Evaluation of a personal protective equipment support programme for staff during the COVID-19 pandemic in London.

BACKGROUND: The coronavirus disease 2019 pandemic has presented an enormous challenge to healthcare providers worldwide. The appropriate use of personal protective equipment (PPE) has been essential to ensure staff and patient safety. The 'PPE Helper Programme' was developed at a large London hospital group to counteract suboptimal PPE practice. Based on a behaviour change model of capability, opportunity and motivation (COM-B), the programme provided PPE support, advice and education to ward staff. AIM: Evaluation of the PPE Helper Programme. METHODS: Clinical and non-clinical ward staff completed a questionnaire informed by the Theoretical Domains Framework and COM-B model. The questionnaire was available in paper and electronic versions. Quantitative responses were analysed using descriptive and non-parametric statistics, and free-text responses were analysed thematically. FINDINGS: Over a 6-week period, PPE helpers made 268 ward visits. Overall, 261 questionnaires were available for analysis. Across the Trust, 68% of respondents reported having had contact with a PPE helper. Staff who had encountered a PPE helper responded significantly more positively to a range of statements about using PPE than staff who had not encountered a PPE helper. Black and minority ethnic staff were significantly more anxious regarding the adequacy of PPE. Non-clinical and redeployed staff (e.g. domestic staff) were most positive about the impact of PPE helpers. Free-text comments showed that staff found the PPE Helper Programme supportive and would have liked it earlier in the pandemic. CONCLUSION: The PPE Helper Programme is a feasible and beneficial intervention for providing support, advice and education to ward staff during infectious disease outbreaks.

Enhanced durability, bio-activity and corrosion resistance of stainless steel through severe surface deformation.

Owing to its good biocompatibility and low cost, stainless steel is one of the most widely utilized biomaterial. However, longtime assessment of stainless steel has shown problems related to material degradation, especially localized corrosion and bio-film formation. In addition, the leaching of toxic nickel and chromium ions from stainless steel leads to additional health complications. Here, we utilized submerged friction stir processing, a severe surface deformation technique for significantly enhancing its durability, bio-activity as well as antibacterial resistance. The processing was done with a wide variation in strain rates to produce tunable surface microstructure. High strain-rate processing resulted in nearly single-phase fine-grained microstructure, while slow strain-rate processing developed a dual-phase fine-grained microstructure. The bio-corrosion rate of processed steel was reduced by more than 60 % along with significant enhancement in the pitting resistance. The processed steel showed nearly no bacterial adhesion/biofilm formation, evaluated using S. aureus and E. coli bacterial strains. Further, the processed stainless steel surface demonstrated minimum leaching of the toxic elements, significantly enhancing its appeal for bio-implant applications. The observed behavior was explained based on the formation of a stable passive layer, rich in Cr2O3, as determined using x-ray photoelectron microscopy (XPS) and increased hydrophilicity.

High Tensile Ductility and Strength in Dual-phase Bimodal Steel through Stationary Friction Stir Processing.

The combination of high strength and good ductility are very desirable for advanced structural and functional applications. However, measures to enhance strength typically lead to ductility reduction due to their inverse correlation, nano-grained structures for an instance. Bi-modal grain structure is promising in this regard, but its realization is limited by multiple complex processing steps. Here, we demonstrate a facile single-step processing route for the development of bimodal grain structure in austenitic stainless steel, SS316L. The bimodal structure comprised of fine martensite grains (<500 nm) sandwiched between coarse austenite grains (~10 µm). The dual-phase bimodal structure demonstrated higher yield strength (~620 MPa) compared to ultra-fine grain structure (~450 MPa) concurrent with high uniform tensile ductility (~35%). These exceptional properties are attributed to unique dual-phase, bimodal grain structure which delayed the onset of plastic instability resulting in higher strength as well as larger uniform elongation and work-hardening rate. Our approach may be easily extended to a wide range of material systems to engineer superior performance.

Microwave synthesized complex concentrated alloy coatings: Plausible solution to cavitation induced erosion-corrosion.

