Management of Deep Vein Thrombosis in Emergency Departments; Time to Change the Viewpoint

Clot formation within a deep vein is called deep vein thrombosis (DVT). It occurs in about 100 persons per 100,000 population each year in the United States and leads to about 600,000 pulmonary thromboembolism (PTE) cases and also causes 60,000 deaths annually. For many years, unfractionated heparin (UFH) and warfarin have been used for treatment of DVT and prevention of PTE. This approach needs hospitalization and necessitates close monitoring by partial thromboplastin time (PTT) measurement. By development of low molecular weight heparin (LMWH) the need for laboratory monitoring was resolved. In addition, some investigators also claimed that it is accompanied with less bleeding risk and better outcome. Accordingly, outpatient management of DVT became possible and nowadays American College of Chest Physicians (ACCP) advocates outpatient therapy for DVT. This method has been shown to be safe and effective in presence of home adequacy criteria. Home adequacy is defined by ACCP as “well-maintained living conditions, strong support from family or friends, phone access, and ability to quickly return to the hospital if there is deterioration”. Yet, many physicians in Iran prefer to hospitalize all DVT patients because of their belief in the impossibility of outpatient treatment

Research Paper: Sex Identification by Morphometric Study of Hyoid Bone

Background: Morphometric measurements are important for identification in forensic medicine. Gender is one of the important components of identity. Many studies have reported that hyoid bone can be used for sex estimation but this claim must be verified in different populations.Methods: We evaluated 372 hyoid bones of 15 to 87 years old Iranian people who had a valid identity certification. Nine anthropometric indices of hyoid bone were measured and investigated in this regard. Computerized tomography scan was done after fixation of dissected tissue in formalin. Logistic regression analysis was performed. The cut-off point (ROC) and discriminative formula were determined.Results: In this study, hyoid bones of Iranian bodies were studied, of which 217 were male and 155 were female cases. The length of the hyoid body, great left horn length, angle between right great horn and left great horn with body of hyoid are associated with sex determination. Conclusion: Hyoid bone in male is generally larger than in females. The result indicate that the hyoid bone morphometry with a high degree of accuracy can determine the sex. Discriminant formula was determined for hyoid bone

The nutrition knowledge level of physicians, nurses and nutritionists in some educational hospitals

Nutritional care is an important part of medical care of patients and plays a key role in improvement, prevention and control of malnutrition in hospitals. The current study aimed to determine the nutrition knowledge level of doctors, nurses and nutritionists in some teaching hospitals in Tehran in 2008. In a cross-sectional study a total of 198 samples including 28 nutritionists, 81 nurses and 89 physicians were selected using simple random sampling. The current study was conducted in 9 hospitals affiliated with the Shahid Beheshti University of Medical Sciences (SBMU) in Tehran. A self-administered multiple choice questionnaire about different aspects of basic and clinical nutrition was completed. Then nutrition knowledge levels of each individual was determined by calculating correct knowledge, perceived knowledge and accuracy of knowledge scores. The median knowledge score of the nutritionists, physicians, and nurses was 85%,77%, and 75%, respectively. The median perceived knowledge of all the groups was above 90%. The mean accuracy score in the 3 groups of nutritionists, physicians and nurses was 87%,79%, and 76%, respectively. The results indicated that all groups have a poor knowledge, especially in clinical nutrition topics. Based on the current results, knowledge level of clinical staff is an effective factor in not paying attention to the importance of nutritional care as a part of medical care of the patients. Enhancing awareness level of all groups especially physicians and nutritionists in clinical division plays an important role in enhancing clinical nutrition care and treatment regime

The assessment quality of effluent from shrimp aquaculture site in Gwater

Present study was conducted in shrimp farm located in east of Chabahar in Sistan and Balouchestan province from August 2001 until May 2003. Fourteen stations at three locations (i.e. supply channel, drainage channel and Gwatr Gulf) were selected to determine physical and chemical factors such as; temperature, salinity, dissolved oxygen, pH, nitrate, nitrite, ammonia, phosphate, silicate, total suspended solid and turbidity. Sampling was conducted twice a month during the shrimp culturing period and monthly at other times. Water samples were collected every two weeks to determine Chemical and Physical factors, Chlorophyll a, Phytoplankton and Zooplankton. Sediment samples were collected seasonally to examine Macrobenthos, Grain size and Total Organic Matter. The results revealed different bioenvironmental area in the three locations (i.e. supply channel, drainage channel and Gwatr gulf) over the study period. One-way analyze of variance of chemical and physical factors indicated significant difference between different times as well as different stations (p<0.05). The negative relationship was observed between the culturing production area and the amount of average dissolved oxygen, pH and total suspend solid. An increase in the culturing production area in 2002 as compared to that of 2001 causes a decrease in the amount of these factors. However, it dose indicates positive relationship with nitrate, nitrite, ammonia, transparency and chlorophyll. Forty nine phytoplankton genus were identified, which mainly belong to diatoma, dinoflagellate and green blue algae. Diatom was dominated among these groups. Diatom and green-blue algae and diatom comprised %79, %69 and %64 of phytoplankton flora respectively in supply channel, Gwater Gulf and drainage channel. Copepod and thintinnida were the major groups of zooplankton. High abundance of bivalve, Polychaetes and amphipoda were found in supply channel, Gwatr Gulf and drainage channel respectively. Analysis of grain size showed the existence of sandy sediment in Gulf of Gwatr and sandy-loom in supply channel. Drainage channel sediment found to be sandy-loom, sandy-silty-loom and sand loom. Among three locations, the highest TOM was found in drainage channel. In last location, production area in 2002 increased as compared to that of 2001, which showed negative relationship with salinity, nitrate, nitrite, ammonia and chlorophyll a. Drainage of the Gwatr s shrimp farm did not cause any thermal contamination in the location. Shrimp aquaculture activities caused an increase in the average of salinity, range of pH in the Gwatr Gulf

