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Background To date, there is no comprehensive meta-analysis analyzing the association between alopecia areata, anxiety, and depression. Objective We sought to analyze the existing literature to examine the association between alopecia areata, anxiety, and depression. Methods We extracted literature from four databases including Medline, Embase, PsychINFO, and Web of Science. We utilized the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines in order to finalize a list of relevant articles to be included in our systematic review and meta-analysis. There were no restrictions placed on publication year or age of participants. Results A total of 8 studies that included 6,010 patients with AA and 20,961 control patients were included in the quantitative analysis. These included 4 cross-sectional studies and 4 case-control studies. Analysis of these studies demonstrated a positive association with anxiety (pooled OR, 2.50; 95% CI, 1.54-4.06) and depression (pooled OR, 2.71; 95% CI, 1.52-4.82). Limitations Publication bias may be a limitation of the study. Conclusion This study suggests that patients with AA are at higher risk of both anxiety and depression. Healthcare professionals must be cognizant of this higher risk and consider routine assessment of these conditions and referral to appropriate providers when indicated.

Background Despite high utilization of complementary and alternative medicine (CAM) for alopecia areata (AA), efficacy and safety remain unclear. Objective To identify all CAM therapies studied for treatment of AA. Outcomes of interest included disease course and psychological well-being. Methods PubMed and Embase were searched to identify English articles containing original data investigating CAM in human subjects with AA from 1950-2018. Quality was assessed with Oxford Centre for Evidence Based Medicine criteria. Results Of 1,015 initial citations, 16 articles met inclusion criteria: 5 randomized controlled trials, 5 prospective controlled cohorts, 4 prospective non-controlled cohorts, 1 retrospective cohort, and 1 case series. CAM therapies with best evidence and efficacy for hair growth in AA include essential oil aromatherapy, topical garlic, and oral glucosides of peony with compound glycyrrhizin. Hypnosis and mindfulness psychotherapy represent low quality evidence for improvement of psychological and quality of life outcomes. Adverse events were rare and mild for all therapies evaluated. Limitations Inconsistent or poorly reported study methodology and non-standardized outcomes limit the conclusions that can be made from these studies. Conclusions This work serves to inform physician management of patients with AA seeking CAM, while encouraging further investigation into these therapies to address some of the therapeutic challenges of AA.

Biocompatible nanocomposites (NCs) with antibacterial activity containing organic matrix and inorganic nanoparticles (NPs) are vital for providing a suitable substrate for hydroxyapatite (HA) formation. Therefore, we fabricated a series of biocompatible NCs of chitosan (CS) and tragacanth gum (TG) and different percentages of ZnO NPs and ZnO@Ag NPs as fillers into the CS-TG blend. The characteristics of the NCs were distinguished with the field-emission scanning electron microscope (FE-SEM), X-Ray diffraction, Fourier transform infrared, and transmission electron microscopy (TEM). The CS-TG/ZnO@Ag(1:0.500) NC 8 wt% showed a rough surface according to FE-SEM. Moreover, the TEM image of CS-TG/ZnO NC 8 wt% depicted a uniform dispersion of NPs into the matrix. The biocompatibility of these NCs was evaluated by the formation of HA on their surfaces. The outcomes depicted the deposition of HA on the surface of all NCs. Also, CS-TG/ZnO@Ag(1:0.500) NC 8 wt% exhibited the most HA deposition on its surface. The antibacterial activity of these NCs toward Staphylococcus aureus and Escherichia coli bacteria was evaluated. The CS-TG/ZnO@Ag(1:0.500) NC 8 wt% exhibited a higher inhibition zone diameter in comparison to the ZnO@Ag (1:0.500) NPs for the S. aureus bacteria. Generally, antibacterial activity of the NCs containing ZnO@Ag NPs are more than NCs containing ZnO NPs.

Aims We aimed to assess the compound muscle action potential (CMAP) scan in the follow-up of chronic inflammatory demyelinating polyneuropathy (CIDP) patients and investigate the correlation of CMAP scan parameters with functional and standard electrodiagnostic tests. Methods We evaluated four parameters of abductor pollicis brevis (APB) CMAP scan (i.e., step numbers, step percentage, S10, S90), functional measures (e.g., Medical Research Council Sum Scores), and electrodiagnostic tests, including nerve conduction study (NCS) and motor NCS of the median nerve in the baseline and after six months of treatment. Results Twenty patients completed baseline clinical and electrodiagnostic studies. However, sixteen patients completed the follow-up study. The median of step numbers at baseline was 3.5 (2–4.2), which decreased to 2.5 (0–3) (p = 0.005). After the treatment, step percentage reduced from 28.6 (23.9–38.7) to 13.4 (0–23.6) (p = 0.001). The scores obtained from the clinical scales showed significant recovery of most of the functions, while the alterations of NCSS and NCS of the median nerve were not significant. Conclusions We found a significant reduction in step number and step percentage after follow-up. This alteration was not reflected in standard electrodiagnostic values. The improvement of functional scales alongside the CMAP scan parameters suggests that the CMAP scan could be considered an appropriate outcome measurement in research and clinical fields.

