Diabetes, Metformin and the Clinical Course of Covid-19: Outcomes, Mechanisms and Suggestions on the Therapeutic Use of Metformin

Objectives: Pre-existing or new diabetes confers an adverse prognosis in people with Covid-19. We reviewed the clinical literature on clinical outcomes in metformin-treated subjects presenting with Covid-19. Methods: Structured PubMed search: metformin AND [covid (ti) OR covid-19 (ti) OR covid19 (ti) OR coronavirus (ti) OR SARS-Cov2 (ti)], supplemented with another PubMed search: “diabetes AND [covid OR covid-19 OR covid19 OR coronavirus (i) OR SARS-Cov2 (ti)]” (limited to “Clinical Study”, “Clinical Trial”, “Controlled Clinical Trial”, “Meta-Analysis”, “Observational Study”, “Randomized Controlled Trial”, “Systematic Review”). Results: The effects of metformin on the clinical course of Covid-19 were evaluated in retrospective analyses: most noted improved clinical outcomes amongst type 2 diabetes patients treated with metformin at the time of hospitalisation with Covid-19 infection. These outcomes include reduced admission into intensive care and reduced mortality in subgroups with versus without metformin treatment. Conclusion: The pleiotropic actions of metformin associated with lower background cardiovascular risk may mediate some of these effects, for example reductions of insulin resistance, systemic inflammation and hypercoagulability. Modulation by metformin of the cell-surface ACE2 protein (a key binding target for SARS-CoV 2 spike protein) via the AMP kinase pathway may be involved. While pre-existing metformin treatment offers potentially beneficial effects and can be continued when Covid-19 infection is not severe, reports of increased acidosis and lactic acidosis in patients with more severe Covid-19 disease remind that metformin should be withdrawn in patients with hypoxaemia or acute renal disease. Prospective study of the clinical and metabolic effects of metformin in Covid-19 is warranted

Transforming Global North-South Research Partnerships: Lessons Learned from Energy, Technology & Enterprise Global Challenge Research Fund Projects

The Global Challenges Research Fund (GCRF) provided a mechanism for academia to undertake projects relevant to the Sustainable Development Goals but there have been limited opportunities to critically interrogate such projects. In this paper we will use the Technology Implementation Model for Energy to deconstruct the purpose, assumptions and expectations, engagement strategies, and reflective processes of four GCRF projects in order to better understand relationships between researchers and those being researched. Thus, the aim of this paper is to explore and understand the lived experiences of four inter-disciplinary GCRF Primary Investigators implementing poverty alleviating technologies in a range of sectors to generate recommendations that can be applied to wider academic communities engaging with vulnerable populations. Our key findings show that despite the integration of Theory of Change models and the Responsible Research and Innovation (RRI) framework in GCRF-funded projects, project aims continue to be driven by researchers rather than reflecting end-user needs. Whilst some projects looked to generate feelings of ownership, adequate engagement strategies and reflective learning practices, these processes are often not formally embedded in project activities resulting in a decoupling of researcher expectations and end-user assumptions – ultimately derailing project outcomes. Our recommendations for academics operating within the International Development space are to 1) Talk early, often and transparently, 2) Keep Thinking – who benefits?, 3) Be reflective, responsive, and open to change and, 4) Use a systematic approach to facilitate this process

Challenges to the industrial melt-processing of conductive plastics

In this work, we investigate the relationship between the timescales available for polymer mobility during processing and post-processing and the electrical resistivity of melt-processed thermoplastics filled with carbon nanoparticles. Post-process annealing below the glass transition temperature was one avenue explored to uplift electrical conductivity. Detailed analysis of available literature on thermoplastics filled with either graphite nanoplatelets or carbon nanotubes, and of relevant processing data suggests that the required timescale for shaping process or post-processing to obtain conductive material needs to be sufficiently longer than that of the base polymer characteristic relaxation time τd. Four factors have been identified that promote the formation of a conductive filler network in thermoplastics: filler loading content, polymer molar mass, processing temperature and processing timescales

TIME to Change: An Evaluation of Practical Action Nepal’s Results Based Finance Program

