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Introduction: Iris retraction syndrome (IRS) is a rare clinical condition characterized by a backbowing of the iris positioned on the lens with a complete pupillary block. Immune checkpoint inhibitors (ICIs) are a new class of immunomodulating agents used in cancer therapy, and although they have high response rates, ophthalmic-related side effects have been reported. We report a rare case of bilateral IRS with hypotony after therapy with nivolumab. Case Presentation: We present a case of bilateral IRS with hypotony, 3 mm Hg OD and 5 mm Hg OS, after therapy with nivolumab. The patient presented with decreased vision, corneal edema, keratic precipitates, deep anterior chamber with posterior synechiae, and hypotony maculopathy. Anterior segment OCT revealed a sharp posterior displacement of the iridolenticular diaphragm consistent with IRS. Discontinuation of nivolumab until ocular improvement was suggested, following oncologic consultation. Four months later, the patient exhibited iris bombé with angle closure and increased IOP. This was managed with phacoemulsification and concomitant surgical iridectomy. One month after surgery, the patient’s IOP had returned to physiologic values, and the iris configuration had returned to normal. Conclusion: The exact mechanism of IRS remains unclear, but it is suggested that an aqueous imbalance, in conjunction with uveitis and hypotony, creates an anterio-posterior movement of the iridolenticular diaphragm when the pupillary block is present. Our case highlights the importance of monitoring patients receiving ICIs for ophthalmic adverse effects and prompt management to prevent permanent visual damage. In conclusion, this is the first reported case of IRS after therapy with ICIs. Further research is needed to fully understand the exact mechanism by which it is induced.

Purpose: To present a case involving a rarely seen prototype posterior chamber phakic IOL (PC-pIOL) in a highly myopic patient with bilateral cataract. Observations: A 64-year-old male presented to our clinic with poor vision in both eyes. Clinical examination revealed bilateral mature cataract, phacodonesis as well as a PC-pIOL implanted 35 years ago to address his high myopia. The visual acuity (VA) was 20/200 in the right eye and no light perception in the left eye. PC-pIOL extraction as well as 23G pars plana vitrectomy (PPV) and fragmentation surgery was scheduled for the right eye. The left eye was treated conservatively. Successful extraction of the PC-pIOL was performed while it was easy to remove. It was a bow-tie shaped lens with a collar-stud-like button in the middle which extended anteriorly into the anterior chamber through the pupil. PPV with lens fragmentation was successful and the patient was left aphakic in order to avoid the placement of a zero diopter IOL. Final best corrected VA was 20/25 one month post-surgery. Conclusions and importance: Removal of this rarely seen pIOL was performed without difficulty while excellent VA was achieved. Aphakia following complete vitrectomy represented a viable option in this case. Furthermore, we highlight the clinical manifestations associated with this IOL more than three decades after implantation.

(1) Background: Lipid accumulation product (LAP) is an anthropometric index of abdominal adiposity that has been associated with increased cardiovascular risk. We aimed to explore the association of LAP with cardiovascular hospitalizations and compare its predictive accuracy with other indices such as body mass index (BMI) and waist circumference. (2) Methods: LAERTES was a prospective, population-based cohort that recruited consecutive patients with stable ischemic heart disease (SIHD) from two Greek hospitals in Athens. Data from 770 participants (13% women, median age 62 years) with a median follow-up of 4.3 years were analyzed in relation to the occurrence of adverse cardiovascular events mandating hospital admission (non-fatal myocardial infarction [MI], non-fatal ischemic stroke and malignant ventricular arrhythmias). (3) Results: A total of 127 (16.5%) of the participants were admitted to cardiology clinics over the follow-up period; 12.4% of them developed MI, 2.6% ventricular arrhythmia and 1.5% ischemic stroke. Patients with cardiovascular hospitalization had higher BMI, larger waist circumference, higher LAP and triglycerides and lower HDL-cholesterol than patients without hospitalization. Upper LAP quartile and hypertension were independent predictors for cardiovascular hospitalization (HR: 2.20, 95% CI: 1.12–4.34, p = 0.02 and HR: 1.57, 95% CI: 1.03–2.39, p = 0.03, respectively). (4) Conclusions: Higher LAP quartiles are predictive of adverse cardiovascular events leading to hospital admission and deserve further evaluation in dedicated studies.

