Cost-effectiveness of Methadone Maintenance Treatment in prevention of HIV among drug users in Shiraz, south of Iran

Background: The increase in high-risk injections and unsafe sexual behaviors has led to increased HIV infection prevalence among Intravenous Drug Users (IDUs). The high costs of HIV/AIDS care and low financial resources necessitate an economic evaluation to make the best decision for the control of HIV/AIDS. Objectives: This study was conducted to determine the cost-effectiveness of Methadone Maintenance Treatment (MMT) centers in HIV infection prevention among drug users. Materials and Methods: In this interventional study, we included all the seven MMT centers and the drug users registered there (n = 694). We calculated all the costs imposed on the government, i.e. Provider of case. Mathematical models were used to estimate the number of HIV cases averted from high-risk behaviors. Sensitivity analyses were performed to show the effects of uncertainty in parameters on the number of HIV cases averted and also Incremental Cost-Effectiveness Ratio (ICER). Results: Based on the averted models, the selected MMT centers could prevent 128 HIV cases during 1 year. The total cost was $547423 and that of HIV/AIDS care in the no intervention scenario was estimated$ 14171816. ICER was $106382 per HIV case averted. The results of the sensitivity analysis indicated that MMT intervention was cost-effective even in the worst scenario and ICER varied from$ 39149 to $ 290004 per HIV case averted. Conclusions: With regard to the high prevalence of drug injection among drug users and considering the high effectiveness and cost-effectiveness of MMT centers in preventing HIV infection, establishment of MMT centers in regional and national levels seems reasonable. © 2013, Iranian Red Crescent Medical Journal

Testing for Twin Deficits and Ricardian Equivalence Hypotheses: Evidence from Iran

The main purpose of this study is to examine the relationship between budget deficit and current account deficit in Iran from 1971 to 2007. Twin deficits, which argues that a larger budget deficit leads to an expanded current account deficit, and Ricardian equivalence hypothesis, which states that there is no casual relationship between these two deficits, are examined for this purpose. To achieve this goal, Johansen co-integration and Granger causality tests are used for the period under study. The results indicate that there exists a long run equilibrium link between budget deficit and current account deficit. There is a one-way causality relationship from the budget deficit toward the current account deficit

The Relationship between Government Size and Economic Growth in Iran; Bivariate and Trivariate Causality Testing

The aim of this study is to demonstrate the relationship between government size and economic growth in Iran within bivariate and trivariate causality framework. For this purpose, Vector Auto Regressive Model, Johansen Test and Auto Regressive Distributed Lag Model were used for analyzing the long run relationship, whereas Error Correction Model was considered for the short run. Moreover Wald Coefficient was used for bivariate and trivariate causality test. The results show that the relationship between government size and economic growth in Iran is negative. Furthermore there is a one-way causality relationship for the long run and the short run-from government size to economic growth. Inclusion of unemployment and oil revenue (separately) as the third variable causes the relationship to remain negative. However the direction of causality depends on the choice of the third variable. If unemployment rate is considered as the third variable instead, there will be no causality between the two variables in the long run. Although in the short run government size is still the cause of economic growth. However, consideration of oil revenue as the third variable results in a two-way causality relationship between the government size and the economic growth in the long run and the short run

Automatic Spike sorting and robust power line interference cancellation for neural signal processing

Ph.DDOCTOR OF PHILOSOPH

Operations research models for investigation and improvement of the hyperacute stroke care system

Stroke is the third most common cause of death and the sixth major cause of disability around the world with ischemic stroke accounting for around 80% of all strokes. It has been clinically indicated in treating ischemic stroke patients that maximum benefits can be achieved with the speediest arterial recanalization by effective and fast application of existing acute therapies. These therapies comprise either (1) dissolving the blood clot using Intravenous Tissue Plasminogen Activator (IV tPA) treatment or (2) physically removing the clot from the artery using endovascular thrombectomy treatment. These treatments should be performed within the hyperacute time window of 6 hours from stroke onset. For nearly two decades until late 2014, the intravenous thrombolysis delivered to patients was the most effective treatment for stroke patients. This was administrated within a maximum of 4.5 hours from stroke onset. In early 2015, results of five clinical trials from different parts of the world demonstrated the effectiveness of the endovascular thrombectomy therapy. This was provided within 6 hours of stroke onset for the eligible stroke patients who already have received thrombolysis treatment. Research presented in this thesis is the first attempt to quantify the link between the earlier treatment and long-term benefits for the hyperacute stroke patients. Moreover, with the gradual emergence of new evidence about effectiveness of the endovascular thrombectomy treatment in the hyperacute stroke care systems, new questions were raised in the clinical literature since not all hospitals have the expertise and equipment required for delivering the endovascular thrombectomy treatment. Some of the most burning questions were formulated in an Editorial article published in the Journal of the American Medical Association (JAMA) by Warach and Johnson (2016). These questions mainly concern the issue of treatment pathway selection between two groups of hospitals with different facilities and expertise to support new investigations in the hyperacute stroke care system by comparing the long-term benefits for individual patients. This research demonstrates how Operations Research (OR) models can be used to answer these and other questions in the hyperacute stroke care system. It is specifically focused on OR models for investigation and improvement to provide better understanding of the complex decisions arising in the hyperacute stroke care system. The main aimof this thesis is to investigate the issue of design, development and validation of OR models used for investigation and improvement of the hyperacute stroke care system. Thus, this work addresses very recent and important questions in the field to support more effective and efficient provision of the services to stroke patients. Three OR models for investigation and improvement are designed and validated in this thesis: (1) ’IV tPA’ model, (2) ‘Endovascular Thrombectomy’ model, and (3) ‘Individual Patient’ model. The first two OR models are used to provide an understanding of the long-term population benefits of faster access to stroke treatment interventions. Based on the first two OR models, one minute earlier of IV tPA and endovascular thrombectomy interventions respectively on average provide 1.8 days and 3.2 extra days of healthy life for the stroke patients. The third OR model is used to provide assistance with maximizing the individual patient’s life-time benefits over two pathways of the hyperacute stroke care system. Finally, we present a novel validation framework that is used to validate all three OR models developed in this thesis. This research contributes to OR/MS literature by design, development and validation of OR models used to provide an improved understanding of the long-term population and individual patient’s benefits due to faster delivery of stroke treatment interventions in the hyperacute stroke care system. A discussion on the validation of OR models is also novel and further addresses the existing gaps in OR/MS literature

