Green energy innovation initiatives for environmental sustainability: current state and future research directions.

Worldwide, all countries have been facing the crisis of climate change problem. They have been addressing this issue by focusing on implementing green energy innovation initiatives and promoting a sustainable future through environmental sustainability. In this research study, we focus on examining the role of green finance through green energy innovations, which are taking place in several sectors across different regions to promote environmental sustainability. The study has analysed 152 articles on this research domain through a systematic literature review to understand the present state of existing knowledge. The current study examines the Scopus-indexed research articles from the time period 2002 to 2023. Six emerging themes have been examined to understand their development and the potential impact of green initiatives for environmental sustainability. Various institutional theories have been explored to understand their association with the investigated research area. The paper has discussed multiple challenges that need to be addressed for the speedy implementation of green innovations. Finally, future research questions have been proposed based on the findings from the extant literature and the existing research gaps.

An artificial intelligence-generated model predicts 90-day survival in alcohol-associated hepatitis: A global cohort study.

BACKGROUND AIMS: Alcohol-associated hepatitis (AH) poses significant short-term mortality. Existing prognostic models lack precision for 90-day mortality. Utilizing artificial intelligence (AI) in a global cohort, we sought to derive and validate an enhanced prognostic model. APPROACH AND RESULTS: The Global AlcHep initiative, a retrospective study across 23 centers in 12 countries, enrolled AH patients per NIAAA criteria. Centers were partitioned into derivation (11 centers, 860 patients) and validation cohorts (12 centers, 859 patients). Focusing on 30 and 90-day post-admission mortality, three AI algorithms (Random Forest, Gradient Boosting Machines, and eXtreme Gradient Boosting) informed an ensemble model, subsequently refined via Bayesian updating, integrating the derivation cohort's average 90-day mortality with each center's approximate mortality rate to produce post-test probabilities. The ALCoholic Hepatitis Artificial INtelligence (ALCHAIN) Ensemble score integrated age, gender, cirrhosis, and 9 laboratory values, with center-specific mortality rates. Mortality was 18.7% (30-day) and 27.9% (90-day) in the derivation cohort, versus 21.7% and 32.5% in the validation cohort. Validation cohort 30 and 90-day AUCs were 0.811 (0.779 - 0.844) and 0.799 (0.769 - 0.830), significantly surpassing legacy models like Maddrey's Discriminant Function, MELD variations, ABIC, Glasgow, and modified Glasgow Scores (p<0.001). ALCHAIN Ensemble score also showcased superior calibration against MELD and its variants. Steroid use improved 30-day survival for those with an ALCHAIN Ensemble score>0.20 in both derivation and validation cohorts. CONCLUSIONS: Harnessing AI within a global consortium, we pioneered a scoring system excelling over traditional models for 30 and 90-day AH mortality predictions. Beneficial for clinical trials, steroid therapy, and transplant indications, it's accessible at: https://aihepatology.shinyapps.io/ALCHAIN/.

Predictors and outcomes of withholding and withdrawal of life-sustaining treatments in intensive care units in Singapore: a multicentre observational study.

BACKGROUND: Clinical practice guidelines on limitation of life-sustaining treatments (LST) in the intensive care unit (ICU), in the form of withholding or withdrawal of LST, state that there is no ethical difference between the two. Such statements are not uniformly accepted worldwide, and there are few studies on LST limitation in Asia. This study aimed to evaluate the predictors and outcomes of withholding and withdrawal of LST in Singapore, focusing on the similarities and differences between the two approaches. METHODS: This was a multicentre observational study of patients admitted to 21 adult ICUs across 9 public hospitals in Singapore over an average of three months per year from 2014 to 2019. The primary outcome measures were withholding and withdrawal of LST (cardiopulmonary resuscitation, invasive mechanical ventilation, and vasopressors/inotropes). The secondary outcome measure was hospital mortality. Multivariable generalised mixed model analysis was used to identify independent predictors for withdrawal and withholding of LST and if LST limitation predicts hospital mortality. RESULTS: There were 8907 patients and 9723 admissions. Of the former, 80.8% had no limitation of LST, 13.0% had LST withheld, and 6.2% had LST withdrawn. Common independent predictors for withholding and withdrawal were increasing age, absence of chronic kidney dialysis, greater dependence in activities of daily living, cardiopulmonary resuscitation before ICU admission, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, and higher level of care in the first 24 h of ICU admission. Additional predictors for withholding included being of Chinese race, the religions of Hinduism and Islam, malignancy, and chronic liver failure. The additional predictor for withdrawal was lower hospital paying class (with greater government subsidy for hospital bills). Hospital mortality in patients without LST limitation, with LST withholding, and with LST withdrawal was 10.6%, 82.1%, and 91.8%, respectively (p < 0.001). Withholding (odds ratio 13.822, 95% confidence interval 9.987-19.132) and withdrawal (odds ratio 38.319, 95% confidence interval 24.351-60.298) were both found to be independent predictors of hospital mortality on multivariable analysis. CONCLUSIONS: Differences in the independent predictors of withholding and withdrawal of LST exist. Even after accounting for baseline characteristics, both withholding and withdrawal of LST independently predict hospital mortality. Later mortality in patients who had LST withdrawn compared to withholding suggests that the decision to withdraw may be at the point when medical futility is recognised.

