Changes In Pressure Research Articles

Home blood pressure-lowering effect of a non-steroidal mineralocorticoid receptor blocker, esaxerenone, versus trichlormethiazide for uncontrolled hypertension: the EXCITE-HT randomized controlled study.

The EXCITE-HT study aimed to evaluate the efficacy and safety of esaxerenone versus thiazide diuretics (trichlormethiazide) as second-line treatment for Japanese patients with uncontrolled essential hypertension. This was a 12-week, multicenter, randomized, open-label, parallel-group study. The non-inferiority of esaxerenone to trichlormethiazide was confirmed if the upper limit of the two-sided 95% confidence interval (CI) for the difference in systolic blood pressure (SBP)/diastolic blood pressure (DBP) change between groups was below 3.9/2.1 mmHg. A total of 295 and 290 patients were included in the esaxerenone and trichlormethiazide groups, respectively. The non-inferiority of esaxerenone to trichlormethiazide was demonstrated: least squares mean change differences in morning home SBP/DBP at end of treatment (EOT) were -2.2 (95% CI, -3.6, -0.8) mmHg for SBP/-0.6 (-1.4, 0.2) mmHg for DBP. Morning home, bedtime home, and office BP significantly decreased (all p < 0.001) from baseline to EOT in both groups. The urinary albumin-to-creatinine ratio and N-terminal pro-brain natriuretic peptide level decreased from baseline to Week 12 in both groups, with no notable intergroup difference. Serum potassium elevations occurred more frequently with esaxerenone, while serum potassium reductions occurred more with trichlormethiazide. Uric acid elevations were observed in both groups, but more frequently with trichlormethiazide than esaxerenone. No cases of gout occurred in this study. Reductions in estimated glomerular filtration rate were similarly observed in both groups. EXCITE-HT is the first randomized controlled study to demonstrate evidence that esaxerenone is non-inferior to trichlormethiazide as second-line treatment for Japanese patients with uncontrolled essential hypertension, with no new safety concerns. The EXCITE-HT study demonstrated the non-inferiority of esaxerenone to trichlormethiazide in its morning home blood pressure lowering effect and safety profile in Japanese patients with uncontrolled essential hypertension who were previously treated with an angiotensin II receptor blocker or calcium channel blocker.

The impact of El Niño–Southern Oscillation on the total column ozone over the Tibetan Plateau

Abstract. The Tibetan Plateau (TP; approximately 27.5–37.5° N, 75.5–105.5° E) is the highest and largest plateau on Earth with a mean elevation of over 4 km. This special geography causes strong surface solar ultraviolet radiation (UV), with potential risks to human and ecosystem health, which is mainly controlled by the local stratospheric ozone concentration. The El Niño–Southern Oscillation (ENSO), the dominant mode of interannual variability on Earth, is characterised by the tropical Pacific Ocean sea surface temperature anomalies (SSTAs) and sea level pressure change for the warm-phase El Niño and cold-phase La Niña events. Although some studies have suggested the existence of positive correlation between ENSO and the total column ozone (TCO) over the TP, the mechanism underlying this effect is not fully understood. Here we use the Copernicus Climate Change Service (C3S) merged satellite dataset, the Stratospheric Water and OzOne Satellite Homogenized (SWOOSH) dataset and the TOMCAT three-dimensional (3D) offline chemical transport model forced by ERA5 meteorological reanalyses from the European Centre for Medium-Range Weather Forecasts (ECMWF) over the period 1979–2021 to investigate the influence of ENSO on the TCO over the TP. We find that the El Niño (La Niña) events favour positive (negative) TCO anomalies over the TP from wintertime of its mature phase to springtime of its decaying phase. Through studying the ozone profile, we attribute the positive (negative) TCO anomalies mainly to the increased (decreased) ozone at the 200–70 hPa levels, i.e. in the upper troposphere and lower stratosphere (UTLS) regions. Our results suggest that the El Niño events impact the TP TCO via the following potential processes: (1) a negative upper-level geopotential height anomaly associated with El Niño is responsible for a decrease in air column thickness; (2) the thickness decrease modulates reduced tropospheric temperature and thus favours a decrease in the tropopause height (TH); and (3) such a TH decrease tends to induce a change in the relative amounts of ozone-poor tropospheric and ozone-rich stratospheric air in the profile, which increases the partial column ozone in the UTLS and hence corresponds to the TP TCO increase. The La Niña events affect TP TCO in a manner resembling the El Niño events, except with anomalies of opposite sign. This work provides a systematic understanding of the influence of ENSO on ozone over the TP, which has implications for the interannual variability of ozone.

