Performance of family physicians (FPS) from viewpoint of managers and experts of northern provinces of Iran

BACKGROUND AND OBJECTIVE: Family physicianis (FPs) responsible for the health team have five duty to health management, external c00peration, Health Promotion, Prevention and Health Services and treatment care and referral. This study evaluated viewpoint of managers, supervisors and experts of Northern Provinces of Iran from the level of performance of Family physicians (FPs) in five basic task. METHODS: This cross-sectional study was performed in winter 2013. The study population includes managers, supervisors and experts at Health Network from the total of 47 cities in 3 provinces of Gilan, Mazandaran and Golestan which were censuses selected. A researcher-made questionnaire was used for data gathering. In this questionnaire, personal characteristics and performance level of FPs from five main task of the Likert scale. Validity and reliability of the questionnaire were approved. FINDINGS: From the perspective of 557 managers, supervisors and experts of Staff in the study, the average performance level of FPs, in the field of health management (of 5 score) was 3±0.8, external c00peration 2.7±0.9, Health Promotion 2.8±0.9, Prevention and Health Services 3.2±0.9 and health care and referral 3±0.8. There was a significant relationship between job experience and performance level of FPs (p0.05). CONCLUSION: The results of this study showed that from the perspective of managers, supervisors and experts the performance level of FPs' was in two task lower moderate and in three task moderate. © 2015, Babol University of Medical Sciences. All Rights Reserved

Seroprevalence of anti-Hp and anti-cagA antibodies among healthy persons in Golestan province, northeast of Iran (2010)

Background: The major cause of peptic ulcer disease is helicobacter pylori (Hp), and it is also implicated in the pathogenesis of adenocarcinoma of the distal stomach and gastric lymphoma. The incidence of peptic ulcer disease, atrophic gastritis, and gastric adenocarcinoma are more common in people infected of cagA positive strains of Hp. The aim of this study was to determine the prevalence of the anti-Hp and anti-cagA antibodies among healthy persons in Golestan province-North of Iran. Methods: The blood samples of 1028 healthy people were collected all over Golestan province by cluster sampling. A demographic questionnaire was completed and body mass index (BMI) was calculated for each case. Hp-IgG (Pishtaz teb Co. Iran) and anti- cagA (DIA.PRO Italy) titer were evaluated by Elisa method. Data were collected and analyzed. Results: Six hundred-eighty three individuals (66.4%) were positive for Hp and 395 (57.8%) of them were cagA positive. Hp positive cases were (66.3%) and (66.6%) in male and female, respectively. Prevalence of cagA was 56.3% and 58.9%, respectively. The most seropositivity of Helicobacter Pylori (75.4%) was in 55-64 years old (p<0.001). Prevalence of cagA (63.4%) was more in age between 15-24 years. Conclusion: Prevalence of anti-Hp antibody and strains of cagA seropositive in healthy persons of this province of Iran were relatively high. Preventive protocol for reducing of the infection is recommended

Complications leading to hospitalization due to consumption of anti-TB drugs in patients with tuberculosis in Gorgan, Iran (2007-12)

Background and Objective: Anti tuberculosis drugs therapy is the most effective method for controling the tuberculosis (TB). Early detection and appropriate treatment can prevent the TB-drug resistance. This study was carried out to determine the complications leading to hospitalization due to consumption of anti-TB drugs in patients with tuberculosis. Methods: In this descriptive-analytic study, 1550 records of patients with TB in urban and rural health centers of Gorgan, north of Iran were assessed during 2007-12. Checklist consists of demographic and clinical data for each patient was recorded in a questionare. Results: 44 cases experienced the complications of anti-TB drugs. 27 (61.4%) of cases with complications were women. 77.3% and 22.7% of patients affected with pulmonary and extra pulmonary tuberculosis,respectively. 38.6% of patients were diabetic. The hepatic complication was seen in 37 cases (84.1%). Skin and other complications were seen in 5 and 2 cases, respectively. There was not any relationship between drug complications and other disases. Conclusion: Hepatic damage is the most common complication leading to hospitalization in tuberculosis patients using anti-TB drugs. Keywords: Tuberculosis, Anti-TB drug, Live

