B-scan measurements of intraocular tumor heights intraoperatively, before and after radioactive plaque application: A comparative prospective study.

PURPOSE: To assess the difference in intraocular tumors height measurements intraoperatively before and after radioactive plaque application. METHODOLOGY: Twenty-four eyes of 24 patients with intraocular tumors, candidates for radioactive therapy, were included. Each tumor was measured at the same setting before and after plaque application independently by 3 sonographers, using a 20-MHz B-scan transducer. Mean pre-plaque and post-plaque measurements were calculated and recorded. An A-scan vector aided in identification of the inner and outer tumor surfaces. RESULTS: Each patient was examined independently three times by three experienced ultrasonographers within the same setting to assess interobserver variability. There was no statistically significant difference between the 3 examiners' readings, with P-value 0.99 for pre-plaque height and 0.97 for post-plaque height. Mean pre-plaque height was 5.16±2.11mm, while post-plaque height was 5.51±2.1mm (P-value 0.001). The Spearman correlation test showed that initial tumor height was negatively correlated with the difference between both heights, but with no statistical significance. CONCLUSION: Intraocular tumor height measurement differs significantly before and after plaque application. Use of the pre-plaque height is advised until further studies are performed to assess the effect of this difference on treatment outcomes.

Post-operative Scar Comparison With Supraorbital Eyebrow and Upper Blepharoplasty Approach in the Management of Zygomaticomaxillary Complex Fractures.

Study Design: A prospective randomized comparative study was conducted to evaluate the postsurgical scar with Supraorbital Eyebrow (SE) Approach and Upper Blepharoplasty (UB) Approach used for open reduction and internal fixation (ORIF) of zygomaticomaxillary complex (ZMC) fractures. Objective: To evaluate and compare the post-operative scar using Vancouver Scar Scale (VSS) following ORIF of ZMC fractures with SE and UB approaches. Methods: In this study, 88 patients with ZMC fractures requiring ORIF and meeting the inclusion criteria were recruited between 2019 and 2020. Patients were randomly divided into SE and UB group, 44 patients in each. Clinical and radiological assessment was done preoperatively and post-operative scar evaluation was carried out at different intervals over a period of 6 months using VSS. A blinded observer rated the scar. Results: The results showed that after 6 months of surgery, all the 44 (100%) patients in UB group had a mild scar (VSS score 1-5), while in the SE group 34 (77.3%) patients had a mild scar (VSS score 1-5) and 10 (22.7%) had a moderate scar (VSS score 6-10). The difference between the 2 groups was statistically significant (P-value = .001). Conclusions: The UB approach has been established to be superior to SE approach in terms of post-operative scar as the results were statistically significant. This study can be used to advocate more frequent use of UB approach as compared to the previously popular SE approach for the management of ZMC fractures.

Interleukin 17 and Growth Differentiation Factor 9 Influence in a Sample of Iraqi Infertile Males.

Infertility is defined as the inability of couples to conceive after 1 year of regular unprotected intercourse, which affects 10-15% of couples. The present study aimed to investigate the influence of Interleukin-17 (IL-17) and growth differentiation factor 9 (GDF9) on three groups of infertile males, including control, azoospermia, and oligozoospermia. In total, this study was performed on 93 participants, consisting of 18, 65, and 10 subjects in the Azoospermia, oligozoospermia, and control groups, respectively. The mean plasma levels of IL-17 in the azoospermia and oligozoospermia groups were 21.317±3.605 and 15.101±2.416 ng/l, respectively, which were significantly higher than that in the control group (5.392±1.731 ng/l). Furthermore, the mean plasma levels of GDF9 in the azoospermia and oligozoospermia groups were 3.299±1.051 and 6.2603±2.621 ng/l, respectively, which was significantly higher than that in the control group (12.807±2.170 ng/l). One-way analysis of variance and least significant difference post-hoc test were performed to assess significant differences among means. R-squared measures how well the linear regression model fits the data. It can be interpreted as the proportion of variance of the outcome Y explained by the linear regression model. R-squared is a number between 0 and 1. In non-obstructive forms of severe oligozoospermia and azoospermia, like the case in the current study, intracytoplasmic sperm injection is suggested by using testicular biopsy for spermatozoa extraction, if viable spermatozoa are present.

The effects of Yakson touch and gentle human touch on preterm infants: A systematic review and meta-analysis.

