Diabetic autonomic neuropathy does not impede improvement in hypoglycaemia awareness in adults: Sub-study results from the HypoCOMPaSS trial.

AIMS: Impaired awareness of hypoglycaemia (IAH) increases the risk of severe hypoglycaemia in people with type 1 diabetes mellitus (T1DM). IAH can be reversed through meticulous avoidance of hypoglycaemia. Diabetic autonomic neuropathy (DAN) has been proposed as an underlying mechanism contributing to IAH; however, data are inconsistent. The aim of this study was to examine the effects of cardiac autonomic neuropathy (CAN) on IAH reversibility inT1DM. METHODS: Participants with T1DM and IAH (Gold score ≥4) recruited to the HypoCOMPaSS (24-week 2 × 2 factorial randomised controlled) trial were included. All underwent screening for cardiac autonomic function testing at baseline and received comparable education and support aimed at avoiding hypoglycaemia and improving hypoglycaemia awareness. Definite CAN was defined as the presence of ≥2 abnormal cardiac reflex tests. Participants were grouped according to their CAN status, and changes in Gold score were compared. RESULTS: Eighty-three participants (52 women [62.7%]) were included with mean age (SD) of 48 (12) years and mean HbA1c of 66 (13) mmol/mol (8.2 [3.3] %). The mean duration of T1DM was 29 (13) years. The prevalence of CAN was low with 5/83 (6%) participants having definite autonomic neuropathy with 11 (13%) classified with possible/early neuropathy. All participants, regardless of the autonomic function status, showed a mean improvement in Gold score of ≥1 (mean improvement -1.2 [95% CI -0.8, -1.6]; p < 0.001). CONCLUSIONS: IAH can be improved in people with T1DM, and a long duration of disease, with and without cardiac autonomic dysfunction. These data suggest that CAN is not a prime driver for modulating IAH reversibility.

Domino Reaction Protocol to Synthesize Benzothiophene-Derived Chemical Entities as Potential Therapeutic Agents.

An efficient synthesis of 3-amino-2-formyl-functionalized benzothiophenes by a domino reaction protocol and their use to synthesize a library of novel scaffolds have been reported. Reactions of ketones and 1,3-diones with these amino aldehyde derivatives formed a series of benzothieno[3,2-b]pyridine and 3,4-dihydro-2H-benzothiopheno[3,2-b]quinolin-1-one, respectively. A plausible mechanism for the formation of fused pyridine derivatives by the Friedlander reaction has been elucidated by density functional theory (DFT) calculations. Furthermore, hydrazones were obtained by reacting the aldehyde functional group of benzothiophenes with different hydrazine derivatives. Preliminary screening of these compounds against several bacterial strains and cancer cell lines led to the discovery of several hit molecules. Hydrazone and benzothieno[3,2-b]pyridine derivatives are potent cytotoxic and antibacterial agents, respectively. One of the potent compounds effected ∼97% growth inhibition of the LOX IMVI cell line at 10 µM concentration.

Black blood MRI sequences in the acute management of ruptured and unruptured intracranial aneurysms.

We present an illustrative case series in which high spatial resolution black blood (BB) MRI sequences were used as an adjunct in the acute management of intracranial aneurysms with diagnostic uncertainty regarding rupture status. Several acute management dilemmas are discussed including the surveillance of previously treated ruptured intracranial aneurysms, identifying culprit lesion(s) amongst multiple ruptured intracranial aneurysms, and risk stratifying incidental unruptured intracranial aneurysms. We present our experience which supports the evaluation of this vessel wall imaging technique in larger multi-centre observational studies. MR imaging was performed on a 3.0 Tesla Siemens Somatom Vida system and sequences used included: Susceptibility Weighted Imaging, Diffusion Weighted Imaging & 3D T1 pre- and post-contrast-enhanced BB sequences.

Volume reduction with surgery for ICH: when is it effective? Analysis of the CT scans from the STICH II trial.