The Association Between Blood Pressure and Clinical Outcomes in Patients Undergoing Transcatheter Aortic Valve Implantation

Introduction: Transcatheter Aortic Valve Implantation (TAVI) has emerged as a common and effective treatment for patients with severe aortic stenosis. Changes in systemic blood pressure after TAVI have been described, yet their prognostic value are not established. Thus, we aimed to examine the association of the peri-procedural changes in systolic blood pressure and in pulse pressure on clinical outcomes after the procedure. Methods: A retrospective study of consecutive patients who underwent TAVI procedure in our medical center. We assessed the effect of the periprocedural changes in blood pressure measurements on mortality, acute myocardial infarction, stroke and hospitalizations at 1-year and on the combined outcome of death, myocardial infarction and stroke at one year following the procedure. Results: Our cohort included 455 patients (44% males). Of them, 343 patients (75.4%) have raised the systolic blood pressure (SBP) immediately after the procedure. Patients who raised SBP had a significantly higher rate of the 1-year composite outcome, compared to patients who did not raise SBP following the procedure (43 [13%] vs 6 [5.4%], respectively, p=0.033). After adjustment for age and sex, the postprocedural increase in SBP was significantly associated with the composite outcome, with a hazard ratio of 2.42, 95% CI 1.03-5.7. Conclusion: An immediate increase in SBP after TAVI is associated with worse 1-year clinical cardiovascular outcomes.

An unusual case: fracture of the handle of the malleus due to finger manipulation

An isolated fracture of the handle of the malleus is arare entity in otorhinolaryngology and manifests clinically as acute-onset unilateral hearing loss. Several factors may cause this injury, including acute barotraumatic pressure changes or traumatic events. Various therapeutic approaches such as tympanoplasty, autologous graft, or application of bone cement are discussed. We report the case of a46-year-old female patient who developed acute hearing loss in her left ear after finger manipulation. Clinical evaluation revealed axial displacement of the handle of the malleus and audiometry indicated conductive hearing loss. After otoscopy, audiometry, and computed tomography, tympanoscopy was indicated due to suspicion of ossicular chain disruption. Intraoperatively, an isolated fracture of the handle of malleus was found, which was treated with glass ionomer cement. Following postoperative examination, there was progressive improvement in the acoustic transmission component, such that anormal hearing threshold was observed 4months postoperatively. This case report underlines the importance of precise diagnosis and individualized treatment for rare middle ear injuries.

Impact of Renin-Angiotensin System Blockade on Mortality and Allograft Loss among Renal Transplant Recipients: A Systematic Review and Meta-Analysis.

The blockade of the renin-angiotensin system (RAS) has a beneficial effect on reducing the levels of proteinuria and blood pressure in patients with chronic kidney disease (CKD) and reduces the risk of developing end-stage kidney disease in CKD patients. Nonetheless, a debate persists regarding the impact of RAS inhibitors on outcomes such as mortality and graft survival in renal transplant patients. To assess the effect of RAS inhibitors on graft recipients in the past decade, we conducted a systematic review and meta-analysis. We searched Embase, PubMed, and the Cochrane Central Register of Clinical Trials from January 1, 2012, to August 1, 2022. We included 14 articles, comprising 5 randomized controlled trials (RCTs) and 9 cohort studies, including 45,377 patients. These studies compared patient or graft survival between an RAS inhibitor treatment arm and a control arm. The meta-analysis revealed that RAS blockade was significantly associated with lower mortality in cohort studies (risk ratio [RR] = 0.66, 95% confidence interval [CI]: 0.55-0.79), reduced allograft loss in cohort studies (RR = 0.62, 95% CI: 0.54-0.71), and significant changes in systolic blood pressure in RCTs. Subgroup analysis of the groups of interest (interventions involving RAS blockade, follow-up period of ≥5 years) showed consistently reduced mortality (RR = 0.67, 95% CI: 0.56-0.81) and reduced allograft loss (RR = 0.61, 95% CI: 0.54-0.70). Our results demonstrated that the application of RAS blockade among renal transplant recipients was associated with lower mortality and allograft loss in cohort studies but not in RCTs. More powered clinical trials are needed to evaluate the effects of RAS blockade in renal transplant recipients.