Opium sale is prohibited in Iran, and sellers mix it with lead to increase the weight. Herein, we describe neuromuscular findings in nine patients who developed lead poisoning due to opium/drug consumption. The mean age of patients was 53 ± 3.5 years and their mean blood lead level was 122.6 ± 20.8 μg/dL. Most of the patients had an acute/subacute course presenting as axonal or demyelinating sensorimotor polyneuropathy, motor neuron disease, and multiple mononeuropathies with favorable response to the chelation therapy. Lead poisoning should be considered in patients with a history of opium use and neuromuscular symptoms.

Bubble dynamics (i.e., bubble shape, bubble size, bubble rise velocity) and bed voidage in a semi-cylindrical gas-solid fluidized bed at various superficial gas velocities and particle sizes were measured by fiber optic probe and image analysis. Measurements in the semi-cylindrical bed were compared with those in the cylindrical bed to investigate the similarity of two fluidized beds and verifying whether a semi-cylindrical bed can be used for measuring hydrodynamic properties of fluidized beds. Experiments were carried out in two Plexiglas semi-cylindrical and cylindrical fluidized beds of 14 cm in diameter at ambient pressure and temperature. Glass beads of various sizes (120, 290 and 450 μm) were used as the bed material. The superficial gas velocity was varied in the range of 0.2–0.8 m/s and both beds were operating in the bubbling fluidization regime. It was shown that increase in the particle size leads to decrease in the emulsion phase fraction while increases the fraction of bubble phase. At low gas velocity, the semi-cylindrical fluidized bed contains normal bubbles while at higher superficial gas velocity, elongated bubbles with normal rising velocity can be found. Increase in the particle size leads to increase in the aspect ratio of bubbles. It was found that the average bubble size and rise velocity increases with increasing particle size and superficial gas velocity. Results indicated that the gas-solid distribution, bubble rise velocity and bubble size in both beds are similar and geometry of the cross-section of column (semi-circular and circular) has no significant effect on these parameters. It was shown that the hydrodynamics of both beds are very similar and the difference is negligible. Since measuring the bubble size and rise velocity in the semi-cylindrical bed can be easily done by visual observation compared to those in a cylindrical bed, using a semi-cylindrical fluidized bed instead of two dimensional fluidized bed in the laboratory scale is the preferred choice which provides bubble dynamics close to that in a three-dimensional bed.

Background Cellulitis has many potential mimickers, and its misdiagnosis often leads to unnecessary hospitalizations and higher health care costs. The ALT-70 predictive model offers an objective tool to help differentiate between cellulitis and other clinically similar conditions at the time of initial emergency department (ED) presentation. Objective To evaluate the performance of the ALT-70 predictive model at 24 and 48 hours following ED presentation. Methods We performed a retrospective review of our prior cohort and expanded our data collection to include data at 24 and 48 hours after initial ED presentation. We compared classification measures for the ALT-70 at the time of initial ED presentation, 24 hours after presentation, and 48 hours after presentation. Results There was a statistically significant difference in median ALT-70 score between patients with true cellulitis and those with mimickers of cellulitis at all time points. Sensitivity, specificity, positive predictive value, and negative predictive value of the ALT-70 score was similar across all 3 time points. Limitations Single-center design may reduce generalizability. Conclusion At 24 and 48 hours, the ALT-70 performed similarly to the way it performed at the time of initial ED presentation, allowing for its use in a wider array of clinical settings.