BACKGROUND: The surgical trial of lobar intracerebral haemorrhage (STICH II) was a randomised controlled trial evaluating early surgical removal of a clot. This paper investigates volume change in both arms of the trial with respect to Extended Glasgow Outcome Scale (GOSE) groups. METHODS: Patients randomised into STICH II had an initial diagnostic CT and a second CT 5 days after randomisation. Each scan was anonymously assessed by at least two central readers. An analysis of agreement between the two readers was conducted using kappa tests and intraclass correlation. The change in volume in both the early surgery (ES) and the initial conservative treatment (ICT) arms were analysed with respect to the six-month GOSE outcome. RESULTS: Of the 597 patients randomised in the trial there were 582 pre-randomisation scans and 566 5-day scans available for analysis of agreement. There was good agreement between the assessors for the radiological inclusion criteria including volume (ICC = 0.87) and this was better than the agreement between the assessor and local investigator (ICC = 0.73). There were 526 patients with two scans available for analysis of change in volume measurement. The median percentage change in volume for the ES group was a reduction of 92.4% (IQR 75.6%, 99.0%) while for the ICT group, in which some cases crossed over to delayed surgery, it was only 5.7% (IQR 16.4% increase, 29.5% reduction). ES patients with almost complete removal (99-100%) had the best outcome with only 30% dead or lower severely disabled. For the ICT group outcome was related to the final volume: the smaller the final volume the better the outcome. CONCLUSIONS: This analysis provides evidence for central assessments of scans in exploratory analyses and further information regarding the potential advantage of early and more complete clot removal on outcome in ICH and should inform the planning of future trials.Clinical trials registration: ISRCTN22153967.

Advanced Energy Management Strategy of Photovoltaic/PEMFC/Lithium-Ion Batteries/Supercapacitors Hybrid Renewable Power System Using White Shark Optimizer.

The slow dynamic response of a proton exchange membrane fuel cell (PEMFC) to high load change during deficit periods must be considered. Therefore, integrating the hybrid system with energy storage devices like battery storage and/or a supercapacitor is necessary. To reduce the consumed hydrogen, an energy management strategy (EMS) based on the white shark optimizer (WSO) for photovoltaic/PEMFC/lithium-ion batteries/supercapacitors microgrid has been developed. The EMSs distribute the load demand among the photovoltaic, PEMFC, lithium-ion batteries, and supercapacitors. The design of EMSs must be such that it minimizes the use of hydrogen while simultaneously ensuring that each energy source performs inside its own parameters. The recommended EMS-based-WSO was evaluated in regard to other EMSs regarding hydrogen fuel consumption and effectiveness. The considered EMSs are state machine control strategy (SMCS), classical external energy maximization strategy (EEMS), and optimized EEMS-based particle swarm optimization (PSO). Thanks to the proposed EEMS-based WSO, hydrogen utilization has been reduced by 34.17%, 29.47%, and 2.1%, respectively, compared with SMCS, EEMS, and PSO. In addition, the efficiency increased by 6.05%, 9.5%, and 0.33%, respectively, compared with SMCS, EEMS, and PSO.

Synthesis and Characterization of Curcumin-Chitosan Loaded Gold Nanoparticles by Oryctes rhinoceros' Chitin for Cosmeceutical Application.

A breakthrough in cosmeceuticals by utilizing insects as major ingredients in cosmetic products is gaining popularity. Therefore, the interest in rare sources of ingredients, for instance, from the Oryctes rhinoceros beetle, can bring huge benefits in terms of turning pests into wealth. In this study, curcumin was chosen as the active ingredient loaded into chitosan-gold nanoparticles (CCG-NP). Curcumin is unstable and has poor absorption, a high rate of metabolism, and high sensitivity to light. These are all factors that contribute to the low bioavailability of any substance to reach the target cells. Therefore, chitosan extracted from O. rhinoceros could be used as a drug carrier to overcome these limitations. In order to overcome these limitations, CCG-NPs were synthesized and characterized. Chitosan was isolated from O. rhinoceros and CCG-NPs were successfully synthesized at 70 °C for 60 min under optimal conditions of a reactant ratio of 2:0.5 (0.5 mM HAuCl4: 0.1% curcumin). Characterizations of CCG-NP involved FTIR analysis, zeta potential, morphological properties determination by FE-SEM, particle size analysis, crystallinity study by XRD, and elemental analysis by EDX. The shape of the CCG-NP was round, its size was 128.27 d.nm, and the value of the zeta potential was 20.2 ± 3.81 mV. The IC50 value for cell viability is 58%, indicating a mild toxicity trait. To conclude, CCG-NP is a stable, spherical, nano-sized, non-toxic, and homogeneous solution.

