A significant portion of the total primary energy is consumed by today's buildings in developed countries In many of these buildings, the energy consumption can be significantly reduced by adopting energy efficiency strategies Due to environmental concerns and the high cost of energy in recent years there has been a renewed interest in building energy efficiency This article strives to make an exhaustive technical review of the building envelope components and respective improvements from an energy efficiency perspective Different types of energy efficient walls such as Trombe walls, ventilated walls, and glazed walls are discussed Performance of different fenestration technologies including aerogel, vacuum glazing and frames are presented Advances in energy efficient roofs including the contemporary green roofs, photovoltaic roofs, radiant-transmittive barrier and evaporative roof cooling systems are discussed Various types of thermal insulation materials are enumerated along with selection criteria of these materials The effects of thermal mass and phase change material on building cooling/heating loads and peak loads are discussed Application of thermal mass as an energy saving method is more effective in places where the outside ambient air temperature differences between the days and nights are high Air tightness and infiltration of building envelopes are discussed as they play a crucial role in the energy consumption of a building Energy efficiency approaches sometimes might not require additional capital investment For example, a holistic energy efficient building design approach can reduce the size of mechanical systems compensating the additional cost of energy efficiency features

Passive building energy savings: A review of building envelope components

These guidelines are designed to assist the pediatrician in caring for the child in whom a diagnosis of Down syndrome has been confirmed by chromosome analysis. Although a pediatrician's initial contact with the child is usually during infancy, occasionally the pregnant woman who has been given a prenatal diagnosis of Down syndrome will be referred for review of the condition and the genetic counseling provided. Therefore, this report offers guidance for this situation as well.

Health Supervision for Children With Down Syndrome

Increasing recognition of malformations of cortical development and continuing improvements in imaging techniques, molecular biologic techniques, and knowledge of mechanisms of brain development have resulted in continual improvement of the understanding of these disorders. The authors propose a revised classification based on the stage of development (cell proliferation, neuronal migration, cortical organization) at which cortical development was first affected. The categories are based on known developmental steps, known pathologic features, known genetics (when possible), and, when necessary, neuroimaging features. In those cases in which the precise developmental and genetic features are uncertain, classification is based on known relationships among the genetics, pathologic features, and neuroimaging features. The major change since the prior classification has been a shift to using genotype, rather than phenotype, as the basis for classifying disorders wherever the genotype-phenotype relationship is adequately understood. Other substantial changes include more detailed classification of congenital microcephalies, particularly those in which the genes have been mapped or identified, and revised classification of congenital muscular dystrophies and polymicrogyrias. Information on genetic testing is also included. This classification allows a better conceptual understanding of the disorders, and the use of neuroimaging characteristics allows it to be applied to all patients without necessitating brain biopsy, as in pathology-based classifications.

A developmental and genetic classification for malformations of cortical development

https://jdc.jefferson.edu/cgi/viewcontent.cgi?article=1106&context=willsfp

Tumors of the conjunctiva and cornea

Erectile Dysfunction in Diabetes Mellitus

A retrospective review of 307 men with Peyronie's disease.

Aim—To evaluate the clinical features, treatment results, and recurrence rates in patients with either intraepithelial or invasive squamous cell carcinoma of the conjunctiva. Methods—Retrospective analysis of 60 cases (22 conjunctival intraepithelial and 38 invasive squamous cell carcinomas) to determine patterns of clinical presentation, aetiological factors, and treatment results. The mean patient age was 64 years old. 70% of the patients were male. Patients were treated with a variety of therapies, depending on the degree of tumour involvement; most cases were treated with frozen section controlled excision and adjunctive cryotherapy. Modified eye wall resection or enucleation was done for intraocular invasion and exenteration was done for orbital involvement. Results—Red eye (68%) and ocular irritation (57%) were the most common presenting symptoms. 44% of the patients had other eye findings consistent with extensive solar exposure. 20% of the patients had a history of malignant skin tumours. Visceral malignancies developed in 8%. Scleral involvement was present in 14 (37%), intraocular involvement in five (13%), and orbital invasion in four (11%) cases with invasive squamous cell carcinoma. After a mean follow up of 56 months (18‐226 months) the rate of new or recurrent tumours was 4.5% for intraepithelial squamous carcinoma and 5.3% for invasive squamous cell carcinoma. No patient developed metastases or tumour related deaths. Conclusion—Excision with intraoperative control of the surgical margins and adjunctive cryotherapy results in good tumour control rates.

https://bjo.bmj.com/content/bjophthalmol/83/1/98.full.pdf

Intraepithelial and invasive squamous cell carcinoma of the conjunctiva: analysis of 60 cases

Laboratory evaluation of hypercoagulable states in patients with central retinal vein occlusion who are less than 56 years of age.

Fifty-five patients with Down's syndrome were examined to evaluate the characteristics and frequency of ocular findings. Of these patients, 29 (52.7%) were hypermetropes, 7 (12.7%) were emmetropes, and 7 (12.7%) were myopes; astigmatism of more than 3.00 diopters was present in 7(12.7%) patients. Strabismus was observed in 12 (21.8%) patients. All but one of these 12 patients also had esotropia. Congenital nasolacrimal duct obstruction was present in 12 subjects (21.8%). Blepharitis was found in 19 (34.5%) cases. Nystagmus occurred in 7 (12.7%) patients. Brushfield spots were detected in only 20 (36.3%) of the patients and were more common in light-colored irides. Lens opacities were diagnosed in 11 (20%) patients, and two underwent successful cataract surgery. On fundus examination, an increased number of retinal vessels crossing the optic nerve head was detected in 21 (38.1%) cases. One of the patients had a retinal detachment. Significant but correctable ocular problems are present in patients with Down's syndrome and may interfere with the quality of life of the patient and with binocular vision. Surgical intervention may be needed for strabismus and for cataracts.

Ocular findings in 55 patients with Down's syndrome.

AIM—To evaluate retrospective data on the clinical findings, histological features, radiological diagnosis, and management outcomes in orbital lymphangioma.
METHODS—Data on 26 orbital lymphangioma patients managed over 16 years were re-evaluated. The computed tomograph and magnetic resonance scans and histological slides were reviewed. Parametric techniques were used to assess correlations among clinical, radiological, and histopathological factors.
RESULTS—At presentation proptosis was present in 85%, ptosis in 73%, and restrictive eye movements in 46% of patients. The accuracy of the initial radiology interpretations was 77%. 24 cases required one or more surgeries. The mean follow up was 9.2 years (range 1-14 years). 58% of patients developed recurrences. In cases that recurred, motility restriction was significantly more frequent at initial examination than cases without recurrence (p<0.05). After therapy, 75% of patients were satisfied with their visual function and cosmetic appearance.
CONCLUSIONS—Conservative management of orbital lymphangioma with multiple partial resections may achieve satisfactory results.

Keywords: orbital lymphangioma

https://bjo.bmj.com/content/bjophthalmol/83/1/76.full.pdf

Murat Tunc

Papers

A retrospective review of 307 men with Peyronie's disease.

Intraepithelial and invasive squamous cell carcinoma of the conjunctiva: analysis of 60 cases

Laboratory evaluation of hypercoagulable states in patients with central retinal vein occlusion who are less than 56 years of age.

Ocular findings in 55 patients with Down's syndrome.

Orbital lymphangioma: an analysis of 26 patients