Further investigation of confirmed urinary tract infection (UTI) in children under five years: a systematic review.

Background: Further investigation of confirmed UTI in children aims to prevent renal scarring and future complications. Methods: We conducted a systematic review to determine the most effective approach to the further investigation of confirmed urinary tract infection (UTI) in children under five years of age. Results: 73 studies were included. Many studies had methodological limitations or were poorly reported. Effectiveness of further investigations: One study found that routine imaging did not lead to a reduction in recurrent UTIs or renal scarring. Diagnostic accuracy: The studies do not support the use of less invasive tests such as ultrasound as an alternative to renal scintigraphy, either to rule out infection of the upper urinary tract (LR- = 0.57, 95%CI: 0.47, 0.68) and thus to exclude patients from further investigation or to detect renal scarring (LR+ = 3.5, 95% CI: 2.5, 4.8). None of the tests investigated can accurately predict the development of renal scarring. The available evidence supports the consideration of contrast-enhanced ultrasound techniques for detecting vesico-ureteric reflux (VUR), as an alternative to micturating cystourethrography (MCUG) (LR+ = 14.1, 95% CI: 9.5, 20.8; LR- = 0.20, 95%CI: 0.13, 0.29); these techniques have the advantage of not requiring exposure to ionising radiation. Conclusion: There is no evidence to support the clinical effectiveness of routine investigation of children with confirmed UTI. Primary research on the effectiveness, in terms of improved patient outcome, of testing at all stages in the investigation of confirmed urinary tract infection is urgently required

Renewable energy choice: Cost and energy analysis of grid connected photovoltaic system in Malaysia

Conventional energy production methods rely upon combustion of hydrocarbon fuels, which exhaust gases that can elevate the temperature of the Earth's atmosphere (greenhouse effect). Alternative methods of power generation are being examined that do not have this negative environmental impact. This study investigates the potential use of a residential grid-connected photovoltaic system in the Klang Valley of Malaysia. A 1-4 kW system would be capable of producing a RM 4,542.00 net profit per year, generating a total cash benefit of RM 95,382.00 in its 21 year project lifespan. Moreover, the system would significantly reduce greenhouse gas emissions (40,604 kg of carbon dioxide, 258 kg of sulfur dioxide, 120 kg of nitrous oxide, and 23 kg of carbon monoxide) throughout its 21 year project lifespan. The results of this study can be used to formulate effective renewable-energy alternatives in Malaysia and elsewhere