A higher non-severe hypoglycaemia rate is associated with an increased risk of subsequent severe hypoglycaemia and major adverse cardiovascular events in individuals with type 2 diabetes in the LEADER study.

AIMS/HYPOTHESIS: Hypoglycaemia is a common side effect of insulin and some other antihyperglycaemic agents used to treat diabetes. Severe hypoglycaemia has been associated with adverse cardiovascular events in trials of intensive glycaemic control in type 2 diabetes. The relationship between non-severe hypoglycaemic episodes (NSHEs) and severe hypoglycaemia in type 2 diabetes has been documented. However, an association between more frequent NSHEs and cardiovascular events has not been verified. This post hoc analysis of the LEADER (Liraglutide Effect and Action in Diabetes: Evaluation of Cardiovascular Outcome Results) trial aimed to confirm whether there is an association between NSHEs and severe hypoglycaemic episodes in individuals with type 2 diabetes. In addition, the possible association between NSHEs and major adverse cardiac events (MACE), cardiovascular death and all-cause mortality was investigated. METHODS: LEADER was a double-blind, multicentre, placebo-controlled trial that found that liraglutide significantly reduced the risk of MACE compared with the placebo. In this post hoc analysis, we explored, in all LEADER participants, whether the annual rate of NSHEs (defined as self-measured plasma glucose <3.1 mmol/l [56 mg/dl]) was associated with time to first severe hypoglycaemic episode (defined as an episode requiring the assistance of another person), time to first MACE, time to cardiovascular death and time to all-cause mortality. Participants with <2 NSHEs per year were used as reference for HR estimates. Cox regression with a time-varying covariate was used. RESULTS: We demonstrate that there is an association between NSHEs (2-11 NSHEs per year and ≥12 NSHEs per year) and severe hypoglycaemic episodes (unadjusted HRs 1.98 [95% CI 1.43, 2.75] and 5.01 [95% CI 2.84, 8.84], respectively), which was consistent when baseline characteristics were accounted for. Additionally, while no association was found between participants with 2-11 NSHEs per year and adverse cardiovascular outcomes, higher rates of NSHEs (≥12 episodes per year) were associated with higher risk of MACE (HR 1.50 [95% CI 1.01, 2.23]), cardiovascular death (HR 2.08 [95% CI 1.17, 3.70]) and overall death (HR 1.80 [95% CI 1.11, 2.92]). CONCLUSIONS/INTERPRETATION: The analysis of data from the LEADER trial demonstrated that higher rates of NSHEs were associated with both a higher risk of severe hypoglycaemia and adverse cardiovascular outcomes in individuals with type 2 diabetes. Therefore, irrespective of the cause of this association, it is important that individuals with high rates of hypoglycaemia are identified so that the potentially increased risk of cardiovascular events can be managed and steps can be taken to reduce NSHEs. TRIAL REGISTRATION: ClinicalTrials.gov (NCT01179048).

A UK nationwide study of people with type 1 diabetes admitted to hospital with COVID-19 infection.