The influence of cohesive interparticle force (IPF) on gas dynamics in a bubbling gas–solid fluidized bed was numerically investigated while the bed hydrodynamics was described with the help of computational fluid dynamics and discrete element method (CFD-DEM). The model was validated by experimental results in terms of total bed pressure drop profile, probability density distribution of instantaneous local bed voidage signals, and Eulerian solid velocity field. The results showed that the model can satisfactorily predict the hydrodynamics of a bubbling gas–solid fluidized bed that is impacted by the presence of cohesive IPF. The validated CFD-DEM model was adopted to delineate the effects of IPF on the distribution of fluidizing gas between the bubble and emulsion phases and bubble characteristics, such as bubble stability and rise path, which could hardly be explored experimentally. Simulation results revealed that the presence of IPF in the bubbling bed alters the distribution of the fluidizing gas between the bubble and emulsion phases in favor of an increase in the propensity of gas to pass through the bed in the emulsion phase. The results also indicated that the bubble stability increases and the straight rise path of bubbles changes to a tortuous path when enhancing IPF.

Hydrodynamic characteristics of a gas-solid semi-cylindrical fluidized bed was experimentally investigated and compared with that of a cylindrical bed by analysis of pressure fluctuations. Pressure fluctuations were analyzed in time and frequency domains using standard deviation, power spectral density function and discrete wavelet transform methods. Experiments were carried out in two semi-cylindrical and cylindrical fluidized beds of 14 cm in diameter each, operating in the bubbling fluidization regime at ambient pressure and temperature. Both beds were filled with glass beads of various sizes (120, 290 and 450 µm). The superficial gas velocity was varied in the range of 0.2–0.8 m/s. Results showed that although the minimum fluidization velocity is influenced by the particle size, it is not affected by the geometry of the bed. It was shown that the hydrodynamics of both beds are very similar and the difference is negligible. Number of large bubbles is slightly larger in the semi-cylindrical bed as compared with the cylindrical bed. Also, increase in the particle size and superficial gas velocity result in a greater difference between the number of large bubbles in both beds and the number of large bubbles in the semi-cylindrical bed increases slightly faster than in the cylindrical bed.

Highlights • Functional seizures remains a complex neuropsychiatric condition to identify and treat. • Practitioners must address management of physical symptoms and underlying causes. • Management strategies can fail if their reasoning is not properly communicated. • Better outcomes may result where treatment rationale is emphasized from outset., Functional seizures can be challenging to properly diagnose, often leading to delays in treatment. The etiology of functional seizures is multifactorial, with psychological factors identified in many, but not all cases. Misdiagnosis may occur due to clinical features mimicking other medical conditions. Once a correct diagnosis is reached, delivery of definitive, evidence-based treatment may be challenging due to limited availability of specialized resources. Research shows psychological education and cognitive behavioral therapy (CBT) have the greatest efficacy. However, individual differences, including acceptance of the diagnosis, therapeutic alliance, duration of symptoms, comorbidities, and access to care may influence outcomes. There is a critical need for reports that can help identify barriers to effective diagnosis and treatment. We present the diagnosis and treatment of a woman who visited the emergency room after an attack of predominant left-sided paralysis, speech dysfunction and altered awareness. Following multiple daily episodes and visits to multiple medical practitioners, testing led to a diagnosis of functional seizures. While the patient was recommended to undergo a variety of therapeutic interventions, including CBT, she ultimately terminated treatment. In a subsequent interview, the patient revealed her personal experience with perceived limitations of acute management strategies. We explore the complexities of diagnosing and treating individuals with functional seizures.

The aim of this review is to provide clinicians with an overview of outcomes in the current literature concerning the use of Photodynamic Therapy to treat Bowen's Disease, also known as Squamous Cell Carcinoma in situ. The review discusses clinical response, recurrence rates, cosmetic outcomes, and adverse effects. Strong evidence shows that PDT is an effective therapy for SCCis with acceptable clinical response rates and lower recurrence rates in comparison to conventional therapies such as cryotherapy and 5-fluorouracil. Furthermore, PDT is associated with superior cosmetic outcomes and is generally well tolerated by patients, with minimal side effects. PDT is especially useful in patients with multiple lesions and those whom are considered to be non-surgical candidates.

