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Three alternative approaches to desalinating seawater were evaluated with respect to their thermodynamic efficiencies and greenhouse-gas emissions. The technologies considered were multistage flash distillation (MSF), reverse osmosis (RO), and membrane distillation (MD). The analysis was based on published stream data from large-scale operational MSF and RO facilities and experimental-scale data for the MD process. RO was found to be the most exergy-efficient (30.1%) followed by MD (14.27%) and MSF (7.73%). RO and MD required less power consumption to produce water (3.29 kWh/m3 and 5.9 kWh/m3, respectively) compared to MSF which had a much higher energy demand (16.7 kWh/m3). Similar results were obtained when comparing equivalent carbon dioxide emissions from each process; MD and RO accounted for 5.22 and 2.91 kg CO2eq/m3, respectively, whereas MSF generated three to four times that amount. The results indicate that MD has potential as a commercially viable technique for seawater desalination provided a source of waste heat is available. This study provides an overview of the use of thermodynamic efficiency analysis to evaluate desalination processes and provides insight into where energy may be saved with developed desalination processes and areas of research for emerging desalination techniques.

BackgroundThis randomized trial compared ultrasound-guided interscalene block (ISB) and costoclavicular brachial plexus block (CCB) for arthroscopic shoulder surgery. We hypothesized that CCB would provide equivalent analgesia to ISB 30 min after surgery without the risk of hemidiaphragmatic paralysis.MethodsAll 44 patients received an ultrasound-guided block of the intermediate cervical plexus. Subsequently, they were randomized to ISB or CCB. The local anesthetic agent (20 mL of levobupivacaine 0.5% and epinephrine 5 µg/mL) and pharmacological block adjunct (4 mg of intravenous dexamethasone) were identical for all study participants. After the block performance, a blinded investigator assessed ISBs and CCBs every 5 min until 30 min using a composite scale that encompassed the sensory function of the supraclavicular nerves, the sensorimotor function of the axillary nerve and the motor function of the suprascapular nerve. A complete block was defined as one displaying a minimal score of six points (out of a maximum of eight points) at 30 min. Onset time was defined as the time required to reach the six-point minimal composite score. The blinded investigator also assessed the presence of hemidiaphragmatic paralysis at 30 min with ultrasonography.Subsequently, all patients underwent general anesthesia. Postoperatively, a blinded investigator recorded pain scores at rest at 0.5, 1, 2, 3, 6, 12, and 24 hours. Patient satisfaction at 24 hours, consumption of intraoperative and postoperative narcotics, and opioid-related side effects (eg, nausea/vomiting, pruritus) were also tabulated.ResultsBoth groups displayed equivalent postoperative pain scores at 0.5, 1, 2, 3, 6, 12, and 24 hours. ISB resulted in a higher incidence of hemidiaphragmatic paralysis (100% vs 0%; P < 0.001) as well as a shorter onset time (14.0 (5.0) vs 21.6 (6.4) minutes; p<0.001). However, no intergroup differences were found in terms of proportion of patients with minimal composite scores of 6 points at 30 min, intraoperative/postoperative opioid consumption, side effects, and patient satisfaction at 24 hours.ConclusionCompared to ISB, CCB results in equivalent postoperative analgesia while circumventing the risk of hemidiaphragmatic paralysis. Further confirmatory trials are required. Future studies should also investigate if CCB can provide surgical anesthesia for arthroscopic shoulder surgery.Clinical Trials RegistrationNCT03411343.

Objective To develop recommendations that can be used as guidance for standardized approach regarding indications, patient preparation, sequences acquisition, interpretation and reporting of magnetic resonance imaging (MRI) for diagnosis and grading of pelvic floor dysfunction (PFD). Methods The technique included critical literature between 1993 and 2013 and expert consensus about MRI protocols by the pelvic floor-imaging working group of the European Society of Urogenital Radiology (ESUR) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) from one Egyptian and seven European institutions. Data collection and analysis were achieved in 5 consecutive steps. Eighty-two items were scored to be eligible for further analysis and scaling. Agreement of at least 80 % was defined as consensus finding. Results Consensus was reached for 88 % of 82 items. Recommended reporting template should include two main sections for measurements and grading. The pubococcygeal line (PCL) is recommended as the reference line to measure pelvic organ prolapse. The recommended grading scheme is the “Rule of three” for Pelvic Organ Prolapse (POP), while a rectocele and ARJ descent each has its specific grading system. Conclusion This literature review and expert consensus recommendations can be used as guidance for MR imaging and reporting of PFD. Key points • These recommendations highlight the most important prerequisites to obtain a diagnostic PFD-MRI. • Static, dynamic and evacuation sequences should be generally performed for PFD evaluation. • The recommendations were constructed through consensus among 13 radiologists from 8 institutions.

Ring laser gyroscopes are top sensitivity inertial sensors used in the measurement of angular rotation. It is well known that the response of such remarkable instruments can in principle access the very low frequency band, but the occurrence of nonlinear effects in the laser dynamics imposes severe limitations in terms of sensitivity and stability. We report here general relationships aimed at evaluating corrections able to effectively account for nonlinear laser dynamics. The so-derived corrections are applied to analyse thirty days of continuous operation of the large area ring laser gyroscope GINGERINO leading to duly reconstruct the Sagnac frequency ω s . The analysis shows that the evaluated corrections affect the measurement of the Earth rotation rate Ω ⊕ at the level of 1 part in 1.5 × 10 3 . The null shift term ω ns plays a non negligible role. It turns out proportional to the optical losses μ of the ring cavity, which are changing in time at the level of 10 % within the considered period of thirty days. The Allan deviation of estimated Ω ⊕ shows a remarkable long term stability, leading to a sensitivity better than 10 - 10  rad/s with more than 10 s of integration time, and approaching ( 8.5 ± 0.5 ) × 10 - 12  rad/s with 4.5 × 10 5  s of integration time.