AIMS/HYPOTHESIS: The aim of this work was to describe the clinical characteristics of adults with type 1 diabetes admitted to hospital and the risk factors associated with severe coronavirus disease-2019 (COVID-19) in the UK. METHODS: A retrospective cohort study was performed using data collected through a nationwide audit of people admitted to hospital with diabetes and COVID-19, conducted by the Association of British Clinical Diabetologists from March to October 2020. Prespecified demographic, clinical, medication and laboratory data were collected from the electronic and paper medical record systems of the participating hospitals by local clinicians. The primary outcome of the study, severe COVID-19, was defined as death in hospital and/or admission to the adult intensive care unit (AICU). Logistic regression models were used to generate age-adjusted ORs. RESULTS: Forty UK centres submitted data. The final dataset included 196 adults who were admitted to hospital and had both type 1 diabetes and COVID-19 on admission (male sex 55%, white 70%, with mean [SD] age 62 [19] years, BMI 28.3 [7.3] kg/m2 and last recorded HbA1c 76 [31] mmol/mol [9.1 (5.0)%]). The prevalence of pre-existing microvascular disease and macrovascular disease was 56% and 39%, respectively. The prevalence of diabetic ketoacidosis on admission was 29%. A total of 68 patients (35%) died or were admitted to AICU. The proportions of people that died were 7%, 38% and 38% of those aged <55, 55-74 and ≥75 years, respectively. BMI, serum creatinine levels and having one or more microvascular complications were positively associated with the primary outcome after adjusting for age. CONCLUSIONS/INTERPRETATION: In people with type 1 diabetes and COVID-19 who were admitted to hospital in the UK, higher BMI, poorer renal function and presence of microvascular complications were associated with greater risk of death and/or admission to AICU. Risk of severe COVID-19 is reassuringly very low in people with type 1 diabetes who are under 55 years of age without microvascular or macrovascular disease. IN PEOPLE WITH TYPE 1 DIABETES AND COVID-19 ADMITTED TO HOSPITAL IN THE UK, BMI AND ONE OR MORE MICROVASCULAR COMPLICATIONS HAD A POSITIVE ASSOCIATION AND LOW SERUM CREATINE LEVELS HAD A NEGATIVE ASSOCIATION WITH DEATH/ADMISSION TO INTENSIVE CARE UNIT AFTER ADJUSTING FOR AGE.

The role of structured education in the management of hypoglycaemia.

The role of intensive glycaemic control in preventing microvascular disease in diabetes is well established. Iatrogenic hypoglycaemia is, however, a major barrier to effective treatment. Hypoglycaemia is associated with a significant level of morbidity and, despite pharmacological and technological therapeutic advances, reported rates of severe hypoglycaemia in clinical practice have not fallen over the last 20 years. This suggests that human factors are of major relevance and that ensuring the effective self-management of diabetes is an important strategy for the reduction of hypoglycaemic risk. Most of the evidence for the impact of this strategy on hypoglycaemia risk is confined to adults with type 1 diabetes although, in this review, we also cite studies that have specifically addressed this in type 2 diabetes. There are relatively few adequately powered RCTs that have rigorously evaluated the effectiveness of structured education and training programmes on hypoglycaemia; however, the available data suggest a subsequent reduction in severe hypoglycaemia rates of around 50%, a rate reduction that is comparable with that observed following technological interventions. Furthermore, longitudinal observational cohorts support these data, showing similar reductions in rates of hypoglycaemia following structured education. Those who continue to experience recurrent hypoglycaemia and impaired awareness of hypoglycaemia despite education and training in diabetes self-management may benefit from technological interventions and/or interventions that specifically address psychological factors that contribute to hypoglycaemia risk; however, there is urgent need for further research in this area. In the meantime, structured education for effective self-management of diabetes should be part of routine therapy for all those with type 1 diabetes.

Unsupervised overnight closed loop insulin delivery during free living: analysis of randomised cross-over home studies in adults and adolescents with type 1 diabetes.

BACKGROUND: The closed-loop system (artificial pancreas) delivers insulin in a glucose-responsive manner by the use of a control algorithm that automatically directs insulin delivery, based on real-time sensor glucose concentrations. Results from hospital-based studies have shown improved overnight glucose control and reduced risk of hypoglycaemia in type 1 diabetes. We aimed to assess whether unsupervised closed-loop systems can provide a realistic treatment option in patients with type 1 diabetes. METHODS: We combined data from two open-label, phase 2, randomised, cross-over, unsupervised home trials of people with type 1 diabetes, one in 24 adults (mean age 43 years [SD 12], HbA1c 8·0% [0·9]) and the other in 16 adolescents (15·6 [3·6], 8·1 [0·8]). In each trial, after training on study devices, participants were allocated to two periods of sensor-augmented pump therapy either with or without overnight closed loop that used a model predictive control algorithm to direct insulin delivery. Allocation sequence was done with a computer-generated random code. Each period lasted 4 weeks in adults and 3 weeks in adolescents. Primary outcome for both trials was time when sensor glucose was in the target range (3·9-8·0 mmol/L). Analysis was by intention to treat. Participants (or parents) gave written informed consent. The trials are registered with ClinicalTrials.gov, numbers NCT01440140 and NCT01221467. FINDINGS: Closed loop was started by participants on their own volition on 866 (89%) of 978 nights. The proportion of time when sensor glucose was in the target range between 0000 h and 0800 h was increased by a mean of 18·4% (95% CI 13·5-23·4, p<0·0001) during closed loop compared with no closed loop. Closed loop significantly reduced mean overnight sensor glucose by 0·9 mmol/L (95% CI 0·4-1·3, p=0·0001), and reduced the proportion of time when sensor glucose values were suggestive of hyperglycaemia (>8·0 mmol/L) (15·9%, 10·7-21·0; p<0·0001) and hypoglycaemia (<3·9 mmol/L) (median 0·9, IQR 0·2-2·2; p=0·014). Lower mean overnight glucose was associated with increased overnight insulin delivery (p<0·0001) without changing total daily insulin amount (p=0·84). INTERPRETATION: Extended use of overnight closed loop at home without supervision is feasible in adults and adolescents with type 1 diabetes. Clinically significant reduction in overnight glucose was observed accompanied by reduced time spent by patients in hypoglycaemia. To our knowledge, such combined effect has not been documented with any other means of intensified conventional insulin delivery. Longer term studies are warranted to assess its clinical potential. FUNDING: Diabetes UK, Juvenile Diabetes Research Foundation, NIHR Cambridge Biomedical Research Centre.