Racial and Ethnic Minorities With Acute Pancreatitis Live in Neighborhoods With Higher Social Vulnerability Scores.

OBJECTIVES: The primary objective was to determine differences in Social Vulnerability Index (SVI) scores among minorities (African-Americans and Hispanics) with acute pancreatitis (AP) compared with non-Hispanic whites (NHWs) with AP. The secondary objectives were to determine differences in diet, sulfidogenic bacteria gene copy numbers (gcn) and hydrogen sulfide (H2S) levels between the 2 groups. MATERIALS AND METHODS: Patients with AP were enrolled during hospitalization (n = 54). Patient residential addresses were geocoded, and the Centers for Disease Control and Prevention's SVI scores were appended. Dietary intake and serum H2S levels were determined. Microbial DNAs were isolated from stool, and gcn of sulfidogenic bacteria were determined. RESULTS: Minorities had higher SVI scores compared with NHWs ( P = 0.006). They also had lower consumption of beneficial nutrients such as omega-3 fatty acids [stearidonic ( P = 0.019), and eicosapentaenoic acid ( P = 0.042)], vitamin D ( P = 0.025), and protein from seafood ( P = 0.031). Lastly, minorities had higher pan-dissimilatory sulfite reductase A ( pan-dsrA ) gcn ( P = 0.033) but no significant differences in H2S levels ( P = 0.226). CONCLUSION: Minorities with AP have higher SVI compared with NHWs with AP. Higher SVI scores, lower consumption of beneficial nutrients, and increased gcn of pan-dsrA in minorities with AP suggest that neighborhood vulnerability could be contributing to AP inequities.

Can green finance facilitate Industry 5.0 transition to achieve sustainability? A systematic review with future research directions.

Most of the world's rising carbon emission results from industrial activities. Previous industrial revolutions did not put much thought into safeguarding the natural world. Governments worldwide have been continuously implementing regulations and policies for the mitigation of climate change to promote sustainable development. To achieve decarbonization, the climate change discussion is merged with Industry 5.0 (I5.0) where green finance (GF) plays a crucial role. This technological metamorphosis of transition from Industry 4.0 (I4.0) to I5.0 will affect humans and their society. I5.0 forms a symbiotic relationship with different aspects of Society 5.0 (S5.0) such as social (human‒machine centricity), ecological (zero emissions), and technological (green innovations). Thus, the I5.0 transition prioritizes greening the economy in pursuit of achieving S5.0. Through a systematic review of 196 articles, this research study concisely summarizes the rapidly expanding body of information. The research domain gave six major themes: Green Innovations (GI), Green Manufacturing Practices (GMP), Circular Economy (CE), Green Supply Chain Management (GSCM), Emerging Economies, and Net Zero Economy (NZE). Finally, a framework has been provided that illustrates the supporting role of GF for the I5.0 transition eventually followed by S5.0. This study provides an overview of these themes with their propositions and future research directions. The present study addresses the knowledge gap by providing valuable contributions to the burgeoning research domain of I5.0 and GF. Moreover, it aims to garner the attention of different stakeholders to integrate these two concepts of research to attain the goal of sustainable development.

MELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis.