A survey on environmental effects of shrimp pond culture effluents in Gwatar area (Sistan & Blouchestan)

Present project was conducted in shrimp farm located in east of Chabahar in Sistan and Balouchestan province.Twentieth sampling stations at three locations (i.e. 2 stations in supply channel,13 stations in drainage channel and 5 stations in Gwatar Gulf) were selected to determine physical and chemical factors such as; temperature, salinity, dissolved oxygen, pH, nitrate, nitrite, ammonia, phosphate and biological parameters for example Chlorophyll a, phytoplankton and zooplankton. Sampling was conducted once a month from March 2003 until January 2004. The results revealed different bioenvironmental area in the three locations (i.e. supply channel, drainage channel and Gwatar Gulf) over the study period. Concentration of salinity ,pH , nitatr ,nitrite ,ammonia and chlorophyll a in drainage channel were more than supply channel and Gawtar Gulf. While concentation dissolved oxygen and phosphate were in drainage channel less than Gawtar Gulf.Also, sediment with small grain size (clay and silt) caused uptake phosphate and amount phosphate decreased in drainage channel. Considering with lack of environment standards in Iran shrimp effluent, data compared with others countries standard. Results showed that with considerable farm area, value of temperature, salinity, dissolved oxygen and pH were in permit range in Gwatar Gulf while concentation nitrate, phosphate and chlorophyll a were sometimes more than permit range that could cause plankton bloom. Also, Gwatar Gulf were influence monsoon. Nitate, phosphate, chlorophyll a and phytoplankton increased in gwatar Gulf.Regards with that postmonsoon was simultaneus with shrimp harvest.Therefore, increase some parameters could be caused from shrimp effluent or postmonsoon. Thirty four phytoplankton genus were identified including diatoma, dinoflagellate, cyanophyta and chlorophyta. In each area maxiumum percentage of phytoplankton were belonged to diatoma (63%) in supply channel, cyanophyta (51.7%) in drainage channel and dinoflagellate (94.5%) in Gwatar Gulf.Amount and range chemical and physical factors and plankton composition were different in drainage channel, supply channel and Gwatar Gulf. Cyanophyta could grow more in drainage channel.Percentage of aboundance and diversity of phytoplankton changed in 2002 inrelation to years ago( before shrimp culture, 2000 year and 2001 year) specially in Gwatar Gulf. Mainly percentage of zooplankton were copepoda and thintinida respectively.Diversity zooplankton decreased ratio to years ago. In drainage channel, abundance total of phytoplankton and zooplankton were more than Gwatar Gulf and supply channel

The possibility production of food pellets for common carp (Cyprinus carpio) in the rearing stage with emphasis on attractiveness and strength

This study was to investigate the possibility of pellet production for grow out common carp considering attractiveness and stability of the pellets. The experiment consisted of two periods and was conducted at the Caspian Sea ecology research center in 2011 and 2012. In period one, two types of pellet with similar protein level (31%) and different energy contents (3000 and 3500 cal/g) were formulated by the ingredients used in fish feed industry. In period two, 316 juvenile carp with initial weight of 27.9g were assigned randomly to 9 fiberglass tanks (4×4×1 m), with three replicates for each treatment. The fish were fed by three diets throughout the eight weeks study, two diets were formulated in the current study and third one was a commercial carp diet with 25% protein. The results showed that feeding with diet containing 31% protein and 3500 cal/g energy led to a feed conversion ratio of 3, but this value was recorded 1.9 for commercial diet. The type of diets was also influenced (P<0.05) average final weight of the fish. Fish fed diet containing 31% protein and 3500 cal/g energy showed largest weight gain and this value was significantly different from the other treatments. Pellet stability test showed that commercial pellet water stability was 3 min, but this value for the two formulated pellet were 12 min. There was a highly significant difference for water stability between the commercial pellet and the formulated pellet. The result suggests that the formulated pellet in the current study can be easily replaced by commercial pellet

Rearing of common carp (Cyprinus carpio) in fiber glass tanks with pellet feeding