Investigating the effect of fuel properties and environmental parameters on low-octane gasoline-like fuel spray combustion and emissions using machine learning-global sensitivity analysis method

The gasoline compression ignition mode is an advanced combustion mode that achieves high efficiency with low emissions. This study constructs a global sensitivity analysis (GSA) by coupling machine learning (ML) algorithms and conducts a comprehensive investigation into the statistical correlations between research octane number (RON), fuel sensitivity (S), three initial ambient parameters, and the spray combustion characteristics of gasoline-like fuels. Eighty sets of CFD numerical simulation data were used for training the machine learning model. Results show liquid length (LL) is most sensitive to changes in ambient pressure while ambient temperature significantly influences vapor penetration length (VPL). Regarding combustion behaviors, ignition delay (ID) and flame lift-off length (LOL) show the highest sensitivity to ambient temperature. The occurrence of distinct ignition points in the domain also advances from 1.75 ms to 0.42 ms as the ambient temperature rises from 1000K to 1200K. Additionally, the ambient temperature has higher-order interaction effects with ambient pressure on LOL. The production of NOx in the field is also more closely correlated with ambient temperature, with higher temperatures promoting its generation. Furthermore, ambient temperature exhibits a positive interaction effect with both ambient pressure and oxygen concentration on NOx emissions.

Nurse-led digital health program for home blood pressure monitoring in stroke patients: protocol for a pooled analysis of randomized controlled trials.

Hypertension is a major risk factor for stroke recurrence in stroke patients. Home blood pressure monitoring, facilitated by digital health technologies and led by nurses, may improve blood pressure control in this high-risk population. However, the evidence is not yet conclusive. This study protocol outlines a pooled analysis of the current literatures to evaluate the effectiveness of nurse-led digital health programs for home blood pressure monitoring in stroke patients. We will conduct a comprehensive search of some major electronic databases (e.g., PubMed, EMBASE, Cochrane Library, and CINAHL) and trial registries for randomized controlled trials evaluating nurse-led digital health programs for home blood pressure monitoring in stroke patients. Two reviewers will independently screen titles and abstracts, review full-text articles, extract data, and assess risk of bias using the revised Cochrane risk-of-bias tool for randomized trials (RoB 2.0). The primary outcome measures will be changes in both systolic and diastolic blood pressure from baseline to the end of the intervention period. Secondary outcomes include adherence to the program, patient satisfaction, and stroke recurrence. Data will be pooled and analyzed using meta-analysis techniques, if appropriate. This study will provide comprehensive evidence on the effectiveness of nurse-led digital health programs for home blood pressure monitoring in stroke patients. The findings could have substantial implications for clinical practice and health policy, potentially informing the development of guidelines and policies related to hypertension management and stroke prevention. By pooling the results of randomized controlled trials, this study will offer a robust evidence base to inform clinical practice and health policy in the context of stroke patients. Despite potential limitations such as heterogeneity among studies and risk of publication bias, the rigorous methodology and comprehensive approach to data synthesis will ensure the reliability and validity of the findings. The results will be disseminated through a peer-reviewed publication and potentially at relevant conferences. https://doi.org/10.17605/OSF.IO/59XQA.

Study on the phase state and temperature-pressure distribution of CO2 injection wellbore and its effect on tubing stress conditions

This study investigates the phenomena observed during CO₂ injection processing in wellbores, particularly the annular pressure buildup typically attributed to inadequate packer sealing. We propose that temperature, pressure, and phase changes during CO₂ injection induce equivalent stresses, leading to packer unsealing. A detailed CO₂ injection model was developed, incorporating temperature-pressure coupling and phase transitions using the state equation. The model evaluates the effects of injection temperature, pressure, and volume on CO₂ density, temperature, pressure, phase state, and velocity, and calculates the stress on the tubing at various depths. Validation against actual measurements showed errors of 1.43% for pressure and 0.66% for temperature, confirming the model's accuracy. Key findings reveal that injection temperature significantly affects CO₂ phase changes, while injection temperature and volume respectively impact stress at the wellhead and bottom. The model provides a robust tool for optimizing CO₂-EOR processes, confirming that changes in injection parameters can indeed cause packer unsealing, and its reliance on precise input data highlights the need for accurate field measurements.

