Enhanced controls for oxy-fuel-fired batch tank during glass working period

One of the most dynamic developments in the glass industry has been the use of oxy-fuel combustion for melting glass. This new technology has not only increased the energy efficiency of the glass industry, but also has reduced its environmental impacts.;A model has been developed to take into account the effect of pulling the glass for nine hours during the working period on the reduced amount of fuel required for the batch tank, as well as the resulting transients.;The two primary goals of this thesis were to develop a transient transfer function for the batch tank and to develop an enhanced controller by the classical approach for the glass working period. Modeling theory was used to develop the transient transfer function for the batch tank. An enhanced controller was designed that incorporates the average rate at which glass is pulled from the batch tank

Importance of controlling diabetes early - The concept of metabolic memory, legacy effect and the case for early insulinisation

Most of the microvascular complications of diabetes are related to the degree and the length of exposure to hyperglycaemia. New data from the follow-up studies of the Diabetes Control and Complications Trial- the Epidemiology of Diabetes Intervention and Complications Study (DCCT- EDIC), and the United Kingdom Prospective Diabetes Study (UKPDS) emphasize the role of glycemic control early in the course of the disorder and its value in prevention of later complications. The phenomenon of ongoing beneficial effects on diabetic complications after a period of improved glycemic control even if followed by a return to usual (often poorer) metabolic control has been described as representing "metabolic memory" by the DCCT/EDIC investigators and as a "legacy effect" by the UKPDS investigators. This article reviews these concepts and explores the role of early use of insulin as a tool to achieve good glycemic control in type 2 diabetes

Association of depression with complications of type 2 diabetes - the Chennai Urban Rural Epidemiology Study (CURES - 102)

Objective: The aim of the study was to assess the relationship between depression and diabetic complications among urban south Indian type 2 diabetic subjects [T2DM]. Methods: T2DM subjects [n= 847] were recruited from the Chennai Urban Rural Epidemiology Study [CURES], a population based study in Chennai (formerly Madras) in South India. A previously validated depression questionnaire [PHQ-12 item] was administered. Four field stereo retinal colour photography was done and diabetic retinopathy [DR] was classified according to the Early Treatment Diabetic Retinopathy Study grading system. Neuropathy was diagnosed if the vibratory perception threshold of the right great toe, measured by biothesiometry, was ≥20. Nephropathy was diagnosed if urinary albumin excretion was ≥300 μg/mg creatinine. Peripheral vascular disease [PVD] was diagnosed if an ankle-brachial index was <0.9. Coronary artery disease [CAD] was diagnosed based on a past history of documented myocardial infarction and/or electrocardiographic evidence of Q wave and/or ST segment changes. Results: Of the 847 T2DM studied, 198 (23.4%) were found have depression. The prevalence of depression was significantly higher among diabetic subjects with DR (35.0% vs 21.1%,p<0.001), neuropathy (28.4% vs15.9%,p=0.023), nephropathy (35.6% vs 24.5%,p=0.04) and PVD (48.0% vs 27.4%,p<0.001) as compared to subjects without these complications. DR, neuropathy, nephropathy, and PVD were associated with depression even after adjusting for age, gender, duration of diabetes and glycated haemoglobin. DR (Odds ratio [OR] =2.19, Confidence interval [CI]:1.45-3.51,p<0.001) was associated with depression even after adjusting for neuropathy and nephropathy. There was also a significant association between depression and neuropathy, after adjusting for retinopathy and nephropathy (OR=2.07,CI:1.41-3.04,p<0.001). There was a significant association of depression with nephropathy but this was lost (OR=1.71, CI: 0.87-3.35,p=0.119) after adjustment for retinopathy. PVD (OR=3.52,CI:1.94- 6.40,p<0.001) remained significantly associated with depression even after adjusting for CAD. However, there was no significant association of depression with CAD (OR=0.73, CI:0.42 -1.27, p=0.264). Conclusion: Among Asian Indians, the prevalence of depression is higher in T2DM subjects with retinopathy, neuropathy, nephropathy and PVD compared to those without the respective complications

Novel subgroups of type 2 diabetes and their association with microvascular outcomes in an Asian Indian population:a data-driven cluster analysis: the INSPIRED study

Introduction: Type 2 diabetes is characterized by considerable heterogeneity in its etiopathogenesis and clinical presentation. We aimed to identify clusters of type 2 diabetes in Asian Indians and to look at the clinical implications and outcomes of this clustering.Research design and methods: From a network of 50 diabetes centers across nine states of India, we selected 19 084 individuals with type 2 diabetes (aged 10-97 years) with diabetes duration of less than 5 years at the time of first clinic visit and performed k-means clustering using the following variables: age at diagnosis, body mass index, waist circumference, glycated hemoglobin, serum triglycerides, serum high-density lipoprotein cholesterol and C peptide (fasting and stimulated). This was then validated in a national epidemiological data set of representative individuals from 15 states across India.Results: We identified four clusters of patients, differing in phenotypic characteristics as well as disease outcomes: cluster 1 (Severe Insulin Deficient Diabetes, SIDD), cluster 2 (Insulin Resistant Obese Diabetes, IROD), cluster 3 (Combined Insulin Resistant and Deficient Diabetes, CIRDD) and cluster 4 (Mild Age-Related Diabetes, MARD). While SIDD and MARD are similar to clusters reported in other populations, IROD and CIRDD are novel clusters. Cox proportional hazards showed that SIDD had the highest hazards for developing retinopathy, followed by CIRDD, while CIRDD had the highest hazards for kidney disease.Conclusions: Compared with previously reported clustering, we show two novel subgroups of type 2 diabetes in the Asian Indian population with important implications for prognosis and management. The coexistence of insulin deficiency and insulin resistance seems to be peculiar to the Asian Indian population and is associated with an increased risk of microvascular complications.</p