Background & Aims: Model for End-Stage Liver Disease (MELD) score better predicts mortality in alcohol-associated hepatitis (AH) but could underestimate severity in women and malnourished patients. Using a global cohort, we assessed the ability of the MELD 3.0 score to predict short-term mortality in AH. Methods: This was a retrospective cohort study of patients admitted to hospital with AH from 2009 to 2019. The main outcome was all-cause 30-day mortality. We compared the AUC using DeLong's method and also performed a time-dependent AUC with competing risks analysis. Results: A total of 2,124 patients were included from 28 centres from 10 countries on three continents (median age 47.2 ± 11.2 years, 29.9% women, 71.3% with underlying cirrhosis). The median MELD 3.0 score at admission was 25 (20-33), with an estimated survival of 73.7% at 30 days. The MELD 3.0 score had a better performance in predicting 30-day mortality (AUC:0.761, 95%CI:0.732-0.791) compared with MELD sodium (MELD-Na; AUC: 0.744, 95% CI: 0.713-0.775; p = 0.042) and Maddrey's discriminant function (mDF) (AUC: 0.724, 95% CI: 0.691-0.757; p = 0.013). However, MELD 3.0 did not perform better than traditional MELD (AUC: 0.753, 95% CI: 0.723-0.783; p = 0.300) and Age-Bilirubin-International Normalised Ratio-Creatinine (ABIC) (AUC:0.757, 95% CI: 0.727-0.788; p = 0.765). These results were consistent in competing-risk analysis, where MELD 3.0 (AUC: 0.757, 95% CI: 0.724-0.790) predicted better 30-day mortality compared with MELD-Na (AUC: 0.739, 95% CI: 0.708-0.770; p = 0.028) and mDF (AUC:0.717, 95% CI: 0.687-0.748; p = 0.042). The MELD 3.0 score was significantly better in predicting renal replacement therapy requirements during admission compared with the other scores (AUC: 0.844, 95% CI: 0.805-0.883). Conclusions: MELD 3.0 demonstrated better performance compared with MELD-Na and mDF in predicting 30-day and 90-day mortality, and was the best predictor of renal replacement therapy requirements during admission for AH. However, further prospective studies are needed to validate its extensive use in AH. Impact and implications: Severe AH has high short-term mortality. The establishment of treatments and liver transplantation depends on mortality prediction. We evaluated the performance of the new MELD 3.0 score to predict short-term mortality in AH in a large global cohort. MELD 3.0 performed better in predicting 30- and 90-day mortality compared with MELD-Na and mDF, but was similar to MELD and ABIC scores. MELD 3.0 was the best predictor of renal replacement therapy requirements. Thus, further prospective studies are needed to support the wide use of MELD 3.0 in AH.

Safety and Efficacy of Endoscopic Submucosal Dissection in the Management of Gastric Tube Cancers After Esophagectomy: A Systematic Review.

Esophagectomy is the proposed standard of care for resectable primary esophageal cancers and recurrent lesions in the reconstructed gastric tube (GT); however, it carries significant morbidity and mortality. Endoscopic submucosal dissection (ESD) has established its role in the management of primary esophageal cancers with growing evidence of its safety in resecting recurrent primary lesions in GT. Our study aims to evaluate the safety and efficacy of ESD in the management of recurrent, localized primary esophageal cancers in GT. We searched PubMed, CENTRAL, EMBASE, Scopus, and clinical trial registries from inception to March 2023 for articles evaluating the safety and efficacy of ESD in the management of recurrent cancerous lesions in GT. Our primary outcome was the en bloc resection rate. Secondary outcomes were curative resection rate, complete resection rate, intra-procedural complication rate, post-procedure complication rate, and five-year survival rate. Seven studies with a total of 165 patients undergoing 192 ESDs were included in the review. The pooled en bloc resection rate was 92.5% (95% CI: 87.7-95.6), which was reported in all seven studies. Pooled complete resection rate was 78.9% (95% CI: 64.5-88.5) per three studies, pooled curative resection rate was 73.9% (95% CI: 63.5-82.2) per four studies, and pooled intra-procedural complication rate was 10.2% (95% CI: 1.5-46.3), which was reported in four studies. Only three studies reported a five-year survival rate that was 65.5% (95% CI: 56.0-73.9). ESD is safe and efficacious in the management of GT cancer after esophagectomy.

