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1.
ACS Appl Mater Interfaces ; 15(41): 48085-48095, 2023 Oct 18.
Article in English | MEDLINE | ID: mdl-37787440

ABSTRACT

Increasing the energy density of lithium-ion batteries, and thereby reducing costs, is a major target for industry and academic research. One of the best opportunities is to replace the traditional graphite anode with a high-capacity anode material, such as silicon. However, Si-based lithium-ion batteries have been widely reported to suffer from a limited calendar life for automobile applications. Heretofore, there lacks a fundamental understanding of calendar aging for rationally developing mitigation strategies. Both open-circuit voltage and voltage-hold aging protocols were utilized to characterize the aging behavior of Si-based cells. Particularly, a high-precision leakage current measurement was applied to quantitatively measure the rate of parasitic reactions at the electrode/electrolyte interface. The rate of parasitic reactions at the Si anode was found 5 times and 15 times faster than those of LiNi0.8Mn0.1Co0.1O2 and LiFePO4 cathodes, respectively. The imbalanced charge loss from parasitic reactions plays a critical role in exacerbating performance deterioration. In addition, a linear relationship between capacity loss and charge consumption from parasitic reactions provides fundamental support to assess calendar life through voltage-hold tests. These new findings imply that longer calendar life can be achieved by suppressing parasitic reactions at the Si anode to balance charge consumption during calendar aging.

2.
ACS Appl Mater Interfaces ; 12(44): 49563-49573, 2020 Nov 04.
Article in English | MEDLINE | ID: mdl-33094999

ABSTRACT

A trace amount of water in an electrolyte is one of the factors detrimental to the electrochemical performance of silicon (Si)-based lithium-ion batteries that adversely affect the formation and evolution of the solid electrolyte interphase (SEI) on Si-based anodes and change its properties. Thus far, a lack of fundamental and mechanistic understanding of SEI formation, evolution, and properties in the presence of water has inhibited efforts to stabilize the SEI for improved electrochemical performance. Thus, we investigated the SEI formed in a Gen2 electrolyte (1.2 M LiPF6 in ethylene carbonate/ethyl methyl carbonate, 3:7 wt %, water content: <10 ppm) with and without additional water (50 ppm) at varying potentials (1.0, 0.5, 0.2, and 0.01 V vs Li/Li+). The impact of additional water on the morphological, (electro)chemical, and structural properties of SEI was studied using microscopic (atomic force microscopy and scanning spreading resistance microscopy) and spectroscopic (X-ray photoelectron spectroscopy, attenuated total reflection Fourier-transform infrared spectroscopy, and time-of-flight secondary ion mass spectrometry) techniques. The SEI exhibits both potential- and water concentration-dependent trends in its morphology and chemical composition. The presence of additional water in the electrolyte causes parasitic reactions, which onset at ∼1.0 V, resulting in a reduction of electrolyte components and result in the formation of an insulating, fluorophosphate-rich SEI. In addition, hydrolysis of LiPF6 creates hydrofluoric acid, which reacts with the surface oxide layer on the Si electrode, leading to a pitted and inhomogeneous SEI structure.