Prediabetes

Prediabetes or intermediate hyperglycaemia represents a preliminary stage in the development of type 2 diabetes mellitus (T2DM). In addition to an increased likelihood of developing T2DM, individuals with prediabetes have an elevated risk of various vascular and non-vascular complications. No consensus has been achieved on the ideal screening strategy for prediabetes, with fasting plasma glucose concentration, glycated haemoglobin (HbA1c) and the oral glucose tolerance test being the most frequently measured parameters. The two major phenotypes of prediabetes, that is, impaired fasting glucose and impaired glucose tolerance, may represent different pathophysiologies with varying natural history, risk of adverse outcomes and responsiveness to treatment. Most of the evidence for managing prediabetes focuses on lifestyle modification with or without medications in individuals with overweight or obesity and impaired glucose tolerance. Whether these interventions are beneficial in individuals with impaired fasting glucose and those of normal body weight is unclear, as is the cost-effectiveness and sustainability of pharmacotherapy for treating prediabetes. Large-scale national T2DM prevention programmes are currently under way to assess whether the benefits of interventions for prediabetes can be translated to the community setting.<br/

Comparison of screening for gestational diabetes mellitus by oral glucose tolerance tests done in the non-fasting (random) and fasting states

AIM: The Diabetes in Pregnancy Study Group of India (DIPSI) guidelines recommend the non-fasting 75-g oral glucose tolerance test (OGTT) as a single-step screening and diagnostic test for gestational diabetes mellitus (GDM). The aim of this study was to compare the DIPSI criteria with the World Health Organization (WHO) 1999 and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for GDM. METHODS: A total of 1,031 pregnant women attending antenatal clinics in urban and rural Tamil Nadu, India, underwent a 75-g OGTT in both non-fasting and fasting states, 2–3 days apart. Venous plasma glucose was measured using an autoanalyser, and GDM was diagnosed by DIPSI, WHO 1999 and IADPSG criteria. RESULTS: Of the 83 women identified to have GDM by WHO 1999 criteria, only 23 were diagnosed by DIPSI criteria. Of the 106 women diagnosed to have GDM by the IADPSG criteria, only 24 were diagnosed by DIPSI. The DIPSI non-fasting OGTT 2-h VPG cut point of 140 mg/dl (7.8 mmol/l) had a very low sensitivity when compared to the WHO 1999 criteria (sensitivity 27.7 %, specificity 97.7 %) and IADPSG criteria (sensitivity 22.6 %, specificity 97.8 %). CONCLUSIONS: The DIPSI non-fasting OGTT criteria cannot be recommended for diagnosis of GDM due to its low sensitivity. Thus, as a single-step diagnostic test for GDM, the fasting OGTT needs to be done. When this is not possible, the well-established two-step procedure using the 50-g glucose challenge test as an initial screening test, followed by the diagnostic fasting OGTT, can be continued

Perception of Availability, Accessibility, and Affordability of COVID-19 Vaccines and Hesitancy: A Cross-Sectional Study in India

Background: The current study aimed to identify the perceptions and issues regarding the affordability, availability, and accessibility of COVID-19 vaccination and determine the extent of vaccine hesitancy among non-vaccinated individuals. Methods: A Prospective cross-sectional study was conducted among 575 individuals for a period of six months. All the relevant information was collected using the peer-validated survey questionnaire. An independent t-test was applied to check the association between variables. Result: Among 575 participants, 80.8% were vaccinated, and 19.2% were non-vaccinated. Among the vaccinated, 35.1% were vaccinated in private centres and 64.9% in public health centres (PHC). In total, 32% had accessibility issues and 24.5% had availability issues. However, responders vaccinated at PHC were having more issues in comparison to other groups which was statistically significant (p &lt; 0.05). Among the 163 privately vaccinated participants, 69.9% found it completely affordable. Another 26.9% and 3.1% found vaccines partly affordable and a little unaffordable. Among the 110 non-vaccinated, 38.1% were found to be vaccine-hesitant. Conclusions: Individuals vaccinated at PHC experienced issues such as long waiting times, unavailability of doses, and registration. Further, a significant level of hesitancy towards COVID-19 vaccines was observed. The safety and efficacy of COVID-19 vaccines contributed to negative attitudes