The Role and Function of TRPM8 in the Digestive System.

Transient receptor potential (TRP) melastatin member 8 (TRPM8) is a non-selective cation channel that can be activated by low temperatures (8-26 °C), cooling agents (including menthol analogs such as menthol, icilin, and WS-12), voltage, and extracellular osmotic pressure changes. TRPM8 expression has been identified in the digestive system by several research teams, demonstrating its significant involvement in tissue function and pathologies of the digestive system. Specifically, studies have implicated TRPM8 in various physiological and pathological processes of the esophagus, stomach, colorectal region, liver, and pancreas. This paper aims to comprehensively outline the distinct role of TRPM8 in different organs of the digestive system, offering insights for future mechanistic investigations of TRPM8. Additionally, it presents potential therapeutic targets for treating conditions such as digestive tract inflammation, tumors, sensory and functional disorders, and other related diseases. Furthermore, this paper addresses the limitations of existing studies and highlights the research prospects associated with TRPM8.

Which compartments of the optic nerve and its sheath are associated with intracranial pressure? An exploratory study.

The optic nerve sheath diameter (ONSD) is a commonly used estimate of intracranial pressure (ICP). The rationale behind this is that pressure changes in the cerebrospinal fluid affect the optic nerve subarachnoid space (ONSAS) thickness. Still, possible effects on other compartments of the optic nerve sheath (ONS) have not been studied. This is the first study ever to analyze all measurable compartments of the ONS for associations with elevated ICP. We measured changes in ICP and changes in ONS compartments in 75 patients treated with invasive ICP monitoring at the Karolinska University Hospital. Associations between changes in ICP and changes in ONS compartments were estimated with generalized estimating equations. The potential to identify elevated ICP was assessed with the area under the receiver operating characteristic curve (AUROC) for ONS compartments associated with ICP changes. Both ONSAS and perioptic dura mater thickness were significantly associated with changes in ICP in multivariable modeling. ONSAS was the only compartment that independently predicted changes in ICP, with an AUROC of 0.69 for predicting ICP increase. Still, both the perioptic dura mater thickness and the optic nerve diameter added value in predicting ICP changes in multivariable modeling. The results from this study challenge the current understanding of the mechanism behind the association between ICP and ONSD. Contrary to the common opinion that ONSAS is the only affected compartment, this study shows a more complex picture. It suggests that all ONS compartments may add value in predicting changes in ICP.

The stimulant cathine from Khat causes tachycardia indirectly in the rat.

Leaves of the Khat plant are widely consumed in the Horn of Africa, Yemen and the Jazan region of Saudi Arabia. I have investigated the mode of cardiovascular and autonomic actions of the stimulant cathine from Khat in terms of direct or indirect adrenergic actions in anaesthetised male and female rats, and in isolated tissues. Male and female rats were anaesthetised with pentobarbitone and changes in diastolic blood pressure and cardioaccelerator responses were examined in vehicle-treated or chemically sympathectomised rats. Cathine produced marked tachycardia and smaller blood pressure responses in vehicle-treated animals, with significant rises in heart rate occurring at cathine (0.1mg/kg). In sympathectomised rats, cardiac actions were greatly attenuated in both male and female animals, with no differences between male and female rats. Although pressor responses to cathine were relatively small, sympathectomy significantly reduced these responses in female, but not male, rats. In rat aorta and spleen, cathine produced almost no direct contractions. It is concluded that cathine acts predominantly indirectly, presumably by the release of noradrenaline, in both male and female rats to produce cardiovascular actions. This may have implications for adverse cardiovascular actions of consumption of the plant Khat, particularly with dried Khat, in which actions of cathine may predominate over those of cathinone.