3.
ACS Appl Mater Interfaces ; 12(37): 42236-42247, 2020 Sep 16.
Article in English | MEDLINE | ID: mdl-32877167

ABSTRACT

High-energy-density systems with fast charging rates and suppressed dendrite growth are critical for the implementation of efficient and safe next-generation advanced battery technologies such as those based on Li metal. However, there are few studies that investigate reliable cycling of Li metal electrodes under high-rate conditions. Here, by employing a superconcentrated ionic liquid (IL) electrolyte, we highlight the effect of Li salt concentration and applied current density on the resulting Li deposit morphology and solid electrolyte interphase (SEI) characteristics, demonstrating exceptional deposition/dissolution rates and efficiency in these systems. Operation at higher current densities enhanced the cycling efficiency, e.g., from 64 ± 3% at 1 mA cm-2 up to 96 ± 1% at 20 mA cm-2 (overpotential <±0.2 V), while resulting in lower electrode resistance and dendrite-free Li morphology. A maximum current density of 50 mA cm-2 resulted in 88 ± 3% cycling efficiency, displaying tolerance for high overpotentials at the Ni working electrode (0.5 V). X-ray photoelectron microscopy (XPS), time-of-flight secondary-ion mass spectroscopy (ToF-SIMS), and scanning electron microscopy (SEM) surface measurements revealed that the formation of a stable SEI, rich in LiF and deficient in organic carbon species, coupled with nondendritic and compact Li morphologies enabled enhanced cycling efficiency at higher currents. Reduced dendrite formation at high current is further highlighted by the use of a highly porous separator in coin cell cycling (1 mAh cm-2 at 50 °C), sustaining 500 cycles at 10 mA cm-2.

4.
ACS Appl Mater Interfaces ; 12(23): 26593-26600, 2020 Jun 10.
Article in English | MEDLINE | ID: mdl-32412232

ABSTRACT

A stable solid electrolyte interphase (SEI) has been proven to be a key enabler to most advanced battery chemistries, where the reactivity between the electrolyte and the anode operating beyond the electrolyte stability limits must be kinetically suppressed by such SEIs. The graphite anode used in state-of-the-art Li-ion batteries presents the most representative SEI example. Because of similar operation potentials between graphite and silicon (Si), a similar passivation mechanism has been thought to apply on the Si anode when using the same carbonate-based electrolytes. In this work, we found that the chemical formation process of a proto-SEI on Si is closely entangled with incessant SEI decomposition, detachment, and reparation, which lead to continuous lithium consumption. Using a special galvanostatic protocol designed to observe the SEI formation prior to Si lithiation, we were able to deconvolute the electrochemical formation of such dynamic SEI from the morphology and mechanical complexities of Si and showed that a pristine Si anode could not be fully passivated in carbonate-based electrolytes.

5.
ACS Appl Mater Interfaces ; 12(9): 10496-10502, 2020 Mar 04.
Article in English | MEDLINE | ID: mdl-32043855

ABSTRACT

LiNi0.5Co0.2Mn0.3O2 (NCM523), as a cathode material for rechargeable lithium-ion batteries, has attracted considerable attention and been successfully commercialized for decades. NCM is also a promising electrocatalyst for the oxygen evolution reaction (OER), and the catalytic activity is highly correlated to its structure. In this paper, we successfully obtain NCM523 with three different structures: spinel NCM synthesized at low temperature (LT-NCM), disordered NCM (DO-NCM) with lithium deficiency obtained at high temperature, and layered hexagonal NCM at high temperature (HT-NCM). By introducing lithium deficiency to tune the valence state of transition metals in NCM from Ni2+ to Ni3+, DO-NCM exhibits the best catalytic activity with the lowest onset potential (∼1.48 V) and Tafel slope (∼85.6 mV dec-1), whereas HT-NCM exhibits the worst catalytic activity with the highest onset potential (∼1.63 V) and Tafel slope (∼241.8 mV dec-1).

6.
J Phys Chem Lett ; 11(1): 286-291, 2020 Jan 02.
Article in English | MEDLINE | ID: mdl-31845806

ABSTRACT

We present a novel spectroscopic technique for in situ Raman microscopy studies of battery electrodes. By creating nanostructures on a copper mesh current collector, we were able to utilize surface-enhanced Raman spectroscopy (SERS) to monitor the evolution of the silicon anode-electrolyte interphase. The spectra show reversible Si peak intensity changes upon lithiation and delithiation. Moreover, an alkyl carboxylate species, lithium propionate, was detected as a significant SiEI component. Our experimental setup showed reproducible and stable performance over multiple cycles in terms of both electrochemistry and spectroscopy.

