A constructability assessment model based on BIM in urban renewal projects in limited lands

One of the most significant concerns in urban development today is the organization of areas of cities that have become run-down over time. In order to complete previous constructability studies in other fields of construction, the current study evaluates constructability based on BIM, specifically in the context of the Tehran limited land renewal project. The motivation for this study is the current difficulties facing renewal designs for limited lands, and the lack of a quantitative constructability model for urban renewal projects in Iran. This paper aims (1) to discuss the design elements that should be considered in the design phase of urban renewal projects; (2) to identify the factors that may affect constructability; and (3) to propose a framework for assessing urban renewal designs by considering constructability factors using building information modeling (BIM). To meet these needs, this paper investigates constructability factors and their relative importance, considering the design elements that should be acknowledged in limited land renewal, using a multicriteria techniques. Some 28 constructability factors are identified through a literature review, and based on 52 responses received from a questionnaire survey, the factors are ranked using pairwise comparisons of the analytic hierarchy process (AHP). The final constructability factors that are identified through the technique for order preference using the similarity to ideal solution (TOPSIS) method are standard dimensions, safety, simplification of structure, resource intelligence and alignment, and skilled labor availability. The contribution of this research to the body of knowledge is, firstly, the development of constructability factors for measuring the constructability of urban renewal designs, and secondly, the introduction of BIM as a most beneficial tool for assessing the constructability of the proposed designs. In using the constructability assessment framework and identifying the trade-offs between the constructability of renewal projects in the limited areas of urban spaces, design alternatives become more feasible

Mesothelioma in an HIV/AIDS patient without history of asbestos exposure: possible role for immunosuppression in mesothelioma: a case report

We describe a 41-year-old African-American male who initially presented in respiratory distress. He had a positive history of asthma, cigarette smoking, and only recent possible asbestos exposure six months prior to onset of symptoms. Mesothelioma was suspected after chest radiography and PET-CT, and confirmed by immunohistochemical tissue analysis. We postulate that immunosuppression enhances susceptibility to mesothelioma, since weakened immune systems are present in both HIV/AIDS patients like this 41-year-old man, and elderly patients who compose the population that classically presents with mesothelioma. Furthermore, immunosuppression may be a prerequisite to the development of mesothelioma

Iranian clinical practice guideline for amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegeneration involving motor neurons. The 3–5 years that patients have to live is marked by day-to-day loss of motor and sometimes cognitive abilities. Enormous amounts of healthcare services and resources are necessary to support patients and their caregivers during this relatively short but burdensome journey. Organization and management of these resources need to best meet patients' expectations and health system efficiency mandates. This can only occur in the setting of multidisciplinary ALS clinics which are known as the gold standard of ALS care worldwide. To introduce this standard to the care of Iranian ALS patients, which is an inevitable quality milestone, a national ALS clinical practice guideline is the necessary first step. The National ALS guideline will serve as the knowledge base for the development of local clinical pathways to guide patient journeys in multidisciplinary ALS clinics. To this end, we gathered a team of national neuromuscular experts as well as experts in related specialties necessary for delivering multidisciplinary care to ALS patients to develop the Iranian ALS clinical practice guideline. Clinical questions were prepared in the Patient, Intervention, Comparison, and Outcome (PICO) format to serve as a guide for the literature search. Considering the lack of adequate national/local studies at this time, a consensus-based approach was taken to evaluate the quality of the retrieved evidence and summarize recommendations

A conceptual framework of decentralized blockchain integrated system based on building information modeling to steering digital administration of disputes in the IPD contracts

Purpose In the construction industry, various parties are involved in a project. Consequently, claims and disputes are inevitable in this industry. This paper aims to develop Integrated project delivery (IPD) practices including early involvement of stakeholders and multiparty contracts which its combination with advanced technologies such as blockchain can lead to better dispute management and improve the whole construction process.Design/methodology/approach Based on literature review, the alternative dispute resolution (ADR) for IPD contacts were identified, and three formats of IPD contracts were selected, and the dispute resolution process of them has been analyzed. Then, based on blockchain review, a conceptual blockchain-based dispute management (BDM) model was generated for ADR in IPD. Model validation was done by an interview. Experts were asked to compare the BDM model with the traditional system regarding the ADR duration. Findings Analyses of the collected data from the experts demonstrated that the BDM model has better function in terms of time and cost for ADR process when the project is facing serious and considerable number of disputes. The relation between blockchain technology (BCT) and building information modeling (BIM) has been examined through a framework, and the ability of the proposed model for administrating dispute resolution process has been verified using four different scenarios of construction claims that show the system can run successfully. Originality The current study proposes a truthful model, reliable framework to address the problem of project dispute management in IPD contracts. The system combines the ability to being unchangeable and the reliability characteristics of BCT with informative and automation aspects of BIM together to improve dispute resolution issue in the IPD system