Objectives:Our aim was to perform a perfluorobutylpentane (F4H5) washout in conjunction with glaucoma drainage device (GDD) placement in patients with silicone oil (SO)-induced glaucoma. In this report we present our preliminary results concerning the effectiveness in clearing the SO and the safety of the procedure.Materials and Methods:Eight patients who previously underwent pars plana vitrectomy with SO tamponade due to retinal detachment were selected. Removal of SO was performed on average 10 months after initial surgery. All patients developed glaucoma with evidence of SO remnants in the anterior chamber (AC) and angle. Removal of the remaining SO with F4H5 washout was performed in all cases with concomitant insertion of a GDD to treat the refractory glaucoma. Intraocular pressure (IOP), SO remnants, endothelial cell count, and need for glaucoma medications were evaluated up to 12 months after the surgical procedure.Results:All patients had uneventful surgery with no major complications 12 months postoperatively. A marked reduction of SO remnants in the AC and angle was observed in all cases after surgery. There was a 60.9% decrease in mean IOP 12 months postoperatively (p0.05), and there were no signs of corneal edema.Conclusion:F4H5 is an effective emulsifier for removing SO remnants and may be safely used in conjunction with GDD placement in order to control IOP in eyes with silicone oil-induced glaucoma.

Background and Objectives: Several studies suggest the complex relationship between Endothelin-1 (ET-1) levels with various types of glaucoma. This systematic review and meta-analysis explore ET-1 levels in plasma and aqueous humor among different types of glaucoma. Materials and Methods: A literature search (PubMed, ScienceDirect, Cochrane Library) was made up to April 2024 (PROSPERO: CRD42023430471). The results were synthesized according to PRISMA Guidelines. Results were presented as standardized mean differences (SMD) with 95% confidence intervals (CI). Results: A total of 2597 subjects (1513 patients with glaucoma vs. 1084 healthy controls) from 23 studies were included in a meta-analysis. Notably, patients with glaucoma reported significantly higher plasma levels of ET-1 compared to controls (SMD: 1.21, 95% CI: 0.59–1.82, p < 0.001). Particularly, plasma ET-1 levels were higher in primary open-angle glaucoma (POAG) (SMD: 0.87, 95% CI: 0.09–1.65, p < 0.05), normal-tension glaucoma (SMD: 0.86, 95% CI: 0.27–1.46, p = 0.05), and angle-closure glaucoma patients (SMD: 1.03, 95% CI: 0.43–1.63, p < 0.001) compared to healthy controls. Moreover, ET-1 aqueous humor levels were significantly higher in patients with glaucoma compared to controls (SMD: 1.60, 95% CI: 1.04–2.15, p < 0.001). In particular, aqueous humor levels were higher in POAG patients (SMD: 2.03 95% CI: 1.00–3.14, p < 0.001), and pseudoexfoliative glaucoma patients (SMD: 2.03, 95% CI: 1.00–3.07, p < 0.001) compared to controls. Conclusions: This meta-analysis indicates that elevated levels of ET-1 plasma and aqueous humor are significantly associated with different types of glaucoma. The pathogenesis of ET-1-related mechanisms may vary across different glaucoma types, indicating that possible therapeutic approaches targeting ET-1 pathways should be tailored to each specific glaucoma type.

Abstract Corneal endothelium is a single cell layer that is mainly responsible for maintaining corneal clarity. Endothelial damage secondary to toxicity, stress, or genetic predisposition are common and in conjunction with the low regenerative ability of the cells, making their preservation critical for maintaining visual acuity. Patients with glaucoma, who are estimated to be close to 80 million worldwide, have a plethora of reasons for developing endothelial damage, being exposed to a spectrum that extends from various medical and surgical interventions to the disease itself. The wide spectrum of glaucoma pharmacotherapy that has been recently extended by addition of newer classes of medications has been the focus of extensive research on its effects on corneal endothelium. Both basic and clinical research have attempted to shine a light on the complex mechanisms associated with the effects of glaucoma medication on corneal endothelium and to answer the important question as to whether these findings are clinically significant. The aim of this review is to summarize and present current literature of the various findings, both from in vivo and in vitro studies that have focused on the complex relationship between different classes of glaucoma medication and their effect on corneal endothelium.

