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Type 2 diabetes mellitus (T2DM) and depression are closely linked. People with T2DM are at increased risk of developing depression and vice versa. T2DM and depression comorbid conditions adversely affect Health-Related Quality of Life (HRQOL) and management of T2DM. In this study, we assessed depression and HRQOL among patients with T2DM in Dhaka, Bangladesh.

Type 2 diabetes mellitus (T2DM) is a major public health problem worldwide. Nearly half a billion people are living with T2DM worldwide, of whom 75% live in low- and middle-income countries (LMICs) [1]. The situation is particularly alarming in South-East Asia, where 87.6 million people were affected with diabetes in 2019, resulting in 1.2 million attributable deaths to T2DM [2]. More specifically, Bangladesh follows along with these estimations [3, 4] amidst the aggravating background of a health system where communicable diseases are still prevalent [5]. Bangladesh is among the top 10 countries with the most cases of undiagnosed T2DM in adults [2]. The burden of T2DM involves high costs to patients (US$88 a year) and providers (US$54-64 a year) in Bangladesh [2, 6]. These costs include medical advice, investigations, treatment, travel, productivity loss, and carers' expenses. As reported by the IDF, the annual health expenditure per person with T2DM in Bangladesh during 2019 was estimated at US$64. This figure represents the expenses directly linked to diabetes, irrespective of who pays, whether patients, private or public payers, or the government [2].

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This cross-sectional study was conducted between November 2014 and January 2015. A total of 318 patients with T2DM were enrolled in the study at two medical centers in Dhaka, Bangladesh. The first one, BIHS, is a medical teaching institute under the Health Care Development Project (HCDP) of Bangladesh Diabetic Samity, attached to a 250-bed diabetic tertiary care hospital [40], but also linked to smaller regional hospitals and ten urban healthcare centers in and around Dhaka [40]. The second one, DMCH, is a medical college attached to a 2,300-bed hospital [41]. Its Department of Medicine provides outpatient services to diabetic patients on Mondays and Saturdays and is attended by patients from all over the country [41].

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Abstract: The cross-linking principle, classification, formulation, process and equipment of silane cross-linked polyethylene insulating material for wire and cable are briefly described, and some characteristics of silane naturally cross-linked polyethylene insulating material in application and use as well as factors affecting the cross-linking condition of the material are introduced.

Keywords: Silane cross-linking; Natural cross-linking; Polyethylene; Insulation; Wire and cable

Silane cross-linked polyethylene cable material is now widely used in the wire and cable industry as an insulating material for low-voltage power cables. The material in the manufacture of cross-linked wire and cable, and peroxide cross-linking and irradiation cross-linking compared with the manufacturing equipment required is simple, easy to operate, low comprehensive cost and other advantages, has become the leading material for low-voltage cross-linked cable with insulation.

As you know, there are two-step and one-step production methods for silane cross-linked cables and their cables. The difference between the two-step method and the one-step method lies in where the silane grafting process is carried out, the grafting process at the cable material manufacturer for the two-step method, the grafting process in the cable manufacturing plant for the one-step method. The two-step silane cross-linked polyethylene insulating material with the largest market share is composed of the so-called A and B materials, with A material being the polyethylene grafted with silane and B material being the catalyst master batch. The insulating core is then cross-linked in warm water or steam.

There is another type of two-step silane cross-linked polyethylene insulator, where the A material is produced in a different way, by introducing vinyl silane directly into the polyethylene during synthesis to obtain polyethylene with silane branched chains.

One-step method also has two types, the traditional one-step process is a variety of raw materials according to the formula in the ratio of special precision metering system, into a specially designed special extruder in one step to complete the grafting and extrusion of cable insulation core, in this process, no granulation, no need for cable material plant participation, by the cable factory to complete alone. This one-step silane cross-linked cable production equipment and formulation technology is mostly imported from abroad and is expensive.