7.
ACS Appl Mater Interfaces ; 11(50): 46993-47002, 2019 Dec 18.
Article in English | MEDLINE | ID: mdl-31738043

ABSTRACT

Because of the complexity, high reactivity, and continuous evolution of the silicon-electrolyte interphase (SiEI), "individual" constituents of the SiEI were investigated to understand their physical, electrochemical, and mechanical properties. For the analysis of these intrinsic properties, known SiEI components (i.e., SiO2, Li2Si2O5, Li2SiO3, Li3SiOx, Li2O, and LiF) were selected and prepared as amorphous thin films. The chemical composition, purity, morphology, roughness, and thickness of prepared samples were characterized using a variety of analytical techniques. On the basis of subsequent analysis, LiF shows the lowest ionic conductivity and relatively weak, brittle mechanical properties, while lithium silicates demonstrate higher ionic conductivities and greater mechanical hardness. This research establishes a framework for identifying components critical for stabilization of the SiEI, thus enabling rational design of new electrolyte additives and functional binders for the development of next-generation advanced Li-ion batteries utilizing Si anodes.

9.
ACS Appl Mater Interfaces ; 10(44): 38558-38564, 2018 Nov 07.
Article in English | MEDLINE | ID: mdl-30362716

ABSTRACT

Silicon (Si) is a commonly studied candidate material for next-generation anodes in Li-ion batteries. A native oxide SiO2 on Si is often inevitable. However, it is not clear if this layer has a positive or negative effect on the battery performance. This understanding is complicated by the lack of knowledge about the physical properties of the SiO2 lithiation products and by the convolution of chemical and electrochemical effects during the anode lithiation process. In this study, Li xSiO y thin films as model materials for lithiated SiO2 were deposited by magnetron sputtering at ambient temperature, with the goal of (1) decoupling chemical reactivity from electrochemical reactivity and (2) evaluating the physical and electrochemical properties of Li xSiO y. X-ray photoemission spectroscopy analysis of the deposited thin films demonstrate that a composition close to previous experimental reports of lithiated native SiO2 can be achieved through sputtering. Our density functional theory calculations also confirm that the possible phases formed by lithiating SiO2 are very close to the measured film compositions. Scanning probe microscopy measurements show that the mechanical properties of the film are strongly dependent on lithium concentration, with a ductile behavior at a higher Li content and a brittle behavior at a lower Li content. The chemical reactivity of the thin films was investigated by measuring the AC impedance evolution, suggesting that Li xSiO y continuously reacts with the electrolyte, in part because of the high electronic conductivity of the film determined from solid-state impedance measurements. The electrochemical cycling data of the sputter-deposited Li xSiO y/Si films also suggest that Li xSiO y is not beneficial in stabilizing the Si anode surface during battery operation, despite its favorable mechanical properties.

10.
ACS Appl Mater Interfaces ; 10(44): 38558-38564, 2018 11 07.
Article in English | MEDLINE | ID: mdl-30360108

ABSTRACT

Silicon (Si) is a commonly studied candidate material for next-generation anodes in Li-ion batteries. A native oxide SiO2 on Si is often inevitable. However, it is not clear if this layer has positive or negative effect on the battery performance. This understanding is complicated by the lack of knowledge about the physical properties, and by convolution of chemical and electrochemical effects during the anode lithiation process. In this study, LixSiOy thin films as model materials for lithiated SiO2 were deposited by magnetron sputtering at ambient temperature, with the goal of 1) decoupling chemical reactivity from electrochemical reactivity, and 2) evaluating the physical and electrochemical properties of LixSiOy. XPS analysis of the deposited thin films demonstrate that a composition close to previous experimental reports of lithiated native SiO2, can be achieved through sputtering. Our density functional theory calculations also confirm that possible phases formed by lithiating SiO2 are very close to the measured film compositions. Scanning probe microscopy measurements show the mechanical properties of the film are strongly dependent on lithium concentration, with ductile behavior and higher Li content and brittle behavior at lower Li content. Chemical reactivity of the thin films was investigated by measuring AC impedance evolution, suggesting that LixSiOy continuously reacts with electrolyte, in part due to high electronic conductivity of the film determined from solid state impedance measurements. Electrochemical cycling data of sputter deposited LixSiOy/Si films also suggest that LixSiOy is not beneficial in stabilizing the Si anode surface during battery operation, despite its favorable mechanical properties.

