Impact of United States political sanctions on international collaborations and research in Iran

International research collaborations improve individual, institutional and governmental capacities to respond to health crises and inequalities but may be greatly affected by political environments. Iran ranks highly in tertiary education, productivity growth, knowledge impact and successful patent applications. In many countries, economic hardship has correlated with increased international research collaborations. Some have hypothesised that financial constraint drives scholars to seek outside collaborations for cost and risk sharing, and to access funding, materials and patient populations otherwise unavailable. This paper explores the history and importance of US political sanctions on the health of Iran’s academic sector. Although Iran’s international research collaborations increased during periods of increased sanctions, the Pearson correlation coefficient between gross domestic product and international research collaborations was not significant (r=0.183, p=0.417). This indicates that other factors are at least in part responsible. Additionally, we found Iran’s quantitative (eg, publication number) and qualitative (eg, visibility indices) publishing metrics to be discordant (two-tailed Mann–Kendall trend; p<0.0002 for both). Reasons for this are multifactorial, including increased indexing of Iranian journals, willingness of lower visibility journals to handle manuscripts with Iranian authors, widespread linkage of career advancement to science visibility indices, and others. During periods of increased sanctions, Iranian scholars were increasingly denied opportunities to publish scientific findings, attend scientific meetings, access to essential medical and laboratory supplies and information resources. We conclude that academic boycotts violate researchers’ freedom and curtail progress. Free exchange of ideas irrespective of creed is needed to optimize global scientific progress

Comparison of non-invasive to invasive oxygenation ratios for diagnosing acute respiratory distress syndrome following coronary artery bypass graft surgery: a prospective derivation-validation cohort study

Objective: To determine if non-invasive oxygenation indices, namely peripheral capillary oxygen saturation (SpO2)/ fraction of inspired oxygen (Fi O2) and partial pressure of alveolar oxygen (PAO2)/Fi O2 may be used as effective surrogates for the partial pressure of arterial oxygen (PaO2)/Fi O2. Also, to determine the SpO2/Fi O2 and PAO2/Fi O2 values that correspond to PaO2/Fi O2 thresholds for identifying acute respiratory distress syndrome (ARDS) in patients following coronary artery bypass graft (CABG) surgery. Methods: A prospective derivation-validation cohort study in the Open-Heart ICU of an academic teaching hospital. Recorded variables included patient demographics, ventilator settings, chest radiograph results, and SPO2, PaO2, PAO2, SaO2, and Fi O2. Linear regression modeling was used to quantify the relationship between indices. Receiver operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the threshold values. Results: One-hundred seventy-five patients were enrolled in the derivation cohort, and 358 in the validation cohort. The SPO2/Fi O2 and PAO2/Fi O2 ratios could be predicted well from PaO2/Fi O2, described by the linear regression models SPO2/Fi O2 = 71.149 + 0.8PF and PAO2/Fi O2 = 38.098 + 2.312PF, respectively. According to the linear regression equation, a PaO2/Fi O2 ratio of 300 equaled an SPO2/Fi O2 ratio of 311 (R2 0.857, F 1035.742, < 0.0001) and a PAO2/Fi O2 ratio of 732 (R2 0.576, F 234.887, < 0.0001). The SPO2/Fi O2 threshold of 311 had 90% sensitivity, 80% specificity, LR+ 4.50, LR- 0.13, PPV 98, and NPV 42.1 for the diagnosis of mild ARDS. The PAO2/Fi O2 threshold of 732 had 86% sensitivity, 90% specificity, LR+ 8.45, LR- 0.16, PPV 98.9, and NPV 36 for the diagnosis of mild ARDS. SPO2/ Fi O2 had excellent discrimination ability for mild ARDS (AUC ± SE = 0.92 ± 0.017; 95% CI 0.889 to 0.947) as did PAO2/ Fi O2 (AUC ± SE = 0.915 ± 0.018; 95% CI 0.881 to0.942). Conclusions: PaO2 and SaO2 correlated in the diagnosis of ARDS, with a PaO2/Fi O2 of 300 correlating to an SPO2/ Fi O2 of 311 (Sensitivity 90%, Specificity 80%). The SPO2/ Fi O2 ratio may allow for early real-time rapid identification of ARDS, while decreasing the cost, phlebotomy, blood loss, pain, skin breaks, and vascular punctures associated with serial arterial blood gas measurements

