graft loss were explored.
In multivariable Cox Proportional Hazard analysis, a probability greater than 0.8 of rapid deterioration was associated with long-term death-censored graft loss (Hazard ratio 2.17; 95% Confidence intervals CI 1.04-4.55). In separate multivariable logistic regression models, cytomegalovirus (CMV) serostatus donor positive to recipient positive (Odds ratio OR 3.82; 95%CI 1.63-8.97), CMV donor positive (OR 2.06; 95%CI 1.15-3.68), and CMV recipient positive (OR 2.03; 95%CI 1.14-3.60) were associated with having a greater than 0.8 probability of an episode of rapid deterioration.
Early episodes of rapid deterioration are associated with long-term death-censored graft loss and are associated with cytomegalovirus seropositivity. Further study is required to better manage these potentially modifiable risks factors and improve long-term graft survival.
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