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Background Right ventricular systolic dysfunction ( RVSD ) is a known risk factor for adverse outcome in surgical aortic valve replacement. Transcatheter aortic valve replacement ( TAVR ), on the other hand, has been shown to be either beneficial or have no effect on right ventricular systolic function. However, the prognostic significance of RVSD on TAVR has not been clearly determined. We conducted a systematic review and meta‐analysis to define the impact of RVSD on outcomes in terms of 1‐year mortality in patients with severe aortic stenosis undergoing TAVR . Methods and Results An extensive literature review was performed, with an aim to identify clinical studies that focused on the prognosis and short‐term mortality of patients with severe symptomatic aortic stenosis who underwent TAVR . A total of 3166 patients from 8 selected studies were included. RVSD , as assessed with tricuspid annular plane systolic excursion, fractional area change or ejection fraction, was found to be a predictor of adverse procedural outcome after TAVR (hazard ratio, 1.31; 95% CI, 1.1–1.55; P =0.002). Overall, we found that RVSD did affect post‐ TAVR prognosis in 1‐year mortality rate. Conclusions Patients with severe, symptomatic aortic stenosis and concomitant severe RVSD have a poor 1‐year post‐ TAVR prognosis when compared with patients without RVSD . Right ventricular dilation and severe tricuspid regurgitation were associated with increased 1‐year morality post‐ TAVR and should be considered as independent risk factors. Further evaluations of long‐term morbidity, mortality, as well as sustained improvement in functional class and symptoms need to be conducted to determine the long‐term effects.

Introduction: Cardiovascular Disease (CVD) is the leading cause of death in the United States. According to the Centers for Disease Control and Prevention (CDC), one person dies every 37 seconds from complications of CVD. One of the main complication of CVD is acute coronary syndrome (ACS) which includes unstable angina as well as an acute myocardial infarction (AMI). 1 More than 790,000 Americans have an AMI annually, of which 73% are first-time AMIs. 2 These events generally affect older people, with an average age of 65.6 years for men and 72 years for women. Furthermore, only 0.3% of men and women under the age of 39 will have an AMI. 3,4 As a result, it is often overlooked among this population in the acute care setting. We present the case of a young man with a delayed diagnosis of ACS despite typical presentation and EKG findings. Case presentation: A 27 year old male presented after three days of progressive substernal chest pain at rest. ECG revealed anterolateral ST elevations, but “No STEMI” was noted on the EKG and a troponin was not drawn for 4 hours. While the ED did not have a specific diagnosis in mind, they did not believe such a young person likely had ACS and originally ‘misread’ the EKG. Triage to PCI did not occur until troponin returned positive later that afternoon, more than 8 hours after initial presentation. Cardiac angiography showed a complete occlusion of the mid LAD requiring a single DES. Post-procedure ECG showed persistent anterolateral ST elevation raising concern for future complications in part due to delayed triage. Discussion: The delayed presentation and triage of this patient warrants discussion. While there is a lack of data on door to balloon time based on age for ACS patients, it appears extremely likely that this diagnosis was missed, despite EKG findings and typical chest pain, in part due to age related bias. This case raises concern that providers are hesitant to diagnosis ACS in young patients due to its low prevalence in this population and warrants further study on steps that can be taken to decrease missed ACS diagnoses and the resultant suboptimal medical outcomes that may follow.

Airborne particulate matter has now become an important global environmental issue because of its many diverse effects on overall health and environmental degradation. Because of its unique complexity, solutions to this problem are challenging. The main objectives of this study were to assess the mineralogical composition and selected chemical properties of atmospheric settleable particulate materials from 15 locations in Sulaimani City, Kurdistan Region, Iraq, sampled between August 2009 and March 2010. In addition, representative samples from a heavy dust storm that affected the region on February 22, 2010, were collected from 3 locations within the city. Organic carbon, total carbonate (CaCO3 equivalent), and total free iron contents, along with pH, were determined in all samples. Mineralogical analysis of the collected samples was performed by x-ray diffraction. Carbonates made up the largest fraction of the identified minerals and were predominantly in an active form. The following abundant minerals occurred in all the studied dust samples in decreasing amounts: calcite, clay minerals, quartz, feldspar, and dolomite. The clay fraction was composed (in descending order of abundance) of palygorskite, illite, muscovite, chlorite, and smectite. Samples from the dust storm event contained gypsum minerals that were not present in the other samples and had the highest percentage of dolomite of all samples, indicating that settleable particulate matter from the meteorological dust storm had a different source than local dust.

Micro wind turbine blades for low average wind speed regions like the Arabian Peninsula, Jordan Desert and United Arab Emirates are designed and implemented. Wind profiles for two locations in UAE are investigated and utilized in the design and the economic analysis. Airfoils BW3, A18 and SG6043 are selected and utilized as candidates for designing micro turbine blades. Blade element momentum theory is used to design the blade 3D geometry. A methodology to optimize the blade geometry for average wind speed 5 m/s based on operational Reynolds number is developed and utilized. To account for the aerodynamic behavior over the 3D blade geometry, the power coefficient for the blades of each airfoil is obtained using the simulation software QBlade. Blades developed using airfoil BW3 showed the highest performance. A prototype is built using 3D printer and tested in open air environment (natural environment) to validate the simulation results. Comparison with existing commercial wind turbines according to cost and output power is carried out based on the concept of replacing wind turbines swept area with the equivalent array of micro wind turbines. The results show that the new design is more cost-effective and more wind energy is harnessed using equivalent swept area.