Healthcare utilization in patients with esophageal cancer in a high risk area in northeast of Iran

Introduction: Golestan, a province located north of Persian Gulf in northeastern part of Iran is a well known area for high risk of esophageal cancer (EC) in the world. There is no information about healthcare utilization in populations residing in the area. This study was conducted to assess utilization of healthcare and its associated factors among esophageal cancer patients in this region as well as to address ethical implication of this utilization. Methods: All new cases of EC in Golestan province during year of 2007 were recruited. Seven diagnostic and five therapeutic services were used to assess diagnostic utilization index (DUI), and therapeutic utilization index (TUI), respectively. Multivariate regression analysis was used to assess the relationship between variables and DUI or TUI. P-value of less than 0.05 was considered as statistically significant. Results: Tow hundred twenty three, patients were enrolled with mean (Standard Deviation) age of 64.3 (12.5) years with 57.8% male. We observed that occupation (P<0.01), ethnicity (P<0.01) and sex (P=0.03) were strongly associated with DUI. Insurance coverage (P<0.01), place of residency (P<0.01), and occupation (P=0.01) were associated with TUI. Conclusion: We concluded that several factors contribute to disparity in healthcare utilization in the studied population

Queuing Models To Balance Systems With Excess Supply

Many manufacturing and service activities can be modeled using queuing theory. The optimization of the long-run solution to imbalances between supply and demand is very important to established businesses. This paper presents a family of queuing models that minimize the expected total cost incurred when restoring equilibrium to a stochastic system that has become unstable due to changes in the environmental parameters affecting its behavior. Analytical expressions for the expected total cost in terms of a policy parameter are derived from which numerically-savvy users can obtain the policy that minimizes the expected total cost. To determine the model parameters that most affect the optimal policy and to facilitate the determination of near-optimal policies, exact solutions were found for a large number of scenarios and then used to fit a regression model. The resulting regression equation can be used by practitioners to find policy parameters that approximately minimize the expected total cost due to imbalances in supply and demand

Optimal Supply & Demand Balance In Service Environments

We study service environments that can be modeled as stochastic finite-capacity double-ended queues, where supply and demand arrive in independent Poisson processes to be instantly paired-off. In the case where throughput (output rate) is not a significant metric of system performance (as typically studied in the literature), we derive analytical results to gain managerial insights. We find that the operational decision on optimal supply/demand balance and the strategic decision on how to achieve that optimal balance can be decoupled and stratified. With the purpose of providing a managerial guide, we identify conditions for when to manipulate demand rather than supply, and vice versa. For the first time in the literature, we study throughput considerations in this context, and we analytically characterize the optimal strategy. Specifically, we show that it is optimal to manipulate either demand, or supply (and not both), and that the optimal system balance and the strategy on how to achieve it are strongly tied. Our findings can shed light on the managerial decision making process in these environments, and they can be used to revisit any governing strategies dictating management of demand (or supply) as a first course of action

The prevalence of metabolic syndrome in the north of Iran. An epidemiologic comparative study

Background and Objective: The metabolic syndrome (MetS) increases the risk of cardiovascular diseases and the main aim of this study is to explorer prevalence of it in the north of Iran with comparison of Turkman and non-Turkman ethnic groups in 2012. Material and Methods: This is a cross-sectional study that conducted on the 248 subjects aged 25-70 years (Turkman=88 and non-Turkman=160). Individuals were chosen randomly from 25 clusters. Waist circumference was measured with the subject standing at the end of normal breathing; blood pressure was measured in three times and 5 ml of venous blood drawn after 8-12 h fast in the morning for laboratory test. Biochemical analysis including fasting blood glucose, triglyceride and high-density lipoprotein (HDL) cholesterol was assayed using a commercially kit (Pars Azmoon, Karaj, Iran). ATP-III method and SPSS 16.0 software (Chicago II, USA) were used for diagnosis of MetS and for statistical analyzes, respectively. P-value < 0.05 considered statistically significant. Results: Compare to Turkman group, the mean of FBG (fasting blood glucose), triglyceride and waist circumference are 15.9 mg/dl, 30.2 mg/dl and 6.5 cm were more in non-Turkman group, respectively (P<0.05 for all). The Pearson's correlation coefficient is positive between age and MetS (r=0.287, P=0.01). Generally, MetS was common in 37.9 of subjects and it was 14.7 in non-Turkman more than in Turkman people (P=0.015). Prevalence rate of MetS in men and women was 29.7 and 43.5, respectively (P=0.001). Conclusion: In the north of Iran, the prevalence of MetS is high and it was in non-Turkman ethnic group more than in Turkman group and in women more than in men while gender differences only was shown in non-Turkman ethnic group