Analytical and Computational Modeling of Relaxation Times for Non-Newtonian Fluids

With the availability of efficient and sophisticated finite element analysis (FEA) and computational fluid dynamics (CFD) tools, engineering designs are becoming more software-driven and simulation-based. However, the insights relevant to engineering designs tend to be hidden within massive temporal and spatial data produced with full-fledged three-dimensional simulations. In this paper, we present a preliminary study of the controlled intermittent dispensing of a typical non-Newtonian glue employed in the manufacturing of electric vehicles (EVs). The focus of the study is on the scaling issues derived from different computational and analytical models of interest and importance to the precision control of this non-Newtonian fluid, the lowest dynamic viscosity of which at extremely high shear rates is nearly four million times that of water. More specifically, the abrupt change of the inlet pressure with a constant outlet or ambient pressure and various modeling strategies for transient viscous internal flow with both Newtonian and non-Newtonian fluids are modeled and compared. The analytical and computational results of the developing Newtonian fluid, i.e., water, are derived and computed for validation and verification purposes before the actual applications to the developing non-Newtonian fluid. The concept of a well-established relaxation time before the onset of the steady solution for Newtonian fluids has been validated with both analytical and computational approaches before its expansion and adoption to non-Newtonian fluids with complex rheological behaviors. Other issues attributed to transient operations and precision controls of non-Newtonian fluid delivery involve the pressure pulse and pressure wave propagation within the flexible pipe with compressible or almost incompressible non-Newtonian fluids with a constant pressure at the outlet and a constant mass flow rate or average axial velocity at the inlet, which will be addressed in a separate paper.

Thermal expansion, [formula omitted] phase diagram and polarization of (1-x)Na[formula omitted]Bi[formula omitted]TiO[formula omitted]-xBaTiO[formula omitted] solid solutions

The paper presents the results of detailed studies of thermal expansion of solid solutions (1-x)Na1/2Bi1/2TiO3-xBaTiO3 with x=0.04-0.97 in the temperature range from 100 to 900 K. A change in chemical pressure associated with the complex cationic substitution, (Na1/2Bi1/2)2+→ Ba2+, result in a very rapid decrease in the temperatures of the transformation P4mm→C2mm→R3m below 100 K which are characteristic of BaTiO3. Significant features in the behavior of thermal expansion were observed near two triple points in the T−x phase diagram where the phases Pm3̄m, P4mm, P4bm (x≈0.15-0.20) and P4bm, P4mm, R3c (x≈0,06) coexist, allow the studied solid solutions to be divided into three groups. The relationship between the effects of internal chemical pressure and external hydrostatic one is discussed. By analyzing the thermodynamic potential, the root-mean-square polarization Pd is determined, which increases by about 16% with a decrease in the BT content from 0.97 to 0.4.

Penerapan Terapi Relaksasi Benson Terhadap Tekanan Darah Sistole Pada Lansia Dengan Hipertensi di Kelurahan Bejen Kabupaten Karanganyar

Hypertension is a disease that commonly occurs in the elderly and is more susceptible to complications. The consequences for elderly people with hypertension are heart failure, stroke and kidney failure. According to the World Health Organization (WHO) in 2020, the prevalence of hypertension in the elderly in the world was around 972 million people or 26.4%. Hypertension in the elderly in Wonorejo Hamlet Rw 17 Bejen Village, Karanganyar Regency totaled 83 people. One form of relaxation that can be applied to hypertension sufferers is Benson relaxation therapy. To describe changes in systolic blood pressure due to the application of Benson relaxation therapy in elderly people with hypertension in Bejen Village, Karanganyar Regency. This research used a descriptive design on 2 female respondents aged 60 years and over. After carrying out Benson relaxation therapy which was carried out on 01-07 May 2024 in Bejen Village, Karanganyar Regency with each respondent being given intervention for 7 consecutive days once a day every morning for 10 minutes, the systolic blood pressure in both respondents decreased from grade 2 hypertension to grade 1 hypertension. Application of Benson relaxation therapy can reduce systolic blood pressure in elderly people with hypertension in Bejen Village, Karanganyar Regency.

A Novel Approach for Preparing Sepiolite Micron Powder Based on Steam Pressure Changes.