We aim to collect the evidence of efficacy of Gentle Guman Touch (GHT) and Yakson Touch in preterm neonates as pain relief, heart rate, oxygen saturation, and urine cortisol level. We made our search through PubMed, Web of Science, Scopus, and Cochrane by the mid of March 2023. Randomized control trials (RCTs) were included, and the Cochrane risk of bias tool was utilized to assess their quality. Using Review Manager software, a meta-analysis was conducted. We computed the mean difference (MD) with a 95% confidence interval (CI) for the continuous data. During the examination, the Neonatal Infant Pain Scale (NIPS) was significantly reduced in the touch group compared to the control group (MD = -3.40, 95% CI [-4.15 to -2.64], P-value= 0.00001). After the examination, the NIPS score was also reduced by both Yakson touch and GHT compared to the control (MD = -2.14, 95% CI [-3.42 to -0.85], P-value <0.00001). Yakson touch and GHT are non-pharmacological, easy, and safe methods that can be used for painful interventions to reduce the pain experience of preterm infants from variable interventions. Both methods improved infant sleep and behavior. Preterm infants' heart rates and oxygen saturation were unaffected by Yakson touch or GHT.

Double-balloon catheter vs dinoprostone (PGE-2) insert for labour induction: A meta-analysis of 2493 pregnancies.

Induction of labor (IOL) is the stimulation of the uterus during pregnancy to begin the onset of labour. Nearly two of five pregnancies require IOL. We compared the effectiveness of double-balloon catheter (DBC) with dinoprostone (PGE-2) insert for labour induction from previous studies. We included randomized controlled trials (RCTs) that compared the safety and efficacy of DBC to PGE-2. To evaluate the studies, we utilized the Cochrane tool for risk of bias assessment. The rates of vaginal birth and cesarean section were the primary outcomes. We included ten RCTs in this meta-analysis with a total sample of 2493 singleton pregnancies. After 24 hours, there was no significant difference in the delivery rates between DBC and PGE-2 s [R.R=1.08, 95% CI, (0.77, 1.52), P.value=0.65], and the rate of cesarean delivery [R.R=1.03, 95% CI, (0.90; 1.18), P.value=0.65]. The DBC showed a significantly higher oxytocin use rate compared to the PGE-2 group [R.R=1.77, 95% CI, (1.41; 2.32), P.value<0.0001]. In the PGE-2 group, there was a significantly higher risk of uterine hyperstimulation, tachysystole, and umbilical artery PH levels below 7. There was no significant difference in the efficacy between the PGE-2 and DBC in terms of delivery rate in 24 hours and the rate of cesarean delivery except for a slight BISHOP score improvement with DBC. However, DBC showed a higher rate of oxytocin use compared to the PGE-2, the DBC seems to be safer with a lower risk of umbilical artery PH < 7, uterine hyperstimulation, and tachysystole incidence than PGE-2.

Web content topic modeling using LDA and HTML tags.

An immense volume of digital documents exists online and offline with content that can offer useful information and insights. Utilizing topic modeling enhances the analysis and understanding of digital documents. Topic modeling discovers latent semantic structures or topics within a set of digital textual documents. The Internet of Things, Blockchain, recommender system, and search engine optimization applications use topic modeling to handle data mining tasks, such as classification and clustering. The usefulness of topic models depends on the quality of resulting term patterns and topics with high quality. Topic coherence is the standard metric to measure the quality of topic models. Previous studies build topic models to generally work on conventional documents, and they are insufficient and underperform when applied to web content data due to differences in the structure of the conventional and HTML documents. Neglecting the unique structure of web content leads to missing otherwise coherent topics and, therefore, low topic quality. This study aims to propose an innovative topic model to learn coherence topics in web content data. We present the HTML Topic Model (HTM), a web content topic model that takes into consideration the HTML tags to understand the structure of web pages. We conducted two series of experiments to demonstrate the limitations of the existing topic models and examine the topic coherence of the HTM against the widely used Latent Dirichlet Allocation (LDA) model and its variants, namely the Correlated Topic Model, the Dirichlet Multinomial Regression, the Hierarchical Dirichlet Process, the Hierarchical Latent Dirichlet Allocation, the pseudo-document based Topic Model, and the Supervised Latent Dirichlet Allocation models. The first experiment demonstrates the limitations of the existing topic models when applied to web content data and, therefore, the essential need for a web content topic model. When applied to web data, the overall performance dropped an average of five times and, in some cases, up to approximately 20 times lower than when applied to conventional data. The second experiment then evaluates the effectiveness of the HTM model in discovering topics and term patterns of web content data. The HTM model achieved an overall 35% improvement in topic coherence compared to the LDA.

