Managing magnets: An audit of introduction of the Royal College of Emergency Medicine Best Practice Guideline.

AIM: To evaluate management of children and young people presenting to the Emergency Department (ED) with magnet ingestion before and after new guidance. METHODS: In May 2021, a National Patient Safety Agency and Royal College of Emergency Medicine (RCEM) Best Practice Guideline about management of ingested magnets was published. This was implemented in our department. Children and young people presenting after magnet ingestion were identified from SNOMED (coded routinely collected data) and X-ray requests between January 2016 and March 2022. Management was compared to national guidance. RESULTS: There were 138 patient episodes of magnet ingestion, with a rising incidence over the 5-year period. Following introduction of the guideline, there was a higher incidence of admission (36% vs. 20%) and operative intervention (15.7% vs. 8%). Use of follow-up X-ray increased from 56% to 90%. There was substantial variation in the management prior to guidance which reduced after introduction of the RCEM guidance. CONCLUSION: Management of magnet ingestion has become more standardised since introduction of the National RCEM Best Practice Guideline, but there is still room for improvement.

Selective Interbundle Cross-Linking for Lightweight and Superstrong Carbon Nanotube Yarns.

In this study, a range of carbon nanotube yarn (CNTY) architectures was examined and controlled by chemical modification to gain a deeper understanding of CNTY load-bearing systems and produce lightweight and superstrong CNTYs. The architecture of CNTY, which has polymer layers surrounding a compact bundle without hampering the original state of the CNTs in the bundle, is a favorable design for further chemical cross-linking and for enhancing the load-transfer efficiency, as confirmed by in situ Raman spectroscopy under a stress load. The resulting CNTY exhibited excellent mechanical performance that exceeded the specific strength of the benchmark, high-performance fibers. This exceptional strength of the CNTY makes it a promising candidate for the cable of a space elevator traveling from the Earth to the International Space Station given its strength of 4.35 GPa/(g cm-3), which can withstand the self-weight of a 440 km cable.

Non-Settling Super-Strong Magnetorheological Fluids.

A magnetorheological (MR) fluid is generally called a suspension in which magnetic particles are dispersed in a non-magnetic medium. When an external magnetic field is applied, a pseudo-phase transition occurs within a short time to generate yield stress, and when the magnetic field is released, it returns to the suspended state. Due to these unique characteristics, it is classified as a smart material to be widely applied in various industries. High performance MR fluids require high yield stress and stability for long-term use. However, it is very difficult to improve performance and stability simultaneously due to the limited amount of magnetic particles in the suspension and particle sedimentation caused by the density mismatch between the suspending particles and the liquid phase. In this study, an MR slurry is developed that is completely different from the MR suspension, starting from the opposite concept. An innovative non-settling (i.e., permanently stable) magnetorheological slurry is successfully created that exhibits unprecedented ultra-high yield stress. This result is expected to be a turning point for applying MR fluids to more diverse industries. In addition, a simple fitting equation expressing the yield stress as a function of the particle volume fraction is proposed.

Intrinsically reversible superglues via shape adaptation inspired by snail epiphragm.

Adhesives are ubiquitous in daily life and industrial applications. They usually fall into one of two classes: strong but irreversible (e.g., superglues) or reversible/reusable but weak (e.g., pressure-sensitive adhesives and biological and biomimetic surfaces). Achieving both superstrong adhesion and reversibility has been challenging. This task is particularly difficult for hydrogels that, because their major constituent is liquid water, typically do not adhere strongly to any material. Here, we report a snail epiphragm-inspired adhesion mechanism where a polymer gel system demonstrates superglue-like adhesion strength (up to 892 N⋅cm-2) that is also reversible. It is applicable to both flat and rough target surfaces. In its hydrated state, the softened gel conformally adapts to the target surface by low-energy deformation, which is locked upon drying as the elastic modulus is raised from hundreds of kilopascals to ∼2.3 GPa, analogous to the action of the epiphragm of snails. We show that in this system adhesion strength is based on the material's intrinsic, especially near-surface, properties and not on any near-surface structure, providing reversibility and ease of scaling up for practical applications.

Superstrong Carbon Nanotube Yarns by Developing Multiscale Bundle Structures on the Direct Spin-Line without Post-Treatment.

Super strong fibers, such as carbon or aramid fibers, have long been used as effective fillers for advanced composites. In this study, the highest tensile strength of 5.5 N tex-1 for carbon nanotube yarns (CNTYs) is achieved by controlling the micro-textural structure through a facile and eco-friendly bundle engineering process in direct spinning without any post-treatment. Inspired by the strengthening mechanism of the hierarchical fibrillary structure of natural cellulose fiber, this study develops multiscale bundle structures in CNTYs whereby secondary bundles, ≈200 nm in thickness, evolve from the assembly of elementary bundles, 30 nm in thickness, without any damage, which is a basic load-bearing element in CNTY. The excellent mechanical performance of these CNTYs makes them promising substitutes for the benchmark, lightweight, and super strong commercial fibers used for energy-saving structural materials. These findings address how the tensile strength of CNTY can be improved without additional post-treatment in the spinning process if the development of the aforementioned secondary bundles and the corresponding orientations are properly engineered.

Super-Strong Hydrogel Composites Reinforced with PBO Nanofibers for Cartilage Replacement.

