A Report on Results of a Qualitative Study on the Factors affecting the Implementation of Clinical Back Pain Guide

Introduction: Today, the use of clinical guidelines is increasing. Unfortunately, their use in therapeutic clinics is facing barriers.   The purpose of this study is to investigate the barriers to the use of clinical guidelines to try to resolve them. Methods and Materials: Qualitative study method was used to study the barriers of using clinical guidelines. 15 physiotherapists from the private and public centers of Tehran participated in the study. In one interview, all of their comments were recorded in relation to the clinical management of back pain. Results: After interviewing each other, their views were summarized and eventually classified into five groups. Conclusions: Despite the positive attitude of interviewed people towards using clinical guidelines, the results showed that there are significant barriers in this regard. Some of the most important barriers are: Content validity of the guide , Individual attitudes , Authorities influencing the implementation process , Financial factors and Publishing and implementation strategyKeyword : Low Back Pain Guideline, Guideline Implementation, Impliments Barrier

The comparison of the effects of both propranolol and transcutaneous electrical nerve stimulation in prevention of migraine headache

زمینه و هدف: سردرد میگرنی یک بیماری شایع با مبنای فامیلی می باشد و شیوع آن بر حسب جنس، سن و نژاد متفاوت است. درمان آن شامل درمان حمله حاد سردرد و درمان پیشگیری جهت جلوگیری از بروز حملات سردرد می باشد. انواع مختلف داروها از جمله بتابلوکرها که رایج ترین آنها پروپرانولول است در پیشگیری از حملات میگرن بکار رفته است. همچنین از درمان های غیر دارویی نظیر TENS (Transcutaneos Electerical Nerve Stimulation) در درمان حمله حاد سردردهای میگرنی و نیز درد های مزمن استفاده می شود. هدف از این بررسی، مقایسه اثر پروپرانولول و TENS در پیشگیری از حملات میگرنی بوده است. روش بررسی: در یک کارآزمایی بالینی تعداد 60 بیمار مبتلا به سردرد میگرنی که میگرن آنها بر اساس مقیاس IHS (International Headache Society) توسط متخصصین نورولوژی تأیید گردید و دارای اندیکاسیون درمان پیشگیری از حملات سردرد میگرنی بودند با روش غیر احتمالی انتخاب و بعد به صورت تصادفی در دو گروه 30 نفری تحت درمان با TENS به مدت ده جلسه به صورت روزانه یک جلسه 15 دقیقه ای و پرویرانولول به میزان 40 میلی گرم روزانه به مدت 6 ماه قرار گرفتند. نتایج از نظر شدت، مدت و تعداد حملات قبل از شروع درمان، بعد از 3 و 6 ماه جمع آوری و با استفاده از آزمون آماری مجذور کا تجزیه و تحلیل گردید. یافته ها: پس از 3 ماه درمان 90 درصد بیمارانی که تحت درمان با TENS قرار گرفتند هیچگونه حمله سردردی نداشتند در حالی که در گروه تحت درمان با پروپرانولول 40 درصد بیماران بدون حمله سردرد بودند (001/0

Optimal placement of wind generation units in order to increase revenues and reduce the imposed costs in the distribution system considering uncertainty

Recent advances in the field of new energies such as wind turbines, solar power plants, fuel cells, micro-turbines, etc., and also the great benefits of these power plants for the power network, attract the attention of distribution companies towards them. As, today, many distribution companies are examining options for changing the distribution network structure in order to exploit new energies. In the meantime, wind energy is one of the most widely used types of distributed generation in the power network. In addition, wind power generation has the most changes to other types of renewable energy. Distribution network planning is one of the major concerns of system designers, especially when wind generation units by their random and variable nature are in system development. Since the proper placement of wind units in the network plays an essential role in improving the performance of the distribution network, providing a comprehensive and appropriate solution for placement of these units in the network is important. In this paper, a method has been presented that by considering the uncertainty in generation and consumption and the network constraints, the placement of wind units in the network is done with the aim of increasing revenues and reducing the imposed costs in the distribution system, taking into account the uncertainity. The algorithm used in this paper is a genetic algorithm with improved operators

