Comparison of generalized estimating equations (GEE), mixed effects models (MEM) and repeated measures ANOVA in analysis of menorrhagia data

     Menorrhagia is one of the most common gynecological problem and leading causes of poor quality of life and iron deficiency anemia in women of reproductive age. Research in gynecological field relies heavily on repeated measure designs. Repeated measure studies are helpful in understanding how factors of interest change over time. Our goal is to apply statistical methods which are appropriate for analyzing repeated measure data such as gynecological data. Three statistical methods were performed by data collection from 100 patients with menorrhagia. One-hundred patients were randomly assigned to two groups, i.e. intervention group (Urtica Dioica and mefenamic acid) and control group (placebo and mefenamic acid) with an equal size of 50. In this study, generalized estimating equations (GEE) and mixed effects models (MEM) were used for analyzing menorrhagia data to determine the effect of hydroalcoholic extract of Urtica Dioica on Menorrhagia. Finally, these methods are compared to the conventional repeated measures ANOVA (RM-ANOVA).Based on the results, the three methods are found to be similar in terms of statistical estimation, the amount of bleeding before and after treatment between and within groups was compared. Results showed the average amount of bleeding was reduced significantly (P˂0/001). The average menorrhagia score in the third month (second cycles after intervention) were 91.38(71.432) and 149.40(127.823) in Urtica Dioica and control groups, respectively. The difference between the two groups was statistically significant (p =0.036). Because their advantages, GEE and MEM should be strongly considered for the analysis of repeated measure data. In particular, GEE should be utilized to explore overall average effects. When in addition to overall average effects, subject-specific effects are of primary interest, MEM should be utilized. With respect to these methods, it seems the extract of Urtica Dioica can be effective in reducing the amount of menstrual bleeding in women of reproductive age with Menorrhagia.

An Evaporation Based Micro-Synthetic Jet in Microchannel and its Applications

An approach to create synthetic jets at micro-scales using periodic bubble growth and collapse was presented and studied over a range of operating frequencies (0.1 to 2.5 Hz) and heating powers (3 to 4.5 Watt). The microfluidic device uses an interfacial layer between vapor and liquid phases which substitutes the requirement for a physical flexible membrane and any other moving parts. The bubble explosion and implosion in the chamber was triggered by periodically powering a micro-heater, which in turn generated the synthetic jet. High-speed camera photography and a microscope were used to capture sequential images of bubble nucleation, growth and collapse in the chamber. In order to characterize the synthetic jet, a momentum coefficient was used. It was found that its average value exceeds unity for a large range of operating frequencies suggesting that this synthetic jet can improve the performance of a range of micro-system performance, such as micro-mixing in microfluidic devices. Subsequently, two potential applications of the introduced synthetic jet for heat transfer enhancement and micro-propulsion were studied. In doing so, first, the influence of the synthetic jet on flow boiling heat transfer in a microchannel was considered. The results showed that the synthetic jet enhanced nucleate flow boiling heat transfer in the microchannel by up to 20% by mitigating dry-out spots over the heated surface and enhancing thin film evaporation. Then in the following section, its application for micro-propulsion was studied. In this method, the interfacial layer movement between the vapor and liquid phases during the bubble growth, propelled the liquid through the micro-nozzle located at the chamber exit. The synthetic jet velocity at the nozzle exit was then numerically simulated using the SST k-ω turbulence model. Comparing the operating power of different types of micro-thrusters showed that the approach is one of the lowest powered micro-thrusters

Numerical analysis of mixed convection characteristics inside a ventilated cavity including the effects of nanoparticle suspensions

A numerical study of mixed convection flow and heat transfer inside a square cavity with inlet and outlet ports is performed. The position of the inlet port is fixed but the location of the outlet port is varied along the four walls of the cavity to investigate the best position corresponding to maximum heat transfer rate and minimum pressure drop in the cavity. It is seen that the overall Nusselt number and pressure drop coefficient vary drastically depending on the Reynolds and Richardson numbers and the position of the outlet port. As the Richardson number increases, the overall Nusselt number generally rises for all cases investigated. It is deduced that placing the outlet port on the right side of the top wall is the best position that leads to the greatest overall Nusselt number and lower pressure drop coefficient. Finally, the effects of nanoparticles on heat transfer are investigated for the best position of the outlet port. It is found that an enhancement of heat transfer and pressure drop is seen in the presence of nanoparticles and augments with solid volume fraction of the nanofluid. It is also observed that the effects of nanoparticles on heat transfer at low Richardson numbers is more than that of high Richardson numbers

