The challenges of urban family physician program over the past decade in Iran: a scoping review and qualitative study with policy-makers

Introduction: Despite all the advantages of urban family physician program (UFPP), there is still a gap between UFPP and what is actually achieved by the community after its implementation in Iran. In response, this study attempted to review published studies related to the barriers to the implementation of the UFPP in Iran as well as potential solutions to improve it. Further, a qualitative study was conducted to learn the perspectives of experts at the national level and in the Fars province in order to better understand the program's challenges. Methods: This study was conducted in two phases. First, a scoping review was done, aiming to identify the common barriers and potential solutions to implementing UFPP in Iran. Second, a qualitative study using semi-structured interviews was conducted to investigate the views of decision- and policy-makers regarding barriers to and solutions for implementing the UFPP in the Fars province over the last decade. The findings were classified using the five control knobs framework (Organization, financing, payment, regulation, and behavior).  Results: The most common barriers to UFPP were: 1) organization (ununited stewardship function of the Ministry of Health, weak management and planning, inadequate training of human resources, and a weak referral system); 2) financing (fragmented insurance funds, insufficient financial resources, and instability of financial resources); 3) payment (inappropriate payment mechanisms and delay in payments); 4) regulation (cumbersome laws and unclear laws); and 5) behavior (cultural problems and conflict of interests). On the other hand, several solutions were identified to improve the implementation of UFPP, including: enhancing the role of government; improving the referral system; providing comprehensive training for UFPP providers; considering sustainable financial resources; moving towards mixed-payment mechanisms; employing appropriate legal and regulatory frameworks; enhancing community awareness; and elevating incentive mechanisms. Conclusion: Our research found that, despite the UFPP having been in place for a decade in Iran, there are still significant challenges in all five components. Therefore, the promotion of this program requires solving the existing implementation challenges in order to achieve the predetermined goals. The ideas in this study can be used to improve the current program in Fars Province and bring it to other cities in Iran

Correlation between Altmetric and Scientometric Indicators

Objective: Despite the increasing attention to altmetric indicators in scientometric research, there is still doubt about the validity of these indicators in evaluating research. The purpose of this study was to investigate the relationship between scientometric and altmetric indices on scientific products. Materials and Methods: In the altmetric indices section, five indicator classes presented in Scopus and 36 sub-indices were examined. The Spearman correlation indicator was used to evaluate the correlation between altmetric and scientometric indices. The SPSS software version 16 was used to analyze data. The significance level was also considered less than 0.05. Results: The correlation between the number of citations to documents and Usage, Citations, and Capture was significant. There was no significant relationship between social media and mention. Also, there is a significant and positive relationship between the citations to documents and sub-indices of Abstract views, Link out, Readers, Export/saves, and Citation indicator. Conclusion: Given the important relationship between citation rates and altmetric indicators, it can be said that web-based platforms like scientific databases or social media that are publicly accessible play a very important role in increasing the visibility and citation rate and thus the effectiveness of research

Making the Most out of Distributed Generation without Endangering Normal Operation: A Model-Based Technical-Policy Approach