Membrane Distillation: Basics, Advances, and Applications

Membrane technology as an emerging separation process has become competitive with other separation techniques in recent decades. Among pressure-driven and isothermal membrane processes, membrane distillation (MD) as a thermally driven process has come out to put an end to hardships of such processes like distillation. MD process can be used in a wide variety of applications such as desalination and wastewater treatment. Generally, MD is a process which water is a main component of the feed solution and only water vapor can pass through a hydrophobic membrane pores. With four main configurations different from each other by their condensation procedure, the performance of MD process is limited due to the lack of appropriate module, membrane, and energy consumption rate. In recent years, many experiments have been carried out to find well-suited membrane type and module. Also, applying solar or waste heat as heat source and the capability of coupling with other processes like forward osmosis and osmotic distillation distinguish MD process from other membrane processes. This chapter addresses membrane characteristics, MD applications, transport mechanisms, and process challenges

Exploring Successful Small Urban Spaces’ Criteria with Emphasis on Cultural Context

In the crowded cities of the present age, public spaces can provide a quiet area away from the hustle and bustle of the city that citizens can interact with by incorporating utility features and meeting human needs and Relax there. Small urban spaces are among the most important and effective urban spaces to achieve this goal. Because these spaces due to their small size and lower costs (compared to larger spaces) for construction can be created in large numbers and distributed throughout the city. In this way, citizens will be able to reach a public urban space on foot in a short time. If these spaces are well designed, they can encourage people to stay in and interact with each other. It is not difficult to identify and experience high-quality successful places, but identifying the reasons for their success is difficult and even more difficult, understanding if similar spaces in other places can be considered successful. This question is important because public space with deep social content is considered a cultural product. Public space is the product of the historical and socio-cultural forces of society. Therefore, one of the most important issues that should be considered in the study of public spaces and the reasons for their success is the cultural context. In Iranian cities that have been influenced by the values and principles of Islam, recognizing Islamic principles and their role in shaping public spaces can lead us to desirable results. The purpose of this article is to develop a conceptual model of successful small urban spaces with an emphasis on cultural issues, especially in Iranian-Islamic cities. In this regard, the effective criteria for the success of urban spaces in general and small urban spaces in particular in the two categories of Western countries and Iranian Islamic cities were examined and then, taking into account the criteria derived from cultural theorists, the conceptual model of research with 38 sub-criteria is provided

Leveraging Optimal Transport for Enhanced Offline Reinforcement Learning in Surgical Robotic Environments

Most Reinforcement Learning (RL) methods are traditionally studied in an active learning setting, where agents directly interact with their environments, observe action outcomes, and learn through trial and error. However, allowing partially trained agents to interact with real physical systems poses significant challenges, including high costs, safety risks, and the need for constant supervision. Offline RL addresses these cost and safety concerns by leveraging existing datasets and reducing the need for resource-intensive real-time interactions. Nevertheless, a substantial challenge lies in the demand for these datasets to be meticulously annotated with rewards. In this paper, we introduce Optimal Transport Reward (OTR) labelling, an innovative algorithm designed to assign rewards to offline trajectories, using a small number of high-quality expert demonstrations. The core principle of OTR involves employing Optimal Transport (OT) to calculate an optimal alignment between an unlabeled trajectory from the dataset and an expert demonstration. This alignment yields a similarity measure that is effectively interpreted as a reward signal. An offline RL algorithm can then utilize these reward signals to learn a policy. This approach circumvents the need for handcrafted rewards, unlocking the potential to harness vast datasets for policy learning. Leveraging the SurRoL simulation platform tailored for surgical robot learning, we generate datasets and employ them to train policies using the OTR algorithm. By demonstrating the efficacy of OTR in a different domain, we emphasize its versatility and its potential to expedite RL deployment across a wide range of fields.Comment: Preprin

Aflatoxin contamination in wheat flour samples from Golestan province, Northeast of Iran

