Quality of life after cesarean and vaginal delivery

Objective: Cesarean rates in recent decades have been increasing and a number of studies have shown that cesarean increases maternal morbidities. The aim of this study is to compare the quality of life after cesarean and vaginal delivery. Methods: This prospective study was carried out on 356 pregnant women visiting urban health centers in Shahroud City, Northeast Iran, in 2011. The subjects completed the quality of life questionnaire in the third trimester of pregnancy and at 8 weeks postpartum. Results: In primiparas, the mean global QOL scores for the cesarean and vaginal delivery groups were 67.65±12.7 and 72.12±11.8, respectively. Also, the scores for the physical, psychological and social domains of QOL as well as the global score of QOL were higher in the vaginal delivery group than the cesarean group (p<0.05). In the case of primiparas, multiple regression analysis revealed that after adjusting for education, desirability of pregnancy and the General Health Questionnaire score, the delivery type remained as a predictor of the scores for the physical (R2=1.7%; B=-3.826; p=0.031; CI [-7.301, -.350]) and social (R2=2.5%; B=-5.708; p=0.017; CI [-10.392, -1.023]) domains of QOL and the global QOL score (R2=2.6%; B=-4.065; p=0.006; CI [-6.964, -1.164]). While multiparas, there was no relationship between QOL and type of delivery. Conclusion: In this sample of low-risk women, cesarean negatively affected the QOL of primiparas. More studies with larger sample sizes should be conducted to examine the effects of cesarean on QOL in both primiparas and multiparas within a shorter period after delivery. © OMSB, 2013

Validation of the World Health Organization-5 well-being index; assessment of maternal well-being and its associated factors

Objective: The aim of this study was to validate the World Health Organization-5 Well-Being Index (WHO-5) in a sample of pregnant Iranian women, to explore the changes in maternal well-being from pregnancy to postpartum, and to determine the factors associated with maternal well-being. Materials and Methods: This study included 341 pregnant women that presented to healthcare centers affiliated with Shahroud University of Medical Sciences, Iran, in 2011. The participants completed the General Health Questionnaire (GHQ-28) and Farsi version of WHO-5 during the third trimester of pregnancy and at 2 months postpartum. Results: Cronbach's alpha coefficient for WHO-5 items was 0.85. The correlation coefficient between WHO-5 and GHQ-28 was -0.64 (P < 0.001). Exploratory factor analysis yielded 1 factor with an eigen value equal to 3.15, which explained 63.1% of the total variance. Confirmatory factor analysis confirmed the 1-factor structure. The area under ROC curve was 0.82. A WHO-5 cut-off score of <50 exhibited optimal sensitivity (0.84) and specificity (0.59) for identifying psychological symptoms (GHQ-28 score ≥24). There was a significant difference between third trimester (58.4 ± 22) and postpartum (64.1 ± 22.3) mean WHO-5 scores (P < 0.001). Maternal level of education (OR = 1.130; 95% CI: 1.307, 1.232) was the only predictor of maternal well-being during third trimester. Breastfeeding difficulty (OR = 0.923; 95% CI: 0.882, 0.965) and maternal well-being scores during third trimester (OR = 1.038; 95% CI: 1.019, 1.058) were predictors of maternal well-being during the postpartum period. Conclusions: The Farsi version of WHO-5 was observed to be a reliable and valid instrument for screening psychological symptoms in pregnant Iranian women. The present findings show that maternal well-being improved following childbirth

Ventilation Rates and Airflow Pathways in Patient Rooms: A Case Study of Bioaerosol Containment and Removal

Most studies on the transmission of infectious airborne disease have focused on patient room air changes per hour (ACH) and how ACH provides pathogen dilution and removal. The logical but mostly unproven premise is that greater air change rates reduce the concentration of infectious particles and thus, the probability of airborne disease transmission. Recently, a growing body of research suggests pathways between pathogenic source (patient) and control (exhaust) may be the dominant environmental factor. While increases in airborne disease transmission have been associated with ventilation rates below 2 ACH, comparatively less data are available to quantify the benefits of higher air change rates in clinical spaces. As a result, a series of tests were conducted in an actual hospital to observe the containment and removal of respirable aerosols (0.5–10 μm) with respect to ventilation rate and directional airflow in a general patient room, and, an airborne infectious isolation room. Higher ventilation rates were not found to be proportionately effective in reducing aerosol concentrations. Specifically, increasing mechanical ventilation from 2.5 to 5.5 ACH reduced aerosol concentrations only 30% on average. However, particle concentrations were more than 40% higher in pathways between the source and exhaust as was the suspension and migration of larger particles (3–10 μm) throughout the patient room(s). Computational analyses were used to validate the experimental results, and, to further quantify the effect of ventilation rate on exhaust and deposition removal in patient rooms as well as other particle transport phenomena

