Aluminum-Based Heterogeneous Surface for Efficient Solar Desalination and Fog Harvesting Processed by a Picosecond Laser.

Solar desalination and fog harvesting are two common ways to obtain fresh water, and both are promising methods to solve the water shortage problem. However, through either the fabrication of interfacial evaporators for solar desalination or the preparation of superwetting surfaces for fog harvesting, current methods suffer from long preparation times, high costs, and low efficiency. Herein, we report an efficient and simple method to process heterogeneous surfaces (HSs) on aluminum (Al) by picosecond laser processing combined with chemical treatment used for fog harvesting and seawater desalination. The as-prepared HS simultaneously consists of regular periodic stripe structures with superhydrophilicity and superhydrophobicity. The spacing of the superhydrophilic and superhydrophobic regions can be adjusted through the processing path. This surface has a 44% improvement in fog harvesting efficiency compared to a pristine Al sheet, which is 0.53 kg·m-2·h-1. Furthermore, it shows a high evaporation rate of 2.35 kg·m-2·h-1 under one sun irradiation with an energy efficiency of 52.39%. Such functional surfaces can be applied to obtain fresh water resources in both coastal regions and arid areas, where water mist is relatively abundant, providing reference and guidance for fresh water collection, and being a promising way to solve the water shortage problem.

Rationale, study design and methodology of the LANDMARC trial: a 3-year, pan-India, prospective, longitudinal study to assess management and real-world outcomes of diabetes mellitus.

AIM: India contributes towards a large part of the worldwide epidemic of diabetes and its associated complications. However, there are limited longitudinal studies available in India to understand the occurrence of diabetes complications over time. This pan-India longitudinal study was initiated to assess the real-world outcomes of diabetes across the country. METHODS: The LANDMARC study is the first prospective, multicentre, longitudinal, observational study investigating a large cohort of people with type 2 diabetes mellitus across India over a period of 3 years. The primary objective of this ongoing study is to determine the proportion of people developing macrovascular diabetes complications over the duration of the study (36 months ± 45 days) distributed over seven visits; the secondary objective is to evaluate microvascular diabetes complications, glycaemic control and time-to-treatment adaptation or intensification. Overall, 6300 participants (aged 25-60 years) diagnosed with type 2 diabetes for at least 2 years will be included from 450 centres across India. Data will be recorded for baseline demographics, comorbidities, glycaemic measurements, use of anti-hyperglycaemic medications and any cardiovascular or other diabetes-related events occurring during the observational study period. CONCLUSIONS: The LANDMARC study is expected to reveal the trends in complications associated with diabetes, treatment strategies used by physicians, and correlation among treatment, control and complications of diabetes within the Indian context. The findings of this study will help to identify the disease burden, emergence of early-onset complications and dose titration patterns, and eventually develop person-centred care and facilitate public health agencies to invest appropriate resources in the management of diabetes. (Trial Registration No: CTRI/2017/05/008452).

Waste biorefineries: Enabling circular economies in developing countries.

This paper aims to examine the potential of waste biorefineries in developing countries as a solution to current waste disposal problems and as facilities to produce fuels, power, heat, and value-added products. The waste in developing countries represents a significant source of biomass, recycled materials, chemicals, energy, and revenue if wisely managed and used as a potential feedstock in various biorefinery technologies such as fermentation, anaerobic digestion (AD), pyrolysis, incineration, and gasification. However, the selection or integration of biorefinery technologies in any developing country should be based on its waste characterization. Waste biorefineries if developed in developing countries could provide energy generation, land savings, new businesses and consequent job creation, savings of landfills costs, GHG emissions reduction, and savings of natural resources of land, soil, and groundwater. The challenges in route to successful implementation of biorefinery concept in the developing countries are also presented using life cycle assessment (LCA) studies.

An "all 5 mm ports" technique for laparoscopic day-case anti-reflux surgery: A consecutive case series of 205 patients.

