The Causes of Discharge against Medical Advice from the Emergency Department of a Teaching Hospital of Tehran in 2012

Background: Discharge against medical advice (DAMA) occurs when a patient leaves the hospital against the physician’s advice. The aim of this study was to investigate the causes of discharge against medical advice. Methods: In this cross-sectional study, all patients who were discharged against medical advice from the Emergency Department of Shohada-e-Tajrish teaching hospital in the second half of 2012, were included. Data were collected by a researcher-made checklist that its validity and reliability had been confirmed. Data were analyzed by using Chi square and independent two-sample t-test. Results: The results show that among all the units of Emergency Department, the units of general surgery (14.4%), internal medicine (11.9%), and neurosurgery (11.9%) had the highest rate of discharge against medical advice, respectively. The main causes of discharge against medical advice were partial recovery according to patients’ opinion, the distance from home to hospital, and patients’ exhaustion from the hospital environment. However, there was no statistically significant relationship between discharge against medical advice and the type of Emergency Department unit, work shifts, or income. Conclusion: Due to the high rate of discharge against medical advice in teaching hospitals of Iran, it is essential to pay more attention to this important issue as the main issue emphasized on in clinical governance in teaching hospitals of Iran, and also prioritize providing high quality services in order to increase patients’ satisfaction and decrease the rate of discharge against medical advic

Regenerative Braking for Electric Vehicles (EVs) Using Permanent Magnet Synchronous Machin (PMSM) with Cascaded Half-bridge (CHB) as Bidirectional Traction Converter

Permanent-magnet synchronous motor (PMSM) is broadly adopted in electric vehicles (EVs) due to its superior advantages like providing high efficiency and excellent torque-speed characteristics. Regenerative braking (RB), which is the recovery of the kinetic energy during deceleration, is an efficient method to restore the kinetic energy into the battery to extend the battery and hence the driving range. In this paper, an RB strategy is proposed where the drive shaft’s torque is estimated using a detailed analysis of all the forces acting on an EV along an inclined road. To achieve the maximum electromagnetic torque, the d-axis component of the stator current is set to zero. Then, the three-phase voltages are generated and applied to the stator windings based on the EV demand. To improve the harmonic performance, the multilevel cascaded half-bridge (CHB) converter is used as the bidirectional traction converter. The proposed RB strategy is verified in the operating modes of acceleration, deceleration (braking), and constant speed using MATLAB/Simulink computer simulations and tested with a small-scale experimental rig controlled by TMSF28335 Digital Signal Processor

Performance evaluation of services quality in higher education institutions using modified SERVQUAL approach with grey analytic hierarchy process (G-AHP) and multilevel grey evaluation

In today’s climate of fierce competition, there is a necessity to pay especial attention on customer demands either in manufacturing or service sector. Managers in service sector are under pressure in terms of environmental factors, they focus on customers’ satisfaction and this has led to the continuous improvement in the performance of service organizations. Meanwhile, customers’ expectations should be properly understood and measured. There have been various efforts to measure the quality of services using the SERVQUAL model. In this study, we try to investigate the concepts and factors influencing the quality of services according to modified SERVQUAL model and then utilize the proposed model of Grey Analytic Hierarchy Process (G-AHP) and Multilevel Grey Evaluation in order to evaluate the quality of services in the framework of Grey Systems Theory (GST). In order to propose our method, we will conduct a case study of the performance of service quality in higher education institutions of Isfahan-Iran

The association between serum lipids profile and HbA1c in type 2 diabetes mellitus in Tehran, Iran

Background and aims: Dyslipidemia is one of the major factors implicated in the development of the vascular complications of diabetes. In this study, it was evaluated the association between serum lipids profile and Hemoglobin A1c (HbA1c) in type 2 diabetes mellitus. Methods: In this cross-sectional study, the serum lipid profile and HbA1c was studied on 562 Iranian patients who were older than 30 years and had type 2 diabetes identified from the diabetes and metabolic diseases clinic of endocrinology and metabolism research institute. A Multiple Linear Regression analysis was also done with the HbA1c as outcome variable and serum lipids profile as predictor variables; adjusted for potential confounders (age, sex, diabetes duration and Body Mass Index (BMI)). Results: In 1966, 6.34 of the national total population was over 60 years compared to mean age of the participants that was 61.6±10.4 years, with a range of 32 to 89 years. The results confirmed that the Triglyceride (TG) (β: 0.11, 95 CI: 0.000-0.004, P=0.01) and cholesterol (β: 0.13, 95 CI: 0.000-0.009, P=0.04) were correlated with the HbA1c value but there were no significant association between HDL and LDL. Conclusion: This study demonstrated that in persons with type 2 Diabetes Mellitus (DM), HbA1c value is a good predictor of lipid profile. Therefore, lipid profiling for all persons with type 2 DM should be a routine test