Myxomatous Liposarcoma of the Mediastinum: A Review of the Literature.

Myxomatous liposarcoma is an extremely rare type of mediastinal tumour that manifests in a manner comparable to other lung pathologies. Chest pain, shortness of breath, and dysphagia are the common presenting complaints. Radiological examinations or postoperative histological examinations provide the majority of the diagnostic evidence. The cornerstone of therapy consists of surgery and sometimes chemotherapy. Those who are afflicted have a better chance of experiencing favourable outcomes if they receive a diagnosis and treatment quickly.

Energy, exergy, environmental impact, and economic analyses of evacuated tube compound parabolic concentrator-powered solar thermal domestic water heating system.

In the reported study, a dynamic analytical model is developed to propose the energy, exergy, environmental impact, and economic analyses of the water heating system at Jaipur (India) with an evacuated tube compound parabolic concentrator field of a total area of 81 m2. Consequently, the model is used to perform parametric studies to report the effect of operating and meteorological parameters on the productivity and performance of the system. Moreover, the system's performance, environmental impact, and economic aspects have been investigated and compared under different meteorological conditions at four different Rajasthan (India) locations using TMY2 weather data files. Results clarified that Jodhpur receives the highest solar radiation intensity from these four locations. The model results were validated with the experimental data, and a good agreement has prevailed. Consequently, the results indicate the highest annual energy and exergy gain for Jodhpur with 79.72 MWh and 9.311 MWh, respectively, followed by Jaisalmer, Barmer, and Jaipur. The economic analysis results clarified that the simple payback period ranged from 4.5 to 4.75 years and the discounted payback period ranged from 6.6 to 7 years based on a 6% discount rate. At the same time, the levelized cost of heating for the given system is around 0.023 $/kWh which is very economical closest to that of CNG as a fuel which costs around 0.059 $/kWh. The internal rate of return is reported to be 16.76, 16.82, 16.77, and 16.75% for Barmer, Jodhpur, Jaipur, and Jaisalmer, respectively, and savings of 74.4, 78.1, 75.4, and 73.8 tonnes of CO2 emission to the environment.

Genotoxicity and Trace Elements Contents Analysis in Nile Tilapia (Oreochromis niloticus) Indicated the Levels of Aquatic Contamination at Three Egyptian Areas.

The toxic waste and pollutants of heavy metals continuously pollute freshwater aquatic reservoirs, which have severe implications on aquatic life and human health. The present work aims to evaluate trace elements (Zn, Mn, Cu, Cd, and Pb) along with three sites, Mariout Lake, Abbassa, and River Nile Aswan in Egypt, using Nile tilapia (Oreochromis niloticus) as bioindicator. The quality assurance, health-risk assessment, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), quantitative polymerase chain reaction (qPCR), and micronucleus test were performed to investigate the effect of different trace elements on Hsp70 gene level and micronuclei formation. We observed the highest expression of Hsp70 protein band of 70 KD and stress-responsive Hsp70 gene in the liver followed by gills of Nile tilapia caught from Mariout and Abbassa, but the lowest expression was in Nile tilapia caught from Aswan. Obvious micronuclei were observed under the microscope in erythrocytes, and their number was gradually decreased in the following manner: Mariout > Abbassa > Aswan. Noticeably, Cu, Zn, and Mn contents were low. Still, Pb and Cd contents were higher than the toxicity level recommended by the Food and Agriculture Organization (FAO), The World Health Organization (WHO), and the European Commission (EC). These results showed that Hsp70's appearance at the two levels of mRNA and protein is an effective indicator for aquatic pollution besides the aberration at the chromosome level represented in the micronucleus test. Furthermore, these results showed that Nile tilapia of the Aswan region had comparatively low trace elements contamination and were suitable for consumption.

Effective and selective electroreduction of aqueous nitrate catalyzed by copper particles on multi-walled carbon nanotubes.