Cysticercosis and epilepsy in rural Tanzania: a community-based case-control and imaging study.

OBJECTIVE: To assess the contribution of neurocysticercosis (NCC) to the burden of epilepsy in a rural Tanzanian population. METHODS: We identified adult people with epilepsy (PWE) in a door-to-door study in an established demographic surveillance site. PWE and community controls were tested for antibodies to Taenia solium, the causative agent of NCC, and all PWE were offered a computed tomography (CT) head scan. Data on household occupancy and sanitation, pig-keeping and pork consumption were collected from PWE and controls and associations with epilepsy were assessed using chi-square or Fisher's exact tests. RESULTS: Six of 218 PWE had antibodies to T. solium (2.8%; 95% CI 0.6-4.9), compared to none of 174 controls (Fisher's exact test, P = 0.04). Lesions compatible with NCC were seen in eight of 200 CT scans (4.0%; 95% CI 1.3-6.7). A total of 176 PWE had both investigations of whom two had positive serology along with NCC-compatible lesions on CT (1.1%; 95% 0.3-4.0). No associations between epilepsy and any risk factors for NCC were identified. CONCLUSIONS: Neurocysticercosis is present in this population but at a lower prevalence than elsewhere in Tanzania and sub-Saharan Africa. Insights from low-prevalence areas may inform public health interventions designed to reduce the burden of preventable epilepsy.

The prevalence of dementia subtypes in rural Tanzania.

OBJECTIVES: The prevalence of dementia is predicted to increase rapidly in developing countries. Vascular risk factors may contribute to this rise. Our aim was to estimate the proportions of Alzheimer's disease (ADD) and vascular dementia (VAD) in a prevalent cohort of dementia cases in rural Tanzania. DESIGN: A two-stage door-to-door dementia prevalence study. SETTING: Hai district, Tanzania PARTICIPANTS: In Phase I, the Community Screening Instrument for Dementia (CSI-D) was used to screen 1198 community-dwelling people for dementia. In Phase II, 168/184 (91.3%) of those with poor performance, 56/104 (53.8%) of those with intermediate performance and 72/910 (7.9%) of those with good performance on CSI-D were interviewed and diagnoses were made using the DSM-IV criteria. MEASUREMENTS: For subtype diagnosis, DSM-IV dementia criteria plus NINCDS-ADRDA criteria were used for ADD and NINDS-AIREN criteria for VAD. Other dementias were diagnosed by international consensus criteria. Diagnoses were confirmed or excluded by computerised tomography where clinically appropriate. RESULTS: Of 78 dementia cases, 38 (48.7%) were ADD and 32 (41.0%) were VAD. The crude prevalence of ADD was 3.7% (95% CI 2.5 to 4.9) and of VAD was 2.9% (95% CI 1.9 to 3.9). The age-adjusted prevalence was 3.0% (95% CI 1.8 to 4.2) for ADD and 2.6% (95% CI 1.6 to 3.6) for VAD. A previous diagnosis of diabetes mellitus was independently associated with greater odds of having VAD than ADD. CONCLUSIONS: VAD accounted for a greater proportion of dementia cases than expected. Further investigation and treatment of risk factors is required in this setting.