Non-Integrated and Integrated On-Board Battery Chargers (iOBCs) for Electric Vehicles (EVs) : A Critical Review

The rising Greenhouse Gas (GHG) emissions stemming from the extensive use of automobiles across the globe represent a critical environmental challenge, contributing significantly to phenomena such as global warming and the deterioration of air quality. To address these challenges, there is a critical need for research and development in electric vehicles (EVs) and their associated charging infrastructure, including off-board and on-board chargers (OBCs). This paper aims to bridge the gaps in existing review literature by offering a comprehensive review of both integrated and non-integrated OBCs for EVs, based on the authors’ knowledge at the time of writing. The paper begins by outlining trends in the EV market, including voltage levels, power ratings, and relevant standards. It then provides a detailed analysis of two-level and multi-level power converter topologies, covering AC-DC power factor correction (PFC) and isolated DC-DC topologies. Subsequently, it discusses single-stage and two-stage non-integrated OBC solutions. Additionally, various categories of integrated OBCs (iOBCs) are explored, accompanied by relevant examples. The paper also includes comparison tables containing technical specifications and key characteristics for reference and analysis

Maximum Wireless Power Transmission Using Real-Time Single Iteration Adaptive Impedance Matching

Wireless power transfer (WPT) systems’ efficiency is significantly impacted by non-monotonic variations in the coupling coefficient. For very short distances or strong-coupling cases, the WPT efficiency is minimal at the natural resonant frequency, with two peaks around this frequency, known as the frequency splitting phenomenon. On the other hand, WPT capability decreases for long distances or weak coupling cases. Therefore, adaptive matching is required for WPT systems with varying distances, like wireless charging systems for electric vehicles (EVs). This paper first presents a detailed analysis of the frequency splitting phenomenon by studying the root locations of the WPT system’s transfer function. Then, a real-time fixed-frequency adaptive impedance matching (IM) method is proposed, in which the amplitude and phase of the input impedance is estimated using the average active power, the average reactive power, and the amplitude of input voltage. Unlike traditional search-and-find techniques, the proposed method calculates the optimal IM network parameters only in a single iteration, which improves the convergent speed. A scaled-down 20-Watt prototype controlled by the TMSF2812 is fabricated and used to validate the effectiveness of the proposed method over a wide range of coil-to-coil distances

The comparison of the effectiveness of contingency management and trans-theoretical model on the risk of sexual behaviors in cocaine users: A short report study

BACKGROUND: A transtheoretical model (TTM) can be considered as a cognitive and motivational view, a component which plays a significant role in addiction. Further, the theoretical basis of contingency management (CM) treatment is the origin of behaviorism and relies on operant conditioning. The present study is performed aiming to determine the effectiveness of TTM and CM on cocaine use and sexual risk behaviors in cocaine users.METHODS: In this randomized clinical trial with 6-month follow-up, which was performed from 15 December 2014 to 20 November 2015, 75 male cocaine users were selected based on a respondent-driven sampling (RDS) method and were randomly divided into three groups by block randomization. The experimental group received a 12-week CM protocol and TTM and the control group was placed on the waiting list. Pre-test, post-test (after 12 weeks of training), and follow-up (six months) were administered. Data analysis was carried out using repeated measures analysis of variance (ANOVA), Scheffe’s post hoc test, and chi-square test through SPSS software.RESULTS: The mean age of the CM group, TTM group, and control group was estimated 26.12, 25.31, and 23.91, respectively. The primary outcome showed that CM and TTM had a significant effect on decreasing the sexual thoughts, sexual hyperactivity, and high risk behaviors. This effectiveness was stable until six months (P = 0.008), however there was not a significant difference between the two treatments (P = 0.200). The secondary outcome showed that in the changing stages, TTM (F-72%) and CM (F-60%) had a significant effectiveness which maintained until the follow-up stage.CONCLUSION: The findings more enhance the hope to integrate the theoretical approaches into the clinical interventions

Effects of Streptozotocin Induced Diabetes on One-Carbon Cycle and Sperm Function