Posterior scleritis is a relatively uncommon form of scleral inflammation of the posterior segment of the eye. Clinical manifestations include ocular pain, headache, pain with ocular movements, and loss of vision. A rare presentation of the disease is acute angle closure crisis (AACC) with elevated intraocular pressure (IOP) secondary to anterior displacement of the ciliary body. Various systemic diseases have been described to co-exist with posterior scleritis; however, psoriasis has not been associated with posterior scleritis. Here, we present a case of posterior scleritis which initially presented as AACC in a patient with pre-existing psoriasis. A 50-year-old male with a history of psoriasis under treatment presented to the emergency department with intense sudden ocular pain and loss of vision on the left eye as well as headache and nausea. A thorough medical and ocular history was taken, and a detailed examination of the anterior and posterior segment was completed including visual acuity and IOP. Initial diagnosis of AACC was made, and appropriate actions were taken with partial resolution of his symptoms. However, upon further work-up including ultrasound (B-scan) of the left eye a final diagnosis of posterior scleritis was made. The patient was treated with steroids and nonsteroidal anti-inflammatory drugs which dramatically improved his condition. Photographic evidence of initial presentation and post-treatment condition was obtained and presented in this report. Posterior scleritis is a potentially vision-threatening condition which is usually challenging to diagnose. In this report, we highlight the challenges one might come into when dealing with different manifestations of the same disease, increasing awareness. This case of posterior scleritis presenting as AACC in a patient with a history of psoriasis enhances what we already know from the literature as well as provides some new insights in the clinical manifestations of posterior scleritis in the setting of psoriasis without arthritis.

The Internet of Things (IoT) is introduced in systems with electrical machines, such as in electric drive systems, wind energy generating systems, and small and special machines, to remote monitor and control the operation for data acquisition and analysis. These systems can integrate with the equipment and retrofit the existing installations. At the end of the control loops there are always motors, or actuators, of big or small ratings, of rotating or linear movements, electrical or nonelectrical, which must produce the motion. This article analyses selected aspects of research and applications of IoT-based control in electric drive systems and of wind energy conversion systems with induction machines. Various applications and study cases of control systems of electrical machines with IoT technology are described. With the IoT-based control of induction machine systems operators can remotely monitor parameters and obtain accurate real-time feedback during fast changing duty cycle operation. Thus, IoT creates multipurpose instruments in the remote control of induction machines. The paper offers a comprehensive analysis of IoT-based control applications in the field of induction machines, with technical details of design, construction, experimental testing, and prototyping, that are useful to energy engineering specialists in the sector of electric drives and wind energy conversion systems.

Lipomatous Hypertrophy of the Interatrial Septum (LHIS) is an unusual condition usually found as an incidental finding on echocardiography. It can create a mass-like bulge typically sparing the fossa ovalis. We describe a 73-year-old overweight Cypriot woman, who visited our clinic in November 2018 and was complaining of dyspnea on exertion, chest tightness, and two episodes of paroxysmal atrial fibrillation for the last eight months. A big sessile mass was detected in the interatrial septum measuring 3.7×4.7 cm during transoesophageal echocardiography. The patient underwent resection of the mass and pericardial patch reconstruction of the defect with significant improvement of her clinical status during the follow-up period. The histopathological analysis suggested LHIS. In patients with persistent cardiac symptoms, a prompt resection is a useful option, although surgery is generally considered unnecessary in this clinical setting.Preprint of this article is available on: https://www.authorea.com/users/380290/articles/496351-a-patient-with-chronic-dyspnea-and-episodes-of-paroxysmal-atrial-fibrillation-in-the-presence-of-a-right-atrial-mass.

Abstract Three spare modules of the ATLAS Tile Calorimeter were exposed to test beams from the Super Proton Synchrotron accelerator at CERN in 2017. The detector’s measurements of the energy response and resolution to positive pions and kaons, and protons with energies ranging from 16 to 30 GeV are reported. The results have uncertainties of a few percent. They were compared to the predictions of the Geant4-based simulation program used in ATLAS to estimate the response of the detector to proton-proton events at the Large Hadron Collider. The determinations obtained using experimental and simulated data agree within the uncertainties.