Comparison of non-invasive to invasive oxygenation ratios for diagnosing acute respiratory distress syndrome following coronary artery bypass graft surgery: a prospective derivation-validation cohort study

Abstract Objective To determine if non-invasive oxygenation indices, namely peripheral capillary oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) and partial pressure of alveolar oxygen (PAO2)/FiO2 may be used as effective surrogates for the partial pressure of arterial oxygen (PaO2)/FiO2. Also, to determine the SpO2/FiO2 and PAO2/FiO2 values that correspond to PaO2/FiO2 thresholds for identifying acute respiratory distress syndrome (ARDS) in patients following coronary artery bypass graft (CABG) surgery. Methods A prospective derivation-validation cohort study in the Open-Heart ICU of an academic teaching hospital. Recorded variables included patient demographics, ventilator settings, chest radiograph results, and SPO2, PaO2, PAO2, SaO2, and FiO2. Linear regression modeling was used to quantify the relationship between indices. Receiver operating characteristic (ROC) curves were used to determine the sensitivity and specificity of the threshold values. Results One-hundred seventy-five patients were enrolled in the derivation cohort, and 358 in the validation cohort. The SPO2/FiO2 and PAO2/FiO2 ratios could be predicted well from PaO2/FiO2, described by the linear regression models SPO2/FiO2-‰=-‰71.149-‰+-‰0.8PF and PAO2/FiO2-‰=-‰38.098-‰+-‰2.312PF, respectively. According to the linear regression equation, a PaO2/FiO2 ratio of 300 equaled an SPO2/FiO2 ratio of 311 (R2 0.857, F 1035.742, &lt;-‰0.0001) and a PAO2/FiO2 ratio of 732 (R2 0.576, F 234.887, &lt;-‰0.0001). The SPO2/FiO2 threshold of 311 had 90% sensitivity, 80% specificity, LR+-‰4.50, LR- 0.13, PPV 98, and NPV 42.1 for the diagnosis of mild ARDS. The PAO2/FiO2 threshold of 732 had 86% sensitivity, 90% specificity, LR+-‰8.45, LR- 0.16, PPV 98.9, and NPV 36 for the diagnosis of mild ARDS. SPO2/FiO2 had excellent discrimination ability for mild ARDS (AUC-‰Â±-‰SE-‰=-‰0.92-‰Â±-‰0.017; 95% CI 0.889 to 0.947) as did PAO2/FiO2 (AUC-‰Â±-‰SE-‰=-‰0.915-‰Â±-‰0.018; 95% CI 0.881 to0.942). Conclusions PaO2 and SaO2 correlated in the diagnosis of ARDS, with a PaO2/FiO2 of 300 correlating to an SPO2/ FiO2 of 311 (Sensitivity 90%, Specificity 80%). The SPO2/ FiO2 ratio may allow for early real-time rapid identification of ARDS, while decreasing the cost, phlebotomy, blood loss, pain, skin breaks, and vascular punctures associated with serial arterial blood gas measurements

Comparison of non-invasive to invasive oxygenation ratios for diagnosing acute respiratory distress syndrome following coronary artery bypass graft surgery: a prospective derivation-validation cohort study