EUS-guided gallbladder drainage in a patient with Billroth II reconstruction.

Video 1EUS-guided gallbladder drainage in a patient with Billroth II gastrojejunostomy.

Are emerging technologies unlocking the potential of sustainable practices in the context of a net-zero economy? An analysis of driving forces.

Increasing globalization and climate change have significantly affected business activities. Government and other stakeholders are creating pressure to have a sustainable business model for efficient resource utilization and minimizing negative environmental impact. Many organizations have started focusing on sustainable and cleaner production through the adoption of net-zero economy (NZE) practices. Certain technological advancements are required to put these concepts into practice. Firms have begun to adopt digital technologies (such as big data analytics, artificial intelligence, and internet of things), and have been widely used in practice to achieve NZE. Is digitalization unlocking the potential of sustainable practices in the context of a net-zero economy? This question is still unanswered; therefore, this study aims to identify and analyze the drivers of digitalization that ensure sustainable practices to achieve net-zero economy. Through an extensive literature review and experts' opinions, a list of drivers was identified. An empirical investigation was conducted to validate the identified drivers and further understand the influencing relationship among the drivers, Pythagorean fuzzy decision-making trial and evaluation laboratory (PF-DEMATEL) was employed. The findings of the study show that "high degree of automation," "enhancing the flexibility in the manufacturing process," and "real-time sensing capability" are the main influencer drivers among all cause group forces. The present study can be a source for industrial practitioners and academia that can provide significant guidance on how the adoption of digitalization can unlock the potential to achieve CE, which can lead us toward net-zero.

Ectopic Opening of the Bile Duct Into the Duodenal Bulb: Complications of Biliary Drainage.

Ectopic opening of the common bile duct is a rare anatomic variant that is associated with increased risk of complications such as cholangitis, peptic ulcer disease, and even cholangiocarcinoma. Ectopic opening of the common bile duct into the duodenal bulb is a rare form of ectopic opening of the common bile duct accounting for 0.1%-2.7% of cases of anomalous biliary drainage. Identification of such pathology is important because of its varied presentation and considerable operative and procedural implications. We report a rare case of duodenal bulb opening of the common bile duct in a patient who presented with cholangitis.

Sequential retinal pigment epithelium tears following intravitreal Ranibizumab injections for age-related macular degeneration.

PURPOSE: To report a case of sequential retinal pigment epithelium (RPE) tears following intravitreal Ranibizumab injections for neovascular age-related macular degeneration (AMD). METHODS: Retrospective, observational case. CASE DESCRIPTION: A 75-year-old hypertensive male was diagnosed with active neovascular AMD and pre-existing RPE tear in the left eye. His presenting best-corrected visual acuity was counting finger @ 1 metre,

SABMIS: sparse approximation based blind multi-image steganography scheme.

We hide grayscale secret images into a grayscale cover image, which is considered to be a challenging steganography problem. Our goal is to develop a steganography scheme with enhanced embedding capacity while preserving the visual quality of the stego-image as well as the extracted secret image, and ensuring that the stego-image is resistant to steganographic attacks. The novel embedding rule of our scheme helps to hide secret image sparse coefficients into the oversampled cover image sparse coefficients in a staggered manner. The stego-image is constructed by using the Alternating Direction Method of Multipliers (ADMM) to solve the Least Absolute Shrinkage and Selection Operator (LASSO) formulation of the underlying minimization problem. Finally, the secret images are extracted from the constructed stego-image using the reverse of our embedding rule. Using these components together, to achieve the above mentioned competing goals, forms our most novel contribution. We term our scheme SABMIS (Sparse Approximation Blind Multi-Image Steganography). We perform extensive experiments on several standard images. By choosing the size of the length and the width of the secret images to be half of the length and the width of cover image, respectively, we obtain embedding capacities of 2 bpp (bits per pixel), 4 bpp, 6 bpp, and 8 bpp while embedding one, two, three, and four secret images, respectively. Our focus is on hiding multiple secret images. For the case of hiding two and three secret images, our embedding capacities are higher than all the embedding capacities obtained in the literature until now (3 times and 6 times than the existing best, respectively). For the case of hiding four secret images, although our capacity is slightly lower than one work (about 2/3rd), we do better on the other two goals (quality of stego-image & extracted secret image as well as resistance to steganographic attacks). For our experiments, there is very little deterioration in the quality of the stego-images as compared to their corresponding cover images. Like all other competing works, this is supported visually as well as over 30 dB of Peak Signal-to-Noise Ratio (PSNR) values. The good quality of the stego-images is further validated by multiple numerical measures. None of the existing works perform this exhaustive validation. When using SABMIS, the quality of the extracted secret images is almost same as that of the corresponding original secret images. This aspect is also not demonstrated in all competing literature. SABMIS further improves the security of the inherently steganographic attack resistant transform based schemes. Thus, it is one of the most secure schemes among the existing ones. Additionally, we demonstrate that SABMIS executes in few minutes, and show its application on the real-life problems of securely transmitting medical images over the internet.