A Multi-Periodic Multi-Product Inventory Control Problem with Discount: GA Optimization Algorithm

In this article, a finite horizon, multi product and multi period economic order quantity like seasonal items is considered where demand rate is deterministic and known but variable in each period. The order quantities of items come in batch sizes and the end of the period order quantity and, consequently, demand of customers are zero. In addition, storage space is constrained and the problem was considered under all units discount (AUD) policy. The modeling technique used for this problem is mixed binary integer programming. The objective was to find the minimization optimal order quantities under time value of money over the finite horizon. The inventory control system costs include three costs: ordering cost, holding cost, and purchase cost. In order to solve the proposed model, a genetic algorithm (GA) is applied. Finally, we provide a number of examples in order to illustrate the algorithms further

Improved genetic algorithms by means of fuzzy crossover operators for revenue management in airlines

Abstract: Revenue Management is an economic policy that increases the earned profit by adjusting the service demand and inventory. Revenue Management in airlines correlates with inventory control and price levels in different fare classes. We focus on pricing and seat allocation problems in airlines by introducing a constrained optimization problem in Binary Integer Programming (BIP) formulation. Two BIP problems are represented. Moreover, some improved Genetic Algorithms (GAs) approaches are used to solve these problems. We introduce new crossover operators that assign a Fuzzy Membership Function to each parent in GAs. We achieve better outputs with new methods that take lower calculation times and earn higher profits. Three different test problems in different scales are selected to evaluate the effectiveness of each algorithm. This paper defines new crossover operators that help to reach better solutions that take lower calculation times and more earned profits

ANALYZING DIFFERENT READINGS OF THE WORD LĀMASTUM AND INVESTIGATING ITS IMPACT ON INTERPRETATIVE PERCEPTIONS AND ENGLISH TRANSLATIONS

This article discusses the difference in the reading of the word Lāmastum QS. Al-Nisa’: verse 43. It has resulted in the formation of two meanings; Shafi'i chose the recitation of Lamastum and stated that touching women invalidates ablution, Hanafi accepted the recitation of Lāmastum and declared that touching women does not invalidate ablution. Others have opinions for and against these two views. This research, which has been carried out in an analytic-descriptive method, has examined the difference in the readings of the word Lāmastum in this verse. The results of this study show that the difference in the reading of Lāmastum-Lamastum does not lead to a difference in meaning, but what causes different jurisprudential views of this verse is paying no attention to the ironical meaning and misunderstanding of the interpretation, which ultimately caused some translators suffice for the literal meaning and did not consider the ironic meaning of the word, and therefore, some English translators of the Holy Qur’an are not immune to this mistake

Identifying and structuring the factors affecting sustainable banking resources with using interpretive structural modeling

Considering the recent developments in banking system, banks are able to increase their power of partnership in different areas of manufacturing, industrial, agricultural and else by attracting more resource approach, and creating competitive advantage, which result in expansion and increase of earnings or benefits of the bank as well as creating competitive advantage. Considering the limitation on resources and time, the ability to jointly invest in all of the influential factors on creating sustainable banking resources cannot be achieved. The main aim of the present research is to provide a model of the influential factors on creating sustainable banking resources so with usage of which, managers can identify the factors that have the highest influence on the others and plan on the them. For this purpose, 10 influencing factors on creating sustainable banking resources such as financial risks, amount and quality of equity, amount of assets, etc. by taking into account the relevant studies as well as benefiting from specialist's opinions are chosen. Then the influential structure of these factors with usage of interpretive structural modeling method is drawn. The obtained results show that management of equities and human resources, are the most influential factors on providing sustainable banking resources