Drinking-water contamination with nitrate ions is inevitable and wide spreading, which demands feasible removal. Water de-nitration by potentiostatic electroreduction is described here. A novel electrocatalyst based on nano-copper particles, supported onto multi-walled carbon nanotubes (MWCNTs), and spray-deposited onto fluorine doped tin oxide-glass substrates, is described. The Cu/MWCNT/FTO electrode has been characterized by several methods and assessed as a working electrode in aqueous nitrate ion electroreduction, in comparison with MWCNT sprayed on FTO (MWCNT/FTO) with no copper. Comparison with earlier reported electrodes is also described. XRD patterns confirm the presence of nano-copper crystallites, in the electrode, with average size ⁓45 nm. Within 2 h of electrolysis, Cu/MWVNT/FTO exhibits more than 65% removal of nitrate at -1.80 V (vs. SCE). In longer time (7 h) the electrode completely converts the nitrate into N2 (∼65%) and (NH4+) ∼35% with no NO2- ions. The kinetics show 0.76 order with respect to nitrate, and a rate constant 4.53 × 10-2 min-1 higher than earlier counterparts. The new electrode functions under various conditions of temperature, pH, electrolyte type and concentration and inter-electrode spacing, only at ambient applied potential. Moreover, the electrode exhibits stability under nitrate electroreduction conditions, and can be recovered and reused for multiple times without efficiency loss. XRD and EDS results also confirm the electrode stability after multiple reuse. Compared to earlier systems, the Cu/MWCNT/FTO is environmentally stable, safe, non-costly with high nitrate removal efficiency and selectivity.

The Pattern of CT Scan Use in the Diagnosis of Abdominal Pain in Children Presenting to the Emergency Department of a Tertiary Community Hospital.

Background and objective Pediatric populations are highly sensitive to ionizing radiations and, therefore, are more at risk of their harmful outcomes. Our study aimed to determine the percentage of children who underwent a CT scan after presenting to the ED with abdominal pain. The secondary aim was to determine the change in management related to the CT results. In addition, we also wanted to determine the predictors associated with the use of abdominal CT scans in the evaluation of children presenting to ED with abdominal pain as well as the predictors associated with positive CT scan results in children with abdominal pain. Materials and methods We retrospectively reviewed the medical records of children with abdominal pain seen in our ED from 01/01/2011 through 12/30/2012. Patients aged 4-18 years presenting with abdominal pain were identified from the medical records. Data on demographics, clinical characteristics, associated factors, CT use, CT findings, and change in management were collected. Data were analyzed using Chi-square (χ2) analysis and Student's t-test. Results A total of 1,780 charts were reviewed and 1,272 children were included in the study. The mean age of the cohort was 12.6 ± 4.6 years; 62.6% were female and 68.7% were African American. Of note, 14% (181/1,272) of the study group had received a CT scan; change in medical management was noted in 34.8% (63/181) of the scanned patients. Predictors of CT use included older age (p<0.0001), male gender (p<0.0001), white race (p<0.0001), an attending without advanced training in pediatric emergencies (p=0.001), acute onset of symptoms (p<0.0001), higher pain score (p<0.0001), right lower quadrant pain (p<0.0001), abdominal wall rebound tenderness (p<0.0001), abdominal tenderness (p<0.0001), fever (p<0.0001), and absence of constipation (p=0.04). Positive CT scan results were predicted by the presence of fever (p=0.013), lack of constipation (p=0.025), and white race (p=0.022). A multivariate analysis could not be done because not all data were available for each patient. Conclusion The use of the CT scan in children with abdominal pain affected the management in one out of three patients (34.8%). Fever, constipation, and white race were the factors associated with an increased likelihood of performing a CT scan and were also linked to positive results.

Comprehensive genome wide identification and expression analysis of MTP gene family in tomato (Solanum lycopersicum) under multiple heavy metal stress.