Determination of Tetanus Antibody Levels in Trauma Patients Referred To Shahid Beheshti Hospital in Kashan, Iran, 2014

Background: There is a noticeable difference in serologic immune status against tetanus among different age and social groups in various countries due to different national vaccination policies and methods. Objectives: Considering that the immunization status of trauma patients against tetanus is not-known or uncertain and they may need to receive the vaccine and tetabulin, this study was conducted to determine the tetanus antibody levels in patients referred to the trauma emergency ward of Shahid Beheshti Hospital in Kashan City, Iran. Patients and Methods: This cross-sectional study was performed on 204 trauma patients referred to the trauma emergency ward of Shahid Beheshti hospital in Kashan City, Iran, in 2014. After obtaining a written informed consent from the patients, a questionnaire consisted of demographic information and tetanus vaccination record was completed by the patients. Afterwards, a 4 - 5 mL venous blood sample was taken from each patient and the tetanus antibody level (IgG) was measured using the enzyme-linked immunosorbent assay method. The tetanus antibody levels equal or more than 0.1 IU/mL were considered protective. Data were analyzed using chi-square test, independent t-test and one-way ANOVA with SPSS software version 16. Results: From a total of 204 patients, 35 cases (16.7%) were females and 169 (83.2%) were males with the mean age of 40.9 ± 3.7 years. There was no statistically significant difference in the tetanus antibody levels between both sexes (P = 0.09). Moreover, there was no significant difference in immunization status between the patients who had a history of tetanus vaccination and those who had not received the vaccine before (P = 0.67). The antibody levels were significantly reduced with the passage of time since the last vaccination (P < 0.001). Also, 87.3% of the patients had the high protective level of immunity to tetanus. Conclusions: The findings of the present study show a high level of tetanus antibody among trauma patients in this hospital; so, taking the tetanus vaccine history can be misleading. It is suggested that further studies be performed in different regions of our country and with larger sample sizes and detection of the immunization status of patients by measuring anti-tetanus antibody levels among trauma patients is recommended to make suitable policy for a national vaccine protocol in the future

Evaluating high risks in large-scale projects using an extended VIKOR method under a fuzzy environment

The complexity of large-scale projects has led to numerous risks in their life cycle. This paper presents a new risk evaluation approach in order to rank the high risks in large-scale projects and improve the performance of these projects. It is based on the fuzzy set theory that is an effective tool to handle uncertainty. It is also based on an extended VIKOR method that is one of the well-known multiple criteria decision-making (MCDM) methods. The proposed decision-making approach integrates knowledge and experience acquired from professional experts, since they perform the risk identification and also the subjective judgments of the performance rating for high risks in terms of conflicting criteria, including probability, impact, quickness of reaction toward risk, event measure quantity and event capability criteria. The most notable difference of the proposed VIKOR method with its traditional version is just the use of fuzzy decision-matrix data to calculate the ranking index without the need to ask the experts. Finally, the proposed approach is illustrated with a real-case study in an Iranian power plant project, and the associated results are compared with two well-known decision-making methods under a fuzzy environment

Influence of tillage depth, penetration angle and forward speed on the soil/thin-blade interaction force

In this study, an experimental investigation regarding the influence of three independent variables including tillage depth (10, 15, 20 cm), angle of attack (60, 75, 90 degrees) and forward speed (0.5, 1, 1.35, 1.7 m/s) on draft force of a thin blade is presented.  Chisel plow in this research was constructed in two furrows with a blade width of 3 cm and a maximum depth of 25 cm (the distance between two blades was 1 m).  Some changes were made in the chassis of the chisel plow in order to obtain different attack angle of the blade.  The experimental work was then complemented with a new theoretical model for predicting the blade force using dimensional analysis method.  The final expression for estimating the pull resistance is as a function of several soil engineering properties (soil bulk density, soil adhesion and cohesion coefficients), blade parameters (blade width and blade rake angle) and operational conditions (tillage depth and forward speed).  Finally constants of the model were computed based on obtained experimental data.  The proposed model properly estimated the draft force of a thin blade.  Results obtained in this study indicate the stronger influence of tillage depth on the pulling force of a thin soil-working blade compared to the penetration angle and forward velocity.  The average error for the vertical blade with depth of 20, 15 and 10 cm were obtained equal to 4.5%, 4% and 1.5%, respectively.   Keywords: tillage, thin blade, chisel plow, interaction force, dimensional analysi

Diffraction in time of a confined particle and its Bohmian paths

Diffraction in time of a particle confined in a box which its walls are removed suddenly at $t=0$ is studied. The solution of the time-dependent Schr\"{o}dinger equation is discussed analytically and numerically for various initial wavefunctions. In each case Bohmian trajectories of the particles are computed and also the mean arrival time at a given location is studied as a function of the initial state.Comment: 8 pages, 6 figure