Inertial sensors are important at application level and also in fundamental physics. Ring laser gyroscopes, which measure angular rotation rates, are among the most sensitive ones. Large area ring laser reach sensitivities at the level of fractions of prad/s, allowing measurements of relevant geophysical signals. Improvements of a factor 10–100 would make these instruments able to measure general relativity effects; this is the goal e.g. of the GINGER project, an Earth based experiment aiming to test the Lense–Thirring effect with an accuracy of \\[1\\%\\]. However, the laser induces non-linearities, effects larger in small scale instruments. We discuss a novel technique to analyse data, able to reduce non-linear laser effects. We apply this technique to data from two ring laser prototypes, and compare the precision of the measurement of the angular rotation rate obtained with the new and the standard methods. We show that the back-scatter problem of the ring laser gyroscopes is negligible with a proper analysis of the data. These results not only allow to improve the performance of large scale ring laser gyroscopes but also pave the way to the development of small scale instruments with nrad/s sensitivity, which are precious for environmental studies and as inertial platforms.

ObjectivesTo develop imaging guidelines for patients with fistula-in-ano and other causes of anal sepsis.MethodsAn expert group of 13 members of the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) used a modified Delphi process to vote on a series of consensus statements relating to the imaging of patients with potential anal sepsis. Participants first completed a questionnaire to gather practice information and to help frame the statements posed.ResultsIn the first round of voting, the expert group scored 51 statements of which 45 (88%) achieved immediate consensus. The remaining 6 statements were redrafted following input from the expert group and consensus achieved for all during a second round of voting, including an additional statement drafted. No statement was rejected due to a lack of consensus. After redrafting to improve clarity, 53 individual statements were presented.ConclusionThese expert consensus statements can be used to guide appropriate indication, acquisition, interpretation and reporting of medical imaging for patients with potential fistula-in-ano and other causes of anal sepsis.Key Points• Medical imaging, notably magnetic resonance imaging, is used widely for the diagnosis and monitoring of fistula-in-ano and other causes of anal and perianal sepsis.• While the indexed medical literature is clear that diagnostic accuracy is potentially excellent, this depends on competent image acquisition and interpretation.• In order to facilitate this, the European Society of Gastrointestinal and Abdominal Radiology (ESGAR) has produced expert consensus guidelines regarding the imaging of fistula-in-ano and related conditions.

A novel approach in monitoring the inner dynamics of mountains, massifs, and of the Earth crust in general, involves hydrogeological measurements, as well as new generation multi-component seismic stations. Several hydrogeological stations monitor the water parameters of the large Gran Sasso aquifer. This is especially important when the instrumentation used has a high sensitivity and is able to access frequencies below 1 mHz, opening the possibility of observing very slow signals of local origin. For several years, the ring laser gyroscope GINGERINO is operative inside the underground Gran Sasso laboratory ( LNGS-INFN ), and monitors the local Earth angular velocity around the vertical axis. Together with the co-located GIGS broadband seismometer (seismic stations of national network of INGV ), it constitutes a 4C seismic station; the 4 degrees of freedom put together give insight into the inner movements of the Gran Sasso massif, that find correspondence in measurements conducted on the groundwater of the aquifer. In particular, the hydrogeological interpretation of the slow dynamics of the period since May to August 2023, and of the powerful mountain bang event of August 14 is consistent with data from GINGERINO . The final large bang event was also detected by the GIGS broadband seismic station and accelerometer station of RAN (National Accelerometer Network of Civil Protection Department). Furthermore, in the underground laboratories the bang event was recorded by an acoustic sensor and the groundwater hydraulic pressure monitor shows an anomaly exactly when the bang event occurred. Finally, the monitoring data of the groundwater at the boundary of the Gran Sasso aquifer also reveal anomalies linked to the bang event.

The absolute measurement of the Earth angular rotation rate with ground-based instruments becomes challenging if the 1 part in 109 of precision has to be obtained. This threshold is important for fundamental physics and for geodesy, to investigate effects of General Relativity and Lorentz violation in the gravity sector and to provide the fast variation of the Earth rotation rate. High sensitivity Ring Laser Gyroscopes (RLG) are currently the only promising technique to achieve this task in the near future, but their precision has been so far limited by systematics related to the laser operation. In this paper we analyze two different sets of observations, each of them three days long. They were obtained from the G ring laser at the Geodetic Observatory Wettzell. The applied method has been developed for the GINGERINO ring laser in order to identify and extract the laser systematics. For the available data sets the residuals show mostly white noise behavior and the Allan deviation drops below 1 part in 109 after an integration time of about 104 s.

The sensitivity to angular rotation of the top class Sagnac gyroscope GINGERINO is carefully investigated with standard statistical means, using 103 days of continuous operation and the available geodesic measurements of the Earth angular rotation rate. All features of the Earth rotation rate are correctly reproduced. The unprecedented sensitivity of fractions of frad/s is attained for long term runs. This excellent sensitivity and stability put Sagnac gyroscopes at the forefront for fundamental physics, in particular for tests of general relativity and Lorentz violation, where the sensitivity plays the key role to provide reliable data for deeper theoretical investigations.