Plant metal tolerance proteins (MTPs) play major roles in enhancing resistance to heavy metal tolerance and homeostasis. However, the role of MTPs genes in tomato, which is one of the most popular crops, is still largely limited. Hence, we investigated genome-wide study of tomato MTPs, including phylogenetic, duplication, gene structure, gene ontology and previous transcriptomic data analysis. Moreover, the MTPs expression behaviour under various heavy metals stress has rarely been investigated. In the current study, eleven MTP candidate genes were genome-wide identified and classified into three major groups; Mn-cation diffusion facilitators (CDFs), Fe/Zn-CDFs, and Zn-CDFs based on the phylogeny. Structural analysis of SlMTPs showed high gene similarity within the same group with cation_efflux or ZT_dimerdomains. Evolutionary analysis revealed that segmental duplication contributed to the expansion of the SlMTP family. Gene ontology further showed the vital roles of MTPs in metal-related processes. Tissue-specific expression profiling exhibited similar expression patterns in the same group, whereas gene expression varied among groups. The MTPs expression was evaluated after tomato treatments by five divalent heavy metals (Cd2+, Co2+, Mn2+, Zn2+, and Fe2+). SlMTP genes displayed differential responses in either plant leaves or roots under heavy metals treatments. Nine and ten SlMTPs responded to at least one metal ion treatment in leaves and roots, respectively. In addition SlMTP1, SlMTP3, SlMTP4, SlMTP8, SlMTP10 and SlMTP11 exhibited the highest expression responses in most of heavy metals treatments. Overall, our findings presented a standpoint on the evolution of MTPs and their evolution in tomato and paved the way for additional functional characterization under heavy metal toxicity.

Inadequate Bowel Preparation in Pediatric Colonoscopy-Prospective Study of Potential Causes.

OBJECTIVES: Inadequate bowel preparation (IBP) for colonoscopy leads to missed diagnosis, longer anesthesia time, higher chance of complications and increased costs. Adult studies have demonstrated that patient characteristics such as male gender and obesity are associated with IBP. Little is known about factors affecting bowel preparation in children. Our aim was to determine factors associated with IBP in children. METHODS: We prospectively enrolled children undergoing outpatient colonoscopy. Quality of bowel preparation was assessed using Boston Bowel Preparation Scale (BBPS) score (range 0-9). Data collected included patient demographics, indication, and type of insurance. Patients were divided into two groups based on BBPS score-adequate (BBPS score > 5) and inadequate (BBPS score < 5) and groups were compared using Student t-test and chi-square test. Possible predictors were analyzed using multivariate logistic regression models. RESULTS: A total of 334 children were prospectively enrolled of whom 321 were studied further (age range 2-18 years; mean age 12.4 years; 60.4% female; 85.9% Caucasian). The mean BBPS score was 6.8 (standard deviation of ±2). IBP was reported in 12.8% (41/321). Multivariable logistic regression analysis did not show statistical differences between the groups in studied patient factors including age, gender, obesity, race, insurance type, and indication for colonoscopy. CONCLUSION: Contrary to several adult studies, the results of our prospective study did not show any relationship between examined patient factors and IBP in children. Interestingly, IBP was less prevalent in our pediatric study compared to published adult data (12.8% vs 20-40%).

Time scale performance of rapid antigen testing for SARS-CoV-2: Evaluation of 10 rapid antigen assays.

There is a great demand for more rapid tests for SARS-CoV-2 detection to reduce waiting time, boost public health strategies for combating disease, decrease costs, and prevent overwhelming laboratory capacities. This study was conducted to assess the performance of 10 lateral flow device viral antigen immunoassays for the detection of SARS-CoV-2 in nasopharyngeal swab specimens. We analyzed 231 nasopharyngeal samples collected from October 2020 to December 2020, from suspected COVID-19 cases and contacts of positive cases at Biotechnology Research Center laboratories, Tripoli, Libya. The performance of 10 COVID-19 Antigen (Ag) rapid test devices for the detection of SARS-CoV-2 antigen was compared to a quantitative reverse transcription-polymerase chain reaction (RT-qPCR). In this study, 161 cases had symptoms consistent with COVID-19. The mean duration from symptom onset was 6.6 ± 4.3 days. The median cycle threshold (Ct ) of positive samples was 25. Among the 108 positive samples detected by RT-qPCR, the COVID-19 antigen (Ag) tests detected 83 cases correctly. All rapid Ag test devices used in this study showed 100% specificity. While tests from six manufacturers had an overall sensitivity range from 75% to 100%, the remaining four tests had a sensitivity of 50%-71.43%. Sensitivity during the first 6 days of symptoms and in samples with high viral loads (Ct < 25), was 100% in all but two of the test platforms. False-negative samples had a median Ct of 34 and an average duration of onset of symptoms of 11.3 days (range = 5-20 days). Antigen test diagnosis has high sensitivity and specificity in early disease when patients present less than 7 days of symptom onset. Patients are encouraged to test as soon as they get COVID-19-related symptoms within 1 week and to seek medical advice within 24 h if they develop disturbed smell/taste. The use of rapid antigen tests is important for controlling the COVID-19 pandemic and reducing the burden on molecular diagnostic laboratories.