11.
BMC Res Notes ; 11(1): 769, 2018 Oct 29.
Article in English | MEDLINE | ID: mdl-30373649

ABSTRACT

OBJECTIVE: To examine anti-microbial prescribing practices associated with ventilator-associated pneumonia from data gathered during an audit of practice and outcomes in intensive care units (ICUs) in a previously published study. RESULTS: The patient sample of 169 was 65% male with an average age of 59.7 years, a mean APACHE II score of 20.6, and a median ICU stay of 11 days. While ventilator-associated pneumonia was identified using a specific 4-item checklist in 29 patients, agreement between the checklist and independent physician diagnosis was only 17%. Sputum microbe culture reporting was sparse. Approximately 75% of the sample was administered an antimicrobial (main indications: lung infection [54%] and prophylaxis [11%]). No clinical justification was documented for 20% of prescriptions. Piperacillin/tazobactam was most frequently prescribed (1/3rd of all antimicrobial prescriptions) with about half of those for prophylaxis. Variations in prescribing practices were identified, including apparent gaps in antimicrobial stewardship; particularly in relation to prescribing for prophylaxis and therapy de-escalation. Sputum microbe culture reports for VAP did not appear to contribute to prescribing decisions but physician suspicion of lung infection and empiric therapy rather than ventilator-associated pneumonia criteria and guideline concordance.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Prescriptions/statistics & numerical data , Intensive Care Units/statistics & numerical data , Pneumonia, Ventilator-Associated/epidemiology , Practice Patterns, Physicians'/statistics & numerical data , Female , Humans , Incidence , Male , Medical Audit/statistics & numerical data , Middle Aged , Prevalence , Prospective Studies
12.
Langmuir ; 33(37): 9398-9406, 2017 09 19.
Article in English | MEDLINE | ID: mdl-28636826

ABSTRACT

The energy density of rechargeable batteries utilizing metals as anodes surpasses that of Li ion batteries, which employ carbon instead. Among possible metals, magnesium represents a potential alternative to the conventional choice, lithium, in terms of storage density, safety, stability, and cost. However, a major obstacle for metal-based batteries is the identification of electrolytes that show reversible deposition/dissolution of the metal anode and support reversible intercalation of ions into a cathode. Traditional Grignard-based Mg electrolytes are excellent with respect to the reversible deposition of Mg, but their limited anodic stability and compatibility with oxide cathodes hinder their applicability in Mg batteries with higher voltage. Non-Grignard electrolytes, which consist of ethereal solutions of magnesium(II) bis(trifluoromethanesulfonyl)imide (Mg(TFSI)2), remain fairly stable near the potential of Mg deposition. The slight reactivity of these electrolytes toward Mg metal can be remedied by the addition of surface-protecting agents, such as MgCl2. Hence, ethereal solutions of Mg(TFSI)2 salt with MgCl2 as an additive have been suggested as a representative non-Grignard Mg electrolyte. In this work, the degradation mechanisms of a Mg metal anode in the TFSI-based electrolyte were studied using a current density of 1 mA cm-2 and an areal capacity of ∼0.4 mAh cm-2, which is close to those used in practical applications. The degradation mechanisms identified include the corrosion of Mg metal, which causes the loss of electronic pathways and mechanical integrity, the nonuniform deposition of Mg, and the decomposition of TFSI- anions. This study not only represents an assessment of the behavior of Mg metal anodes at practical current density and areal capacity but also details the outcomes of interfacial passivation, which was detected by simple cyclic voltammetry experiments. This study also points out the absolute absence of any passivation at the electrode-electrolyte interface for the premise of developing electrolytes compatible with a metal anode.