Heat transfer augmentation of magnetohydrodynamics natural convection in L-shaped cavities utilizing nanofluids

A numerical study of natural convection heat transfer through an alumina-water nanofluid inside L-shaped cavities in the presence of an external magnetic field is performed. The study has been carried out for a wide range of important parame­ters such as Rayleigh number, Hartmann number, aspect ratio of the cavity and solid volume fraction of the nanofluid. The influence of the nanoparticle, buoyancy force and the magnetic field on the flow and temperature fields have been plotted and discussed. The results show that after a critical Rayleigh number depending on the aspect ratio, the heat transfer in the cavity rises abruptly due to some significant changes in flow field. It is also found that the heat transfer enhances in the presence of the nanoparticles and increases with solid volume fraction of the nanofluid. In addition, the performance of the nanofluid utilization is more effective at high Ray­leigh numbers. The influence of the magnetic field has been also studied and de­duced that it has a remarkable effect on the heat transfer and flow field in the cavity that as the Hartmann number increases the overall Nusselt number is significantly decreased specially at high Rayleigh numbers

Evaluation of perinatal and neonatal risk factors of children with cerebral palsy referred from health-care centers in north and east of Tehran

"n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui) } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Cerebral palsy (CP) is a group of nonprogressive motor impairment syndromes with potentially different risk factors and causal pathways which is caused by damage in the very young brain. The etiology of CP is mostly unknown and the prevalence has not decreased in comparison to past decades, although many advances have occurred in obstetric and neonatal care. In fact, it seems that the prevalence might have even increased in term infants. The aim of this study was the evaluation of cerebral palsy risk factors in Iran to compare them with other countries."n"nMethods: In this case-control study, all one to six years old children who were referred to a rehabilitation center from Shahid Beheshti child-health-care centers during the years 2007-2008, with documented cerebral palsy for evaluation of perinatal and neonatal risk factors were enrolled in the study, with matched controls. "n"nResults: 112 in the case and 113 in the control group were studied. The main factors associated with CP, were: preterm delivery, neonatal and postnatal seizures, Apgar score of zero to three at twentieth minute after birth, low birth weight, and multiple gestations. The majority of infants with CP were born at term and only 37.8% before 37 weeks."n"nConclusions: Preterm birth, hypoxic-ischemic encephalopathy and low birth weight were the independent predictors of CP in this population

Effect of Child Friendly Constraint Induced Movement Therapy on Unimanual and Bimanual Functions in Children with Cerebral Palsy

Objective: Effectiveness of Constraint Induced Movement Therapy (CIMT) has been approved in adult persons, while it seems that we need many researches with higher levels of evidences in children. This research aimed to identify the efficacy of CIMT on unimanual and bimanual functions in children with Cerebral Palsy. Materials & Methods: In this interventional study, twenty eight participants were selected that had the inclusion and exclusion criteria and then divided into two groups ofCIMT and control. The intervention was provided on 10 out of 12 consecutive days in CIMT group and another group was received occupational therapy services. Assessment tools which were utilized in the survey were Bruininks-Oseretsky Motor Proficiency Test, Caregiver Functional Use Survey (CFUS), Jebsen-Taylor Test in Hand Function. In order to compare two groups Independent t-test was used and to compare each group from pre-test to post-test paired t-test was utilized. Results: Data showed significant differences between two groups in dexterity, bilateral coordination, bimanual coordination, bimanual function, unimanual function and Caregiver Functional Use Survey (how well & how frequently) (P<0.05). Also comparison between pre-test and post-test in each group showed improvement in most of variables in research. Conclusion: protocol of child friendly Constraint Induced Movement Therapywas lead to improvement in either unimanual or bimanual hand functions in children with cerebral palsy

بررسی میزان استفاده از «کار» در مداخلات کاردرمان‌گران اصفهان و تهران در مقایسه با کاردرمان‌گران آمریکا