Use of hypertonic saline in severe symptomatic hyponatraemia; results from a national survey of endocrinologists in the United Kingdom.

BACKGROUND: Severe symptomatic hyponatraemia is potentially life-threatening and hypertonic saline (HTS) is effective at rapidly correcting serum sodium. Several clinical guidelines have aimed to standardise the administration of HTS. However, evidence supporting the guidelines is limited, and concerns have been raised regarding the potential for overcorrection. OBJECTIVE: To assess the practices and perceptions surrounding HTS use in severe symptomatic hyponatraemia among United Kingdom (UK) endocrinologists and trainees. METHODS: An anonymous online survey was disseminated to Society for Endocrinology (UK) clinical members between 24/10/2023 and 30/11/2023 using a web-based multiple-choice questionnaire. RESULTS: We received 133 responses with a survey response rate of 8.3% (60.1% consultants, 33.1% trainees, 6.8% others). 85% of respondents employed bolus treatment with HTS only, with 9.8% using both bolus and continuous infusions. Most (53.2%) preferred 150 mL boluses, followed by 100 mL boluses (19.8%), while 5.5% of respondents used weight-based dosage. Commonly used HTS strengths were 2.7% (45.1%), followed by 1.8% (31.6%), while the 3% HTS strength recommended in guidelines was used by 21.8%. Contrary to guidelines, 78.6% did not administer a second bolus without waiting for the sodium result after the first bolus. Moreover, 86% have experience using venous blood gas sodium readings for monitoring. Overcorrection targets defined by 10 and 8 mmol/24 h cut-offs were used by 48.9% and 39.9%, respectively. For definite or anticipated overcorrection, 75.9% preferred 5% dextrose, while 40.6% had experience with desmopressin. CONCLUSION: Significant variation exists in HTS use for severe symptomatic hyponatraemia in the UK. Most clinicians prefer a more cautious approach in administering HTS. These data offer insight into real-life care and call for future research.

Deep Learning for Alzheimer's Disease Prediction: A Comprehensive Review.

Alzheimer's disease (AD) is a neurological disorder that significantly impairs cognitive function, leading to memory loss and eventually death. AD progresses through three stages: early stage, mild cognitive impairment (MCI) (middle stage), and dementia. Early diagnosis of Alzheimer's disease is crucial and can improve survival rates among patients. Traditional methods for diagnosing AD through regular checkups and manual examinations are challenging. Advances in computer-aided diagnosis systems (CADs) have led to the development of various artificial intelligence and deep learning-based methods for rapid AD detection. This survey aims to explore the different modalities, feature extraction methods, datasets, machine learning techniques, and validation methods used in AD detection. We reviewed 116 relevant papers from repositories including Elsevier (45), IEEE (25), Springer (19), Wiley (6), PLOS One (5), MDPI (3), World Scientific (3), Frontiers (3), PeerJ (2), Hindawi (2), IO Press (1), and other multiple sources (2). The review is presented in tables for ease of reference, allowing readers to quickly grasp the key findings of each study. Additionally, this review addresses the challenges in the current literature and emphasizes the importance of interpretability and explainability in understanding deep learning model predictions. The primary goal is to assess existing techniques for AD identification and highlight obstacles to guide future research.

Exergetic analysis of direct contact membrane distillation (DCMD) using PVDF hollow fiber membranes for the desalination brine treatment.

The brines from desalination plants need to be disposed of due to their strong impact on the environment. Membrane operations, like direct contact membrane distillation (DCMD), provide a possible solution to reduce the amount of brine while producing further desalinated water. In this study, an exergy analysis of a laboratory membrane distillation unit working with brines from reverse osmosis (RO) is analyzed. Exergy analysis enables us to assess the energy lost in entropy generation; therefore, it commits us to identify the less efficient configuration of the DCMD module. Unlike other exergy analyses for distillation, in this study, only module inputs and outputs were incorporated. The exergy is calculated at different infeed temperatures, for both in-out and out-in feed configurations of hollow fiber membrane modules. Also, exergy difference, flux, and exergetic efficiency for both configurations are calculated. At high feed temperatures, there is an increase in both flux and exergy change, which increases water recovery and feed side exergetic efficiency. The highest flux that is obtained in the out-in configuration is 13.3 kg/h.m2 while it is only 6.23 kg/h.m2 for the in-out system of the module. Also, these exergy changes and feed efficiencies are higher in the out-in module configuration than in the in-out module configuration. Conversely, the exergetic efficiency of the permeate is higher at lower feed temperatures, due to the lower accumulation of concentration polarization along the membrane wall.