13.
ACS Appl Mater Interfaces ; 8(45): 30853-30862, 2016 Nov 16.
Article in English | MEDLINE | ID: mdl-27775318

ABSTRACT

Hybrid supercapacitors that follow a "rocking-chair"-type mechanism were developed by coupling divalent metal and activated carbon electrodes in nonaqueous electrolytes. Conventional supercapacitors require a large amount of electrolyte to provide a sufficient quantity of ions to the electrodes, due to their Daniell-type mechanism that depletes the ions from the electrolyte while charging. The alternative "rocking-chair"-type mechanism effectively enhances the energy density of supercapacitors by minimizing the necessary amount of electrolyte, because the ion is replenished from the metal anode while it is adsorbed to the cathode. Newly developed nonaqueous electrolytes for Mg and Zn electrochemistry, based on bis(trifluoromethylsulfonyl)imide (TFSI) salts, made the metal hybrid supercapacitors possible by enabling reversible deposition on the metal anodes and reversible adsorption on an activated carbon cathode. Factoring in gains through the cell design, the energy density of the metal hybrid supercapacitors is projected to be a factor of 7 higher than conventional devices thanks to both the "rocking-chair"-type mechanism that minimizes total electrolyte volume and the use of metal anodes, which have substantial merits in capacity and voltage. Self-discharge was also substantially alleviated compared to conventional supercapacitors. This concept offers a route to build supercapacitors that meet dual criteria of power and energy densities with a simple cell design.

14.
Sci Rep ; 6: 32102, 2016 08 25.
Article in English | MEDLINE | ID: mdl-27558638

ABSTRACT

In advanced electrical grids of the future, electrochemically rechargeable fluids of high energy density will capture the power generated from intermittent sources like solar and wind. To meet this outstanding technological demand there is a need to understand the fundamental limits and interplay of electrochemical potential, stability, and solubility in low-weight redox-active molecules. By generating a combinatorial set of 1,4-dimethoxybenzene derivatives with different arrangements of substituents, we discovered a minimalistic structure that combines exceptional long-term stability in its oxidized form and a record-breaking intrinsic capacity of 161 mAh/g. The nonaqueous redox flow battery has been demonstrated that uses this molecule as a catholyte material and operated stably for 100 charge/discharge cycles. The observed stability trends are rationalized by mechanistic considerations of the reaction pathways.

15.
ACS Appl Mater Interfaces ; 8(25): 16002-8, 2016 Jun 29.
Article in English | MEDLINE | ID: mdl-27255422

ABSTRACT

Mg battery operates with Chevrel phase (Mo6S8, ∼1.1 V vs Mg) cathodes that apply Grignard-based or derived electrolytes, which allow etching of the passivating oxide coating forms at the magnesium metal anode. Majority of Mg electrolytes studied to date are focused on developing new synthetic strategies to achieve a better reversible Mg deposition. While most of these electrolytes contain chloride as a component, and there is a lack of literature which investigates the fundamental role of chloride in Mg electrolytes. Further, ease of preparation and potential safety benefits have made simple design of magnesium electrolytes an attractive alternative to traditional air sensitive Grignard reagents-based electrolytes. Work presented here describes simple, non-Grignard magnesium electrolytes composed of magnesium bis(trifluoromethane sulfonyl)imide mixed with magnesium chloride (Mg(TFSI)2-MgCl2) in tetrahydrofuran (THF) and diglyme (G2) that can reversibly plate and strip magnesium. Based on this discovery, the effect of chloride in the electrolyte complex was investigated. Electrochemical properties at different initial mixing ratios of Mg(TFSI)2 and MgCl2 showed an increase of both current density and columbic efficiency for reversible Mg deposition as the fraction content of MgCl2 increased. A decrease in overpotential was observed for rechargeable Mg batteries with electrolytes with increasing MgCl2 concentration, evidenced by the coin cell performance. In this work, the fundamental understanding of the operation mechanisms of rechargeable Mg batteries with the role of chloride content from electrolyte could potentially bring rational design of simple Mg electrolytes for practical Mg battery.