Objective: Diabetic men suffer an increased risk of infertility associated with signs of oxidative damage and decreasedmethylation in sperm pointing to a deficit of the one-carbon cycle (1CC). We aimed to investigate this deficit using micemodels (type 1 and 2) of streptozotocin-induced diabetes.Materials and Methods: In this experimental study, 50 male mice, aged eight weeks, were divided randomly intofour groups: sham, control, type 1 diabetes mellitus (DM1), and DM2. The DM1 group was fed a normal diet (ND) foreight weeks, followed by five consecutive days of intraperitoneal administration of Streptozotocin (STZ, 50 mg/kg bodyweight). The DM2 group was fed a high-fat diet (HFD) for eight weeks, followed by a single intraperitoneal injectionof STZ (100 mg/kg). After twelve weeks, all the mice were euthanized, and study parameters assessed. In the shamgroup, citrate buffer as an STZ solvent was injected.Results: Both types of diabetic animals had serious impairment of spermatogenesis backed by increased DNA damage(P=0.000) and decreased chromatin methylation (percent: P=0.019; intensity: P=0.001) and maturation (P=0.000).The 1CC was deeply disturbed with increased homocysteine (P=0.000) and decreased availability of carbon units[methionine (P=0.000), serine (P=0.088), folate (P=0.016), B12 (P=0.025)] to feed methylations.Conclusion: We have observed a distinct impairment of 1CC within the testes of individuals with diabetes. Wespeculate that this impairment may be linked to inadequate intracellular glucose and diminished carbon unit supplyassociated with diabetes. As a result, interventions focusing on enhancing glucose uptake into sperm cells and providingsupplementary methyl donors have the potential to improve fertility issues in diabetic patients. However, additionalclinical testing is required to validate these hypotheses

Treatment of Automatic Negative Thoughts and Non-suicidal Self-injury (NSSI) Behavior in Borderline Personality Disorder Adolescents: Dialectical Behavior Therapy

Background: About 17 to 80% of borderline personality disorder (BPD) patients suffer repeated NSSI (most frequently, cutting/burning self-injury), while 46 to 92% of BPD patients attempt suicide. This study aimed to investigate the effectiveness of the condensed dialectic behavior in reducing automatic negative thoughts and its positive effects on non-suicidal self-injury (NSSI) behavior in borderline personality disorder (BPD). Methods: A semi-experimental study with pre-and post-tests is going on with both an experimental group and a control group. In 2019, twenty-two BPD adolescents who attended the treatment clinic) Masire Sabz), district 8, Tehran, were divided into two groups. Two questionnaires of automatic negative thoughts and non-suicidal suicide self-injury were administered before and after the intervention. This study employed SPSS 23 with Levene's test, as well as ANOVA to analyze the data. During the intervention group, twelve 90-minute sessions took place with participants in the intervention group, which followed a protocol adapted from a standard DBT protocol for BD participants in the control group waited for a treatment appointment. Results: The results showed that the scores of the intervention group significantly decreased in the Automatic negative thoughts and non-suicidal self-injury after 2 months of the intervention (Pvalue<0.001). Conclusions: It can be concluded that dialectical behavior therapy was effective on automatic negative thoughts and non-suicidal self-injury (NSSI) behavior among borderline personality disorder adolescents. Keywords: Automatic negative thoughts, Non-suicidal self-injury (NSSI) behavior, Borderline personality disorder

Intraocular Injection of Stivant® (A Biosimilar to Bevacizumab): A Case Series

Purpose: To report the results of intravitreal injection of a bevacizumab biosimilar called Stivant®. Methods: This prospective interventional case series was conducted on eyes with neovascular age-related macular degeneration (nAMD), retinal vein occlusion (RVO), and diabetic macular edema (DME). Stivant® was injected in three consecutive months and changes in best-corrected visual acuity (BCVA) and central macular thickness (CMT) were measured at baseline and monthly up to one month after the third injection. Results: Three hundred and eighty-five eyes with DME (234 eyes, 61%), nAMD (87 eyes, 22%), and macular edema secondary to RVO (64 eyes, 17%) were enrolled. The mean ± standard deviation age of the patients was 61.7 ± 7.20 years. The mean BCVA and CMT changed from 0.63 ± 0.3 to 0.51 ± 0.3 LogMAR (P = 0.12 ) and from 420.4 ± 47.3μm at baseline to 316.7 ± 50.6 μm (P < 0.001) in the DME group; from 0.79 ± 0.3 to 0.68 ± 0.3 LogMAR (P = 0.19) and from 376.1 ± 31.7 μm to 303 ± 31.3 μm (P = 0.019) in the nAMD group; and from 0.81 ± 0.4 to 0.63 ± 0.4 LogMAR (P = 0.05) and from 424.21 ± 18 μm to 303.4 ± 18.8 μm (P < 0.001) in the RVO group, respectively. Conclusion: Our limited experience showed that the intravitreal injection of Stivant® was well tolerated. Although the results of this case series showed relative improvement in CMT one month after the last injection of Stivant®, BCVA improvement was statistically significant only in the RVO group. This would be essential to design a randomized clinical trial to evaluate the non-inferiority of Stivant® in comparison to bevacizumab