مقدمه: کار «Occupation» شامل تکالیف روزمره و فعالیت‌های هدفمندی است که هر فرد در آن‌ها مشارکت می‌کند و برای وی معنی و یا ارزش شخصی یا ذهنی خاصی دارد. مفهوم «کار» هسته مرکزی کاردرمانی را تشکیل می‌دهد. کاردرمان‌گران به وسیله تسهیل مشارکت در کار‌ فرصتی برای تکامل فرد ایجاد می‌کنند و استقلال وی را افزایش می‌دهند. با توجه به اهمیت استفاده از کار در کاردرمانی و با توجه به این که تاکنون در ایران پژوهشی در زمینه کار صورت نگرفته است، این سؤال مطرح می‌شود که آیا کاردرمان‌گران در ایران نیز به استفاده از کار در مداخلات خود التزام دارند؟ در این پژوهش به بررسی میزان استفاده از کار توسط کاردرمان‌گران ایران در مقایسه با کاردرمان‌گران آمریکا پرداخته شده است. مواد و روش‌ها: این پژوهش به روش کمی پیمایشی انجام شد. ابزار مورد استفاده مقیاس کارِ درمانی (Inpatient rehabilitation–scale of therapeutic occupation) بود که در سال 1998 توسط Sass و Nelson طراحی شده است. این ابزار پس از اعمال تغییراتی مورد استفاده قرار گرفت. جامعه مورد بررسی کاردرمان‌گران از شهر تهران و اصفهان بودند که نام آن‌ها در انجمن کاردرمانی ایران یا سازمان نظام پزشکی ثبت شده بود. در این پژوهش از نمونه‌گیری در دسترس استفاده شد. برای تجزیه و تحلیل داده‌ها، ابزار 17SPSS مورد استفاده قرار گرفت. سطح معنی‌داری در این پژوهش 01/0 در نظر گرفته شد. یافته‌ها: شرکت کنندگان در این پژوهش شامل 70 نفر (31 مرد و 39 زن) با میانگین سنی حدود 29 سال بودند. نتایج این پژوهش با پژوهش صورت گرفته توسط Sass و Nelson در آمریکا در سال 1998 مقایسه شد. میزان t محاسبه شده نشان داد که کاردرمان‌گران آمریکا بیش از کاردرمان‌گران ایران از کار در مداخلاتشان استفاده می‌کردند (001/0 > P). نتیجه گیری: با توجه به نتایج این پژوهش، ملاحظه می‌شود که تفاوت زیادی میان میزان استفاده کاردرمان‌گران از کار در درمان در ایران و آمریکا وجود دارد؛ به طوری که کاردرمان‌گران در آمریکا بیش از کاردرمان‌گران در ایران از کار در درمان استفاده می‌کنند. از دلایلی که می‌توان در تبیین این تفاوت نام برد تفاوت در سابقه حرفه کاردرمانی، شرایط کار بالینی و برنامه‌های آموزشی در ایران و آمریکا است. به نظر می‌رسد جهت پیشرفت بیشتر حرفه کاردرمانی در ایران، آموزش بیشتر و بالینی‌تر در زمینه کار و ایجاد شرایط کاری مناسبتر امری ضروری باشد. کلید واژه‌ها: مداخلات کاردرمانی، کار، کاردرمان‌گران ایران و آمریکا، مقیاس کار درمان