Herein, we report a case of acute failure of a previously successful trabeculectomy, following an infection with herpes zoster ophthalmicus (HZO). HZO remains a common infection, especially among elderly and immunocompromised patients. There is a strong link between HZO infection, the incidence of secondary glaucoma, and the need for glaucoma filtering surgery. Though, to our knowledge, there are no cases reporting on the effect that a concomitant infection may have on a previously successful trabeculectomy. In our case, a 76-year-old immunocompetent male with primary open-angle glaucoma in both eyes and a history of a successful right eye trabeculectomy 1 year earlier presented with acute primary HZO involving the ophthalmic branch of the right trigeminal nerve. Appropriate topical and systemic treatment was immediately initiated. Three days later, the trabeculectomy bleb showed hyperemia and flattening and concomitant rise of intraocular pressure was noted. A week later, the cutaneous signs were improving yet the trabeculectomy had failed and high intraocular pressure was established, requiring both topical and systemic antiglaucoma medications. Our study suggests that a previously successful trabeculectomy may manifest signs of compromise and subsequent failure following a HZO infection.

In recent years, the environmental effects of both active and legacy mining activity have motivated many research groups worldwide through the use of a variety of methods that have been conducted among diverse environments. In this study, we measured radionuclide concentrations at two coastline locations of the Northern Aegean Sea: Stratoni and Ierissos. We deployed KATERINA II, an in situ gamma ray spectrometer. Our results indicate that the activity concentration for 238U progenies (214Bi), 232Th progenies (208Tl and 228Ac) and 40K vary by up to (33 ± 4) Bq kg−1, (19 ± 3) Bq kg−1, and (420 ± 30) Bq kg−1, respectively. The activity concentration of the 137Cs in Stratoni and Ierissos beach sands were (8.1 ± 2.2) and (3.9 ± 1.2) Bq kg−1, respectively. Lab-based measurements were also collected prior to the in situ data collection for the determination of radionuclide and metal concentrations. The lab-based data were found to be (800 ± 40) μg g−1 and (12 ± 1) μg g−1, for As, (1200 ± 60) μg g−1 and (33.3 ± 0.3) μg g−1 for Pb, (100 ± 6) μg g−1 and (6.0± 0.3) μg g−1 for Cu and (2000 ± 60) μg g−1 and (8.0 ± 0.4) μg g−1 for Zn, respectively. We used the R language and environment for statistical computing to produce radiological maps of the subject beach sands. We used the Enrichment Factor (EF) to estimate assessment indices for the target area and compared them to internationally recommended values. The in situ maps will be discussed since the beach area of the load-out pier area of Stratoni was undergoing the first phase of active remediation. We conclude that the temporal aspect of this dataset can be of significant reference value against future comparative studies after the remediation of the Stratoni beach with potentially denser spatial and temporal data coverage.

Aim: Statins have been established in the market not only due to their ability to lower plasma cholesterol levels but also due to their pleiotropic effects. In the literature, there is a controversy regarding the role of statins in ophthalmology. We aimed to systematically address the possible effect of statin therapy on ocular diseases and to identify if there is a beneficial relationship. Methods: We searched PubMed and Cochrane Library databases up to 31 December 2022 for studies evaluating the effect of statins on ocular diseases. We included all relevant Randomized Control Trials (RCTs) that have been conducted in the adult population. PROSPERO registration number: CRD42022364328. Results: Nineteen RCTs were finally considered eligible for this systematic review, with a total of 28,940 participants. Ten studies investigated the role of simvastatin, suggesting a lack of cataractogenic effect and a possible protective role in cataract formation, retinal vascular diseases, and especially diabetic retinopathy, age-related macular disease progression, and non-infectious uveitis. Four studies investigated lovastatin, showing no cataractogenic effect. Three studies examined atorvastatin, revealing conflicting results regarding diabetic retinopathy. Two studies examined rosuvastatin, indicating a possibly harmful effect on lenses and a significant protective effect on retinal microvasculature. Conclusions: Based on our findings, we believe that statins have no cataractogenic effect. There are indications that statins may have a protective role against cataract formation, AMD, diabetic retinopathy progression, and non-infectious uveitis. However, our results were insufficient for any robust conclusion. Future RCTs, with large sample sizes, on the current topic are therefore recommended to provide more solid evidence.

