Efficacy of Hi-Lo Evac Endotracheal Tube in Prevention of Ventilator-Associated Pneumonia in Mechanically Ventilated Poisoned Patients

Background. Ventilator-associated pneumonia (VAP) is the most common health care-associated infection. To prevent this complication, aspiration of subglottic secretions using Hi-Lo Evac endotracheal tube (Evac ETT) is a recommended intervention. However, there are some reports on Evac ETT dysfunction. We aimed to compare the incidence of VAP (per ventilated patients) in severely ill poisoned patients who were intubated using Evac ETT versus conventional endotracheal tubes (C-ETT) in our toxicology ICU. Materials and Methods. In this clinical randomized trial, 91 eligible patients with an expected duration of mechanical ventilation of more than 48 hours were recruited and randomly assigned into two groups: (1) subglottic secretion drainage (SSD) group who were intubated by Evac ETT (n = 43) and (2) control group who were intubated by C-ETT (n = 48). Results. Of the 91 eligible patients, 56 (61.5) were male. VAP was detected in 24 of 43 (55.8) patients in the case group and 23 of 48 (47.9) patients in the control group (P = 0.45). The most frequently isolated microorganisms were S. aureus (54.10) and Acinetobacter spp. (19.68). The incidence of VAP and ICU length of stay were not significantly different between the two groups, but duration of intubation was statistically different and was longer in the SSD group. Mortality rate was less in SSD group but without a significant difference (P = 0.68). Conclusion. The SSD procedure was performed intermittently with one-hour intervals using 10 mL syringe. Subglottic secretion drainage does not significantly reduce the incidence of VAP in patients receiving MV. This strategy appears to be ineffective in preventing VAP among ICU patients. © 2016 Ahmad Ghoochani Khorasani et al

A Case Study on the Impact of Personal Characteristics on Residents’ Support for Tourism Development

A Case Study on the Impact of Personal Characteristics on Residents’ Support for Tourism Development Abstract This research assessed resident attitudes towards tourism including those areas that residents believe impact their quality of life. Specifically, the purpose of this study was to find how personal characteristics (distance from tourism zone, length of residency, and employment in the tourism sector) influence residents’ attitudes towards supporting tourism and the need for broader regulations to manage the sector’s impact on residents’ quality of life. Framed in social exchange theory and based on the works, this research proposes a serious of hypotheses and a structural equation model which examines the relationships among personal characteristics, the perceived positive/negative impact, and subsequent support for tourism development. Data were collected from a stratified random sample of residents of Charleston, SC in April 2014. AMOS program was utilized to test the conceptual model. Results reveal the existence of an indirect relationship between living distance to tourism district and residents’ attitude to tourism development, which is mediated by residents’ perception on the impact of tourism

Environmental values in the petrochemical industry: A Q-method study in South West Iran

Achieving sustainable development in different regional and cultural contexts is dependent, in part, upon an understanding of key actors’ underlying environmental, social and economic values. The social research technique called Q-methodology presents an effective means to explore such values as a matter of discourse: revealing the typologies of stakeholder perspectives within a given debate. Q-method involves factor analysis of participant rank-ordered preselected statements on a topic. The resultant factors are then reinterpreted as social discourses. In this study we use Q-methodology to explore the environmental values of Health Safety and Environmental (HSE) managers in petrochemical companies in Khuzestan province in southwest Iran. Khuzestan is a key region of petrochemical product development, with significant associated environmental pollution effects. Understanding HSE managers’ attitudes to environmental protection is of value in predicting broader environmental impacts to the region, given the relative importance of their role in regulating the environmental performance of this industry. Our results reveal four distinct and varied perspectives on environmental protection labelled: ‘Environmental stewardship’, ‘Environmental presentism’, ‘Technological optimism’ and ‘Enlightened anthropocentrism’. We then discuss how these four emergent perspectives correspond to broader environmental discourses as categorized by John Dryzek: i.e. green rationalism, economic rationalism, prometheanism and ecological modernization respectively

Effectiveness of naltrexone in the prevention of delayed respiratory arrest in opioid-naive methadone-intoxicated patients

Acute methadone toxicity is a major public health concern in Iran. Methadone-intoxicated patients are in a great risk of recurrent or delayed respiratory arrest despite the prescription of initial doses of naloxone. This study aimed to evaluate the effectiveness of oral naltrexone in the management of acute methadone overdose in opioid-naive patients and check if it could be a substitute of continuous infusion of naloxone in maintaining adequate ventilation. In a randomized, double-blind, placebo-controlled study, a total of 54 opioid-naive patients with acute methadone toxicity were enrolled. The patients received either oral naltrexone or placebo capsules after awakening by naloxone. All patients underwent close monitoring of respiration. Frequency of respiratory depression or arrest, need for another dose of naloxone, duration of hospital stay, and adverse outcomes compared between the two groups. The incidence of respiratory depression was significantly less in those who had received naltrexone. Our results show that single oral dose of naltrexone is quite efficient in the prevention of recurrent or delayed respiratory arrest in opioid-naive methadone-intoxicated patients. It can shorten the duration of hospitalization and, as a consequence, decreased the risk of complications. Further studies are warranted before the generalization of this approach to other patient populations. © 2013 Abbas Aghabiklooei et al