Generating homogenous cortical preplate and deep-layer neurons using a combination of 2D and 3D differentiation cultures.

Embryonic stem cells (ESCs) can be used to derive different neural subtypes. Current differentiation protocols generate heterogeneous neural subtypes rather than a specific neuronal population. Here, we present a protocol to derive separate two-deep layer cortical neurons from mouse ESCs (mESCs). mESCs were differentiated into mature Tbr1 or Ctip2-positive neurons using a monolayer-based culture for neural induction and neurosphere-based culture for neural proliferation and expansion. The differentiation protocol relies on SMAD inhibition for neural induction and the use of FGF2 and EGF for proliferation and it is relatively short as mature neurons are generated between differentiation days 12-16. Compared with the monolayer-based differentiation method, mESCs can be directed to generate specific deep-layer cortical neurons rather than heterogeneous cortical neurons that are generated using the monolayer differentiation culture. The early analysis of progenitors using flow cytometry, immunocytochemistry, and qRT-PCR showed high neuralization efficiency. The immunocytochemistry and flow cytometry analyses on differentiation days 12 and 16 showed cultures enriched in Tbr1- and Ctip2-positive neurons, respectively. Conversely, the monolayer differentiation culture derived a mixture of Tbr1 and Ctip2 mature neurons. Our findings suggested that implementing a neurosphere-based culture enabled directing neural progenitors to adopt a specific cortical identity. The generated progenitors and neurons can be used for neural-development investigation, drug testing, disease modelling, and examining novel cellular replacement therapy strategies.

Report of a Fatal Case of Hemophagocytic Lymphohistiocytosis Syndrome and a Review of the Literature.

Hemophagocytic lymphohistiocytosis (HLH) is a rare condition in children, with a high mortality rate of 41.99%. Often, due to the atypical presentation of HLH, the syndrome is difficult to diagnose. We report a case of an atypical presentation of HLH and the diagnostic dilemma that we faced. An 11-year-old boy was hospitalized with recurrent fever, hepatosplenomegaly, and worsening jaundice. Initial laboratory workup revealed an elevated prothrombin time (PT), high bilirubin, increased alanine transaminase (ALT), and positive Epstein Barr virus (EBV) deoxyribonucleic acid (DNA) polymerase chain reaction (PCR) and EBV immunoglobulin G (IgG). Based on our patient's presentation and initial laboratory findings, further extensive workup was done, which revealed cytopenias, hypofibrinogenemia, hemophagocytosis on biopsy, absent natural killer (NK) cell activity, high serum ferritin level, and high soluble CD25 (sIL-2 receptor); a diagnosis of HLH was made. He was started on broad-spectrum antibiotics, antivirals, antifungals, and cyclosporine. He became hypoxic and hypotensive and hence was intubated and started on vasopressors. However, his coagulation profile continued to deteriorate. He started bleeding from multiple sites and became unresponsive to ventilatory support, eventually dying as a result of complications of HLH. The ambiguous clinical presentation makes the diagnosis of this syndrome difficult. However, due to the high fatality rate, early recognition and prompt treatment are of utmost importance.

A state of the art on solar-powered vapor absorption cooling systems integrated with thermal energy storage.

The intermittent nature of solar energy is a dominant factor in exploring well-designed thermal energy storages for consistent operation of solar thermal-powered vapor absorption systems. Thermal energy storage acts as a buffer and moderator between solar thermal collectors and generators of absorption chillers and significantly improves the system performance. Vapor absorption chillers are available in half, single, double, and triple-effect modes of operation and operate at temperatures ranging from 75 to 220 °C to produce a cooling effect with COPs ranging from 0.3 to 1.8. Thus, the selection of appropriate solar collectors and thermal energy storages are two significant decisions affecting the consistency of output of a vapor absorption refrigeration system. The present review of state of the art is focused on the appropriate selection, from among different types of solar collectors available to meet the demand of capacity and degree of thermal energy required in operating absorption chillers at optimum performance. Characteristics of various thermal energy storage systems and their integration with solar thermal collectors and absorption chillers are also investigated to meet the demand for heat during non-sunshine hours or periods of low solar intensity. In the latter section, economic feasibility is explored so that a sustainable solar cooling system can be proposed which can work consistently with the best performance throughout its entire life.