Cartilage replacement materials exhibiting a set of demanding properties such as high water content, high mechanical stiffness, low friction, and excellent biocompatibility are quite difficult to achieve. Here, poly(p-phenylene-2,6-benzobisoxazole) (PBO) nanofibers are combined with polyvinyl alcohol (PVA) to form a super-strong structure with a performance that surpasses the vast majority of previously existing hydrogels. PVA-PBO composites with water contents in the 59-76% range exhibit tensile and compressive moduli reaching 20.3 and 4.5 MPa, respectively, and a coefficient of friction below 0.08. Further, they are biocompatible and support the viability of chondrocytes for 1 week, with significant improvements in cell adhesion, proliferation, and differentiation compared to PVA. The new composites can be safely sterilized by steam heat or gamma radiation without compromising their integrity and overall performance. In addition, they show potential to be used as local delivery platforms for anti-inflammatory drugs. These attractive features make PVA-PBO composites highly competitive engineered materials with remarkable potential for use in the design of load-bearing tissues. Complementary work has also revealed that these composites will be interesting alternatives in other industrial fields where high thermal and mechanical resistance are essential requirements, or which can take advantage of the pH responsiveness functionality.

Mechanically Strong Electrically Insulated Nanopapers with High UV Resistance Derived from Aramid Nanofibers and Cellulose Nanofibrils.

Aramid nanofibers (ANFs) have great potential for civil and military applications due to their remarkable mechanical modulus, excellent chemical reliability, and superior thermostability. Unfortunately, the weak combination of neighboring ANFs limits the mechanical properties of ANF-based materials owing to their inherent rigidity and chemical inertness. Herein, high-performance nanopapers are fabricated by introducing a tiny amount of cellulose nanofibrils (CNFs) to serve as reinforcing blocks via vacuum filtration. As a result of the formation of nanosized building blocks and hydrogen-bonding interaction of CNFs, the resultant ANF/CNF nanopaper yields a record-high tensile strength (406.43 ± 16.93 MPa) and toughness (86.13 ± 5.22 MJ m-3), which are 1.8 and 4.3 times higher than those of the pure ANF nanopaper, respectively. When normalized by weight, the specific tensile strength of the nanopaper is as high as 307.90 MPa·g-1·cm3, which is even significantly superior to that of titanium alloys (257 MPa·g-1·cm3). The ANF/CNF nanopaper also possesses excellent dielectric strength (53.42 kV mm-1), superior UV-shielding performance (≥99.999% absorption for ultraviolet radiation), and a favorable thermostability (Tonset = 530 °C). This study proposes a new design strategy for developing ultrathin ANF-based nanopapers combined with high reliability and thermostability for application in high-end electrical insulation fields, such as 5G communication, wearable electronics, and artificial intelligence.

Super-Strong, Nonswellable, and Biocompatible Hydrogels Inspired by Human Tendons.

Fabricating artificial materials that mimic the structures and properties of tendons is of great significance. Possessing a tensile stress of approximately 10.0 MPa and a water content of around 60%, human tendons exhibit excellent mechanical properties to support daily functions. In contrast to tendons, most synthetic hydrogels with similar water content typically exclude qualified strength, swelling resistance, and biocompatibility. Herein, a facile strategy based on poly(vinyl alcohol) (PVA) and tannic acid (TA) is demonstrated to tackle this problem via a combination of sequential steps including freezing-thawing PVA aqueous solutions to form crystalline regions, prestretching and air drying in confined conditions to induce anisotropic structures, soaking in TA solutions to form multiple hydrogen bondings between PVA and TA, and finally dialyzing against water for the removal of residual TA molecules and the rearrangements and homogenization of multiple hydrogen bonds. The obtained PVA hydrogels possess hierarchically anisotropic structures, where the alignment of PVA bundles promotes high modulus, while the hydrogen bonding between PVA and TA endows them with an energy dissipation mechanism. Benefitting from the synergy of material composition and structural engineering, the obtained hydrogel displays super-strong mechanics (a tensile stress of 19.3 MPa and a toughness of 32.1 MJ/m3), outperforming most tough hydrogels. Remarkably, this hydrogel demonstrates excellent swelling resistance. It barely expands after immersion in deionized water, phosphate-buffered saline (PBS), and SBF aqueous solutions for 7 days with the strength and volume nearly the same as their initial values. All of the features, combined with excellent cytocompatibility, make it an ideal material for biotechnological and biomedical applications.

Super-Strong, Super-Stiff Macrofibers with Aligned, Long Bacterial Cellulose Nanofibers.

With their impressive properties such as remarkable unit tensile strength, modulus, and resistance to heat, flame, and chemical agents that normally degrade conventional macrofibers, high-performance macrofibers are now widely used in various fields including aerospace, biomedical, civil engineering, construction, protective apparel, geotextile, and electronic areas. Those macrofibers with a diameter of tens to hundreds of micrometers are typically derived from polymers, gel spun fibers, modified carbon fibers, carbon-nanotube fibers, ceramic fibers, and synthetic vitreous fibers. Cellulose nanofibers are promising building blocks for future high-performance biomaterials and textiles due to their high ultimate strength and stiffness resulting from a highly ordered orientation along the fiber axis. For the first time, an effective fabrication method is successfully applied for high-performance macrofibers involving a wet-drawing and wet-twisting process of ultralong bacterial cellulose nanofibers. The resulting bacterial cellulose macrofibers yield record high tensile strength (826 MPa) and Young's modulus (65.7 GPa) owing to the large length and the alignment of nanofibers along fiber axis. When normalized by weight, the specific tensile strength of the macrofiber is as high as 598 MPa g-1 cm3 , which is even substantially stronger than the novel lightweight steel (227 MPa g-1 cm3 ).