Combustion and pollutant characteristics of IC engines fueled with hydrogen and diesel/hydrogen mixtures using 3D computations with detailed chemical kinetics

In order to develop design guidelines for optimum operations of internal combustion engines fueled with alternative fuels, a comprehensive understanding combustion behavior and the pollutant formation inside the cylinder are needed. The first part of this thesis aimed to numerically study the engine performance and in-cylinder pollutant formation in a spark ignition engine fueled with hydrogen. Advanced simulations were performed using multi- dimensional software AVL FIRE coupled with CHEMKIN. The detailed chemical reactions with 29 steps of hydrogen oxidation with additional nitrogen oxidation reactions were also employed. Formation rates of nitrogen oxides (NOx) within the engine were accurately predicted using the extended Zeldovich mechanism with parameters adjusted for a carbon-free fuel. The computational results were first validated against experimental results with different equivalence ratios and then employed to examine a spark-ignition engine fueled with hydrogen under different operating conditions. Strategies that could have significant effects on the engine performance and emissions, such as exhaust gas recirculation (EGR) and ignition timing were also investigated. Furthermore, the maximization of engine power and minimization of NOx emissions were considered as conflicting objectives for preliminary optimization. Finally, a skeletal reaction mechanism was developed to include the reaction kinetics of diesel and hydrogen fuel mixtures to investigate in-cylinder combustion processes of such a dual fuel compression-ignition engine. The model was then employed to examine the effects of exhaust gas recirculation (EGR) and N2 dilution on NOx emissions --Abstract, page iii

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Studies on Arabic Dialectology and Sociolinguistics

This volume contains over fifty articles related to various fields of modern Arabic dialectology. All the articles are revised and enhanced versions of papers read on the 12th Conference of the Association Internationale de Dialectologie Arabe (AIDA) held in Marseille in June 2017. Since its first conference in Paris in 1993, AIDA members gather every two years in different country. The collection of the AIDA proceedings offer an updated insight of the development of the field. During the past few decadesthe the study of Arabic dialects has become an important branch of research covering a wide range of subjects from phonological analyses, morphosyntax, semantics to pragmatics, sociolinguistics, folk linguistics, studies on literacy and writings, cultural and artistic practices, etc. As many articles of this volume illustrate, the study of Arabic dialects explores different aspects of the languages and cultures of the contemporary Arab world. A remarkable feature is the growing and constant participation of young scholars from all around the globe

Causes of blindness and vision impairment in 2020 and trends over 30 years, and prevalence of avoidable blindness in relation to VISION 2020: the Right to Sight: an analysis for the Global Burden of Disease Study

Background: Many causes of vision impairment can be prevented or treated. With an ageing global population, the demands for eye health services are increasing. We estimated the prevalence and relative contribution of avoidable causes of blindness and vision impairment globally from 1990 to 2020. We aimed to compare the results with the World Health Assembly Global Action Plan (WHA GAP) target of a 25% global reduction from 2010 to 2019 in avoidable vision impairment, defined as cataract and undercorrected refractive error. Methods: We did a systematic review and meta-analysis of population-based surveys of eye disease from January, 1980, to October, 2018. We fitted hierarchical models to estimate prevalence (with 95% uncertainty intervals [UIs]) of moderate and severe vision impairment (MSVI; presenting visual acuity from <6/18 to 3/60) and blindness (<3/60 or less than 10° visual field around central fixation) by cause, age, region, and year. Because of data sparsity at younger ages, our analysis focused on adults aged 50 years and older. Findings: Global crude prevalence of avoidable vision impairment and blindness in adults aged 50 years and older did not change between 2010 and 2019 (percentage change −0·2% [95% UI −1·5 to 1·0]; 2019 prevalence 9·58 cases per 1000 people [95% IU 8·51 to 10·8], 2010 prevalence 96·0 cases per 1000 people [86·0 to 107·0]). Age-standardised prevalence of avoidable blindness decreased by −15·4% [–16·8 to −14·3], while avoidable MSVI showed no change (0·5% [–0·8 to 1·6]). However, the number of cases increased for both avoidable blindness (10·8% [8·9 to 12·4]) and MSVI (31·5% [30·0 to 33·1]). The leading global causes of blindness in those aged 50 years and older in 2020 were cataract (15·2 million cases [9% IU 12·7–18·0]), followed by glaucoma (3·6 million cases [2·8–4·4]), undercorrected refractive error (2·3 million cases [1·8–2·8]), age-related macular degeneration (1·8 million cases [1·3–2·4]), and diabetic retinopathy (0·86 million cases [0·59–1·23]). Leading causes of MSVI were undercorrected refractive error (86·1 million cases [74·2–101·0]) and cataract (78·8 million cases [67·2–91·4]). Interpretation: Results suggest eye care services contributed to the observed reduction of age-standardised rates of avoidable blindness but not of MSVI, and that the target in an ageing global population was not reached. Funding: Brien Holden Vision Institute, Fondation Théa, The Fred Hollows Foundation, Bill & Melinda Gates Foundation, Lions Clubs International Foundation, Sightsavers International, and University of Heidelberg