Set against the United Nations Sustainable Development Goal 7, and the need to increase biomass Improved Cookstove (ICS) adoption and sustained use across the globe, this paper presents an evaluation of Practical Action Nepal’s (PAN) Results Based Financing for Improved Cookstove Market Development in Nepal (RBF) project, which was conducted between January and April 2020. Nepal has a long history of International Development assistance, yet 65.8% of rural households still use firewood as their primary source of energy. With this in mind we aimed to understand the barriers, enablers and engagement strategies for the adoption and sustained use of Improved Cookstoves (ICS), map key stakeholder role perceptions and interactions, and identify areas for improvement to increase the sustained use of ICS in the focus communities. This paper uses the methodological approach from the qualitative Technology Implementation Model for Energy (TIME) for the data collection and analysis elements. Our core results show a direct need for improved communication between all key stakeholder groups, the impact of demand and supply side financial incentives in creating reputational risk for community-based key stakeholders, and how the RBF mechanism promotes initial end-user adoption but not sustained use of ICS due to a focus on immediate results

A Review of Permeability and Flow Simulation for Liquid Composite Moulding of Plant Fibre Composites

Liquid composite moulding (LCM) of plant fibre composites has gained much attention for the development of structural biobased composites. To produce quality composites, better understanding of the resin impregnation process and flow behaviour in plant fibre reinforcements is vital. By reviewing the literature, we aim to identify key plant fibre reinforcement-specific factors that influence, if not govern, the mould filling stage during LCM of plant fibre composites. In particular, the differences in structure (physical and biochemical) for plant and synthetic fibres, their semi-products (i.e., yarns and rovings), and their mats and textiles are shown to have a perceptible effect on their compaction, in-plane permeability, and processing via LCM. In addition to examining the effects of dual-scale flow, resin absorption, (subsequent) fibre swelling, capillarity, and time-dependent saturated and unsaturated permeability that are specific to plant fibre reinforcements, we also review the various models utilised to predict and simulate resin impregnation during LCM of plant fibre composites

Cooking for communities, children and cows: lessons learned from institutional cookstoves in Nepal

Despite a long history of Improved Cookstove (ICS) interventions by Non-Governmental Organizations, International Development partners and the Government of Nepal, the majority of rural Nepalese people cook on a traditional open fire for their large-scale cooking needs due to a significant lack of approved institutional-scale cooking solutions. Whilst 65.8% of rural Nepalese households cook with biomass as their primary fuel source to satisfy their personal energy needs, there is no information collected on institutional cooking use by the Government of Nepal. In this paper our main objective was to design, implement and evaluate a novel Institutional Improved Cookstove (IICS) to satisfy this gap and following its manufacturing and testing in a Government of Nepal approved test center, to identify the complex contextual factors that often override the technical capabilities of IICS. Our three-phase method combined qualitative and quantitative research approaches, as well as north-south collaborations involving a transdisciplinary research team to create an integrated systems approach taking into account the voices of all key energy stakeholders. Phase 1 included UK based co-design and testing at the University of Nottingham in 2017 to develop a novel IICS that could be used in rural Nepal. Phase 2 involved adapting the design to accommodate contextual factors highlighted by Nepalese partners and to meet testing requirements at a Government of Nepal approved testing center in late 2017. Phase 3 was conducted between December 2017 and April 2020 and focused on piloting the novel IICS in a range of locations, altitudes, socio-economic and cultural settings, monitoring sustained use and obtaining user feedback. We present our results through three case studies that highlight the highly contextualized nature of IICS adoption and sustained use, the importance of stacking, usability and cost savings, and a number of pathways to scale in an institutional setting

Understanding the current market enablers for Nepal’s biomass cookstove industry

This paper applies the market map tool to the Nepalese biomass cookstove market highlighting existing weaknesses in government policy, cookstove market chains and providing a framework for cookstove interventions that better address the social, economic and cultural needs of users. Findings indicate government policy actively promotes cooking technologies however, this may not result in sustained use. Tracking mechanisms focus on numbers of stoves disseminated rather than numbers used. Attention is given to links between the underdeveloped nature of the institutional cookstove market and restrictive government policy. The methodological approach involved semi-structured interviews, field observations and analysis of government policy documents. Abstract This paper applies the Market Map tool to the Nepalese biomass Improved Cookstove (ICS) sector highlighting existing weaknesses in government policy and biomass cookstove market chains to provide recommendations to better address the social, economic and cultural needs of users. This addresses the problem of low adoption rates of biomass ICS in Nepal. Our research objectives set out to explore the effectiveness of market maps designed for East Africa's ICS sector (Stevens et al., 2019) in Nepal, co-develop a revised market map for Nepal's biomass ICS sector, conduct a parallel process for institutional-scale biomass ICS and draw on the co-produced market map to inform policy and regulatory frameworks relating to biomass-fuelled ICS. The methodological approach involved reviewing cookstove-related policy documents and regulatory frameworks, undertaking 31 semi-structured interviews, analysing findings from an Institutional Top-Loading Down-Draft (TLUD) Natural Draft Gasifier Pilot study and co-developing the final market map in collaboration with key ICS stakeholders. The results indicate that although government policy actively promotes biomass ICS, this often results in cookstove 'stacking' rather than the sustained and exclusive use of clean cooking solutions necessary to promote health benefits. Attention is also focused on the underdeveloped nature of the institutional cookstove market. Our conclusions highlight the usefulness of market maps with a monitoring and evaluation element for identifying barriers to clean cooking uptake and facilitating product improvement by integrating end-user feedback

