The thermoelectric properties of nanostructured Ni doped Dy filled CoSb3 skutterudites (Dy0.4Co4−xNixSb12 (x = 0, 0.4, and 0.8)) have been reported.

An integrated, modular, and multifunctional process is conceptually designed, simulated, and optimized for direct utilization of CO2 from dilute flue gas to produce high-quality syngas, a precursor for many value-added chemicals and liquid transportation fuels. The process is intensified to simultaneously capture and convert CO2 using methane, natural gas, or excess fuel gas from the same plant, or using nearby unconventional methane from biogas or landfill gas. It is an integrated adsorption-purge-reaction system where CO2 is first adsorbed and then desorbed using methane-rich feed leading to a mixture suitable for dry-reforming. The merging of concentration-based CO2 desorption with the reactor feed premixing step eliminates the need for pressure or temperature swings and significantly reduces the energy penalty and cost of CO2 capture and utilization. The process is simulated at different conditions using a high-fidelity process model to elucidate the effects of key decision variables as well as the trade-offs and interactions between the capture and reforming sections. The technology is flexible to handle different feedstock compositions, and is amenable to both centralized and distributed production of syngas. A constrained grey-box optimization method is employed to achieve a maximum of 99.7% net overall CO2 utilization considering auxiliary emissions at a total cost ranging from $110–130 per ton of syngas. As much as 14.6% of the total CO2 input to the process comes “directly” from flue gas without additional cost for CO2 capture while maintaining about 91% overall CO2 utilization. The technology is also computationally found to be robust in terms of CO2 utilization and cost for different natural gas feeds with CO2 contamination as high as 60%. This can be attributed to the novel process intensification concept and the gray-box constrained optimization method presented in this work.

Aims Diabetes mellitus is a risk factor for nephrolithiasis. A recent observational study found that SGLT2 inhibitor use by type 2 diabetes (T2D) patients was associated with a 49% lower risk of nephrolithiasis, compared to GLP-1 receptor agonists. We examined the association between nephrolithiasis and the SGLT2 inhibitor empagliflozin, using existing data from randomized clinical trials. Methods We pooled data from 15,081 T2D patients randomized to empagliflozin (n=10,177) or placebo (n=4,904) from 20 phase I-IV trials including the large CV outcome trial, EMPA-REG OUTCOME. Incident urinary tract stone events were captured using a pre-defined collection of MedRA terms. A sensitivity analysis using a narrower definition was also performed. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated using the relative risk estimate, stratified by study. Results The median exposures to study drug was 543 days (placebo) and 549 days (empagliflozin).183 patients experienced an incident urolithiasis during follow-up (placebo, 79; empagliflozin,104), yielding annual incidence rates of 1.01 versus 0.63 events/100 patient-years in the two respective groups. The IRR was 0.64 (95% CI 0.48, 0.86), in favor of empagliflozin. In the sensitivity analysis, the results were similar (IRR, 0.62 [95% CI 0.45, 0.85]). Conclusion Compared to placebo, empagliflozin therapy was associated with an approximate 40% reduced risk of urinary tract stone events in T2D patients. The underlying mechanisms are unknown but may involve altered lithogenic profile of the urine. Dedicated randomized prospective clinical trials are warranted to confirm these initial observations in both patients with and without T2D.

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Objective Severe hypoglycemia (blood glucose < 50 mg/dl) in hospitalized patients with diabetes mellitus is associated with poor outcomes such as increased mortality and readmission rates. We study the effects of system based interventions in managing severe hypoglycemia and its impact on outcomes. Research design and methods We performed retrospective review of pre- and post- intervention study to quantify severe hypoglycemia in patients admitted in the general internal medicine wards with primary or secondary diagnosis of diabetes mellitus based on ICD-9 and ICD-10 codes. We implemented multidisciplinary interventions including standardization of treatment, education of in-patient medical teams and physician notification and feedback immediately after severe hypoglycemia. The endpoints were the comparative analysis of incidence of severe hypoglycemia, in-patient mortality rate, 30-day mortality rate, 30-day readmission rate, recovery time from hypoglycemia, time to next glucose measurements, use of standardized treatment and physician notification rate pre-and post-intervention. Results The incidence of severe hypoglycemia per patient with diabetes was reduced from 9.6% (233/2416) to 5.6% (202/3607) (p<0.001) post-intervention. The in-patient mortality rate in patients with severe hypoglycemia reduced from 4.1% to 0% (p = 0.019), 30-day mortality rate reduced from 9.8% to 3.8% (p = 0.058) post-intervention. 30-day readmission rate was comparable between pre-intervention (31.7%) and post-intervention (29%) (p = 0.60). In comparison, the mortality and readmission rates of all diabetic patients did not reduce during the same observation periods. Recovery time reduced from 116 (83–161) to 75 (57–102) min (p<0.01), time to next glucose measurement reduced from 39.5 (34–48) to 32 (28–35) min (p<0.01), use of standardized treatment improved from 22.7% (53/233) to 72.2% (146/202) (p<0.001) and physician notification rate increased from 29.2 (68/233) to 84.7% (171/202) post-intervention. Conclusions Our study shows that multidisciplinary strategies improves the process of early detection and management of severe hypoglycemia and reduce incidence and in-patient mortality rate.