Surface phenomenon such as cavitation erosion-corrosion limits the working life and durability of the fluid machines through significantly altering the efficiency. Surface modification is an apparent and economical route for improving the sustainability of these components. Recently developed complex concentrated alloys (CCAs) or high entropy alloys (HEAs) possess exceptional properties owing to high configurational entropy. We developed CCA coatings on the stainless steel using a facial and effective microwave processing technique. The effect of Al molar fraction in AlxCoCrFeNi (x = 0.1-3) CCAs on ultrasonic cavitation erosion-corrosion was investigated in 3.5% NaCl solution. For comparison, cavitation erosion and electrochemical corrosion behavior of the pre- and post-tested samples was also performed. Detailed microstructure and mechanical characterization of the developed coatings were also preformed using different analytical techniques. The equimolar CCA coating showed apical degradation resistance under both pure erosion and erosion-corrosion conditions. The observed behavior is attributed to high strain hardening, optimal hardness, fracture toughness, and utmost stability of the passive layer. The phenomenal conjugation of these properties was associated with highest configurational entropy for equimolar composition resulting in sluggish diffusion, and severe lattice straining. Compared to pits, striations and cracks characterizing the morphology of the degraded stainless steel, the equimolar and Al0.1CoCrFeNi CCAs showed TTS (tearing topograph surface) as the dominant failure mode characterized by presence of microplastic deformation. The degradation of the Al3CoCrFeNi CCA occurred mainly through brittle failure mode. The difference in failure mechanism is related to the mechanical properties and underlying microstructure.

Exceptionally high cavitation erosion and corrosion resistance of a high entropy alloy.

Cavitation erosion and corrosion of structural materials are serious concerns for marine and offshore industries. Durability and performance of marine components are severely impaired due to degradation from erosion and corrosion. Utilization of advanced structural materials can play a vital role in limiting such degradation. High entropy alloys (HEAs) are a relatively new class of advanced structural materials with exceptional properties. In the present work, we report on the cavitation erosion behavior of Al0.1CoCrFeNi HEA in two different media: distilled water with and without 3.5wt% NaCl. For comparison, conventionally used stainless steel SS316L was also evaluated in identical test conditions. Despite lower hardness and yield strength, the HEA showed significantly longer incubation period and lower erosion-corrosion rate (nearly 1/4th) compared to SS316L steel. Enhanced erosion resistance of HEA was attributed to its high work-hardening behavior and stable passivation film on the surface. The Al0.1CoCrFeNi HEA showed lower corrosion current density, high pitting resistance and protection potential compared to SS316L steel. Further, HEA showed no evidence of intergranular corrosion likely due to the absence of secondary precipitates. Although, the degradation mechanisms (formation of pits and fatigue cracks) were similar for both the materials, the damage severity was found to be much higher for SS316L steel compared to HEA.

Friction Stir Processing of Stainless Steel for Ascertaining Its Superlative Performance in Bioimplant Applications.

Substrate-cell interactions for a bioimplant are driven by substrate's surface characteristics. In addition, the performance of an implant and resistance to degradation are primarily governed by its surface properties. A bioimplant typically degrades by wear and corrosion in the physiological environment, resulting in metallosis. Surface engineering strategies for limiting degradation of implants and enhancing their performance may reduce or eliminate the need for implant removal surgeries and the associated cost. In the current study, we tailored the surface properties of stainless steel using submerged friction stir processing (FSP), a severe plastic deformation technique. FSP resulted in significant microstructural refinement from 22 µm grain size for the as-received alloy to 0.8 µm grain size for the processed sample with increase in hardness by nearly 1.5 times. The wear and corrosion behavior of the processed alloy was evaluated in simulated body fluid. The processed sample demonstrated remarkable improvement in both wear and corrosion resistance, which is explained by surface strengthening and formation of a highly stable passive layer. The methylthiazol tetrazolium assay demonstrated that the processed sample is better in supporting cell attachment, proliferation with minimal toxicity, and hemolysis. The athrombogenic characteristic of the as-received and processed samples was evaluated by fibrinogen adsorption and platelet adhesion via the enzyme-linked immunosorbent assay and lactate dehydrogenase assay, respectively. The processed sample showed less platelet and fibrinogen adhesion compared with the as-received alloy, signifying its high thromboresistance. The current study suggests friction stir processing to be a versatile toolbox for enhancing the performance and reliability of currently used bioimplant materials.