راهبردهای آرام سازی نوزاد بر مبنای تجربه مادران ایرانی: یک مطالعه پدیدارشناختی

مقدمه:همچون هر تمدن دیگری،مادران ایرانی از دیرباز جهت آرام کردن نوزادان خود و مواجهه با مشکلات تنظیمی نوزاد از روش های سنتی و بومی مختلفی بهره می گرفتند. هدف این پژوهش عبارت بود از بررسی تجربه و نظر مادران ایرانی درباره روش آرام کردن نوزادانشان. مواد و روش ها: ملاک های ورود شرکت کنندگان در این پژوهش کیفی پدیدارشناختی عبارت بود از: تمایل  به حضور در پژوهش ، داشتن توانایی برقراری ارتباط ،  مادر بودن، داشتن سابقه مراقبت از حداقل یک نوزاد ،  ایرانی بودن و ملاک های خروج در این پژوهش عبارت بود از وجود مشکلات حافظه و اختلالات روانی. انتخاب شرکت کنندگان با استفاده از روش نمونه گیری هدفمند انجام شد و  به منظور گرداوری  اطلاعات 4 سوال در قالب مصاحبه عمیق و نیمه ساختار یافته )هر جلسه به مدت 30 تا 60 دقیقه) از شرکت کنندگان پرسیده شد. مصاحبه با شرکت کنندگان تا زمان اشباع اطلاعات با شرکت 21 نفرادامه یافت.در نهایت اطلاعات به دست آمده با استفاده از روش هفت مرحله ای کلایزی مورد تجزیه و تحلیل قرار  گرفت. یافته ها:داده های مربوط به تجربه های مادران منجر به ایجاد 8 تم شامل تحریکات وستیبولار، تحریکات لمسی، تحریکات شنیداری، تحریکات بینایی، تحریکات حرارتی، تحریکات حس عمقی، رفع نیاز های فیزیولوژیک و روش های  فرا-ماده و خرافی شده است. نتیجه گیری:یافته های حاصل از این مطالعه حاکی از وجود ارتباط بین  روش های سنتی و بومی که  مادران ایرانی جهت آرام کردن نوزادشان به کار می گیرند، با اصول علمی مبتنی بر نظریه یکپارچگی حسی است که می تواند با استفاده از پژوهش های مکمل کیفی و کمی مورد بررسی دقیق تر واقع شود.جهت بررسی تاثیر راهبردهایی که مادران ایرانی برای آرام سازی نوزادان خود استفاده می کنند، نیاز مطالعات متعدد کیفی و کمی وجود دارد. کلیدواژه ها:راهبردهای آرام سازی، نوزاد، مادر،  مطالعه  پدیدارشناخت

Effect of Child Friendly Constraint Induced Movement Therapy on Unimanual and Bimanual Function in Hemiplegia

Objectives: Hemiplegia is a non-progressive damage in premature growing brain which causes movement disorders in one side of the body. The objective of present research is to study the method of modified constraints induced movement therapy (CIMT) which can be appropriate on unimanual and bimanual functions of children with Hemiplegia. Methods: This single-blinded, randomized, control trial study performed on twenty-eight participants who were selected based on specific inclusion criteria and divided into two groups of CIMT and conventional therapy. Intervention at CIMT was done six hours every day, for 10 days, whereas another group received conventional occupational therapy. Results: To analyze the data, independent-sample t-test and paired-sample t-test were used. Results showed that significant differences in variables of unimanual function, Jebson Taylor test and dexterity of involved hand in CIMT group, but, these variables did not show any difference in conventional group. Also bimanual functions in CIMT demonstrated significant difference in variables of bimanual function, bilateral coordination, and caregivers&rsquo; perception (how much) and (how well), whereas this variables did not show any difference in pre-test and post-test of conventional therapy. Discussion: Child friendly CIMT has fairly good effects on unimanual function and some variables of bimanual function of children with hemiplegia

Comparison of arm-hand bimanual intensive therapy and current therapy for unimanual and bimanual functions in children with cerebral palsy

Introduction: Studies have showed that although Constraint Induced Movement Therapy can lead into improvement of hand function in children with Cerebral Palsy, it has several important limitations. Charles and Gordon introduced Hand-Arm Bimanual Intensive Therapy (HABIT) in an attempt to compensate for such deficits. This study aimed at evaluating the efficacy of HABIT on unimanual and bimanual functions in children with Cerebral Palsy. Materials and Methods: The participants of this single-blinded randomized control study were twenty-eight children with CP who were divided into two groups of HABIT and controls according to a set of inclusionary and exclusionary criteria. Subjects in HABIT group received the intervention 6 hours per day over 10 successive days and the members of the other group were provided with occupational therapy services. Assessment tools administered in this study were Bruininks-Oseretsky Test of Motor Proficiency, Caregiver Functional Use Survey (CFUS), and Jebsen-Taylor Test in Hand Function. Independent and paired t tests were respectively used for comparing the two groups and to compare each group with regard to pre-test and post-test conditions. Results: Study results showed significant differences between two groups concerning dexterity, bilateral coordination, bimanual coordination, bimanual function, unimanual function and Caregiver Functional Use Survey (how well & how frequently) (P < 0.05). Also comparison of pre-test and post-test results for each of the two studied groups indicated improvement in most of domains evaluated. Conclusion: The protocol of Arm-Hand Bimanual Intensive Therapy may result in improvement of either bimanual or unimanual hand functions in children with cerebral palsy. Keywords: Arm-Hand bimanual intensive therapy, Hand function, Hemiplegia, Occupational therap