Therapeutic Options for the Treatment of Hypertension in Children and Adolescents

Primary hypertension in children is increasing in prevalence with many cases likely going undiagnosed. The prevalence is currently estimated at between 3%–5% in the United States and may be higher in certain ethnic groups. Primary hypertension, once felt to be rare in children, is now considered to be about five times more common than secondary hypertension. This review provides information to guide physicians through an organized approach to: 1) screening children and adolescents for hypertension during routine visits; 2) using normative percentile data for diagnosis and classification; 3) performing a clinical evaluation to identify the presence of co-morbidities; 4) initiating a plan of care including subsequent follow-up blood pressure measurements, therapeutic lifestyle changes and pharmacologic therapies

Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: An international case-cohort study

We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts. A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (\u3baw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the Cindex. A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (\u3baw=0.65, IQR 0.53-0.72, p20 years of experience (C-index=0.72, IQR 0.0-0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70-0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72-0.75). Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts

Matchline dosimetry of half beam technique at fixed SSD using Co-60 and 4 MV photons in the treatment of head and neck tumors

The problem of beam divergence and overlapping of adjacent fields in the conventional treatment of cancer of the head and neck is well known. The use half beam technique has been suggested as one way of solving this problem. This work reports a matchline dosimetry of this technique using Co-60 beam and 4 MV photons beam and fixed SSD technique

Evaluation of volumetric modulated arc therapy technique for cranio-spinal irradiation: A rando - phantom based dosimetric study

Background: In this study, clinical advantages and the dosimetric accuracy of volumetric modulated arc therapy (VMAT) technique for cranio-spinal irradiation (CSI) were investigated and compared with field in field (FinF) and intensity modulated radiotherapy (IMRT) techniques. Materials and Methods: The organs at risk (OARs) and planning target volume (PTV) were generated on the RANDO phantom computerized tomography (CT) image series. The dose-volume parameters for PTVs and OARs were compared for three techniques. Furthermore, the dose distribution inside the RANDO phantom was measured with thermoluminescent dosimeter (TLD) for all three techniques. Comparisons were done between measured and calculated doses of field junctions, targets and OARs. Results: FinF failed to obtain an adequate dose distribution for the upper spine (US), while VMAT and IMRT provided good dose coverage for all parts of the PTV. The most homogeneous dose distribution at the field junctions was obtained with the VMAT. Although heart, thyroid, intestine, lung, liver and testicular maximum doses were lower for the VMAT, the mean doses were higher except for the heart and thyroid. The absolute volume receiving prescription dose was significantly lower for the VMAT. The median differences between the TLD measurements and TPS calculations were 0.27% (7.8, -9.7; p=0.394), -0.28% (8.1, -10.7; p=0.322) and 0.33% (8.4, -12; p=0.338) for the FinF, IMRT and VMAT, respectively. These differences were not found statistically significant for the VMAT technique, as were the other two techniques. Conclusion: We conclude that the VMAT technique is the optimal Linac based CSI treatment in regards to dose coverage, dose homogeneity in field junctions and OAR sparing for higher doses. In addition, the VMAT showed dose distribution accuracy as good as the two other techniques in measurements simulating real clinical situations

Dielectric characterization of electro-coagulated boron waste

WOS: 000330143000055The source of electro-coagulation boron waste (ECBW) is wastewater. In order to remove boron from wastewater, boron carried to mud in the form of industrial solid waste is rinsed through electrocoagulation method. The dielectric dispersion properties of the ECBW were analyzed determining the parameters such as complex dielectric functions, dissipation factor and surface conductivity. It is found that at lower frequencies, ECBW sample exhibits a high dissipation factor. The Cole-Cole plots of the sample indicate that the dielectric dispersion mechanism is a Debye type. The boron waste exhibits a high resistance material behavior with a value of 1.03 x 10(9) ohm/sq. and this result is consistent with the electrical behavior of ECBW plate. This study has shown that due to its high resistance and high dielectric dissipation factor, ECBW can be a valuable material for use in many industrial applications which require electrostatic dissipation or electromagnetic shielding. (C) 2013 Elsevier Ltd. All rights reserved.Yildiz Technical University [2011-01-01-KAP01]This work was partially supported by Yildiz Technical University through the project number is 2011-01-01-KAP01