Balancing Queueing Systems With Excess Demand

In a rough economic environment and increased competition, one issue critical to many businesses is to achieve an optimum balance between supply and demand. Double-ended queuing structure, where demand and supply occur simultaneously, can be utilized to model various manufacturing and service activities. By associating costs per time unit due to a unit of excess of supply or demand, the total cost will include now costs due to imbalance of demand and supply. The authors examine the queuing behavior and how to minimize the above total cost by advanced planning aimed to hold imbalance costs at a minimum.In this paper, the main focus will be on situations where a stochastic system has become unstable due to demand exceeding supply. To determine how sensitive optimal solutions are to changes in model parameters, for each policy, either decreasing demand or increasing supply, exact optimal solutions were found for a large number of scenarios and then used this scenarios database to fit the best possible regression model. The paper ends illustrating the use of the model to research funding where typically proposals compete for scarce funding resources

The association of fasting blood glucose (FBG) and waist circumference in northern adults in Iran: A population based study

Objectives: The aim of this study was to evaluate the association between Fasting Blood Glucose (FBG) level and Waist Circumference (WC) in men and women among 25-65 years old people in the north of Iran.Material and methods: This was a cross-sectional and analytical research gender that carried out on the 1797 subjects (941 males and 856 females) between 25-65 years old using multistage cluster sampling technique. FBG was measured in the morning after a 12-hour fast and was determined by using laboratory kits (enzymatic methods) and spectrophotometry technique. Central obesity was defined based on World Health Organization criteria: waist circumference ≥102 cm and ≥88 cm in men and women, respectively. The SPSS.16 software was used for statistical analysis.Results: As whole, the mean of FBG in women (98.3 ± 40.1 mg/dl) was higher than in men (94.6 ± 32.2 mg/dl). Also, the mean of WC in men 4.5 cm was lower than in women. In men, the mean of FBG statistically differs between normal and central obese subjects both in 35-45 year-age group (P = 0.001) and in 45-55 year-age group (P = 0.042). As whole, in men, the FBG level increased up 2.82 mg/dl in each 10 cm of WC with the highest rate in 35-45 year-age group. In totally, in women, the FBG level increased up 3.48 mg/dl in each 10 cm of WC and in 25-35 year-age group and it was higher than in other age groups. In men, the regression coefficients were constant with age increasing while in women it was decreased. Constant trend in men and decreasing trend in women with age was shown between FBG and WC. The cut-off point of WC for detecting of diabetes obtained 89 cm and 107 cm in men and women, respectively.Conclusion: The positive correlation was seen between WC and FBG level and it was declined with age in women. Cut-off point for detecting of diabetes in men was less than in women. WC is useable as a predictor of type 2 diabetes mellitus risk among adults in the north of Iran. © 2014 Veghari et al.; licensee BioMed Central Ltd

Optical coherence tomography angiography (OCTA) applications in ocular oncology

Optical coherence tomography angiography (OCTA) is a revolutionary method in the visualization of the vascular system in different retinal and choroidal layers. During the last 4 years since the commercial availability of different OCTA devices, attempts have been made to utilize this technology in various aspects of ocular oncology from the differentiation of benign and malignant lesions to assisting in evaluation of post-treatment complications, such as radiation retinopathy. However, current OCTA technology is restricted by various artefacts and inherent limitations, some of which are more pronounced in the presence of elevated tumoural lesions. Imminent advancements in OCTA systems and image acquisition processes promise a great potential for application of OCTA in ocular oncology. © 2020, The Author(s), under exclusive licence to The Royal College of Ophthalmologists