As a common method for preparing micron powder in industrial operations, the mechanical extrusion method simply pursues the particle size without considering the microstructure characteristics of sepiolite, which leads to problems such as bundles of sepiolite not being effectively dispersed, and thus the disruption of fibers is inevitably caused. In this work, a new micronization method for disaggregating these bundles while preserving the original structural integrity of the fibers is proposed based on steam pressure changes. The effects of steam pressure changes on the particle size distribution, microstructure, and properties of treated sepiolite are studied using X-ray fluorescence spectrometer (XRF), X-ray diffractometer (XRD), Field Emission Scanning Electron Microscopy (FESEM), Transmission Electron Microscopy (TEM), and a specific surface area and aperture analyzer (BET). The experimental results show that the particle size of sepiolite powder depends greatly on steam pressure, and sepiolite powder with mass ratio of 91.6% and a particle size D97 of 21.27 μm is obtained at a steam pressure of 0.6 MPa. Compared to the sepiolite after mechanical extrusion, the sepiolite treated with steam pressure changes can maintain the integrity of its crystalline structure. The specific surface area of sepiolite enhanced from 80.15 m2 g-1 to 141.63 m2 g-1 as the steam pressure increased from 0.1 to 0.6 MPa, which is about 1.6 times that of the sample treated with mechanical extrusion.

The influence of earthworks construction on pore water pressures in clays and mudstones of the Lias Group

Monitoring the changes in pore water pressure associated with the construction of earthworks can yield information on the stiffness and permeability of the ground, as well as how the natural groundwater regime might be impacted. This paper presents three years of pore water pressure measurements in weathered Lias Group mudstone, obtained from a trial cutting and a trial embankment constructed for the UK's High Speed Two (HS2) railway. The immediate changes in pore water pressure were small in relation to the changes in total stress imposed. This can be explained by the consolidation or swelling during the period of construction, combined with the sensitivity of very stiff clays and mudstones to a very small (0.5%) reduction in the degree of saturation. In the longer-term, pore water pressures reduced across the site owing to the reduction in ground level at the trial cutting. Rates of pore water pressure change were accelerated by more permeable limestone within the ground profile reducing drainage path lengths. It is concluded that construction-induced pore water pressure changes may be smaller, and their rate of dissipation more rapid, in weathered clays and mudstones such as those of the Lias Group than in younger, more compressible clay deposits.

Functional control of myosin motors in the cardiac cycle.

Contraction of the heart is driven by cyclical interactions between myosin and actin filaments powered by ATP hydrolysis. The modular structure of heart muscle and the organ-level synchrony of the heartbeat ensure tight reciprocal coupling between this myosin ATPase cycle and the macroscopic cardiac cycle. The myosin motors respond to the cyclical activation of the actin and myosin filaments to drive the pressure changes that control the inflow and outflow valves of the heart chambers. Opening and closing of the valves in turn switches the myosin motors between roughly isometric and roughly isotonic contraction modes. Peak filament stress in the heart is much smaller than in fully activated skeletal muscle, although the myosin filaments in the two muscle types have the same number of myosin motors. Calculations indicate that only ~5% of the myosin motors in the heart are needed to generate peak systolic pressure, although many more motors are needed to drive ejection. Tight regulation of the number of active motors is essential for the efficient functioning of the healthy heart - this control is commonly disrupted by gene variants associated with inherited heart disease, and its restoration might be a useful end point in the development of novel therapies.

Design, development, and testing of active valve piezo-hydraulic pump

Valves play a major role in rectifying the fluid flow through piezo-hydraulic pumps, which may be active or passive. Passive valves operate due to changes in the fluid pressure whereas active valves are operated through control signals. This paper presents a novel design of an active valve chamber assembly for a piezo-hydraulic pump. It is a novel design since none of the research publications has addressed the application of a Flexurally amplified piezoelectric actuator (FAPA) for valve actuation in active valve chamber assembly. The piezo-hydraulic pump design is done using solid edge design software. FAPA’s are used for pumping and valve actuation. Structural analysis with experimental verification for the valve chamber component is presented. The valve opening and the pumping displacement are mathematically modeled in MATLAB Simulink software. Also, mathematical simulations for pump flow rates at different actuation frequencies and voltage are discussed. The piezo-hydraulic pump components are fabricated and assembled with the actuators. Experimental investigations on the flow rate performance of the active valve piezo-hydraulic pump are carried out with changing frequency and voltage amplitude of actuators. The interpretation of results is done by comparing the experimental and simulation results. During experiments, the pump delivered a maximum flow rate of 4.5 ml min−1 at 140 V when actuated at 0.25 Hz actuation frequency.