Tamoxifen retinopathy and macular telangiectasia: A comparative case series.

PURPOSE: To report a case series of tamoxifen retinopathy (TR) with and without type 2 macular telangiectasia (MacTel) and compare their clinical and imaging findings. METHODS: Retrospective comparative study. Female patients with tamoxifen use or with clinical diagnosis of type 2 MacTel were divided into 4 groups: Group A-tamoxifen use without retinopathy; Group B-tamoxifen use with retinopathy; Group C-type 2 MacTel with tamoxifen use and Group D-type 2 MacTel without tamoxifen use. Clinical and image analysis was conducted. RESULTS: There were 6 patients (11 eyes) in group A, 8 (13 eyes) patients in Group B, 2 patients (4 eyes) in Group C and 8 patients (14 eyes) in Group D respectively. TR patients were young, showed retinal crystals, perifoveal greying and no retinal pigment clumps (RPC) on examination. Foveal contour irregularity (n = 13, 100%) and outer retinal layer damage (n = 11, 85%) were common OCT findings seen in TR. In group C, all eyes showed 360° middle retinal layer (MRL) hyperreflectivity (100% vs 86%) and presence of outer retinal hyporeflective cavitation (100% vs 43%) on OCT compared to patients in group D. Abnormal autofluoroscence, detection and leakage from the telangiectatic vessels on fluorescein and OCT angiography was seen in type 2 MacTel disease. CONCLUSION: Patients with TR showed retinal crystals and outer retinal hyporeflective foveal cavitation on OCT. Patients with type 2 MacTel having with tamoxifen intake showed hyporeflective outer retinal foveal cavitation and 360° perifoveal MRL hyperreflectivity on OCT. RPC was observed exclusively in the type 2 MacTel group.

Immunoglobulin G4 associated autoimmune cholangitis and pancreatitis following the administration of nivolumab: A case report.

BACKGROUND: Immune checkpoint inhibitors have significantly improved survivals for an increasing range of malignancies but at the cost of several immune-related adverse events, the management of which can be challenging due to its mimicry of other autoimmune related disorders such as immunoglobulin G4 (IgG4) related disease when the pancreaticobiliary system is affected. Nivolumab, an IgG4 monoclonal antibody, has been associated with cholangitis and pancreatitis, however its association with IgG4 related disease has not been reported to date. CASE SUMMARY: We present a case of immune-related pancreatitis and cholangiopathy in a patient who completed treatment with nivolumab for anal squamous cell carcinoma. Patients IgG4 levels was normal on presentation. She responded to steroids but due to concerns for malignant biliary stricture, she opted for surgery, the pathology of which suggested IgG4 related disease. CONCLUSION: We hypothesize this case of IgG4 related cholangitis and pancreatitis was likely triggered by nivolumab.

Expression of IL-6, TNF-α, and hs-CRP in the serum of patients undergoing single-sitting and multiple-sitting root canal treatment: A comparative study.

Background: In recent times, single-sitting root canal therapy has gained momentum over multiple-sitting root canal therapy due to its superior clinical outcome and less time required for treating the patient. Aim: Thus, the aim of current study was to compare the expression of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and high-sensitivity C-reactive protein (hs-CRP) in the serum of patients undergoing single-sitting and multiple-sitting root canal treatment. Materials and Methods: This cross-sectional experimental study was conducted on 300 subjects who were indicated for root canal treatment. Subjects were categorized into Group I (single visit) and Group II (multiple visits).Clinical data was obtained and serum samples were collected both before and after 1 week of treatment completion. Inclusion criteria were those patients (a) over 18 years of age, (b) without any disease of inflammatory etiology, and (c) who had not previously received endodontic treatment or any related therapeutic treatment. Exclusion criteria were those (a) without a complete clinical history, (b) with greater than one indicated tooth, (c) who did not complete their treatment, and (d) with any periodontal disease. Chi-square and Student's t-test were applied. Results: It was found that in single-sitting root canal treatment, there was a statistically significant reduction in these inflammatory biomarkers, although no difference in clinical efficacy was observed. Conclusion: Single-visit root canal treatment is a better option for treatment of pulpitis compared to multiple-sitting treatment.