Geriatric Conditions and Prescription of Vitamin K Antagonists vs. Direct Oral Anticoagulants Among Older Patients With Atrial Fibrillation: SAGE-AF.

Background: Geriatric conditions are common among patients with atrial fibrillation (AF) and relate to complications of oral anticoagulation (OAC). Objective: To examine the prevalence of geriatric conditions among older patients with AF on OAC and relate type of OAC to geriatric conditions. Methods: Participants had a diagnosis of AF, were aged ≥65 years, CHA2DS2VASC ≥ 2, and had no OAC contraindications. Participants completed a 6-component geriatric assessment that included validated measures of frailty (CHS Frailty Scale), cognitive function (MoCA), social support (MOS), depressive symptoms (PHQ9), vision, and hearing. Type of OAC prescribed was documented in medical records. Results: 86% of participants were prescribed an OAC. These participants were on average aged 75.7 (SD: 7.1) years, 49% were women, two thirds were frail or pre-frail, and 44% received a DOAC. DOAC users were younger, had lower CHA2DS2VASC and HAS-BLED scores, and were less likely to be frail. In Massachusetts, pre-frailty was associated with a significantly lower odds of DOAC vs. VKA use (OR = 0.64, 95%CI 0.45, 0.91). Pre-frailty (OR = 0.33, 95%CI 0.18-0.59) and social isolation (OR = 0.38, 95%CI 0.14-0.99) were associated with lower odds of DOAC receipt in patients aged 75 years or older. Social isolation was associated with higher odds of DOAC use (OR = 2.13, 95%CI 1.05-4.29) in patients aged 65-74 years. Conclusions: Geriatric conditions were common and related to type of OAC prescribed, differentially by age group. Research is needed to evaluate whether a geriatric examination can be used clinically to better inform OAC decision-making in older patients with AF.

Clinical Variables as Predictors of First Relapse in Pediatric Crohn's Disease.

Introduction Crohn's disease (CD) is an immune-mediated inflammatory bowel disease (IBD) that can affect any portion of the gastrointestinal tract from the mouth to the anus. The clinical course of CD is characterized by periods of symptomatic relapse and remission. Clinical variables may identify a subset of patients with CD at risk for relapse. Identifying these patients, and early stratification-based treatment would be of utmost clinical importance in optimizing the management and is likely to improve long-term disease outcome. In pediatric-onset IBD there is a paucity of data for predicting clinical behavior and results are conflicting. With this background, we hypothesized that routinely measured clinical variables at the time of diagnosis would predict relapse in patients with CD, and sought to investigate the clinical predictors of relapse present at the time of diagnosis in our patient population. We further compared differences in clinical variables and laboratory values for patients who relapsed early, compared with those who relapsed late. Methods We conducted a retrospective chart review of patients diagnosed with CD by clinical, radiological, endoscopic and histological criteria at St. John Providence Children's Hospital pediatric GI clinic between 01/2006 and 12/2014. Patients were followed until they had their first relapse or for three years from diagnosis, whichever was earlier. Variables studied included demographic factors (age, gender, race, BMI, BMI percentiles and family history of IBD), presenting symptoms (blood in stools, nocturnal stools, fever, and extra-intestinal manifestations), phenotypic characteristics (using Montreal classification), and laboratory data [white blood cell (WBC) count, hemoglobin, hematocrit, platelet count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP)]. Results Twenty-nine patients were included in the study. One was lost to follow up, and 28 were included in the analyses. The relapse rate was 50% at three years, and 32% patients relapsed within one year of diagnosis. Low BMI percentile at diagnosis (41.5 ± 28.8 vs. 18.0 ± 20.3; p-value 0.03) was a predictor of relapse. Comparing early relapse to those who relapsed late, there were no statistically significant differences between the two groups. Conclusions Low BMI percentile at presentation was associated with increased risk of relapse, suggesting that routinely measured clinical variables may have role in predicting first relapse in this patient population. There was no significant difference in the variable comparing patients who relapsed early vs. those who relapsed late. Future prospective studies with larger sample sizes need to be done to predict relapse.