INTRODUCTION: Laparoscopic anti-reflux surgery is conventionally performed using two 10/12 mm ports. While laparoscopic procedures reduce post-operative pain, the use of larger ports invariably increases discomfort and affects cosmesis. We describe a new all 5 mm ports technique for laparoscopic anti-reflux surgery and present a review of our initial experience with this approach. METHODS: All patients undergoing laparoscopic fundoplication over a 35 month period from February 2013 under the care of a single surgeon were included. A Lind laparoscopic fundoplication was performed using an all 5 mm port technique. Data was recorded prospectively on patient demographics, operating surgeon, surgical time, date of discharge, readmissions, complications, need for re-intervention, and reasons for admission. RESULTS: Two hundred and five consecutive patients underwent laparoscopic fundoplication over the study period. The all 5 mm port technique was used in all cases, with conversion to a 12 mm port only once (0.49%). Median operating time was 52 min 185 (90.2%) patients were discharged as day cases. Increasing ASA grade and the presence of a hiatus hernia were associated with the need for overnight stay with admission required in 33% of patients with ASA 3, compared to 4% with ASA 1 (p = 0.001), and 29% of those with a hiatus hernia vs. 5% without (p < 0.001). No port-related complications occurred, and no patients developed recurrence of reflux symptoms. A single patient required mesh repair of a large hiatus hernia. CONCLUSION: The all 5 mm ports approach to laparoscopic anti-reflux surgery is a safe, efficient, and cost-effective technique which facilitates same day discharge and minimises port related complications. National commissioning guidelines in the UK should target quality improvements in anti-reflux surgery based around day-case management. This would improve the service for these patients and culminate in cost savings for the NHS.

The influence of key clinical practices on the knowledge of first year doctors about the patients under their care.

AIMS: In 2009 in the United Kingdom the 48-h working week was introduced for junior doctors. To comply with this traditional working practices have changed. This study aims to assess how much first year (FY1) doctors know about the acute surgical patients they manage and how this is influenced by changes in key working practices. METHODS: Surgical FY1s working in NHS hospitals answered 16 clinical questions about a standard acute surgical patient under their care 48 h after admission. Scores were analysed according to how long the FY1 had been looking after the patient, whether they had clerked the patient in, attended the post take ward round (PTWR), used a handover sheet to answer the questions and had sole or shared responsibility for the patient. RESULTS: Two hundred and seventy-four FY1s (92% response rate) from 36 hospitals were surveyed. The overall median score was 11/16 (inter-quartile range 8-13). Only 8.4% (23/274) FY1s had clerked in the patient and 58.4% (160/274) had attended the PTWR. Clerking patients and attending the PTWR resulted in significantly higher test scores compared to FY1s who did not perform these activities (p = < 0.001 and 0.001 respectively). The scores of the 67.2% who used a handover sheet were significantly lower than those who did not (p = 0.001). Having sole or shared responsibility and duration of care made no significant difference (p = 0.143 and p = 0.458 respectively) CONCLUSIONS: The results demonstrate that junior doctors' knowledge of their patients is significantly enhanced when they have the opportunity to perform the admission clerking and attend the PTWR. Because of working hours' restrictions this is now rare. Although use of handover sheets appears to ensure that certain key facts immediately related to the current admission are passed on, it is associated with significantly poorer wider knowledge of the patient.

Energy conversion performance of black liquor gasification to hydrogen production using direct causticization with CO(2) capture.

This paper estimates potential hydrogen production via dry black liquor gasification system with direct causticization integrated with a reference pulp mill. The advantage of using direct causticization is elimination of energy intensive lime kiln. Pressure swing adsorption is integrated in the carbon capture process for hydrogen upgrading. The energy conversion performance of the integrated system is compared with other bio-fuel alternatives and evaluated based on system performance indicators. The results indicated a significant hydrogen production potential (about 141MW) with an energy ratio of about 0.74 from the reference black liquor capacity (about 243.5MW) and extra biomass import (about 50MW) to compensate total energy deficit. About 867,000tonnes of CO(2) abatement per year is estimated i.e. combining CO(2) capture and CO(2) offset from hydrogen replacing motor gasoline. The hydrogen production offers a substantial motor fuel replacement especially in regions with large pulp and paper industry e.g. about 63% of domestic gasoline replacement in Sweden.

Black liquor gasification integrated in pulp and paper mills: A critical review.

Black liquor gasification (BLG) has potential to replace a Tomlinson recovery boiler as an alternative technology to increase safety, flexibility and energy efficiency of pulp and paper mills. This paper presents an extensive literature review of the research and development of various BLG technologies over recent years based on low and high temperature gasification that include SCA-Billerud process, Manufacturing and Technology Conversion International (MTCI) process, direct alkali regeneration system (DARS), BLG with direct causticization, Chemrec BLG system, and catalytic hydrothermal BLG. A few technologies were tested on pilot scale but most of them were abandoned due to technical inferiority and very fewer are now at commercial stage. The drivers for the commercialization of BLG enabling bio-refinery operations at modern pulp mills, co-producing pulp and value added energy products, are discussed. In addition, the potential areas of research and development in BLG required to solve the critical issues and to fill research knowledge gaps are addressed and highlighted.