N-Acetylcysteine Overdose: A Case Report

Background: N-Acetylcysteine (NAC) is a cost-effective antioxidant and very useful treatment for several diseases. Methods: Here we report a rare case of iatrogenic NAC overdose following the mistake in calculation of the loading dose. Results: The patient was 14 years old girl referred to a local hospital due to history of intentional ingesting about 7grams acetaminophen. The physician prescribed her 6 grams NAC as a loading dose but 42grams NAC were infused by mistake. After infusion, the patient showed signs of anaphylactic shock and then transferred to Imam Reza toxicology-unite with weakness, lethargy, extreme fatigue, nausea, and dizziness. NAC overdosing, in a short period of time, led to coagulopathy, reduced platelet count, acute renal failure and metabolic acidosis. After 24 h, the patient died. The Medical forensic examination showed minor lung hemorrhage and presence of little amount of Aluminum phosphide in tissues they did not find no vital organ hemorrhage. It is unclear related to NAC overdose, phosphine intoxication or synergic effects. Conclusion: Massive transfusion of NAC was associated with impairment of coagulation factors, intracranial hypertension, renal failure and metabolic acidosis. Thus, NAC administration should be with caution. The medical history of patients committed suicide are not always accurate and complete evaluation are recommended

Combined Effects of Noise and Hand-transmitted Vibration on Workers’ Muscle and Mental Fatigues in a Simulated Construction Operation

Background: The frequent use of hand-held vibrating tools by construction workers exposes them to hand-transmittedvibratio n (HTV) and noise. This study investigated the effect of combined exposure to HTV and noise on workers’ fatigues under simulated work with a typical building destruction tool. Methods:The repeated measures study was conducted on 40 construction workers exposed to HTV (5 m/s2 rms with frequencies of 31.5, 63, and 125 Hz), HTV (10 m/s2 rms- 31.5 Hz), noise (90 dBA), and concurrent exposure (noise (90 dBA) + HTV (10 m/s2 rms- 31.5 Hz)) with the typical vibrating hand-held tool for 30 minutes. Electromyography signals determined each worker’s fatigue level in the Flexor digitorum superficialis (FDS) muscle in two pre- and post-exposure periods. The subjects also filled out the visual analog scale to evaluate mental fatigue severity subjectively. Results: The mean difference of muscle fatigue parameters was significant in all scenarios except for the two scenarios of alone exposure to HTV (5 m/s2 -125 Hz) and noise exposure (p-value < 0.05). The mean difference of mental fatigue in all scenarios except for the two scenarios of exposure to HTV (5 m/s2 -125 Hz) and exposure to HTV (5 m/s2 -63 Hz) was significant (p-value < 0.05). The most differences in muscle fatigue parameters (Amplitude = 8.16±5.63, Mean frequency=-4.69±3.78) and mental fatigue (4.97±2.38) were observed in the simultaneous exposure to noise and HTV. Conclusion: Noise exposure alone cannot produce remarkable effects on muscle fatigue but can aggravate the effects of vibrations as a consequence of synergistic interaction. However, the role of noise on perceived mental fatigue was more dominant than the HTV.These findings should be considered to adapt the existing exposure limits to actual work conditions

The role of personal and social characteristics on acceptance of new telephone banking services

For over two decades, telephone banking has steadily become a useful feature and all banks have tried to provide this feature as part of their services. In this paper, we present an empirical investigation to study the role of personal and social characteristics on acceptance of new telephone banking services. The proposed study designs two questionnaires and distributes them among 384 randomly selected people who use telephone banking in city of Tehran, Iran. Using structural equation modeling, the study examines various hypotheses and the results of our survey indicate that there were some positive and meaningful relationships between perception usefulness and users’ attitude, perception and ease of use, perception and intention to use as well as perception and intention to use. In addition, the study has detected a negative and meaningful relationship between personal risk and intention to use and perception of personal time and intention to use among mobile users