Influence of Inner Gas Curing Technique on the Development of Thermoplastic Nanocomposite Reinforcement.

In this work, a comprehensive shrinkage and tensile strength characterization of unsaturated polyester (UPE-8340) and vinyl ester (VE-922) epoxy matrices and composites reinforced with multiwall carbon nanotubes (MWCNTs) was conducted. The aspect ratio of UPE and VE with methyl ethyl ketone peroxide (MEKP) was kept at 1:16.6; however, the weight of the MWCNTs was varied from 0.03 to 0.3 gm for the doping of the reinforced nanocomposites. Using a dumbbell-shaped mold, samples of the epoxy matrix without MWCNTs and with reinforced UPE/MWCNT and VE/MWCNT nanocomposites were made. The samples were then cured in a typical ambient chamber with air and an inner gas (carbon dioxide). The effect of the MWCNTs on UPE- and VE-reinforced composites was studied by observing the curing kinetics, shrinkage, and tensile properties, as well as the surface free energy of each reinforced sample in confined saline water. The CO2 curing results reveal that the absence of O2 shows a significantly lower shrinkage rate and higher tensile strength and flexural modulus of UPE- and VE-reinforced nanocomposite samples compared with air-cured reinforced nanocomposites. The construction that was air- and CO2-cured produced results in the shape of a dumbbell, and a flawless surface was seen. The results also show that smaller quantities of MWCNTs made the UPET- and VE-reinforced nanocomposites more stable when they were absorbed and adsorbed in concentrated salt water. Perhaps, compared to air-cured nanocomposites, CO2-cured UPE and VE nanocomposites were better at reducing shrinkage, having important mechanical properties, absorbing water, and being resistant to seawater.

Desalination technologies, membrane distillation, and electrospinning, an overview.

Water is a critical component for humans to survive, especially in arid lands or areas where fresh water is scarce. Hence, desalination is an excellent way to effectuate the increasing water demand. Membrane distillation (MD) technology entails a membrane-based non-isothermal prominent process used in various applications, for instance, water treatment and desalination. It is operable at low temperature and pressure, from which the heat demand for the process can be sustainably sourced from renewable solar energy and waste heat. In MD, the water vapors are gone through the membrane's pores and condense at permeate side, rejecting dissolved salts and non-volatile substances. However, the efficacy of water and biofouling are the main challenges for MD due to the lack of appropriate and versatile membrane. Numerous researchers have explored different membrane composites to overcome the above-said issue, and attempt to develop efficient, elegant, and biofouling-resistant novel membranes for MD. This review article addresses the 21st-century water crises, desalination technologies, principles of MD, the different properties of membrane composites alongside compositions and modules of membranes. The desired membrane characteristics, MD configurations, role of electrospinning in MD, characteristics and modifications of membranes used for MD are also highlighted in this review.

Musculoskeletal pain among desk-based officials of Bangladesh: Association with mental health and individual factors.