Objective: To determine if non-invasive oxygenation indices, namely peripheral capillary oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) and partial pressure of alveolar oxygen (PAO2)/FiO2 may be used as effectivesurrogates for the partial pressure of arterial oxygen (PaO2)/FiO2. Also, to determine the SpO2/FiO2 and PAO2/FiO2values that correspond to PaO2/FiO2 thresholds for identifying acute respiratory distress syndrome (ARDS) inpatients following coronary artery bypass graft (CABG) surgery.Methods: A prospective derivation-validation cohort study in the Open-Heart ICU of an academic teaching hospital.Recorded variables included patient demographics, ventilator settings, chest radiograph results, and SPO2, PaO2,PAO2, SaO2, and FiO2. Linear regression modeling was used to quantify the relationship between indices. Receiveroperating characteristic (ROC) curves were used to determine the sensitivity and specificity of the threshold values.Results: One-hundred seventy-five patients were enrolled in the derivation cohort, and 358 in the validationcohort. The SPO2/FiO2 and PAO2/FiO2 ratios could be predicted well from PaO2/FiO2, described by the linearregression models SPO2/FiO2 = 71.149 + 0.8PF and PAO2/FiO2 = 38.098 + 2.312PF, respectively. According to the linearregression equation, a PaO2/FiO2 ratio of 300 equaled an SPO2/FiO2 ratio of 311 (R2 0.857, F 1035.742, &lt; 0.0001) anda PAO2/FiO2 ratio of 732 (R2 0.576, F 234.887, &lt; 0.0001). The SPO2/FiO2 threshold of 311 had 90% sensitivity, 80%specificity, LR+ 4.50, LR- 0.13, PPV 98, and NPV 42.1 for the diagnosis of mild ARDS. The PAO2/FiO2 threshold of 732had 86% sensitivity, 90% specificity, LR+ 8.45, LR- 0.16, PPV 98.9, and NPV 36 for the diagnosis of mild ARDS. SPO2/FiO2 had excellent discrimination ability for mild ARDS (AUC ± SE = 0.92 ± 0.017; 95% CI 0.889 to 0.947) as did PAO2/FiO2 (AUC ± SE = 0.915 ± 0.018; 95% CI 0.881 to0.942). Conclusions: PaO2 and SaO2 correlated in the diagnosis of ARDS, with a PaO2/FiO2 of 300 correlating to an SPO2/FiO2 of 311 (Sensitivity 90%, Specificity 80%). The SPO2/ FiO2 ratio may allow for early real-time rapid identification ofARDS, while decreasing the cost, phlebotomy, blood loss, pain, skin breaks, and vascular punctures associated withserial arterial blood gas measurements

Impact of United States political sanctions on international collaborations and research in Iran

International research collaborations improve individual,institutional and governmental capacities to respondto health crises and inequalities but may be greatlyaffected by political environments. Iran ranks highlyin tertiary education, productivity growth, knowledgeimpact and successful patent applications. In manycountries, economic hardship has correlated withincreased international research collaborations. Somehave hypothesised that financial constraint drives scholarsto seek outside collaborations for cost and risk sharing,and to access funding, materials and patient populationsotherwise unavailable. This paper explores the historyand importance of US political sanctions on the healthof Iran"s academic sector. Although Iran"s internationalresearch collaborations increased during periods ofincreased sanctions, the Pearson correlation coefficientbetween gross domestic product and internationalresearch collaborations was not significant (r=0.183,p=0.417). This indicates that other factors are at least inpart responsible. Additionally, we found Iran"s quantitative(eg, publication number) and qualitative (eg, visibilityindices) publishing metrics to be discordant (two-tailedMann--Kendall trend; p&lt;0.0002 for both). Reasons for thisare multifactorial, including increased indexing of Iranianjournals, willingness of lower visibility journals to handlemanuscripts with Iranian authors, widespread linkageof career advancement to science visibility indices, andothers. During periods of increased sanctions, Iranianscholars were increasingly denied opportunities to publishscientific findings, attend scientific meetings, access toessential medical and laboratory supplies and informationresources. We conclude that academic boycotts violateresearchers" freedom and curtail progress. Free exchangeof ideas irrespective of creed is needed to optimize globalscientific progress