The intensive culture of common carp (Cyprinus carpio) evaluated in fibreglass tanks (2*2m) with feeding on pellet during 8 weeks. The fish (n=201)of common carp selected from three treatments along with three replicates as the average of fish weight was less than 100(g )which divided into 0.05).The common pellet food was chosen for feeding from market as fish were fed by the mean of 4% of their body weight a day. The result indicated that the mean of particular growth ratio at first treatment (0.54) has higher than second treatment (0.34) but in comparison with third treatment (0.46), there was no statistically significant difference (P<0.05).Also, the conversion ratio at first treatment (5.28) and third treatment (6.09) was lower than second treatment (35.66) and third treatment (20.91) was lower than second treatment (24.24), (P<0.05). This study showed that monoculture in small scale is feasible by utilizing artificial diet, if the water quality is exposed to change. In this survey, the conversion ratio of the fish was relatively high whereas the growth rate was low

The study of abundance and dynamic zooplankton in the Southern of Caspian Sea

The Caspian Sea is the largest lake, both by its area and volume. Zooplankton are very important in the food web since many animals eat them. The Sampling was done in 4 transacts in Anzali, Tonekaboun, Noushahr and Amirabad at 3 different depths including 5, 10 and 20 m. Sampling was carried out in four seasons of spring, summer, autumn and winter in 2013. The annual changes of zooplankton was between 392±113 ind./ m^3 in autumn (Amirabad) to 8065±11735 ind./m^3 in winter (Amirabad). The lowest density of zooplankton in the spring was 2207 ind./ m^3 in Anzali. The density of zooplankton in Tonekabon and Amirabad was 2.0 and 2.8 fold more than other transects respectively. The results showed that the abundance of zooplankton in summer was between 1964±470 ind./m^3 (Amirabad) to 5706±6088 ind./m^3 (Tonekabon). The biomass was 30.02, 52.22, 22.98 and 18.31 in Anzali, Tonekabon, noshahr and Amirabad respectively. The abundance of zooplankton in the autumn reached the lowest value. The lowest value was 392 ±113 ind./m^3 and 3.71±0.19 mg/m^3 (Amirabad) and highest value was 2280 ±1435 ind./ m3 and 20.23±14.50 5mg/m^3 (Anzali). The highest density was observed in Amirabad (8065 ind./m^3) and Anzali (8061 ind./m^3) in winter. The aim of this study was diversity, distribution, density and biomass of zooplankton in the southern of Caspian Sea

Prevention of burnout among nursing staff: A literature review

Community nursing is associated with stress and burnout, which can impact heavily on the individuals and organizations. These impacts can be both economically and also the negatives effects on the quality of patient care. The purpose of this thesis is to provide evidence based information about prevention of burnout among nurses. This thesis aimed to review what kinds of interventions are needed to be done by nurses and organizations to prevent this phenomenon among nurses in order to reduce the prevalence of this syndrome among health care professionals and its consequences. The research method that was used in this thesis is literature review. Data were collected from academic nursing data bases including CINAHL (EBSCO), ProQuest, PubMed Central and ScienceDirect. After using thesis search words in advance search machine of these databases considering some inclusion and exclusion criteria, 44 articles were achieved. 11 out of these 44 articles were chosen to be reviewed in this thesis based on their title, abstract and full text. Collected data were analysed using inductive content analysis method. The findings were categorized in four major themes considering the party that should implement those measures for preventing burnout in nurses. These parties consist of workplace, nurses as a community in the ward, and nurses as individuals. Various methods have been found to be efficient in preventing this phenomenon among nurses. Since in collecting the data for this thesis there was no locational limitation, the data that were used, were from different parts of the world with different working conditions, cultures, and resources. The authors recommend further researches to evaluate the efficiency of suggested methods among Finnish nurses

Evaluation and reporting of investment property: Turkey and USA sample

Uluslararası Finansal Raporlama Standartları (UFRS) birçok ülkede uygulanmaktadır. UFRS setinin içerisinde yatırım amaçlı gayrimenkullere ayrılmış olan bir standartta da bulunmaktadır. Bu bağlamda; muhasebe uygulamalarına yeni bir yaklaşım getiren alanlardan biri de UMS 40 standardı ile düzenlenen yatırım amaçlı gayrimenkullerdir. Yatırım Amaçlı Gayrimenkul kavramının önemi; Uluslararası Standartlarının yayınlanmış olması nedeniyle artmaktadır. Çalışmanın kapsamı dahilindeki UMS 40'ın GAAP ile benzerlik ve farklılık açısından karşılaştırılmasına yöneliktir. Bu çalışma, ilgili kişi ve kuruluşlara uygulama ve teorik açıdan kolaylık sağlayacaktır.International Financial Reporting Standards are applied in many countries. International Financial Reporting Standards. a set of standards that are allocated to investment properties located within. In this context, one of the areas in which a new approach to accounting practices with IAS 40 standard, held for investment properties. The importance of the concept of Investment Property, International Standards published due to the increase. Study within the scope of IAS 40's aimed at the comparison in terms of similarities and differences with GAAP. This study will make it easier for individuals and organizations practice and theoretical aspects