Musculoskeletal (MS) pain is widely prevalent and is an important health issue for desk-based employees which has a negative impact on both personal and work life. This study aimed to determine the MS pain status and its association with mental health and other individual factors among desk-based officials of Dhaka, Bangladesh. This cross-sectional study comprised a sample of 526 desk-based officials from Dhaka, Bangladesh. Data were collected between November 2020 to March 2021. MS pain was determined by the visual analog scale (VAS) and depression and anxiety were screened by Hospital Anxiety and Depression Scale (HADS). Logistic regression analyses were employed to estimate the adjusted effect of independent factors on MS pain. The overall prevalence of MS pain was 64% among desk-based officials. The corresponding prevalence were 19% severe, 21% moderate and 24% mild MS pain. In the adjusted model, gender (AOR: 0.19, 95% CI: 0.07-0.46), BMI (AOR: 0.28, 95% CI: 0.14-0.59), monthly income (AOR: 5.17, 95% CI: 2.18-12.25), organization type (AOR: 4.3, 95% CI:1.8-10.1), floor living (AOR: 4.7, 95% CI:2.1-10.8), physical activity (AOR: 0.16, 95% CI: 0.06-0.45), and lift facility in the house (AOR: 4.11, 95% CI: 2.06-8.23) were associated with MS pain. In addition, the prevalence of anxiety and depression was 17.7% and 16.4%, respectively. Depression was identified as a significant predictor for severe MS pain (AOR: 2.44, 95%CI:1.29-4.63). This study has revealed a relatively high prevalence of MS pain and mental health problems among Bangladeshi desk-based officials. Preventive measures need to be taken from both organizational and personal sides to delimitate MS pain and mental health problems.

Influence of hydrogenated diesel/H2O2 blend fuel on diesel engine performance and exhaust emission characterization.

The oxygenated hydro diesel (OHD) is prepared from hydrogen peroxide (H2O2), acetone, and seaweed polysaccharide. A long-term study was carried out on the OHD fuel blend stability for about a year at various temperatures. The long-term stability shows very stable properties, no easy emulsion breaking, and a long storage period. The neat diesel and blend fuel performance test was conducted at various engine speeds, 1700-3100 RPM the diesel blend with 5 wt.% and 10 wt. % of H2O2 revealed the best fraction for reducing smoke and emissions. The blend contains 15 wt.% H2O2, revealing a significant reduction in exhaust temperature without considering the engine's performance. Moreover, the performance of the OHD also revealed an economizing rate, decreasing environmental pollution and prolonging the engine's service life. The diesel engine performance and environmental evaluation leading to exhaust emissions characterization ([Formula: see text], [Formula: see text], and others). Based on the results, the various concentrations of H2O2 are an effective method for reducing the emission of diesel engines. Decreased CO, SO2, unburned hydrocarbons, and NO2 were also observed as percentages of H2O2. Due to increased oxygen content, water content and cetane number, the number of unburned hydrocarbons from diesel fuel decreased with the addition of H2O2. Therefore, the OHD blend can significantly curtail the exhaust emission of conventional diesel fuel, which will help reduce the harmful greenhouse gas emissions from diesel fuel sources.

Outcome study of the Pipeline Vantage Embolization Device (second version) in unruptured (and ruptured) aneurysms (PEDVU(R) study).

BACKGROUND: The Pipeline Vantage Embolization Device (PEDV) is the fourth-generation pipeline flow diverter for intracranial aneurysm treatment. There are no outcome studies for the second PEDV version. We aimed to evaluate safety and efficacy outcomes. Primary and secondary objectives were to determine outcomes for unruptured and ruptured cohorts, respectively. METHODS: In this multicenter retrospective and prospective study, we analyzed outcome data from eight centers using core laboratory assessments. We determined 30-day and ≥3-month mortality and morbidity rates, and 6- and 18-month radiographic aneurysm occlusion rates for procedures performed during the period July 2021-March 2023. RESULTS: We included 121 consecutive patients with 131 aneurysms. The adequate occlusion rate for the unruptured cohort at short-term and medium-term follow up, and also for the ruptured cohort at short-term follow up, was >90%. Two aneurysms (1.5%) underwent retreatment. When mortality attributed to a palliative case in the unruptured cohort, or subarachnoid hemorrhage in the ruptured cohort, was excluded then the overall major adverse event rate in respective cohorts was 7.5% and 23.5%, with 0% mortality rates for each. When all event causes were included on an intention-to-treat basis, the major adverse event rates in respective cohorts were 8.3% and 40.9%, with 0.9% and 22.7% mortality rates. CONCLUSIONS: For unruptured aneurysm treatment, the second PEDV version appears to have a superior efficacy and similar safety profile to previous-generation PEDs. These are acceptable outcomes in this pragmatic and non-industry-sponsored study. Analysis of ruptured aneurysm outcomes is limited by cohort size. Further prospective studies, particularly for ruptured aneurysms, are needed.