<p>In this dissertation we introduce a model-based approach for efficiently locating and operating distributed generation (DG) without endangering stable system operation. The proposed approach supports quantifiable policy making based on technical design. The model used is structural and it comprises local models of DGs and loads interconnected via distribution grid system. While similar model structure can be used to represent meshed transmission grids, identifying model properties unique to distribution systems sets the basis for interpreting power delivery losses as the key measure of the overall system efficiency. It furthermore sets the basis for designing decentralized control specifications necessary to ensure system-wide stability. Once the underpinnings of the technical design are understood, the findings are used to propose a model-based quantifiable policy design to support process of integrating and operating DGs in distribution systems.</p> <p>We first investigate efficient integration of distributed generation on the distribution side of electric energy systems. We introduce a notion of efficiency in distribution systems which is uniquely determined by the fact that DG units are clean and inexpensive; because of this DGs are always scheduled and there is no need for economic dispatch. This points to the fact that the main measure of efficiency is loss minimization. This notion helps us in streamlining specific methods for optimizing losses both in planning and operation. At the planning stage the best location is found, and in operation optimal voltage dispatch is done to reduce losses. We show that a 10% penetration of DG units can reduce up to 50% of distribution losses, if DG units are strategically located and optimally operated in distribution systems.</p> <p>One possible problem with optimal placement of DG units may be an overly high sensitivity of their response to even small perturbations from normal conditions. Therefore, a very efficient distribution system with optimally-placed DG units may not be robust in operations. In order to assess robustness of distribution energy systems with respect to small disturbances, we model distribution systems as dynamical systems. We show that because of the strongly coupled voltage/real-power interdependencies in power flows of distribution systems, it is no longer possible to use a decoupled real-power dynamic model which neglects the effects of voltage dynamics. This conclusion is a direct consequence of a non-negligible resistance-reactance ratio in distribution systems which differentiate them from the typical transmission systems. Therefore, only coupled models should be used for stability analysis and for control tuning of DGs in distribution systems.</p> <p>Using such a dynamic model we show that distribution systems with high penetration of DG units can exhibit frequency- and/or voltage-instabilities when power plants have conventionally tuned control. Such instabilities are particularly pronounced when the DG units are electrically close. Gerschgorin circle theorem and participation factor-based methods are used to identify the main cause of instabilities as being the interactions of the local DG dynamics through the distribution power grid. Since the proposed dynamical model structure allows us to represent any type of DG plant and its local control, stability analysis can be performed for a general type of a DG using these methods to determine bounds on interactions between each specific DG and the rest of the system so that no interactions occur.</p> <p>These bounds are dependent on the machine type and parameters, the local control and the grid parameters. Some DGs may not have sufficient control as measured in terms of these bounds, and, these are the ones which require enhanced control to ensure system-level stability without unstable interactions, as discussed next.</p> <p>The severity of dynamical problems in specific distribution systems with DGs depends on the technology and control of DGs and on the electrical distances between the DGs. Typical DGs are either synchronous machines or induction machines whose inertia may be much smaller than the inertia of large generators. Their local control may range from no control, through well-understood governor-excitation control of synchronous machines, through power electronically controlled inverters of synchronous and/or induction machine type DGs (power system stabilizers (PSS) and/or doubly fed induction machines (DFIG)).</p> <p>In this dissertation we have studied stability problems in systems with DGs being small and/or medium size synchronous machines controlled by governor-excitation systems and/or by pitch control combined with PSS control. We assess possible instabilities in such systems when controllers are tuned on a stand-alone machine connected to the impedance representing the rest of the system (today's practice). We show that a more systematic fully decentralized, and, therefore, simple, control design proposed, in this dissertation, could stabilize synchronous machine-type DGs, such as diesel and hydro plants, without inverter control. Moreover, synchronous machine-type wind power plants can be stabilized in a decentralized way by combining advanced pitch control and/or PSS control.</p> <p>Based on the above technical findings we propose a policy-making process for giving guidelines: (1) to best locate candidate DG units; (2) to dispatch set points on the voltage controllers of DGs in coordination with dispatching set points of other voltage-controllable equipment for ensuring minimal losses in operations; and, (3) to enhance the existing control of the DGs and/or deploy new enhanced decentralized control. Because the solutions are system-dependent, simple one-size-fits-all policies are no longer viable; instead, policy decisions must be supported by software for placing the DGs and for designing their voltage dispatch and control. This approach leads to systematic institutional agreements and policies needed to support large penetration of DG units while ensuring both efficiency and robustness of distribution energy systems.</p

Renal ablation for treatment of hypertension without Symplicity catheter: The first human experience

BACKGROUND: Hypertension (HTN) treatment has remained insufficient. New modalities such as &ldquo;Symplicity method&rdquo; for the treatment of HTN are a priority, especially in patients with resistant hypertension. In this study, we describe our first experience with a novel percutaneous treatment modality, without using Symplicity catheter. METHODS: 30 Patients who were resistant to at least three types of antihypertensive medical therapy were selected. Patients received percutaneous renal artery denervation, without Symplicity catheter method, and were followed up for 1 week, 1, 3, and 6 months later after treatment. Ambulatory 24-hour blood pressure (BP) Holter was performed 1 week before intervention and after 1 month. The primary outcome was change in 24-hour ambulatory BP and change in office and home-based BP measurements. RESULTS: The mean age of the studied patients was 52 &plusmn; 15.4 years and 43.3% (n = 13) were female. Systolic and diastolic BP at baseline was 163 &plusmn; 17.2 and 95 &plusmn; 8.2 mmHg, respectively. Patients took 3.6 &plusmn; 1.3 hypertensive medications. Systolic and diastolic BP at 1-week, 1-month, 3-month and 6-month after renal denervation significantly decreased compared to the baseline (P &lt; 0.0001). Average BP derived from 24-hour ambulatory BP monitoring changed in parallel with office-based BP measurements. Most of patients (50%) who underwent renal denervation had reductions of 10 mmHg or greater in systolic BP and 56.7% of them had reductions of 5 mmHg or greater in diastolic BP. 33.3% of patients also achieved the target of systolic BP less than 140 mmHg and 60% achieved the target of diastolic BP less than 90 mmHg. No patients showed vascular damage at final angiography. CONCLUSION: Catheter based renal ablation was associated with a significant reduction in both systolic and diastolic BP, on top of maximal medical therapy, which persisted throughout 6 months follow-up in the first-in-man study without the Symplicity catheter. &nbsp; Keywords: Renal Denervation, Resistant Hypertension, Catheter</div