Rationale, Design and Baseline Characteristics of a Randomized Controlled Trial of a Cardiovascular Quality Improvement Strategy in India: The C-QIP Trial

BackgroundQuality of chronic care for cardiovascular disease (CVD) remains suboptimal worldwide. The Collaborative Quality ImProvement (C-QIP) trial aims to develop and test the feasibility and clinical effect of a multicomponent strategy among patients with prevalent CVD in India. MethodsThe C-QIP is a clinic-based, open randomized trial of a multicomponent intervention versus usual care that was locally developed and adapted for use in Indian settings through rigorous formative research guided by Consolidated Framework for Implementation Research (CFIR). The C-QIP intervention consisted of 5 components: 1) electronic health records and decision support system for clinicians, 2) trained non-physician health workers (NPHW), 3) text-message based lifestyle reminders, 4) patient education materials, 5) quarterly audit and feedback reports. Patients with CVD (ischemic heart disease, ischemic stroke, or heart failure) attending outpatient CVD clinics were recruited from September 2022 to September 2023 and were randomized to the intervention or usual care arm for at least 12 months follow-up. The co-primary outcomes are implementation feasibility, fidelity (i.e., dose delivered and dose received), acceptability, adoption and appropriateness, measured at multiple levels: patient, provider and clinic site-level, The secondary outcomes include prescription of guideline directed medical therapy (GDMT) (provider-level), and adherence to prescribed therapy, change in mean blood pressure (BP) and LDL-cholesterol between the intervention and control groups (patient-level). In addition, a trial-based process and economic evaluations will be performed using standard guidelines. ResultsWe recruited 410 socio-demographically diverse patients with CVD from four hospitals in India. Mean (SD) age was 57.5 (11.7) years, and 73.0% were males. Self-reported history of hypertension (48.5%) and diabetes (41.5%) was common. At baseline, mean (SD) BP was 127.9 (18.2) /76.2 (11.6) mm Hg, mean (SD) LDLc: 80.3 (37.3) mg/dl and mean (SD) HbA1c: 6.8% (1.6%). At baseline, the GDMT varied from 62.4% for patients with ischemic heart disease, 48.6% for ischemic stroke and 36.1% for heart failure. ConclusionThis study will establish the feasibility of delivering contextually relevant, and evidence-based C-QIP strategy and assess whether it is acceptable to the target populations. The study results will inform a larger scale confirmatory trial of a comprehensive CVD care model in low-resource settings. Trial registrationClinical Trials Registry India: CTRI/2022/04/041847; Clinicaltrials.gov number: NCT05196659

Flameless venting characteristics and design model of micro-nano PMMA dust explosion

The effects of Fe–Ni foam thickness and dust size on flame propagation, reduced overpressure, and venting efficiency in 30 μm and 150 nm polymethyl methacrylate (PMMA) dust explosions were investigated. The flame quenching mechanism was revealed by coupling the heat transfer and flow of the dust flame within the Fe–Ni foam. It is found that micron dust is more prone to quenching than nano dust, and the differences in the quenching process of micro-nano dust are explained by combining the dust combustion kinetics and the theory of inter-particle heat transfer. The pressure venting mechanism of micro-nano dust was analysed under different thicknesses of Fe–Ni foam, and the thermal expansion effect of the flame passing through the Fe–Ni foam and its flow resistance significantly increased the reduced explosion overpressure. The flow continuity of the micro-nano dust was classified by means of the Knudsen number (Kn), which elucidates the effect of dust size differences on the pressure evolution. A prediction model for the maximum reduced explosion overpressure is proposed based on the explosion pressure venting of micro-nano dust. Changes in vented pressure have a direct impact on the efficiency of flameless venting. Nano-dust has an efficiency of more than 20 % lower than that of micron dust.