Investigating the role of temperature on thermal stress and fracture propagation in geothermal systems

Available geothermal energy extractable by conventional techniques is in dry and comparatively impermeable rocks. Enhanced Geothermal System (EGS) technologies enhance geothermal resources in the hot dry rock (HDR) through fracture operations, usually through hydro-shearing. Large scale deployment of geothermal power production requires the demonstration of successful EGS projects extracting heat from reservoirs constituting a variety of geological conditions. In this part, numerical models are very important to show how geothermal power plant operations can be less risky and safer. Owing the fact that, some major challenges in these operations are interaction between shear and tensile fractures with natural faults. These interactions can be seen in two different cases, either these faults are badly oriented or these faults are fill in pore fluids or gases which are mainly high pressure. Fluids and gases are important on account for because of the fact that these pore fluids can over whelmed the injection pressure and cause well blow out. Furthermore, to prevent these operational hazards, we use field data and analysis in combination with experimental tests and numerical/analytical models with finite element method software such as COMSOL Multiphysics. Further work will be required for improving enhanced geothermal production by optimizing hydro-shearing practices

Defining polypharmacy in the elderly: A systematic review protocol

Introduction: Ageing-along with its associated physiological and pathological changes-places individuals at a higher risk of multimorbidity and treatment-related complications. Today, polypharmacy, a common and important problem related to drug use, occurs subsequent to this multimorbidity in the elderly in all populations. In recent decades, several scientific investigations have studied polypharmacy and its correlates, using different approaches and definitions, and their results have been inconclusive. Differences in definitions and approaches in these studies form a barrier against reaching a conclusion regarding the risk factors and consequences of polypharmacy. It is therefore imperative to establish an appropriate definition of polypharmacy. Methods and analysis: A systematic review will be conducted using PubMed, Scopus, Web of Science, EMBASE, PsycINFO and AgeLine bibliographic databases, as well as the grey literature on polypharmacy in older adults to answer these two questions: What definitions in the literature are being used for polypharmacy in older people?, and Which definitions are more comprehensive and applicable? 2 independent reviewers will conduct the primary screening of the articles and data extraction, and eligible sources will be selected after discussing nonconformities. All extracted data from selected articles will be categorised based on the type of study participants, study design and setting, the methodological quality of primary studies and any other potential source of heterogeneity, and results will be summarised in a table, which will contain the levels of evidence and methodological quality of the included studies. The most comprehensive definition of polypharmacy will be selected from the final list of definitions through an international expert webinar. Ethics and Dissemination: This research is exempt from ethics approval because the work is carried out on published documents. We will disseminate this protocol in a related peer-reviewed journal

Aging Puerto Ricans’ Experiences of Depression Treatment: A New Ethnographic Exploration

PurposeTo examine aging Puerto Ricans’ experiences with and perceptions of depression treatment.Methodology/approachIn-depth analysis of eight exemplary cases from ethnographic interviews with a subsample of 16 aging Puerto Ricans in the Boston area who are part of the Boston Puerto Rican Health Study.FindingsThe results show that respondents were resistant to accepting pharmacological treatment for their depression, and they often characterized antidepressants as “dope.” Moreover, they claimed that in addition to their health problems, social stressors such as financial strain, lack of jobs, housing problems, and social isolation are triggering or contributing to their depression. Because of this, they express reluctance in accepting clinical treatment only, and suggest that broader social issues and other health needs ought to be addressed as part of an effective treatment. For many, pharmacological treatment is acceptable only in the more severe forms of depression.Research limitations/implicationsThese results have important implications for improving the quality of depression treatment and reducing health disparities for mainland Puerto Ricans.Originality/value of chapterEven though recent studies continue to show a high frequency of depression among Puerto Ricans, issues of treatment quality are still understudied and ethnographic accounts are especially lacking. Our study offers an exploratory investigation of this unresolved research issue

Integrating a suicide prevention program into the primary health care network: A field trial study in Iran

Objective. To describe and evaluate the feasibility of integrating a suicide prevention program with Primary Health Care services and evaluate if such system can improve screening and identification of depressive disorder, reduce number of suicide attempters, and lower rate of suicide completion. Methodology. This was a quasi-experimental trial in which one community was exposed to the intervention versus the control community with no such exposure. The study sites were two counties in Western Iran. The intervention protocol called for primary care and suicide prevention collaboration at different levels of care. The outcome variables were the number of suicides committed, the number of documented suicide attempts, and the number of identified depressed cases. Results. We identified a higher prevalence of depressive disorders in the intervention site versus the control site (� 2 = 14.8, P < 0.001). We also found a reduction in the rate of suicide completion in the intervention region compared to the control, but a higher prevalence of suicide attempts in both the intervention and the control sites. Conclusion. Integrating a suicide prevention program with the Primary Health Care network enhanced depression and suicide surveillance capacity and subsequently reduced the number of suicides, especially in rural areas. © 2015 Seyed Kazem Malakouti et al

Scattering Theory for Jacobi Operators with Steplike Quasi-Periodic Background

We develop direct and inverse scattering theory for Jacobi operators with steplike quasi-periodic finite-gap background in the same isospectral class. We derive the corresponding Gel'fand-Levitan-Marchenko equation and find minimal scattering data which determine the perturbed operator uniquely. In addition, we show how the transmission coefficients can be reconstructed from the eigenvalues and one of the reflection coefficients.Comment: 14 page

The association between melasma and iron profile: A case-control study

Background ' Melasma is a chronic acquired localized hypermelanosis, causing aesthetic problem for women and impairing their quality of life. Evidence has suggested that hyperpigmentation can occur as a result of iron deficiency anemia and vitamin B12 deficiency. Aim ' We aimed to evaluate the serum parameters of iron profile in melasma patients. Material and Methods ' This case-control study investigated 51 adult non pregnant women with melasma, compared with 51 controls, from patients referred to the Hospital, Tehran, Iran, 2017-2018. Melasma was diagnosed clinically according to the melasma area and severity index (MASI) score was calculated and recorded by the physician. The groups were compared in terms of vitamin B12, folate, serum iron, hemoglobin (Hb), mean corpuscular volume (MCV), total iron binding capacity (TIBC), and ferritin. Results ' The mean and standard deviation of the women's age was 36.89±8.88 years, significantly higher in the group of patients with melasma. Comparing the serum parameters between the groups indicated no statistically significant difference in terms of mean levels of ferritin, Hb, MCV, iron, vitamin B12, TIBC, and folate. The women in melasma group had a higher frequency in below normal range of ferritin and serum iron compared to the control group. None of the serum parameters were correlated with MASI. Conclusion ' The higher frequency of below normal range of ferritin and serum iron levels in women with melasma compared to the control group showed a possible association between these serum parameters and melasma. © 2020, LLC Science and Innovations, Saratov, Russi

Experiences of stigma in healthcare settings among adults living with HIV in the Islamic Republic of Iran

<p>Abstract</p> <p>Background</p> <p>People living with HIV (PLHIV) sometimes experience discrimination. There is little understanding of the causes, forms and consequences of this stigma in Islamic countries. This qualitative study explored perceptions and experiences of PLHIV regarding both the quality of healthcare and the attitudes and behaviours of their healthcare providers in the Islamic Republic of Iran.</p> <p>Methods</p> <p>In-depth, semi-structured interviews were held with a purposively selected group of 69 PLHIV recruited from two HIV care clinics in Tehran. Data were analyzed using the content analysis approach.</p> <p>Results and discussion</p> <p>Nearly all participants reported experiencing stigma and discrimination by their healthcare providers in a variety of contexts. Participants perceived that their healthcare providers' fear of being infected with HIV, coupled with religious and negative value-based assumptions about PLHIV, led to high levels of stigma. Participants mentioned at least four major forms of stigma: (1) refusal of care; (2) sub-optimal care; (3) excessive precautions and physical distancing; and (4) humiliation and blaming. The participants' healthcare-seeking behavioural reactions to perceived stigma and discrimination included avoiding or delaying seeking care, not disclosing HIV status when seeking healthcare, and using spiritual healing. In addition, emotional responses to perceived acts of stigma included feeling undeserving of care, diminished motivation to stay healthy, feeling angry and vengeful, and experiencing emotional stress.</p> <p>Conclusions</p> <p>While previous studies demonstrate that most Iranian healthcare providers report fairly positive attitudes towards PLHIV, our participants' experiences tell a different story. Therefore, it is imperative to engage both healthcare providers and PLHIV in designing interventions targeting stigma in healthcare settings. Additionally, specialized training programmes in universal precautions for health providers will lead to stigma reduction. National policies to strengthen medical training and to provide funding for stigma-reduction programming are strongly recommended. Investigating Islamic literature and instruction, as well as requesting official public statements from religious leaders regarding stigma and discrimination in healthcare settings, should be used in educational intervention programmes targeting healthcare providers. Finally, further studies are needed to investigate the role of the physician and religion in the local context.</p

Scattering theory with finite-gap backgrounds: Transformation operators and characteristic properties of scattering data

We develop direct and inverse scattering theory for Jacobi operators (doubly infinite second order difference operators) with steplike coefficients which are asymptotically close to different finite-gap quasi-periodic coefficients on different sides. We give necessary and sufficient conditions for the scattering data in the case of perturbations with finite second (or higher) moment.Comment: 23 page

Integrating a suicide prevention program into the primary health care network: A field trial study in Iran

Objective. To describe and evaluate the feasibility of integrating a suicide prevention program with Primary Health Care services and evaluate if such system can improve screening and identification of depressive disorder, reduce number of suicide attempters, and lower rate of suicide completion. Methodology. This was a quasi-experimental trial in which one community was exposed to the intervention versus the control community with no such exposure. The study sites were two counties in Western Iran. The intervention protocol called for primary care and suicide prevention collaboration at different levels of care. The outcome variables were the number of suicides committed, the number of documented suicide attempts, and the number of identified depressed cases. Results. We identified a higher prevalence of depressive disorders in the intervention site versus the control site (χ2=14.8, P<0.001). We also found a reduction in the rate of suicide completion in the intervention region compared to the control, but a higher prevalence of suicide attempts in both the intervention and the control sites. Conclusion. Integrating a suicide prevention program with the Primary Health Care network enhanced depression and suicide surveillance capacity and subsequently reduced the number of suicides, especially in rural areas