Introduction - Several studies have shown a strong relationship between schizophrenia and epilepsy. This association implies a common genetic susceptibility for both conditions. This study aims to identify genetic variants of susceptibility to epilepsy and schizophrenia in an Algerian family.Patients and methods - All available members of this family underwent clinical and electroencephalographic evaluation. Genetic analysis by whole exome sequencing was performed after DNA extraction.Results - In this study, we report a family with two brothers having temporal lobe epilepsy associated to schizophrenia in one, and to recurrent depressive disorder in the other. Exome sequencing identified homozygous single nucleotide variant in theRELN gene (rs55689103) in patient with schizophrenia. His brother was heterozygous for the same variant.Conclusion - The polymorphism rs55689103 could be involved in schizophrenic phenotype in this family, but not in epilepsy phenotype. Further investigations of blood Reelin level and RELN promoter methylation are key components to interpreting the results of this study.

In this study, a thermal spring located in the Gulf of Gera (Lesvos Island) is investigated in terms of radiotracers, water flow velocities and acoustic back-scattering properties by in situ observations. Water flow characteristics were deduced using in situ deployments of three marine sensors: an Acoustic Doppler Velocimeter (ADV), a High-Frequency Acoustic Doppler Current Profiler (ADCP), and a medium-resolution underwater gamma-ray detection system. The flow velocity combined with the activity concentration of natural radionuclides in the thermal spring provided information on the characteristics of the thermal spring in the specific gulf. The proposed methodology estimated the water supply, the residence time in the effective area of the in situ systems, and the residence time in the gulf. Eventually, the estimation of the characteristics of the discharged water source resulted from the synthetic evaluation of oceanographic measurements alongside appropriate models.

Hydraulic turbines contribute to 60% of renewable energy in the world; however, they also entail some adverse effects on the aquatic ecology system. One such effect is their excessive noise and vibration. To minimize this effect, one of the most effective and feasible solutions is to modify the design of the turbine rotor blade by introducing a skew. In this study, two 0.3-meter tidal turbines with 0-degree (no-skewness) and positive 90-degree skewness made of stainless steel 316L were designed and printed using a 3-D printing powder bed fusion technique. These rotors were then tested at the Emerson Cavitation Tunnel (ECT) at Newcastle University, UK, and the variation in the skewness of the blades of the turbines as a function of the power coefficient on a given tip speed ratio (TSR) value was ascertained. Results showed that the highly skewed rotor had significantly lower drag and torque fluctuations, with a slight decrease in efficiency compared to the non-skewed one, which warrants further investigation on the effect of added skew to reduce vibration and noise. Numerical simulations were also performed for verification and validation of the experimental tests, using the H45 dynamometer at the ECT. A comprehensive software code for propellers and tidal turbines, ROTORYSICS, was used to examine the cavitation effect of the two rotors; a comparison was made for both, with and without cavitation. The results indicate that for a high immersion depth of tidal turbine rotors, cavitation rarely occurs, but for hydrokinetic turbines that are installed on dams in rivers and falls, cavitation could be a serious concern. It was concluded that the 0-degree skewed rotor is more hydrodynamically efficient than the 90-degree skewed rotor.

The technology of Internet of Things (IoT) can be integrated with systems of electrical machines, for electric drives and wind and solar generation systems, and advance controlling and monitoring. This work presented recent research and progress of electrical drives with IoT technology, regarding design, operation, and trial of the control system for induction motors (ΙΜ). Also, the developed software code and hardware units for speed control were detailed and the results obtained from tests of performance of the ΙΜ integrated with IoT were described. With the IoT integration set-up, the operator can control the frequency values, obtain real-time feedback of the process, and monitor the system during varying loads in steady state. The operation of the ΙΜ system driven by inverter and its monitoring over IoT was proven to have high-accuracy speed control and increased efficiency at supersynchronous speeds. Thus, IoT establishes potentials to become a multipurpose tool in the industrial control of electric drives. This paper established one case study of an IoT set-up and control technique for IM, which is suitable for energy engineering experts in the field of IoT control of industrial equipment.