The National Cancer Institute's Skin Cancer Intervention across the Cancer Control Continuum model was developed to summarize research and identify gaps concerning skin cancer interventions. We conducted a mapping review to characterize whether behavioral interventions addressing skin cancer prevention and control from 2000 to 2015 included (1) technology, (2) environmental manipulations (policy and/or built environment), and (3) a theoretical basis. We included 86 studies with a randomized controlled or quasi-experimental design that targeted behavioral intervention in skin cancer for children and/or adults; seven of these were dissemination or implementation studies. Of the interventions described in the remaining 79 articles, 57 promoted only prevention behaviors (e.g., ultraviolet radiation protection), five promoted only detection (e.g., skin examinations), 10 promoted both prevention and detection, and seven focused on survivorship. Of the 79 non-dissemination studies, two-thirds used some type of technology (n=52; 65.8%). Technology specific to skin cancer was infrequently used: UVR photography was used in 15.2% of studies (n=12), reflectance spectroscopy was used in 12.7% (n=10), and dermatoscopes (n=1) and dosimeters (n=2) were each used in less than 3%. Ten studies (12.7%) targeted the built environment. Fifty-two (65.8%) of the studies included theory-based interventions. The most common theories were Social Cognitive Theory (n=20; 25.3%), Health Belief Model (n=17; 21.5%), and the Theory of Planned Behavior/Reasoned Action (n=12; 15.2%). Results suggest that skin cancer specific technology and environmental manipulations are underutilized in skin cancer behavioral interventions. We discuss implications of these results for researchers developing skin cancer behavioral interventions.

Dynamic equations for an anisotropic cylindrical shell are derived using a series expansion technique. First the displacement components are expanded into power series in the thickness coordinate relative to the mid-surface of the shell. By using these expansions, the three-dimensional elastodynamic equations yield a set of recursion relations among the expansion functions that can be used to eliminate all but the six of lowest order and to express higher order expansion functions in terms of these of lowest orders. Applying the boundary conditions on the surfaces of the cylindrical shell and eliminating all but the six lowest order expansion functions give the shell equations as a power series in the shell thickness. These six differential equations can in principle be truncated to any order. The method is believed to be asymptotically correct to any order. For the special case of a ring, the eigenfrequencies are compared with exact two-dimensional theory, generally with a good correspondence.

In this article, we study symmetric designs admitting a flag-transitive and point-primitive automorphism group whose socle is a symplectic group of dimension four. We prove a reduction theorem severely restricting the possible parameters of such designs, and we show that such a parameter set belongs to one of the eight infinite families of parameter sets. For four families of these parameter sets, we know two sporadic examples of symmetric designs with parameters ( 45 , 12 , 3 ) and ( 36 , 15 , 6 ) arose from PSp 4 ( 3 ) and two infinite families of 2-designs namely the complement of a point-hyperplane design of PG ( 3 , q ) and the complement of a Higman design. The existence of any symmetric designs with the remaining four parameter sets is still open.

In this study, the effect of CuO/distilled water nanofluid on the performance of evacuated tube solar collector (ETSC) water heater with internal coil under thermosyphon system circulations was experimentally investigated. The volume fraction of nanoparticles was considered at 0.03–0.06%. The mass flow rate of water passing through the coil was varied from 20 to 60 L/h. ASHRAE standard 86–93 was considered to calculate the efficiency of the collector. From the study, we found that the efficiency of ETSC increase when the nanofluid was used as an absorption medium. CuO nanofluids at 0.03% volume fraction in ETSC gave enhancement up to 14%, when compared to water.

Dynamic equations for an isotropic spherical shell are derived by using a series expansion technique. The displacement field is split into a scalar (radial) part and a vector (tangential) part. Surface differential operators are introduced to decrease the length of the shell equations. The starting point is a power series expansion of the displacement components in the thickness coordinate relative to the mid-surface of the shell. By using the expansions of the displacement components, the three-dimensional elastodynamic equations yield a set of recursion relations among the expansion functions that can be used to eliminate all but the four of lowest order and to express higher order expansion functions in terms of these of lowest orders. Applying the boundary conditions on the surfaces of the spherical shell and eliminating all but the four lowest order expansion functions give the shell equations as a power series in the shell thickness. After lengthy manipulations, the final four shell equations are obtained in a more compact form which can be represented explicitly in terms of the surface differential operators. The method is believed to be asymptotically correct to any order. The eigenfrequencies are compared to exact three-dimensional theory and membrane theory.

In this paper, ANFIS (adaptive neuro-fuzzy inference system) as a powerful tool for modeling complex and nonlinear systems, was used to predict permeate volume of oil/water membrane separation process. The data used for modeling the flux behavior consisted of three inputs (TMP, oil concentration, filtration time) and experimental permeation values as the output. First type gaussian membership function was used for fuzzification of input variables and hybrid algorithm was chosen for the learning method of input–output data. Very well agreements were observed between experimental and simulation results. From the results, the ANFIS can be used as a reliable tool for prediction of microfiltration systems’ behavior. The coefficient of determination ( R 2 ) between the experimental and predicted values was greater than 0.99 and the mean percentage error was less than 2%, showing the great efficiency and reliability of the developed model.