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A numerical investigation was carried out in ANSYS Fluent ® on a photovoltaic/thermal (PV/T) system with MXene/water nanofluid as heat transfer fluid (HTF). The interaction of different operating parameters (nanofluid mass fraction, mass flow rate, inlet temperature and incident radiation) on the output response of the system (thermal efficiency, electrical efficiency, thermal exergy efficiency, and electrical exergy efficiency) was studied using a predictive model generated using response surface methodology (RSM). The analysis of variance (ANOVA) method was used to evaluate the significance of input parameters affecting the energy and exergy efficiencies of the nanofluid-based PV/T system. The nanofluid mass flow rate was discovered to be having an impact on the thermal efficiency of the system. Electrical efficiency, thermal exergy efficiency, and electrical exergy efficiency were found to be greatly influenced by incident solar radiation. The percentage contribution of each factor on the output response was calculated. Input variables were optimized using the desirability function to maximize energy and exergy efficiency. The developed statistical model generated an optimum value for the mass flow rate (71.84 kgh -1 ), the mass fraction (0.2 wt%), incident radiation (581 Wm -2 ), and inlet temperature (20 °C). The highest overall energy and exergy efficiency predicted by the model were 81.67% and 18.6%, respectively.

Background: In response to the COVID-19 pandemic, telemedicine utilization has increased dramatically, yet most institutions lack a standardized approach to determine how much to invest in these programs., Methods: We used the Quadruple Aim to evaluate the operational impact of CardioClick, a program replacing in-person follow-up visits with video visits in a preventive cardiology clinic. We examined data for 134 patients enrolled in CardioClick with 181 video follow-up visits and 276 patients enrolled in the clinic's traditional prevention program with 694 in-person follow-up visits., Results: Patients in CardioClick and the cohort receiving in-person care were similar in terms of age (43 vs 45 years), gender balance (74% vs 79% male), and baseline clinical characteristics. Video follow-up visits were shorter than in-person visits in terms of clinician time (median 22 vs 30 min) and total clinic time (median 22 vs 68 min). Video visits were more likely to end on time than in-person visits (71 vs 11%, p < .001). Physicians more often completed video visit documentation on the day of the visit (56 vs 42%, p = .002)., Conclusions: Implementation of video follow-up visits in a preventive cardiology clinic was associated with operational improvements in the areas of efficiency, patient experience, and clinician experience. These benefits in three domains of the Quadruple Aim justify expanded use of telemedicine at our institution., Implications: The Quadruple Aim provides a framework to evaluate telemedicine programs recently implemented in many health systems., Level of Evidence: Level III (retrospective comparative study)., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Chronic kidney disease (CKD) and end-stage renal disease are a global health problem worldwide. In developing countries, it is a particular challenge to deliver optimal hemodialysis (HD) due to prevailing socioeconomic conditions. This has multiple downstream effects, including frequent hospitalizations and increased morbidity. We conducted this retrospective study to identify the etiology of hospital admission in HD patients and to detect the duration and costs associated with their hospitalizations. A total of 42 maintenance HD patients were hospitalized during this time frame and their hospitalizations were studied for the purpose of this study. CKD is growing global public health problem causing socioeconomic impact. Hence, early detection and referral to nephrology services can reduce hospitalization rates after a planned dialysis start thus might improve patients' quality of life., Competing Interests: None

Papillary solid and cystic neoplasm (PSCN) is a rare neoplasm of the pancreas with low-grade malignant potential and favorable prognosis. We report an 18-year-old girl with PSCN presenting with advanced disease. The tumor regressed with six cycles of gemcitabine and cisplantin-based neoadjuvant chemotherapy; spleen-preserving distal pancreatectomy was then done. She is disease-free at 13 months' follow-up.