Unusual levels of agricultural product waste are becoming one of the issues and dangers that human societies face in their efforts to achieve food security. Therefore, reducing agricultural product ...waste is one of the main strategies for the optimal use of production resources and support food security. In this study, a multilevel Bayesian technique was used to examine the characteristics of customers and the effects of marketing mix on the waste of selected agricultural products—a subgroup of fruits and vegetables in Mashhad, Iran. Based on this, 368 consumers (at the first level), 53 fruit and vegetable markets (at the second level), and 3 main supply centers of fruit and vegetables in the city (at the third level) were evaluated using the Bayesian multilevel model. The results showed that approximately 56% of food waste variance was caused by differences between consumers, 29% is due to the differences between fruit and vegetable markets, and almost 14% is due to the differences between the main supply centers of Mashhad. Also, the effects of the marketing mix showed that the place of distribution of agricultural products always has an increasing effect on the waste of agricultural products. Moreover, increasing the price of agricultural products reduces waste by consumers and keeps the consumer away from unnecessary purchases. The product factor also has an increasing effect on the waste of agricultural products, and consumers are encouraged to consume more and create more waste. A good way to reduce agricultural product waste is to use solutions that slow down the spoilage process and extend the shelf life of fruit and vegetables. Using an appropriate marketing mix and considering the characteristics of consumers can also control the waste of agricultural products.
Purpose
The relationship between posterior-circulation lesion volume (PCLV) and clinical outcomes is poorly investigated. We aimed to analyze, in patients with acute basilar artery occlusion (ABAO), ...if pre-endovascular treatment (EVT) PCLV was a predictor of outcomes.
Methods
We analyzed consecutive MRI selected, endovascularly treated ABAO patients. Baseline PCLV was measured in milliliters on apparent diffusion-coefficient map reconstruction. Univariable and multivariable logistic models were used to test if PCLV was a predictor of 90-day outcomes. After the received operating characteristic (ROC) analysis, the optimal cut-off was determined to evaluate the prognostic value of PCLV.
Results
A total of 110 ABAO patients were included. The median PCLV was 4.4 ml (interquartile range, 1.3–21.2 ml). Successful reperfusion was achieved in 81.8% of cases after EVT. At 90 days, 31.8% of patients had a modified Rankin scale ≤ 2, and the mortality rate was 40.9%. PCLV was an independent predictor of functional independence and mortality (odds ratio OR:0.57, 95% confidence interval CI, 0.34–0.93 and 1.84, 95% CI, 1.23–2.76, respectively). The ROC analysis showed that a baseline PCLV ≤ 8.7 ml was the optimal cut-off to predict the 90-day functional independence (area under the curve AUC = 0.68, 95% CI, 0.57–0.79, sensitivity 88.6%, and specificity 49.3%). In addition, a PCLV ≥ 9.1 ml was the optimal cut-off for the prediction of 90-day mortality (AUC = 0.71, 95% CI, 0.61–0.82, sensitivity 80%, and specificity 60%).
Conclusions
Pre-treatment PCLV was an independent predictor of 90-day outcomes in ABAO. A PCLV ≤ 8.7 and ≥ 9.1 ml may identify patients with a higher possibility to achieve independence and a higher risk of death at 90 days, respectively.
Background and Purpose
The best embolic protection strategy has not yet been established for carotid artery stenting (CAS). This article reports a new simplified approach using a balloon guide ...catheter inspired by stroke therapy, in patients harboring a symptomatic ICA atherosclerotic stenosis or web. In addition, the three angiographic patterns and clinical outcomes associated with this technique, called the simple flow blockage (SFB) technique are described.
Material and Methods
This was a retrospective study with data extraction from a monocentric prospective clinical registry of consecutive patients admitted for symptomatic ICA stenosis or web. The primary study outcome (composite endpoint) was the rate of occurrence of death, symptomatic stroke or acute coronary syndrome within 30 days of the intervention.