A Computational Study of In-Cylinder NOₓ Reduction Strategies for a Compression-Ignition Engine Fueled with Diesel/Hydrogen Mixtures

Considerable efforts have been made to introduce alternative fuels for use in conventional diesel and gasoline engines. There is significant interest in adding hydrogen to a diesel engine to reduce emissions and improve efficiency. However, the main challenge associated with the use of hydrogen in diesel engines is high nitrogen oxide (NOX) emissions. In the present study, a reduced chemical kinetics mechanism, consisting of 52 reactions and 29 chemical species for n-heptane fuel combustion, was incorporated with detailed chemical kinetics consisting of 29 reactions for hydrogen as well as additional nitrogen oxidation. This reaction mechanism was coupled with 3-D advanced CFD software to investigate the performance and emission characteristics of a diesel-hydrogen dual-fuel engine. Computational results showed good agreements with the experimental results for brake thermal efficiency, CO2, CO, and NOX emissions. The model was then employed to examine the effects of exhaust gas recirculation (EGR) and N2 dilution on NOX emissions. The computational results quantified the reduction in NOX emissions with EGR and N2 dilution, and a more remarkable reduction was found with 30% N2 dilution. However, in terms of the N2 dilution, a general decreasing trend was observed for both NOX and CO2 emissions, while CO emissions increased. In relation to the EGR, the NOX emissions decreased while CO2 and CO emissions significantly increased. Additionally, the results showed that the indicated mean effective pressure (IMEP) and indicated power decreased as the N2 dilution increased. The same trend was observed for the EGR but the reduction was less compared to that of the N2 dilution

Influence of Ignition Timing and EGR on the NOₓ Emission and the Performance of an SI Engine Fueled with Hydrogen

Exhaust gas recirculation (EGR) and ignition timing have strong effects on engine performance and exhaust emissions. In the present study, detailed chemical reactions with 29 steps of hydrogen oxidation with additional nitrogen oxidation reactions were coupled with an advanced CFD code to investigate the engine performance and emission characteristics of a SI engine fueled with hydrogen. The NOx formation within the engine was computed using the extended Zeldovich mechanism with parameters adjusted for a carbonfree fuel such as hydrogen. The computational results were validated against experimental results with equivalence ratio of 0.84 and fixed ignition timing at crank angle of 5° BTDC (before top dead center). The simulations were then employed to examine the effects of EGR and ignition timing on the engine performance and NOx formation and emission. The EGR ratio was varied between 5% and 15% while the ignition timings considered were 5°, 10°, 15°, and 20° BTDC. It was found that NOx emission increased with advancing the ignition timing away from TDC while the indicated engine power showed an increasing trend with further advancing the ignition timing. Higher indicated mean effective pressure (IMEP) and indicated thermal efficiency were obtained with an advanced ignition timing of 20° BTDC. The model was also run with three different EGR ratios of 5%, 10% and 15% with fixed ignition timing at 5° BTDC. The simulation results quantified the reduction in NOx and the indicated engine power with the increase in the EGR ratio. The computations were consistent with the hypothesis that the combustion duration increases with the EGR ratio. Finally, the maximization of engine power and minimization of NOx emissions were considered as conflicting objectives. The different data points were plotted in the objective space. Using the concept of knee , (5° BTDC, 0% EGR) was selected as the optimal operating point representing the best trade-off between maximum engine power and minimum NOx emissions