Nanotribological and wetting performance of hierarchical patterns.

Surface modification is a promising method to solve the tribological problems in microsystems. To modify the surface, we fabricated hierarchical patterns with different pitches of nano-scale features and different surface chemistries. Micro- and nano-patterns with similar geometrical configurations were also fabricated for comparison. The nano-tribological behavior of the patterns was investigated using an atomic force microscope at different relative humidity levels (5% to 80%) and applied normal loads (40 nN to 120 nN) under a constant sliding velocity. The results showed significant enhancement in the de-wetting and tribological performance of the hierarchical patterns compared with those of flat and micro- and nano-patterned surfaces. The PTFE-coated hierarchical patterns showed similar dynamic contact angles (advancing and receding) to those of the real lotus leaf. The influence of relative humidity on adhesion and friction behavior was found to be significant for all the tested surfaces. The tribological performance was improved as the pitch of the nano-scale geometry of the hierarchical pattern increased, even though the wetting property was not influenced significantly. A model was proposed based on the role of intermolecular force to explain the effect of the pitch of the hierarchical patterns on the adhesion and friction behavior. According to the model based on the molecular force, the contact between a ball and the patterned surface was a multi-asperity contact, contrary to the single-asperity contact predicted by the Johnson-Kendall-Roberts (JKR) and Maugis-Dugdale (MD) models. The strong intermolecular forces, which are activated in the confined spaces between the adjacent nano-pillars and the ball, contributed to the contact area and hence the adhesion and friction forces.

Role of Viscous Dissipative Processes on the Wetting of Textured Surfaces.

We investigate the role of viscous forces on the wetting of hydrophobic, semi-hydrophobic, and hydrophilic textured surfaces as second-order effects. We show that during the initial contact, the transition from inertia- to viscous-dominant regime occurs regardless of their surface topography and chemistry. Furthermore, we demonstrate the effect of viscosity on the apparent contact angle under quasi-static conditions by modulating the ratio of a water/glycerol mixture and show the effect of viscosity, especially on the semi-hydrophobic and hydrophobic textured substrates. The reason why the viscous force does not affect the apparent contact angle of the hydrophilic surface is explained based on the relationship between the disjoining pressure and surface chemistry. We further propose a wetting model that can predict the apparent contact angle of a liquid drop on a textured substrate by incorporating a viscous force component in the force balance equation. This model can predict apparent contact angles on semi-hydrophobic and hydrophobic textured surfaces exhibiting Wenzel state more accurately than the Wenzel model, indicating the importance of viscous forces in determining the apparent contact angle. The modified model can be applied for estimating the wetting properties of arbitrary engineered surfaces.

The role of bio-inspired hierarchical structures in wetting.

Superhydrophobicity facilitates the development of self-cleaning, anti-biofouling, and anti-corrosion surfaces. The leaves of the lotus (Nelumbo nucifera) and taro (Colocasia esculenta) plants are well known for their self-cleaning properties. A hierarchical structure comprising papillae epidermal cells superimposed with epicuticular wax crystalloids of varying shapes, sizes, and orientations is an important aspect of the surface of these plant leaves. We fabricated two types of hierarchical structures biomimicking the surface topography of the lotus leaf. The hierarchical patterns successfully demonstrated the superhydrophobic state in comparison with nano and micro patterns. We used the finite element method (FEM) to simulate and understand the wetting process. The FEM simulations showed good correlation with the experimental results. FEM was helpful in understanding the wetting of enormously complex biological surfaces with relative ease, and it qualifies as a potential tool for designing superhydrophobic surfaces. Using the FEM framework, we further designed surfaces to optimize the order of the shapes in hierarchy. The results showed that the superhydrophobic surface with the lowest wetted area was obtained by placing shapes with smaller geometric angles at the top of the hierarchy. This arrangement of shapes provides the optimum combination of superhydrophobicity and surface integrity. This observation explains why the hierarchical structure of many superhydrophobic leaves follows this order. We also investigated the complex hierarchical structure of Salvinia minima. Owing to its remarkable ability to entrap air and pin the contact line, it exhibits superhydrophobicity along with the much-required Cassie state. These properties of Salvinia minima make it an excellent candidate for developing omniphobic surfaces.