Radiation exposure to anaesthetists during interventional radiology.

This prospective study determined the level of radiation exposure of anaesthetists during interventional radiological procedures performed in the endoscopic retrograde cholangiopancreatography suite and cardiac catheterisation laboratory and compared it with the current safety guidelines. Anaesthetists wore area-specific lithium fluoride thermo-luminescent dosimeter badges at standardised positions. A total of 1344 procedures were performed over a 6-month period. Anaesthetists were involved in 39/645 (6.0%) procedures associated with ionisation radiation in the endoscopic retrograde cholangiopancreatography suite and 86/699 (12.3%) in the cardiac catheterisation laboratory. The mean (SD) duration of endoscopic retrograde cholangiopancreatography was 54.8 (29.1) min compared with 67.9 (42.8) min for cardiac catheterisation suite procedures (p = 0.058). The mean (SD) fluoroscopy time per procedure for endoscopic retrograde cholangiopancreatography was 5.5 (4.1) min compared with 12 (10.9) min in the cardiac catheterisation suite (p < 0.001). The combined net radiation exposure over 6 months was 0.28 mSv for endoscopic retrograde cholangiopancreatography procedures and 2.32 mSv in the cardiac catheterisation suite. The combined exposure was less than the maximum recommended exposure of 20 mSv per year.

Bio-refinery system of DME or CH4 production from black liquor gasification in pulp mills.

There is great interest in developing black liquor gasification technology over recent years for efficient recovery of bio-based residues in chemical pulp mills. Two potential technologies of producing dimethyl ether (DME) and methane (CH(4)) as alternative fuels from black liquor gasification integrated with the pulp mill have been studied and compared in this paper. System performance is evaluated based on: (i) comparison with the reference pulp mill, (ii) fuel to product efficiency (FTPE) and (iii) biofuel production potential (BPP). The comparison with the reference mill shows that black liquor to biofuel route will add a highly significant new revenue stream to the pulp industry. The results indicate a large potential of DME and CH(4) production globally in terms of black liquor availability. BPP and FTPE of CH(4) production is higher than DME due to more optimized integration with the pulping process and elimination of evaporation unit in the pulp mill.

Prenatal diagnosis of a neonate with fetus in fetu.

Fetus in fetu is a rare condition not usually considered in the differential of a neonatal abdominal mass. This article illustrates the importance of prenatal ultrasound in the treatment of this condition as it facilitated the assembly of a multispecialty healthcare team that intervened within days of birth.

Radiation exposure of trainee anaesthetists.

This prospective study was conducted to determine the level of radiation exposure of trainee anaesthetists working in urology, orthopaedics and radiology environments. Anaesthetists wore lithium fluoride thermoluminescent dosimeter (TLD) badges over a 6-month period. The position of badges was standardised at the collar site (TLD1) and at waist level (TLD2). Area specific dosimeters were used and exchanged between anaesthetists. Of a total of 723 procedures, anaesthetists were exposed to radiation in 33% of procedures in orthopaedics, 30% in urology and 39% in radiology. The mean (SD) exposure time to radiation per case was significantly greater in orthopaedics than in urology (9.2 (4) min vs. 4.2 (2) min). The radiation exposure per case was highest in radiology (19.2 (22) min). The net combined exposure over a 6-month period was 0.2177 mSv in urology, 0.4265 mSv in orthopaedics and 3.8457 mSv in radiology. The combined exposure was less than the 20 mSv recommended as the maximum exposure per year. Our data does not support the need for routine dosimetric monitoring of anaesthetists working in the above settings.

Gastric ulcer presenting as gastroesophageal reflux and apnea in a term neonate.