The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 1—global current practice patterns for the management of Herpes Simplex Virus and Varicella Zoster Virus anterior uveitis

Aims: To present current expert practice patterns and to formulate a consensus for the management of HSV and VZV AU by uveitis specialists worldwide. Methods: A two-round online modified Delphi survey with masking of the study team was conducted. Responses were collected from 76 international uveitis experts from 21 countries. Current practices in the diagnosis and treatment of HSV and VZV AU were identified. A working group (The Infectious Uveitis Treatment Algorithm Network [TITAN]) developed data into consensus guidelines. Consensus is defined as a particular response towards a specific question meeting ≥75% of agreement or IQR ≤ 1 when a Likert scale is used. Results: Unilaterality, increased intraocular pressure (IOP), decreased corneal sensation and diffuse or sectoral iris atrophy are quite specific for HSV or VZV AU from consensus opinion. Sectoral iris atrophy is characteristic of HSV AU. Treatment initiation is highly variable, but most experts preferred valacyclovir owing to simpler dosing. Topical corticosteroids and beta-blockers should be used if necessary. Resolution of inflammation and normalisation of IOP are clinical endpoints. Conclusions: Consensus was reached on several aspects of diagnosis, choice of initial treatment, and treatment endpoints for HSV and VZV AU. Treatment duration and management of recurrences varied between experts.</p

The Infectious Uveitis Treatment Algorithm Network (TITAN) Report 1—global current practice patterns for the management of Herpes Simplex Virus and Varicella Zoster Virus anterior uveitis

Aims: To present current expert practice patterns and to formulate a consensus for the management of HSV and VZV AU by uveitis specialists worldwide. Methods: A two-round online modified Delphi survey with masking of the study team was conducted. Responses were collected from 76 international uveitis experts from 21 countries. Current practices in the diagnosis and treatment of HSV and VZV AU were identified. A working group (The Infectious Uveitis Treatment Algorithm Network [TITAN]) developed data into consensus guidelines. Consensus is defined as a particular response towards a specific question meeting ≥75% of agreement or IQR ≤ 1 when a Likert scale is used. Results: Unilaterality, increased intraocular pressure (IOP), decreased corneal sensation and diffuse or sectoral iris atrophy are quite specific for HSV or VZV AU from consensus opinion. Sectoral iris atrophy is characteristic of HSV AU. Treatment initiation is highly variable, but most experts preferred valacyclovir owing to simpler dosing. Topical corticosteroids and beta-blockers should be used if necessary. Resolution of inflammation and normalisation of IOP are clinical endpoints. Conclusions: Consensus was reached on several aspects of diagnosis, choice of initial treatment, and treatment endpoints for HSV and VZV AU. Treatment duration and management of recurrences varied between experts.</p

The Collaborative Ocular Tuberculosis Study (COTS)-1: A Multinational Descriptive Review of Tubercular Uveitis in Paediatric Population

Purpose To examine disease profile of tubercular uveitis (TBU) in Paediatric population. Methods Among 945 patients of the retrospective multinational study by the Collaborative Ocular Tuberculosis Study (COTS)-1, 29 Paediatric patients diagnosed with TBU were analyzed. Results Mean age of disease presentation was 12.8 (range 4-18 years), with predominance of males (n = 14/20; 70.0%) and Asian ethnicity (n = 25/29; 86.2%). Posterior uveitis (n = 14/28; 50%) was the most frequent uveitis phenotype, with choroidal involvement occurring in 64.7% (n = 11/17). Incidence of optic disc edema and macular edema was higher in children (n = 8/18; 44.4% and n = 5/18; 27.8%, respectively) than in adults (n = 160/942; 16.9% and n = 135/942; 14.3%, respectively). Comparison of optic disc edema between subgroups showed a significant difference (P =.006). All patients received oral corticosteroids, most of them with antitubercular therapy. Treatment failure developed in 4.8% (n = 1/21). Conclusions Children have a more severe inflammatory response to the disease, and an intensive anti-inflammatory therapeutic regimen is required to achieve a positive treatment outcome