The underwater gamma-ray spectrometer KATERINA was calibrated in a special tank and then demonstrated in the Southern Caspian Sea to determine the radioactivity levels in seawater as well as in the sediment. The simulated marine efficiency of the in situ detection system was validated analyzing the high energetic (1764 keV of 214Bi and 2614 keV of 208Tl) gamma-ray peaks using their known activity concentration as determined from the low energy emissions. The analysis of the in situ gamma-ray spectra in a short acquisition time period provided quantitative data for 226Ra and 232Th progenies as well as for 40K. A satisfactory analysis was performed for quantifying the observed energy peaks in the seawater and sediment measurements acquired at the south coast of the Caspian Sea. The spectrum in the water tank was also analyzed using full spectrum analysis methods, and the reproduced spectrum was in a very good agreement with the experimental spectrum giving as an output the activity concentrations of the observed radionuclides.

Background and objectives: We aimed to evaluate the effects of the water drinking test (WDT) on several systemic and ocular parameters, including choroidal thickness, which was assessed through optical coherence tomography angiography (OCTA), in glaucoma suspects. Materials and Methods: A total of 40 eyes from 20 glaucoma suspects without any systemic or ocular diseases were included in this prospective observational study. All the participants undertook the WDT, which required the drinking of 1 L of table water in 5 min. The outcome measures included IOP, systolic and diastolic blood pressure (SBP and DBP), mean arterial pressure (MAP), mean ocular perfusion pressure (MOPP), ocular pulse amplitude (OPA), and subfoveal and peripapillary choroidal thickness, which were assessed at baseline and at four 15 min intervals after the WDT. Generalized least squares models and mixed model analyses that take into account repeated measurements were used to assess the changes over time of these parameters. Results: All the ocular and systemic parameters showed statistically significant changes at all time points compared to baseline apart from choroidal thickness. The peak changes were an IOP of 20.1 mmHg versus 17.3 mmHg at 45 min, an SBP of 137.6 mmHg versus 125 mmHg at 30 min, a DBP of 95.9 mmHg versus 85.7 mmHg at 15 min, and an MOP of 53.51 mmHg versus 48.89 mmHg at 15 min. Conclusions: Despite elevations in IOP and significant changes in all the assessed systemic parameters, the WDT was not associated with changes in choroidal thickness in glaucoma suspects.

Research exploring CycleGAN-based synthetic image generation has recently accelerated in the medical community due to its ability to leverage unpaired images effectively. However, a commonly established drawback of the CycleGAN, the introduction of artifacts in generated images, makes it unreliable for medical imaging use cases. In an attempt to address this, we explore the effect of structure losses on the CycleGAN and propose a generalized frequency-based loss that aims at preserving the content in the frequency domain. We apply this loss to the use-case of cone-beam computed tomography (CBCT) translation to computed tomography (CT)-like quality. Synthetic CT (sCT) images generated from our methods are compared against baseline CycleGAN along with other existing structure losses proposed in the literature. Our methods (MAE: 85.5, MSE: 20433, NMSE: 0.026, PSNR: 30.02, SSIM: 0.935) quantitatively and qualitatively improve over the baseline CycleGAN (MAE: 88.8, MSE: 24244, NMSE: 0.03, PSNR: 29.37, SSIM: 0.935) across all investigated metrics and are more robust than existing methods. Furthermore, no observable artifacts or loss in image quality were observed. Finally, we demonstrated that sCTs generated using our methods have superior performance compared to the original CBCT images on selected downstream tasks.