Apnea in the neonatal period frequently is associated with prematurity. Full-term infants who develop apnea usually have associated clinical conditions such as infection, shock, metabolic disorders, neonatal abstinence syndrome, intracranial pathology, and gastroesophageal reflux. Gastric ulcer also is a rare phenomenon in the neonatal period. We describe a full-term infant presenting with apnea. Upon investigation, a 6-channel pneumocardiogram revealed central apnea and multiple episodes of low esophageal pH (< 4), which is suggestive of gastroesophageal reflux. This was confirmed by an upper gastrointestinal series. A small antral ulcer crater also was demonstrated. When assessing the etiology of apnea in a full-term infant, gastroesophageal reflux and gastric ulcer should be considered.

Immunohistochemical estrogen receptor determination in human breast carcinoma: correlation with histologic differentiation and age of the patients.

An immunohistochemical assay for the measurement of estrogen receptor (ER) has been evaluated on 290 consecutive human breast biopsy and mastectomy specimens in the year 1992 at The Aga Khan University Hospital laboratories. Immunohistochemical localization of estrogen receptor on frozen/paraffin section was scored in a semi-quantitative fashion incorporating both the intensity and the distribution of specific staining. Histologic grading of the tumour was performed according to Bloom's method. In this study, 21% of the tumours were estrogen receptor negative, 15% were weak positive, 25% intermediate positive and 39% strong positive. Fifty percent of the well differentiated tumours showed strong ER positivity against 27% of the poorly differentiated tumours. Seventy eight percent of all negative estrogen receptors were in patients younger than 50 years of age (pre-menopausal group), while 52% of strong estrogen receptor positivity was observed in patients older than 50 years (post- menopausal). This study demonstrates the value of immunohistochemical method to determine the ER status in patients with advanced breast cancer.

Effect of fertilizer diammonium phosphate on liver, kidney and muscle 5'-nucleotidase activity of fresh water teleost fish Clarias batrachus.

The toxic effect of fertilizer Diammonium phosphate resulted in alterations of 5'-Nucleotidase activity of tissues--liver, kidney and muscles of fish C. batrachus at varying intervals and exposures. Alterations in 5'-Nucleotidase activity of body organs gave an idea of the toxicity caused by the fertilizer. Thus the enzyme 5'-Nucleotidase can be used to monitor the pollution in aquatic ecosystem.

Postnatal timing of spontaneous umbilical cord separation.

A population of 293 consecutive healthy term newborns were enrolled in this study to determine the time of their umbilical cord separation while using our current nursery protocol with isopropyl alcohol as a method of cord care. Cord separation occurred from days 3 to 42, with a mean of 10.9 days. This was considerably shorter than previously reported studies in the United States, but still longer than reported data from the Netherlands and developing countries. In this study there were no significant differences noted when comparing the mode of delivery, sex, or race of infant, with respect to time interval for their cord separation.

Responses of three arid zone grass species to varying Na/Ca ratios in saline sand culture.

The effects on three grass species, Cenchrus pennisetiformis Hochst. & Steud., Leptnchloa fusca (L.) Kunth. and Panicum turgidum Forssk., of decreasing Ca2+ concentration in a saline growth medium were assessed after 7 weeks growth in sand culture. The different Na/Ca ratios of the salt treatment were 24, 49, 99, and 199, at a constant concentration of 200 mol m-3 . Leptuchloa fusca produced the highest fresh and dry biomass, and was able to maintain Na+ and Cl- Concentrations in the shoots and roots almost constant at varying external Na/Ca ratios, except that the shoot Na+ concentration increased significantly at the highest Na/Ca ratio. In C, pennisetiformis the shoot Na+ decreased, whereas the shoot Cl- concentration increased at the highest external Na/Ca ratio. But the root Na+ and Cl- concentrations in this species remained unchanged at varying Na/Ca ratios. C. pennisetiformis and L. fusca maintained almost constant K+ and Ca2+ concentrations in both shoots and roots at varying Na/Ca ratios. In P. turgidum the shoot K+ and shoot and root Ca2+ remained almost unchanged at all Na/Ca ratios, whereas the root K+ concentration decreased significantly but uniformly at the three, higher Na/Ca ratios. No consistent pattern of increase or decrease was observed in the shoot and root Na/K and Na/Ca ratios of all the species. The shoot selectivity (Sk + na ) increased consistently in C pennisetiformis with the increase in Na/Ca ratios and it decreased in L. fusca only at the highest Na/Ca ratio in the growth medium It was established that L. fusca was tolerant, C. penni-setiformis intermediate and P. turgidum relatively sensitive to low Ca2+ concentrations of the saline growth medium.