16.
ChemSusChem ; 9(6): 595-9, 2016 Mar 21.
Article in English | MEDLINE | ID: mdl-26845373

ABSTRACT

A series of strong Lewis acid-free alkoxide/siloxide-based Mg electrolytes were deliberately developed with remarkable oxidative stability up to 3.5 V (vs. Mg/Mg(2+)). Despite the perception of ROMgCl (R=alkyl, silyl) as a strong base, ROMgCl acts like Lewis acid, whereas the role of MgCl2 in was unambiguously demonstrated as a Lewis base through the identification of the key intermediate using single crystal X-ray crystallography. This Lewis-acid-free strategy should provide a prototype system for further investigation of Mg-ion batteries.


Subject(s)
Electric Power Supplies , Electrolytes/chemistry , Lewis Bases/chemistry , Magnesium Chloride/chemistry , Carbon-13 Magnetic Resonance Spectroscopy , Microscopy, Electron, Scanning
17.
Med J Aust ; 204(2): 73, 2016 02 01.
Article in English | MEDLINE | ID: mdl-26821106

ABSTRACT

OBJECTIVE: To implement a statewide program for the early recognition and treatment of sepsis in New South Wales, Australia. SETTING: Ninety-seven emergency departments in NSW hospitals. INTERVENTION: A quality improvement program (SEPSIS KILLS) that promoted intervention within 60 minutes of recognition, including taking of blood cultures, measuring serum lactate levels, administration of intravenous antibiotics, and fluid resuscitation. MAIN OUTCOME MEASURES: Time to antibiotics and fluid resuscitation; mortality rates and length of stay. RESULTS: Data for 13 567 patients were entered into the database. The proportion of patients receiving intravenous antibiotics within 60 minutes of triage increased from 29.3% in 2009-2011 to 52.2% in 2013. The percentage for whom a second litre of fluid was started within 60 minutes rose from 10.6% to 27.5% (each P < 0.001). The proportion of patients classed as Australasian Triage Scale (ATS) 1 increased from 2.3% in 2009-2011 to 4.2% in 2013, and the proportion classed as ATS 2 rose from 40.7% in 2009-2011 to 60.7% in 2013 (P < 0.001). There was a linear decrease in mortality from 19.3% in 2009-2011 to 14.1% in 2013; there was also a significant decline in time in intensive care and total length of stay (each P < 0.0001). The mortality rate for patients with severe sepsis (serum lactate ≥ 4 mmol/L or systolic blood pressure [SBP] < 90 mmHg) was 19.7%. The mortality rates for patients with severe sepsis admitted to intensive care and for those admitted to a ward did not change significantly over time. The proportion of patients with uncomplicated sepsis (SBP ≥ 90 mmHg, serum lactate < 4 mmol/L) transferred to a ward increased, and the mortality rate after transfer increased from 3.2% in 2009-2011 to 6.2% in 2013 (P < 0.05). The survival benefit was greatest for patients with evidence of haemodynamic instability (SBP < 90 mmHg) but normal lactate levels (P = 0.03). CONCLUSIONS: The SEPSIS KILLS program has improved the process of care for patients with sepsis in NSW hospitals. The program has focused attention on sepsis management in the wards.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacteremia/diagnosis , Bacteremia/therapy , Blood/microbiology , Lactic Acid/blood , Aged , Bacteremia/mortality , Bacteremia/prevention & control , Biomarkers/blood , Early Diagnosis , Emergency Service, Hospital , Fluid Therapy , Guidelines as Topic , Humans , Incidence , Length of Stay/statistics & numerical data , Middle Aged , New South Wales/epidemiology , Prospective Studies , Retrospective Studies , Risk Factors , Survival Rate , Time Factors
18.
ACS Appl Mater Interfaces ; 8(5): 3021-31, 2016 Feb 10.
Article in English | MEDLINE | ID: mdl-26765789