Effect of topography on the wetting of nanoscale patterns: experimental and modeling studies.

We investigated the influence of nanoscale pattern shapes, contours, and surface chemistry on wetting behavior using a combination of experimental and modeling approaches. Among the investigated topographical shapes, re-entrant geometries showed superior performance owing to their ability to restrain the liquid-air interface in accordance with Gibbs criteria. The wetting state is also controlled by the surface texture in addition to the surface chemistry. Topographies with smaller intrinsic angles are better able to support the liquid droplet. Based on these observations, two geometrical relationships for designing superhydrophobic patterns exhibiting the Cassie-Baxter state are proposed. A detailed analysis of the simulation results showed the presence of viscous forces during the initial transient phase of the droplet interaction with the solid surface even at negligible normal velocity, which was verified experimentally using a high-speed imaging technique. During this transient phase, for a polystyrene surface, the liquid front was observed to be moving with a radial velocity of 0.4 m s(-1), which gradually decreased to almost zero after 35 ms. We observed that the viscous energy dissipation density is influenced by the surface material and topography and the wetting state. The viscous energy dissipation density is minimal in the case of the Cassie-Baxter state, while it becomes quite significant for the Wenzel state. The viscous effects are reduced for topographies with smooth geometries and surfaces with high slip length.

Bone grafting for spinal fusion.

At least 250,000 spinal fusions are performed in the United States each year, nearly all requiring implantation of bone graft material. The preferred technique for most of these operations is the transplantation of structured or morcellized autologous corticocancellous bone from the iliac crest. Further, because of the increasing frequency of spinal fusion surgery during the 1990s, arthrodesis of the spine has become the most common reason for autologous bone graft harvest. This article reviews the current clinical status of autogenous bone grafts and alternative materials in spinal fusion surgery.

Fungal production of citric acid.

Citric acid is the principal organic acid found in citrus fruits. To meet increasing demands it is produced from carbohydrate feedstock by fermentation with the fungus Aspergillus niger and the yeasts of Candida spp. Effect of various fermentation conditions and the biochemistry of citric acid formation by A. niger have been discussed. Commercially citric acid is produced by surface, submerged and solid state fermentation techniques. Recovery of pure acid from fermentation broth is done primarily by precipitation with lime and also by solvent extraction.

Susceptibility of two crossbreeds of sheep to Haemonchus contortus.

Studies were conducted on 20 crossbred lambs of 4-5 months old. Ten lambs were Nali x Corriedale cross (Hisardale) and the other 10 were Nali x Lohi cross (Munjal). Seven lambs each of both crossbreeds were infected with 10,000 infective larvae of Haemonchus contortus. Three lambs of each crossbreed served as uninfected controls. Clinicopathological examinations were done before and after infection and all the lambs were necropsied 28 days post-infection. The body weight gain, haemoglobin and packed cell volume were significantly lower in Hisardale lambs and the peripheral eosinophil count was significantly higher in Munjal lambs. Significant hypoalbuminaemia and hypoglobulinaemia, a sharp increase in albumin: globulin ratio; significantly higher faecal egg counts; adult worm counts; abomasal pH, volume, congestion and oedema were observed in Hisardale lambs as compared to Munjal lambs. Clinical signs of haemonchosis were more severe in Hisardale lambs and two of them died. Munjal lambs therefore seem less susceptible than Hisardale lambs to H. contortus infection.