The Effect of Fiscal Decentralization on Under-five Mortality in Iran: A Panel Data Analysis

Background: Fiscal Decentralization (FD) in many cases is encouraged as a strong means of improving the efficiency and equity in the provision of public goods, such as healthcare services. This issue has urged the researchers to experimentally examine the relationship between fiscal decentralization indicators and health outcomes. In this study we examine the effect of Fiscal Decentralization in Medical Universities (FDMU) and Fiscal Decentralization in Provincial Revenues (FDPR) on Under-Five Mortality Rate (U5M) in provinces of Iran over the period between 2007 and 2010. Methods: We employed panel data methods in this article. The results of the Pesaran CD test demonstrated that most of the variables used in the analysis were cross-sectionally dependent. The Hausman test results suggested that fixed-effects were more appropriate to estimate our model. We estimated the fixed-effect model by using Driscoll-Kraay standard errors as a remedy for cross-sectional dependency. Results: According to the findings of this research, fiscal decentralization in the health sector had a negative impact on U5M. On the other hand, fiscal decentralization in provincial revenues had a positive impact on U5M. In addition, U5M had a negative association with the density of physicians, hospital beds, and provincial GDP per capita, but a positive relationship with Gini coefficient and unemployment. Conclusion: The findings of our study indicated that fiscal decentralization should be emphasized in the health sector. The results suggest the need for caution in the implementation of fiscal decentralization in provincial revenues

Compassionate Care Among Iranian Nurses Caring for Candidate Brain Death Organ Donor Patients: A hermeneutic study

Apart of cares provided at the end oflife of patients in intensive care unitsis allocated to the care of brain deathpatients, which is considered under title of one caringunit. Many nurses tend to provide high-quality and compassionatecare. However, studies indicated that almost allpatients do not receive compassionate cares. This researchwas carried out to explain the living experiences of nursesin intensive units providing care for brain death patients.In this hermeneutic phenomenological study, van Manen’smethodology was used. Ten nurses (9 women and 1 man)working in Intensive Care Units were interviewed usingsemi-structured interviews. The data derived from the interviewswas analyzed after recording and transcribing.The main theme of this study, which manifested the importantand innovative aspect of caring the brain deathpatients, was “compassionate care”. It included two subthemesof commitment and devotion with sub subthemesof responsible caring and kindness in caring and sympatheticsupport with sub subthemes of providing emotionalsupport to family and emotional influence.According to the results of this research, it can be concludedthat providing care for brain death patients, whowere candidate for donation, despite imposing psychologicalburden on nurses, has provided a compassionate carefor patient and family. This care is due to commitment,professional responsibility and deep emotional effects inthem. The research results provide the conditions for educationalplanners to train nurses in order to improve theircare provided for the patients and support the nurses

Comparison of Blood Transfusion Plus Chelation Therapy and Bone Marrow Transplantation in Patients with β-Thalassemia : Application of SF-36, EQ-5D, and Visual Analogue Scale Measures

Date of Acceptance: 08/06/2015 © 2015 by Kerman University of Medical Sciences. Acknowledgments The present article was extracted from the thesis written by Hassan Karami and was financially supported by Shiraz University of Medical Sciences, Shiraz, Iran (grant No. 6292). The authors would like to thank all participants in the study IJHPM supports the Open Access initiative. Abstracts and full texts (PDF format) of all articles published by IJHPM are freely accessible to everyone immediately upon publication. IJHPM also does not charge any submission or publication fees.Peer reviewedPublisher PD