ABSTRACT

Through coupled experimental analysis and computational techniques, we uncover the origin of anodic stability for a range of nonaqueous zinc electrolytes. By examination of electrochemical, structural, and transport properties of nonaqueous zinc electrolytes with varying concentrations, it is demonstrated that the acetonitrile-Zn(TFSI)2, acetonitrile-Zn(CF3SO3)2, and propylene carbonate-Zn(TFSI)2 electrolytes can not only support highly reversible Zn deposition behavior on a Zn metal anode (≥99% of Coulombic efficiency) but also provide high anodic stability (up to ∼3.8 V vs Zn/Zn(2+)). The predicted anodic stability from DFT calculations is well in accordance with experimental results, and elucidates that the solvents play an important role in anodic stability of most electrolytes. Molecular dynamics (MD) simulations were used to understand the solvation structure (e.g., ion solvation and ionic association) and its effect on dynamics and transport properties (e.g., diffusion coefficient and ionic conductivity) of the electrolytes. The combination of these techniques provides unprecedented insight into the origin of the electrochemical, structural, and transport properties in nonaqueous zinc electrolytes.

19.
ACS Appl Mater Interfaces ; 7(51): 28438-43, 2015 Dec 30.
Article in English | MEDLINE | ID: mdl-26641524

ABSTRACT

We report an approach to control the reversible electrochemical activity (i.e., extraction/insertion) of Mg(2+) in a cathode host through the use of phase-pure epitaxially stabilized thin film structures. The epitaxially stabilized MgMn2O4 (MMO) thin films in the distinct tetragonal and cubic phases are shown to exhibit dramatically different properties (in a nonaqueous electrolyte, Mg(TFSI)2 in propylene carbonate): tetragonal MMO shows negligible activity while the cubic MMO (normally found as polymorph at high temperature or high pressure) exhibits reversible Mg(2+) activity with associated changes in film structure and Mn oxidation state. These results demonstrate a novel strategy for identifying the factors that control multivalent cation mobility in next-generation battery materials.

20.
BMJ Open ; 5(10): e008924, 2015 Oct 29.
Article in English | MEDLINE | ID: mdl-26515685

ABSTRACT

OBJECTIVES: With disagreements on diagnostic criteria for ventilator-associated pneumonia (VAP) hampering efforts to monitor incidence and implement preventative strategies, the study objectives were to develop a checklist for clinical surveillance of VAP, and conduct an audit in Australian/New Zealand intensive care units (ICUs) using the checklist. SETTING: Online survey software was used for checklist development. The prospective audit using the checklist was conducted in 10 ICUs in Australia and New Zealand. PARTICIPANTS: Checklist development was conducted with members of a bi-national professional society for critical care physicians using a modified Delphi technique and survey. A 30-day audit of adult patients mechanically ventilated for >72 h. PRIMARY AND SECONDARY OUTCOME MEASURES: Presence of items on the screening checklist; physician diagnosis of VAP, clinical characteristics, investigations, treatments and patient outcome. RESULTS: A VAP checklist was developed with five items: decreasing gas exchange, sputum changes, chest X-ray infiltrates, inflammatory response, microbial growth. Of the 169 participants, 17% (n=29) demonstrated characteristics of VAP using the checklist. A similar proportion had an independent physician diagnosis (n=30), but in a different patient subset (only 17% of cases were identified by both methods). The VAP rate per 1000 mechanical ventilator days for the checklist and clinician diagnosis was 25.9 and 26.7, respectively. The item 'inflammatory response' was most associated with the first episode of physician-diagnosed VAP. CONCLUSIONS: VAP rates using the checklist and physician diagnosis were similar to ranges reported internationally and in Australia. Of note, different patients were identified with VAP by the checklist and physicians. While the checklist items may assist in identifying patients at risk of developing VAP, and demonstrates synergy with the recently developed Centers for Disease Control (CDC) guidelines, decision-making processes by physicians when diagnosing VAP requires further exploration.


Subject(s)
Checklist , Critical Care , Intensive Care Units , Mass Screening/methods , Pneumonia, Ventilator-Associated/diagnosis , Adult , Aged , Australia/epidemiology , Consensus , Female , Humans , Incidence , Inflammation , Male , Medical Audit , Middle Aged , New Zealand/epidemiology , Physicians , Pneumonia, Ventilator-Associated/epidemiology , Prospective Studies
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