Time analysis of fatal traffic accidents in Fars Province of Iran

【Abstract】 Objective: To analyze the time factor in road traffic accidents (RTAs) in Fars Province of Iran. Methods: This study was conducted in Fars Province, Iran from November 22, 2009 to November 21, 2011. Victims’ information consisted of age, sex, death toll involving dri-vers or passengers of cars, motorcycles and pedestrians, and site of injury etc. Accidents were analyzed in relation to hour of the day, season of the year, lighting condition in-cluding sunrise, sunset, daytime and nighttime. Results: A total of 3 642 deaths (78.3% were males, and the ratio of males to females was about 3.6:1) were studied regarding their autopsy records. There was a steady in-crease in fatal accidents occurring at midnight to 15:59. The risk of being involved in a fatal traffic accident was higher for those injured between 4:00 to 7:59 than at other times (OR=2.13, 95% CI 1.85-2.44). The greatest number of fatal RTAs took place in summer. Mortalities due to RTA during spring and summer were more pronounced at 20:00 to 23:59 and midnight to 3:59, whereas mortalities in fall and winter were more pronounced from 12:00 to 15:59. Conclusion: The high mortality rate of RTA is a major public health problem in Fars Province. Our results indicate that the time is an important factor which contributes to road traffic deaths. Key words: Accidents, traffic; Epidemiology; Mortality; Ira

Epidemiological characteristics of fatal pedestrian ac-cidents in Fars Province of Iran: a community-based

【Abstract】Objective: To determine the epidemio-logical characteristics of fatal pedestrian accidents in Fars Province of Iran. Methods: This cross-sectional study was conducted in Fars Province of Iran during a 29-month period from March 2009 to July 2011. The data were from the Fars Forensic Medi-cine Registry. In 4 923 recorded road traffic accident fatalities, 971 deaths were due to pedestrian accidents. The demographic and accident-related information were analyzed by SPSS ver-sion 11.5. P value less than 0.05 was considered significant. Results: The mean age of decedents was (47.2±26.2) years, ranging from 6 months to 103 years old. Males ac-counted for 69.8% of all deaths. Fatal accidents were most common in September; 56.1% of the fatal injuries occurred on intracity roads and 33.1% on extracity roads. Fatal head injuries were present in 60.54% of cases. Evaluation of the injury site and the cause of death found that they were significantly associated with age, interval between injury and death. Besides, the type of roads played an important role in mortality. Conclusion: Although the clinical management of trauma patients has been improved in our country in the recent decade, decreasing the burden of injuries needs co-ordination among trauma system organizations. Key words: Accidents, traffic; Epidemiologic studies; Mortality; Ira

Iranian clinical practice guideline for amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegeneration involving motor neurons. The 3-5 years that patients have to live is marked by day-to-day loss of motor and sometimes cognitive abilities. Enormous amounts of healthcare services and resources are necessary to support patients and their caregivers during this relatively short but burdensome journey. Organization and management of these resources need to best meet patients' expectations and health system efficiency mandates. This can only occur in the setting of multidisciplinary ALS clinics which are known as the gold standard of ALS care worldwide. To introduce this standard to the care of Iranian ALS patients, which is an inevitable quality milestone, a national ALS clinical practice guideline is the necessary first step. The National ALS guideline will serve as the knowledge base for the development of local clinical pathways to guide patient journeys in multidisciplinary ALS clinics. To this end, we gathered a team of national neuromuscular experts as well as experts in related specialties necessary for delivering multidisciplinary care to ALS patients to develop the Iranian ALS clinical practice guideline. Clinical questions were prepared in the Patient, Intervention, Comparison, and Outcome (PICO) format to serve as a guide for the literature search. Considering the lack of adequate national/local studies at this time, a consensus-based approach was taken to evaluate the quality of the retrieved evidence and summarize recommendations

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk