Prevention of Drowning by Community-Based Intervention: Implications for Low- and Middle- Income Countries

Background: Drowning is a serious but neglected health problem in low-and middle-income countries. Objectives: To describe the effectiveness of drowning prevention program on the reduction of drowning mortality rates in rural settings at the north of Iran, and guide its replication elsewhere. Patients and Methods: This interventional design included pre- and post-intervention observations in the rural area of the Caspian Sea coastline without a comparison community. Cross-sectional data were collected at pre- and post-intervention phases. Outcome evaluation was based on a four-year period (March 2005-March 2009) utilizing drowning registry data for the north of Iran. Results: The implementation program increased the rate of membership in an organization responsible for promoting safety in high risk areas near the Caspian Sea. Compared to a WHO standardized population, drowning incidence in rural areas of the study demonstrated a continuous decrease in age-specific drowning rate among the oldest victims with a gradual decline during the implementation. In the study area, the epidemiological aspects of the study population were exposed and contributing factors were highlighted. Conclusions: This study showed that the promotion of passive interventions had a greater effect on drowning rate than that of active interventions

A Time Series Model for Assessing the Trend and Forecasting the Road Traffic Accident Mortality

Background: Road traffic accident (RTA) is one of the main causes of trauma and known as a growing public health concern worldwide, especially in developing countries. Assessing the trend of fatalities in the past years and forecasting it enables us to make the appropriate planning for prevention and control. Objectives: This study aimed to assess the trend of RTAs and forecast it in the next years by using time series modeling. Materials and Methods: In this historical analytical study, the RTA mortalities in Zanjan Province, Iran, were evaluated during 2007 - 2013. The time series analyses including Box-Jenkins models were used to assess the trend of accident fatalities in previous years and forecast it for the next 4 years. Results: The mean age of the victims was 37.22 years (SD = 20.01). From a total of 2571 deaths, 77.5% (n = 1992) were males and 22.5% (n = 579) were females. The study models showed a descending trend of fatalities in the study years. The SARIMA (1, 1, 3) (0, 1, 0) 12 model was recognized as a best fit model in forecasting the trend of fatalities. Forecasting model also showed a descending trend of traffic accident mortalities in the next 4 years. Conclusions: There was a decreasing trend in the study and the future years. It seems that implementation of some interventions in the recent decade has had a positive effect on the decline of RTA fatalities. Nevertheless, there is still a need to pay more attention in order to prevent the occurrence and the mortalities related to traffic accidents

Accessibility to the public facilities: A mean to achieve civil rights of the people with disabilities in Iran

Objective: Civil rights may cover different aspects of citizens' lives. All the members of the society should have equal access to the public facilities and public transportation system. Barriers and obstacles in society may limit the accessibility of these facilities to the disabled people. Method: This article contains a part of the results in a phenomenological study of the Disability Rights. The purpose of this phenomenological study was to describe experiences of disability rights among 11 physically disabled that were living in Tehran, Iran. The study involves secondary analysis of in-depth transcribed interview data, using colazzi's method. Results:A total of 655 descriptive expressions were categorized in to 25 preliminary structural elements (sub themes). 7 essential structural elements (themes) emerged from an analysis of the sub themes. One of these themes was right to access which was emerged from an analysis of 6 sub themes. Conclusion: These sub themes that were obtained from an analysis of descriptive expressions of the participants, are: right to access to housing, right to access to education and information, right to access to job facilities, right to access to medical care and rehabilitation, right to access to rest, leisure and sport and right to access to places and transportation system. The right to access theme, was then categorized in to the civil rights field. In this article we will describe the right to access as it was experienced by those physically disabled people who participated in the interviews

Laser powder bed fusion of 17–4 PH stainless steel:A comparative study on the effect of heat treatment on the microstructure evolution and mechanical properties

17–4 PH (precipitation hardening) stainless steel is commonly used for the fabrication of complicated molds with conformal cooling channels using laser powder bed fusion process (L-PBF). However, their microstructure in the as-printed condition varies notably with the chemical composition of the feedstock powder, resulting in different age-hardening behavior. In the present investigation, 17–4 PH stainless steel components were fabricated by L-PBF from two different feedstock powders, and subsequently subjected to different combinations of post-process heat treatments. It was observed that the microstructure in as-printed conditions could be almost fully martensitic or ferritic, depending on the ratio of Creq/Nieq of the feedstock powder. Aging treatment at 480 °C improved the yield and ultimate tensile strengths of the as-printed components. However, specimens with martensitic structures exhibited accelerated age-hardening response compared with the ferritic specimens due to the higher lattice distortion and dislocation accumulation, resulting in the “dislocation pipe diffusion mechanism”. It was also found that the martensitic structures were highly susceptible to the formation of reverted austenite during direct aging treatment, where 19.5% of austenite phase appeared in the microstructure after 15 h of direct aging. Higher fractions of reverted austenite activates the transformation induced plasticity and improves the ductility of heat treated specimens. The results of the present study can be used to tailor the microstructure of the L-PBF printed 17–4 PH stainless steel by post-process heat treatments to achieve a good combination of mechanical properties

The Relationship Between Serum Levels of Interleukins 6, 8, 10 and Clinical Outcome in Patients With Severe Traumatic Brain Injury

Background: Clinical outcome in patients with severe traumatic brain injury (TBI) depends on both primary and secondary brain injuries. Neuroinflammation is an important secondary mechanism, which occurs by releasing interleukins (ILs). Increased levels of ILs may affect clinical outcome following TBI. Objectives: This study aimed to determine the relationship between the serum levels of interleukins 6, 8 and 10 and clinical outcome in patients with severe TBI 6 months after injury. Patients and Methods: In a descriptive-analytical study, 44 patients with GCS ≤ 8 (Glasgow coma scale) and age ≥ 14 years were included. Their blood samples were collected at first 6 hours after injury. Clinical outcome was determined based on GOS (Glasgow Outcome Scale) at 6 months after head injury. Serum levels of interleukins 6, 8 and 10 were measured using the ELISA method. Spearman's rho, independent T-Test, and Mann-Whitney Test were used for data analysis. Results: Comparing the serum levels of interleukins in two groups with favorable and unfavorable clinical outcomes showed that the mean serum levels of interleukins 6 and 8 in group with favorable outcome was 85.2 ± 51.6 and 52.2 ± 31.9, respectively lower than those of group with unfavorable outcome with 162.3 ± 141.1 and 173.6 ± 257.3 (P < 0.03) and (P < 0.01). Conclusions: Increased serum levels of interleukins 6 and 8 as a predictive marker might be associated with unfavorable clinical outcome in patients with severe TBI

Hard-yet-tough high-vanadium hierarchical composite coating:Microstructure and mechanical properties

In this work, we report a high-vanadium hierarchical coating prepared on the surface of nodular cast iron substrate by a low-cost plasma transferred arc (PTA) surface alloying process. The coating consists of a graded layer with an alloyed zone (AZ) rich in submicron sized granular (V-Ti-Nb-Cr-Mo) composite carbides on top of intermediate melted zone characterized by refined ledeburite and martensite. The dense spherical particles in the AZ are FCC structured MC-type (M = V, Ti and Nb) carbides which tend to aggregate while M7C3 and M2C carbides nucleate on MC. The super-lattice V8C7 maintains its cube-on-cube orientation relationship with TiC. The hardness of the AZ is 9.6 +/- 1.0 GPa, similar to 4 times that of the substrate. Nano- and micro-indentations point at a superior strength-toughness in the AZ, where cracks are deflected and bridged by the spherical MC carbides in a compressive residue stress state. The fracture mode appears to be rather ductile in the AZ whereas brittle failure appears in both the melted zone and substrate. TEM and EDS results confirm that such a micro architecture design, assisted by the rapid solidification rate of the PTA process, concurrently activates various strengthening micromechanisms including the precipitation hardening and grain refinement

Assessing the design of road traffic death information systems in Iran: a participatory systems approach

AIM: To describe and analyze the information architecture and information pathways of the road traffic death recording, registration and reporting system in Guilan Province, northernIran. METHODS: We used Business Process Mapping, a qualitative approach. This participatory and iterative approach consists of a document review, key informant interviews, development of a process map and a participatory workshop with key stakeholders to illuminate and validate the findings. We classified the tasks performed in the system into three phases: (1) Identification and recording; (2) Notification and registration, and (3) Production of statistics. RESULTS: We identified 13 stakeholders, with operating and influencing roles in the process of identification, registration and production of statistics about road traffic deaths in Guilan province. The three main sources of road traffic death statistics are the Ministry of Health and Medical Education, the National Organization for Civil Registration and the Forensic Medicine Organization. Our results reveal a highly fragmented system with minimal cross-sectoral data exchange. Each stakeholder operates in a silo resulting in delays and redundancies in the operating system. In the absence of an effective communication among stakeholders, the information exchange was dependent on the family of the deceased. These fragmented information silos alter the compilation of cause of death statistics and result in under-reporting and discrepancies in road traffic deaths figures. CONCLUSIONS: Designing a comprehensive road traffic information system that provides accurate and timely information requires an understanding of the information flow and the entangled web of different stakeholders operating in the system. Participatory systems approaches such as process mapping can assist in capturing the complexity of the system and the integration process by facilitating stakeholders' engagement and ownership in improving the design of the system

Enhancing smart city operation management: integrating energy systems with a subway synergism hub

This paper is centered on establishing a secure framework for the optimal concurrent operation of a smart city, encompassing transportation, water, heat, electrical, and cooling energy systems. The studied smart city includes the microgrid, smart transportation system (STS), energy hub (EH) and smart grid. In this regard, a subway synergism hub (SSH) as a new non-energy system is added to the smart city with the aim of serving the subway's water, heat, electrical and cooling demands as well as diminishing the operation cost of the smart city. The EH within the SSH cooperated with a desalination unit is considered to supply the subway's stations water demand by using the sea water. The investigation of the optimal allocation of the SSH unit for reducing the cost of smart city operation is also conducted by introducing a novel intelligent priority selection (IPS) analytical algorithm. In comparison to common meta-heuristic algorithms for allocation problems, the accurate optimal solution can be found in low runtime by the IPS algorithm. To achieve an accurate model of the smart city, directed acyclic graph (DAG) based blockchain approach is provided which can enhance the data and energy exchanges security within the smart city. This research paper introduces a security framework deployed in a smart city setting to establish a secure platform for energy transactions. The findings validate the effectiveness of this model and highlight the value of the IPS method. The effectiveness of the suggested approach has been assessed using the smart city system is comprised of various sections, including EVs, smart grid, microgrid, and SSH, demonstrating the credibility and accuracy of this study

European Society of Coloproctology: guidelines for the management of diverticular disease of the colon

The guideline was developed during several working phases including three voting rounds and one consensus meeting. The two project leads (JKS and EA) appointed by the ESCP guideline committee together with one member of the guideline committee (WB) agreed on the methodology, decided on six themes for working groups (WGs) and drafted a list of research questions. Senior WG members, mostly colorectal surgeons within the ESCP, were invited based on publication records and geographical aspects. Other specialties were included in the WGs where relevant. In addition, one trainee or PhD fellow was invited in each WG. All six WGs revised the research questions if necessary, did a literature search, created evidence tables where feasible, and drafted supporting text to each research question and statement. The text and statement proposals from each WG were arranged as one document by the first and last authors before online voting by all authors in two rounds. For the second voting ESCP national representatives were also invited. More than 90% agreement was considered a consensus. The final phrasing of the statements with < 90% agreement was discussed in a consensus meeting at the ESCP annual meeting in Vienna in September 2019. Thereafter, the first and the last author drafted the final text of the guideline and circulated it for final approval and for a third and final online voting of rephrased statements