Results
In this study 75 symptomatic patients with >50% carotid artery atherosclerotic stenosis or web were included. All procedures were successfully performed. The composite endpoint occurred in 3 patients (4.0%, 95% confidence interval, CI, 0.0–11.3): 1 had symptomatic ischemic stroke, 1 had reperfusion syndrome with symptomatic intracranial hemorrhage and 1 had acute coronary syndrome. After proximal balloon inflation three angiographic patterns were observed: complete contrast column stagnation in the ICA (38.7%), retrograde washout of the ICA from the intracranial circulation towards the external carotid artery (35.5%) and antegrade washout of contrast medium towards the intracranial circulation (25.8%). The median procedure length was 40 min. New asymptomatic ischemic lesions were observed in 22.5% on DWI-MRI.
Conclusion
The SFB technique enables fast and safe procedures in CAS. A favorable angiographic pattern after proximal balloon inflation was observed in 74.2% of cases.
Objective: The key point to detect patients’ need in pre-hospital emergency is to have high ability to take medical history. All research findings show that this ability is low. The objective of this ...research is to investigate the ability to take medical history of patients among the personnel of pre-hospital emergency medical service (EMS) in Golestan province, Iran. Methods: This research was a descriptive cross-sectional study carried in 2016. The population included non-staff technicians and an operator working in the message center (N = 171). The samples were selected using multi-stage cluster sampling. Data were collected by a researcher-developed questionnaire. The collected data were analyzed by SPSS software version 16 conducting descriptive and inferential statistics. All tests were administered at a significance level of P < 0.05. Results: One hundred sixty-five (96.5%) participants were male. The mean score of the ability to take medical history was 58.4 ± 11.1. Therefore, 95 participants (58.3 %) had poor ability and 64 participants (39.3 %) owned moderate ability. The highest score concerning the ability to take medical history was for the aspect of professional knowledge (mean rank = 5). The most influential aspect in the ability was respectively for ‘professional knowledge’ (P = 0.0001, Beta = 0.509). Pearson correlation coefficient indicated a relationship (r=-0.149, P = 0.05) between the ability to take medical history and age. Conclusion: The results of the current study indicated that the ability to take medical history among the personnel of pre-hospital medical emergency of Golestan province was low. Therefore, a thorough review of trainings promoting personnel’s professional knowledge is urgently required.
In this study, we aimed to determine the frequency and clinical impact of new ischemic lesions detected with diffusion-weighted-imaging-MRI (DWI-MRI) as well as the clinical outcomes after carotid ...artery stenting (CAS) using the simple flow blockage technique (SFB). This is a retrospective study with data extraction from a monocentric prospective clinical registry (from 2017 to 2019) of consecutive patients admitted for symptomatic cervical ICA stenosis or web. Herein, patients benefited from DWI-MRI before and within 48 h of CAS for symptomatic ICA stenosis or web. The primary endpoint was the frequency of new DWI-MRI ischemic lesions and the secondary (composite) endpoint was the rate of mortality, symptomatic stroke or acute coronary syndrome within 30 days of the procedure. All of the 82 CAS procedures were successfully performed. Among the 33 patients (40.2%) with new DWI-MRI ischemic lesions, 30 patients were asymptomatic (90.9%). Irregular carotid plaque surface with (n = 13, 44.8%) or without ulceration (n = 12, 60.0%) was associated with higher rates of new DWI-MRI lesions by comparison to patients with a regular plaque (n = 7, 25%) (p = 0.048) using the univariate analysis. Less than half of this CAS cohort using the SFB technique had new ischemic lesions detected with DWI-MRI. Among these patients, more than 90% were asymptomatic. Irregularity of the plaque seems to increase the risk of peri-procedural DWI-MRI lesions.
Reduction in traffic congestion and overall number of accidents, especially within the last decade, can be attributed to the enormous progress in active safety. Vehicle path following control with ...the presence of driver commands can be regarded as one of the important issues in vehicle active safety systems development and more realistic explanation of vehicle path tracking problem. In this paper, an integrated driver/DYC control system is presented that regulates the steering angle and yaw moment, considering driver previewed path. Thus, the driver previewed distance, the heading error and the lateral deviation between the vehicle and desired path are used as inputs. Then, the controller determines and applies a corrective steering angle and a direct yaw moment to make the vehicle follow the desired path. A PID controller with optimized gains is used for the control of integrated driver/DYC system. Genetic Algorithm as an intelligent optimization method is utilized to adapt PID controller gains for various working situations. Proposed integrated driver/DYC controller is examined on lane change manuvers andthe sensitivity of the control system is investigated through the changes in the driver model and vehicle parameters. Simulation results show the pronounced effectiveness of the controller in vehicle path following and stability.