Effectiveness of naltrexone in the prevention of delayed respiratory arrest in opioid-naive methadone-intoxicated patients

Acute methadone toxicity is a major public health concern in Iran. Methadone-intoxicated patients are in a great risk of recurrent or delayed respiratory arrest despite the prescription of initial doses of naloxone. This study aimed to evaluate the effectiveness of oral naltrexone in the management of acute methadone overdose in opioid-naive patients and check if it could be a substitute of continuous infusion of naloxone in maintaining adequate ventilation. In a randomized, double-blind, placebo-controlled study, a total of 54 opioid-naive patients with acute methadone toxicity were enrolled. The patients received either oral naltrexone or placebo capsules after awakening by naloxone. All patients underwent close monitoring of respiration. Frequency of respiratory depression or arrest, need for another dose of naloxone, duration of hospital stay, and adverse outcomes compared between the two groups. The incidence of respiratory depression was significantly less in those who had received naltrexone. Our results show that single oral dose of naltrexone is quite efficient in the prevention of recurrent or delayed respiratory arrest in opioid-naive methadone-intoxicated patients. It can shorten the duration of hospitalization and, as a consequence, decreased the risk of complications. Further studies are warranted before the generalization of this approach to other patient populations. © 2013 Abbas Aghabiklooei et al

Performance, kinetic, and biodegradation pathway evaluation of anaerobic fixed film fixed bed reactor in removing phthalic acid esters from wastewater

Emerging and hazardous environmental pollutants like phthalic acid esters (PAEs) are one of the recent concerns worldwide. PAEs are considered to have diverse endocrine disrupting effects on human health. Industrial wastewater has been reported as an important environment with high concentrations of PAEs. In the present study, four short-chain PAEs including diallyl phthalate (DAP), diethyl phthalate (DEP), dimethyl phthalate (DMP), and phthalic acid (PA) were selected as a substrate for anaerobic fixed film fixed bed reactor (AnFFFBR). The process performances of AnFFFBR, and also its kinetic behavior, were evaluated to find the best eco-friendly phthalate from the biodegradability point of view. According to the results and kinetic coefficients, removing and mineralizing of DMP occurred at a higher rate than other phthalates. In optimum conditions 92.5, 84.41, and 80.39% of DMP, COD, and TOC were removed. DAP was found as the most bio-refractory phthalate. The second-order (Grau) model was selected as the best model for describing phthalates removal

An application of European Performance Satisfaction Index toward rural tourism: The case of western Iran. Tourism Management Perspectives

Iran is endowed with numerous historic and cultural attractions spanning more than 7000 years of continuous civilization, affording it much tourism potential. However, the country currently ranks 70th worldwide in tourists' arrivals and 77th in revenues generated by tourism. Though tourism potential does not always lead to its development, an assessment of resident attitudes towards tourism as an economic development strategy is a needed precursor to an integrated management approach so that once the impediments are lifted, the industry can develop in an appropriate and sustainable way. To achieve this end, this study operationalized the European Performance Satisfaction Index to assess resident attitudes and commitment towards tourism in Oraman County in Iran's Kurdistan province. Yielded from the survey data was a causal chain of factors influencing commitment towards tourism among those known in the community to have experience in current tourism offerings and upon whom future tourism development would likely depend

Explaining the Attitudes and Behavioral Intention of Farmers toward Water Users’ Cooperatives in South of Karkhe Nur River

The main purpose of this study was to explain the farmer’s attitudes and behavioral intention toward membership in water users’ cooperation in the South of Kharkhe Nur River in the Khuzestan province. This study used a mixed method. All farmers who their fields located in the South of Kharkhe Nur River (Area of construction, equipping and modernization of land of Dezh) considered as statistical population. In the qualitative sector, the researchers used depth observation in about 14 months in the research area and tried to have an accurate cognition about the area’s context. Then, according to the result of qualitative research and also literature review a researcher made questionnaire was designed, which its validity and reliability confirmed by expert’s panel and cronbach’s alpha coefficient respectively. The data described and analyzed using SPSS V20. The results revealed that the farmers have positive attitudes towards water users’ cooperation and there was potential for establishing of the cooperation in the region. Also the results revealed that there was a positive association between attitude and behavioral intention of the farmers towards membership in the water users’ cooperatives