Chemical compositions and antioxidant activity of Heracleum persicum essential oil

ABSTRACT In this study essential oil of the aerial parts of Heracleum persicum a spice widely used in Iran was isolated by conventional hydrodistillation (HD) and microwave-assisted hydrodistillation (MAHD) techniques. The extraction yield was determined and the chemical compositions of essential oils were identified by the application of gas chromatography/mass spectrometry (GC/MS). The antioxidant activity was determined by two different methods: 1,1-diphenyl-2-picrylhydrazyl (DPPH) free radical scavenging and oven test methods. Although the main compounds of essential oils by the both extraction methods were similar, the essential oil extracted by HD with lower extraction efficiency showed more diverse compounds. The evaluation of antioxidant activity of the essential oil measured by delay in sunflower oil oxidation indicated that the antioxidant activity was dependent on the concentration which increased when higher concentrations of the essential oils were applied. The results of DPPH radical assay also indicated that the percentage of inhibition increased with increasing of essential oil concentration and IC50 value for essential oil extracted by MAHD method was obtained 1.25 mg/mL. Therefore the Heracleum persicum essential oil might be recommended for use as a flavoring agent and a source of natural antioxidants in functional foods, formulation of the supplements and in medicinal due to numerous pharmacological activities

Optimization of Lutein Extraction from Pistachio Waste Using Experimental Design and Ultrasonic Method

Background Agricultural by-products rich in lutein such as pistachio hull can be applied in pharmaceutical, cosmetics and food manufacturing. The development of rapid and cost-effective extraction methods of lutein from pistachio hull to optimize lutein recovery is of great interest to transpose to an industrial scale. Herein, we optimized the extraction protocol of lutein from the Iranian pistachio hull using experimental design and ultrasonic method. Methods Fresh raw un-hulled pistachios were harvested and dehulled, then hulls were dried and finely powdered to use for further analysis. Soxhlet process was carried out to obtain pistachio hull oleoresin and response surface methodology (RSM) was used for the optimization of saponification and ultrasonic methods. The lutein contents were quantitatively analyzed and validated using LC-MS/MS system. Results Our results showed that lutein in pistachio hull is mainly in free form, therefore the saponification method is not necessary for its extraction. Under optimal experimental design conditions, the maximum amount of lutein predicted and observed was 7.90 and 7.97 mg/100 g, respectively. Ethyl acetate was applied as an extraction solvent with the ultrasonic method followed by the setting up of the extraction time, temperature and solvent/sample ratio as variables. Under optimal experimental conditions corresponding to 45 min extraction time at 50 °C and 35.5 mg/ml of the solvent/sample ratio, the amount of lutein obtained from dried pistachio hull was 5.14 mg/100 g. Conclusion Pistachio waste products are rich in lutein which is in free from, so the administration of ultrasonic extraction using Ethyl acetate as a green and cost-effective method can be applied for lutein extraction from other plant materials and suggested for application on an industrial scale.</p

Application of Microwave-Assisted Method for Lutein Extraction from Pistachio Waste

Lutein is a xanthophyll family of carotenoids, found in flowers, vegetables, and fruits either in esterified or non-esterified fatty acid form. It is mainly administered in pharmacological products, dietary additives, the food industry, and animal feeding industries. This study was conducted on the ̳Fandoghi‘ variety from the Markazi province for pistachio hull lutein extraction and quantification. This study aimed to assess the lutein in pistachio hull and optimize its extraction protocol by new extraction methods with emphasis on microwave-assisted method (MAE). The powder from dried pistachio hulls obtained from fresh raw un-hulled pistachios was applied for further analysis. An experimental design based on the central composite design was applied for the extraction using the MAE method and extraction optimization. The lutein contents were quantitatively analyzed using a validated LC-MS/MS method. According to the free form of lutein, Ethyl acetate was applied as an extraction solvent with the MAE method followed by the setting up of the extraction time, temperature, and solvent/sample ratio as variables. Under optimal experimental conditions corresponding to 5 min extraction time at 40°C, and 30 mg ml-1 of the solvent/sample ratio, the amount of lutein obtained from dried pistachio hull was 3.86 mg 100 g-1. The MAE method is a green, time-saving, and cost-effective method for lutein extraction from pistachio hull that can be suggested for lutein extraction from other plant materials and it can be applied in industrial scale