Automated geometric modelling of textile structures

An automated approach (TexGen) for modeling the geometry of textile structures is presented. This model provides a generic approach to the description of yarn geometry and yarn interlacement for all types of weaving. One feature of this model is that the shape and size of the cross sections may change locally; this is exploited in the functions for interference correction, which modify the textile according to geometric considerations to avoid penetration of yarns. Another feature of this model is that it acts as a pre-processor for finite element simulations by generating a mesh, definition of contact, materials orientation and boundary conditions, thus providing an automatic procedure. This paper describes the modelling techniques, algorithms and concepts implemented in TexGen and examines the functionality of their implementation for a range of two-dimensional/three-dimensional commercial fabrics. Comparisons between the images of real fabrics and modeled fabric structures confirm that the software is capable of modeling sophisticated fabric architectures, including twisted yarns with varied yarn cross sections. Accurate input measurements of fabric geometry are critical for successful results. The paper also discusses directions for further development of the approach to overcome current limitations

Variation in the helminth community structure in spiny mice (Acomys dimidiatus) from four montane wadis in the St Katherine region of the Sinai Peninsula in Egypt

We compared helminth communities in spiny mice (Acomys dimidiatus) from 4 wadis in the arid montane region of the southern Sinai in Egypt, in a 4-week period in late summer. Total helminth species richness was 14 (8 nematodes, 5 cestodes and 1 acanthocephalan) with 94% of mice carrying at least 1 species and an overall mean species richness of 1.85. The most prevalent parasites were Protospirura muricola (47.8%) and Dentostomella kuntzi (46.3%). One larval cestode, Joyeuxiella rossicum, represents a new host record. The helminth community was dominated by intestinal nematodes (88.7%) of which 58.2% were arthropod-transmitted heteroxenic species. At the component community level, 70% of the worms were recovered from mice in just two wadis (Gharaba and Tlah) and 48.6% of intestinal nematodes were from Wadi Gharaba. Although only 7 species of helminths were recorded from Wadi Gharaba, this site gave the highest Berger-Parker dominance index because P. muricola. P. muricola was also dominant in Wadi El Arbaein whilst Syphacia minuta was the dominant species in Wadis Gebal and Tlah. At the infracommunity level, mean species richness and Brillouin’s index of diversity were highest in Wadi Tlah and lowest in Wadi Gebal, and the former was age dependent. Whilst mice from different wadis differed in the nematodes that were most common, those from Wadi Gharaba carried the highest mean number of worms/mouse. The abundance of P. muricola in particular varied markedly between sites: Wadi Gharaba was distinct as the site showing the highest mean worm burden whereas mice from Wadi Gebal were uninfected. None of the directly transmitted oxyuroid nematodes showed significant variation in abundance between wadis, or host sex or age classes. Overall, the single extrinsic factor in the study, site of capture, was more important than the intrinsic factors in explaining variation in helminth communities in the region. We conclude that in the high mountains of southern Sinai, each wadi is distinct in terms of its rodent parasites, and hence we expect spatially different coevolutionary pressures on their hosts, with resultant variation in life-histories

Dacryocystitis presenting as post-septal cellulitis: a case report

Dacryocystitis is relatively common, the majority of patients present with pre-septal cellulitis and not an orbital abscess due to anatomical barriers. The authors report a case of dacryocystitis presenting as post-septal cellulitis in a postmenopausal lady with an underlying malignancy. Following antibiotic therapy and elective dacryocystorhinostomy the patient is still under follow-up, and has no further recurrence of symptoms. Orbital abscess in postmenopausal women presenting with dacryocystitis should be considered, as prompt recognition and early surgical intervention is required to prevent visual loss