Background: Due to the high toxicity of aflatoxin and its effects on public health, determination of aflatoxin level in Wheat flour samples in the Golestan province, north of Iran was investigated. To examine the effect of seasonal changes, summer and winter sampling was performed with standard sampling methods. Methods: A total of 200 flour samples were collected from 25 factories. HPLC method with immunoaffinity chromatography was used to measure aflatoxin types (G2, G1, B2 and B1). Statistical analysis was performed by the Pearson correlation test, One-way ANOVA and multivariate regression analysis. Results: Mean total aflatoxin levels of samples were 0.82 and 1.99 ng/g in summer and winter, respectively. Aflatoxin B1 levels were detected in 3.1%, 7.4% over permissible limits by worldwide regulations in samples collected in summer and winter, respectively. Aflatoxins in winter were higher than summer. The highest frequency of aflatoxin contamination in winter was B2 (98%) and in summer G1 (51%). The relationship between humidity and rate of aflatoxin B1 and total aflatoxin was significant in winter. Results of multivariate regression were showed the strongest relationship with humidity and aflatoxin level. Despite the contamination of flour samples, there was no contamination higher than the standard limit of Iran Standard Institute. But it was significantly higher than similar studies from other regions. Conclusions: Therefore, with regard to negative impacts of aflatoxin on health, aflatoxin contamination should be considered in future programs. Decrease of aflatoxin contamination may be made practical through reducing wheat storage duration and controlling humidity

Marked increase in the incidence rate of esophageal adenocarcinoma in a high-risk area for esophageal cancer

BACKGROUND: Esophageal cancer (EC) is the eighth common cancer worldwide. Esophageal squamous cell carcinoma (ESCC) and adenocarcinoma (EAD) are the most common histologic types of EC. Many recent reports showed an increasing trend in EAD and a decreasing trend in ESCC in many Western countries. Golestan Province in northeastern Iran has been known as a high-risk area for EC. The aim of this study was to describe the time trend of EAD in this area between 2000-2009. METHODS: Data on cancer cases were obtained from Golestan Population-based Cancer Registry. Analysis was done using Joinpoint software. To examine the incidence trends, the annual percent change was calculated. The possibilities of anatomic and histologic misclassification were considered by assessing the trend of ESCC and gastric adenocarcinoma. RESULTS: A total number of 1186 histologically-confirmed EC cases were recruited. The incidence rate of EAD showed a significant increasing trend. There was no significant trend in the incidence of ESCC during the study period. A significant increase in the incidence rate of gastric adenocarcinoma was observed during the period of 2000-2005, followed by a plateau during the period of 2005-2009. CONCLUSIONS: We found a significant increasing trend in the incidence rate of EAD. We find no evidence to support an alternative explanation including anatomic and histologic misclassification. So, the observed rise in the incidence of EAD seems to be real. Therefore, designing and implementation of control programs, including control of preventable risk factors of EAD, should be considered in this high- risk area

Determinants of healthcare utilisation and predictors of outcome in colorectal cancer patients from Northern Iran

We aimed to assess healthcare utilisation (HU), its determinants, as well as its relationship with survival in colorectal cancer (CRC) patients. This study was conducted on incident CRC cases from Northern Iran. Information on HU was collected using a valid questionnaire, considering eight diagnostic and four therapeutic services. The results were categorised as good and poor HU. Multivariate logistic regression analysis was used to assess the relationship between HU and other variables. Cox regression analysis was performed to determine major predictors of survival. In total, 227 new cases of CRC were enrolled. HU could be assessed in 218 subjects (96). Living in rural areas was the strongest variable related to poor HU (adjusted OR, odds ratio=2.65; CI, confidence interval: 1.30-5.40). The median survival time was 40.5months. The 1-, 3- and 5-year survival rates were 71, 52 and 44 respectively. Cox regression analysis showed a significant lower survival rate in patients with poor HU (HR=2.3; CI: 1.46-3.64). HU was an independent predictor of survival in our CRC patients. Patients' place of residence was a significant determinant of HU. Regarding its effects on patients' outcome, HU and its determinants should be considered in designing CRC controlling programmes in our region and similar high-risk populations. © 2016 John Wiley & Sons Ltd