Synchronous primary pancreatic ductal adenocarcinoma (PDAC) is very rare and can be formed either through multicentric carcinogenesis or intrapancreatic metastasis. We report the case of an 80-year-old man with a history of type 2 diabetes mellitus who presented with abdominal pain and weight loss. Laboratory tests showed elevated levels of blood glucose and CA 19-9, and Computed Tomography revealed two hypoenhancing lesions in the head and tail of the pancreas. Endoscopic ultrasound, which is the imaging method of choice for pancreatic cancer, was performed with a fine needle biopsy, and the cytological analysis diagnosed PDAC in both lesions. The patient underwent total pancreatectomy, and pathologic evaluation revealed synchronous primary PDAC with moderate to poor differentiation in the head and tail in the setting of IPMN (intraductal papillary mucinous neoplasia) and chronic pancreatitis. After his recovery from postoperative pulmonary embolism, the patient was discharged home with sufficient glycemic control. Multifocal PDAC occurs more often when precursor lesions, such as IPMN, pre-exist. The optimal treatment for multiple lesions spread all over the pancreas is total pancreatectomy. Diabetes mellitus is a serious complication of total pancreatectomy (new-onset or type 3c), but overall, long-term survival has been significantly improved.

Previous studies have found positive effects of Game-Based Learning for mathematics. While most studies assume that this effect is explained by the presence of flow/immersion during games, this has not yet been established. The aim of the current study is to verify if immersion indeed is associated with mathematical skills improvement when using a Game-Based Learning intervention. This was tested among 59 Greek high school students, using authentic design. After having received a traditional education module, the students were tested and then engaged for four weeks in a desktop-based 3D Virtual Learning Environment where they could play mathematic minigames. They were subsequently re-tested to verify if they showed a significant increase in mathematical skills. The students showed an improvement in their mathematical skills (Cohen's d = 1.26), with significant results for functions, geometry, and thinking skills and methods. On the individual level, about half of the students showed a 10% increase in one of the domains (numbers & calculations, functions, geometry, thinking skills and methods, and algorithms and number theory). Immersion was found to be reflected by engagement and presence, but neither one of these aspects was associated with mathematical achievement after the intervention. It is concluded that Game-Based Learning is an effective approach to increasing mathematical skills, yet the underlying mechanisms are not yet understood. The authors discuss several alternative mechanisms based on the literature that can be verified in future studies.

This article presents an integrated approach for solving the optimization of economic dispatch and commitment EDC problems of hybrid thermosolar concentrating power generating systems using matrix mathematics. The model uses matrices, and is solved by matlab programming. The study case of a hybrid thermosolar system in the north-west of Greece shows the impact of concentrating solar power (CSP) generation on the optimal cost of energy produced: the CSP system increases the operational costs as compared to the fossil fuel thermal systems. To acquire the benefits of cleaner electric energy with diminished emissions versus the minimal cost of electrical energy generation belongs to multicriteria managerial decisions. This approach can be applied to hybrid energy systems with large numbers of thermal and CSP generators. It offers an accurate instrument to energy engineers and researchers, for critical managerial decisions regarding electrical energy economics.

At the present time, as newer techniques and minimally invasive procedures gain popularity among anterior segment surgeons for regulating intraocular pressure, trabeculectomy still has a leading role in glaucoma surgery. Trabeculectomy retains a highly successful and safe profile; however, one of the major complications includes bleb-related infections (BRIs). To date, the most common pathogens remain Gram-positive cocci, but the list of pathogens that have been identified in the literature includes more than 100 microorganisms. Because antibiotic use is more widespread than ever before and our ability to identify pathogens has improved, the pathogen spectrum will broaden in the future and more pathogens causing BRIs will be described as atypical presentations. The scope of this review was to identify all pathogens that have been described to cause bleb-related infections to date, as well as focus on the risk factors, clinical presentation, and various available diagnostic tools used for an appropriate diagnostic workup.

PURPOSE: To report patient outcomes and local tumor control rates in a cohort of patients with biopsy-proven HER-2 positive breast cancer treated with stereotactic radiosurgery (SRS) for brain metastases (BM). METHODS: This international, retrospective, multicenter study, included 195 female patients with 1706 SRS-treated BM. Radiologic and clinical outcomes after SRS were determined and prognostic factors identified. RESULTS: At SRS, median patient age was 55 years [interquartile range (IQR) 47.6-62.0], and 156 (80%) patients had KPS ≥ 80. The median tumor volume was 0.1 cm3 (IQR 0.1-0.5) and the median prescription dose was 16 Gy (IQR 16-18). Local tumor control (LTC) rate was 98%, 94%, 93%, 90%, and 88% at six-, 12-, 24-, 36- and 60-months post-SRS, respectively. On multivariate analysis, tumor volume (p =