Ankylosing Spondylitis (AS) is a chronic rheumatic disease which mainly involves the axial skeleton. It seems that non-HLA genes, as well as HLA-B27 gene, are linked to the etiology of the disease. ...Recently, it has been documented that KIRs and their HLA ligands are contributed to the Ankylosing Spondylitis. The aim of this study was to evaluate the KIR genes and their HLA ligands in Iranian AS patients and healthy individuals. The present study includes 200 AS patient samples and 200 healthy control samples. KIR genotyping was performed using the polymerase chain reaction sequence-specific primer (PCR-SSP) method to type the presence or absence of the 16 KIR genes, 6 known specific HLA class I ligands and also, two pseudogenes. Two KIR genes (KIR-2DL3 and KIR2DL5), and among the HLA ligands, two HLA ligands (HLA-C2Lys80 and HLA-B27) genes were significantly different between case and control groups. In addition, we found some interesting KIR/HLA compound genotypes, which were associated with AS susceptibility. Our results suggest that the AS patients present more activating and less inhibitory KIR genes with combination of their HLA ligands than healthy controls. Once the balance of signal transduction between activating and inhibitory receptors is disturbed, the ability of NK cells to identify and lyse the targets in immune responses will be compromised. Accordingly, imbalance of activating and inhibitory KIR genes by up-regulating the activation and losing the inhibition of KIRs signaling or combination of both might be one of the important factors which underlying the pathogenesis of AS.
Spondyloarthropathies (SpA), defined by inflammatory situations, are a category of rheumatic diseases with mainly involvement of the spine, enthuses, and peripheral joints. Ankylosing spondylitis ...(AS), as the prototype of this category, is an autoimmune disease with a chronic inflammatory arthritis which is characterized by axial skeletal ankylosis, inflammation at the entheses, and arthritis of the peripheral limbs. AS shows a strong association with Human Leucocyte Antigen (HLA)-B27 hereditary, and the misfolded HLA-B27 heavy chain homodimer in an animal model has supported the important role of this molecule in the pathogenesis of AS. Toll-like receptors (TLRs) are categorized as type I integral membrane glycoproteins which play important roles in the innate immune system. In human, 11 members of TLR family have been identified. There is an evidence demonstrating the role of TLR4 in the perforin production by helper T cells in ankylosing spondylitis. Nevertheless, it has been demonstrated that the level of TLR4 protein on peripheral-blood leucocytes of AS patients and healthy individuals is different.
In this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from ...pulmonary contusion.
All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP.
In the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the Group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the Group P (p = 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the Group PP (p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the Group PP.
We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy.
The aim of the present study was to appraisal the prose and cone of Shiraz City in terms of its potential in the context of health tourism.
The statistical sample included medical and health tourism ...sector in the city of Shiraz in the northwest of Fars Province, south of Iran. The efficient authorities on the topic were identified through the hospitals engaging in medical tourism. The research was based on theoretical sampling through which the experienced people of extensive knowledge on medical tourism were interviewed.
Active hospitals on attraction foreign patients averagely admit 15 and 50 foreign patients monthly and annually, respectively. Arab countries in the Persian Gulf were detected as the main marketing for Shiraz medical tourism. Oman encompassed the highest rate with 20% of admitted patients. Eye treatments with 30% and orthopedic with 6% were demonstrated as the highest and lowest rates in terms of foreign patients' needs, respectively. Closeness of cultural and religious beliefs and familial relationships on one hand and trusting to Iranian physicians on the other hand were amongst the most reasons for selecting Iran as a destination for medical tourism by patients.
Implementing 4 strategies on monitoring medical tourism would result into significant improvement of attracting more foreigner patients not only into Shiraz but all around Iran. These items have been discussed in the text.
PDF