Intercalary membrane break and detachment causes intrachoroidal cavitation in macular coloboma.

PURPOSE: To describe the clinical and imaging features in a series of patients diagnosed with macular coloboma (MC) and intrachoroidal cavitation (ICC). METHODS: Patients diagnosed with MC based on clinical examination between June 2017 and July 2021 were retrieved from the electronic medical record system and were included in the study. Colour fundus photographs, optical coherence tomography (OCT) and Multicolour® imaging scans of these patients were analysed. RESULTS: We identified 16 eyes of 11 patients with MC on fundus examination. Based on OCT imaging features, conforming variant of MC was seen in 9 (56%) eyes and non-conforming variant in 7 (44%) eyes. No eyes with MC in the study showed features of both conforming and non-conforming varieties simultaneously. In the non-conforming variety of MC with presence of intercalary membrane break, ICC was identified in 5 (71%) of these eyes. ICC in MC appeared as flat, dark greenish areas with or without an orange-coloured boundary abutting the margin of the coloboma on Multicolour® imaging. CONCLUSION: In 31% eyes, ICC was seen in non-conforming type of MC and was well-identified on Multicolour® imaging. It appears that presence of intercalary membrane break and detachment are prerequisites for developing ICC.

Predictors of poor bowel preparations and colonoscopy cancellations in inpatient colonoscopies, a single center retrospective study.

BACKGROUND: An adequate bowel preparation prior to colonoscopy is a major quality-limiting factor that determines both the diagnostic and therapeutic yield of a colonoscopy. Colonoscopy is considered the gold standard for colon cancer screening and it is the primary approach to the workup of hematochezia, diarrhea and iron deficiency anemia (IDA). Several modifiable factors of bowel prep adequacy have been identified, that account for around 25% of inadequate bowel preparations in outpatient colonoscopies. However, the literature is sparse when examining the factors associated with inadequate preparations and procedure cancellations in an inpatient hospital setting. We aim to identify factors that affect bowel preparation adequacy and procedure cancellations among diagnostic colonoscopies performed during hospitalization. METHODS: We retrospectively reviewed the electronic medical records of 1,500 consecutive patients who had a diagnostic colonoscopy as an inpatient at a tertiary level hospital over a 2-year period. All patients were administered a clear liquid diet the day prior to the colonoscopy. Patients were then instructed to drink 4 L of polyethylene glycol (PEG, Golytely) between 5 am to 9 am on the day of the procedure. The clinical course of each case was followed to identify quality of preparations, cancelled procedures and the reasons for cancellations. We applied univariate and multivariate logistic regression analysis to identify variables to predict cancellation and poor preparation. RESULTS: A total of 1,029 patients were included in the study. 194 (18.8%) patients had colonoscopy cancellations and 268 (26.0%) had poor bowel preparations. Multivariate analysis revealed these factors to be associated with colonoscopy cancellations: education at the graduate school level [odds ratio (OR) =1.93, P=0.04], Hispanic ethnicity (OR =0.47, P<0.01), hemoglobin level <10 g/dL (OR =1.41, P=0.05) and if the colonoscopy was done for other indications (OR =0.53, P=0.04). Factors associated with poor bowel preparation on multivariate analysis, were dementia (OR =2.44, P=0.02), gastroparesis (OR =3.97, P=0.01) and inpatient opioids use (OR =1.69, P=0.04). CONCLUSIONS: The rate of colonoscopy cancellations and poor bowel preparations in inpatient colonoscopies were high, and we were able to identify predictors of inadequate colon preparation and procedure cancellations. Exploring more individualized colon preparation regimens based on personal risk factors could reduce the number of inadequate and cancelled colonoscopies in an inpatient setting.