Another type of one-step silane cross-linked polyethylene insulation material is produced by cable material manufacturers, is all raw materials according to the formula in the ratio of a special method of mixing together, packaged and sold, there is no A material and B material, cable plant can be directly in the extruder to complete a step at the same time grafting and extrusion of cable insulation core. The unique feature of this method is that there is no need for expensive special extruders, as the silane grafting process can be completed in an ordinary PVC extruder, and the two-step method eliminates the need to mix A and B materials before extrusion.

(1) The base resin is generally a low density polyethylene (LDPE) resin with a melt index (MI) of 2, but recently, with the development of synthetic resin technology and cost pressures, linear low density polyethylene (LLDPE) has also been used or partially used as the base resin for this material. Different resins often have a significant impact on grafting and cross-linking due to differences in their internal macromolecular structure, so the formulation will be modified by using different base resins or the same type of resin from different manufacturers.

(2) The initiator commonly used is diisopropyl peroxide (DCP), the key is to grasp the amount of the problem, too little to cause silane grafting is not enough; too much to cause polyethylene cross-linking, which reduces its fluidity, the surface of the extruded insulation core rough, difficult to squeeze system. As the amount of initiator added is very small and sensitive, it is important to disperse it evenly, so it is generally added together with the silane.

(3) Silane is generally used vinyl unsaturated silane, including vinyl trimethoxysilane (A2171) and vinyl triethoxysilane (A2151), due to the fast hydrolysis rate of A2171, so choose A2171 more people. Similarly, there is a problem of adding silane, the current cable material manufacturers are trying to achieve its lower limit to reduce costs, because the silane are imported, the price is more expensive.

(4) Anti-oxidant is to ensure the stability of polyethylene processing and cable anti-aging and added, anti-oxidant in the silane grafting process has the role of inhibiting the grafting reaction, so the grafting process, the addition of anti-oxidant to be careful, the amount added to consider the amount of DCP to match the selection. In the two-step cross-linking process, most of the antioxidant can be added in the catalyst master batch, which can reduce the impact on the grafting process. In the one-step cross-linking process, the antioxidant is present in the entire grafting process, so the choice of species and amount is more important. Commonly used antioxidants are 1010, 168, 330, etc.

(5) Polymerization inhibitor is added in order to inhibit some grafting and cross-linking process of side reactions occur, in the grafting process to add an anti-cross-linking agent, can effectively reduce the occurrence of C2C cross-linking, thereby improving the processing fluidity, in addition, the addition of a graft in the same conditions will be preceded by the hydrolysis of silane on the polymerization inhibitor can reduce the hydrolysis of grafted polyethylene, to improve the long-term stability of the graft material.

(6) Catalysts are often organotin derivatives (except for natural crosslinking), the most common being dibutyltin dilaurate (DBDTL), which is generally added in the form of a masterbatch. In the two-step process, the graft (A material) and the catalyst master batch (B material) are packaged separately and the A and B materials are mixed together before being added to the extruder to prevent pre-crosslinking of the A material. In the case of one-step silane cross-linked polyethylene insulations, the polyethylene in the package has not yet been grafted, so there is no pre-cross-linking problem and therefore the catalyst does not need to be packaged separately.

In addition, there are compounded silanes available on the market, which are a combination of silane, initiator, antioxidant, some lubricants and anti-copper agents, and are generally used in one-step silane cross-linking methods in cable plants.

Therefore, the formulation of silane cross-linked polyethylene insulation, the composition of which is not considered to be very complex and is available in the relevant information, but the appropriate production formulations, subject to some adjustments in order to finalise, which requires a full understanding of the role of the components in the formulation and the law of their impact on performance and their mutual influence.

In the many varieties of cable materials, silane cross-linked cable material (either two-step or one-step) is considered to be the only variety of chemical processes occurring in extrusion, other varieties such as polyvinyl chloride (PVC) cable material and polyethylene (PE) cable material, the extrusion granulation process is a physical mixing process, even if the chemical cross-linking and irradiation cross-linking cable material, whether in the extrusion granulation process, or extrusion system Cable, there is no chemical process occurs, so, in comparison, the production of silane cross-linked cable material and cable insulation extrusion, process control is more important. 17dc91bb1f