Saffron yield and quality as influenced by different irrigation methods

Dried stigma of saffron is the most expensive spice in the world. In Iran, the majority of saffron farms use the traditional basin method for irrigation, which, together with other irrigation methods may soon face serious problems because of droughts in the future. Making an evaluation of the regional crop response to the irrigation method is important to the adoption of a proper irrigation management strategy. In this study, the effect of employing different irrigation methods, including the sprinkler, drip, furrow, and basin, on the following factors was evaluated: the saffron stigma dry weight, quality, water use efficiency (WUE), and Irrigation water use efficiency (IWUE) in the arid climate of Qaen, South Khorasan, Iran, over three consecutive crop years. The experiment was undertaken using a randomized complete block design with three replications. The results showed that seasonal saffron Evapotranspiration (ETC) was recorded as 356.5, 339.1, and 330.7 mm, in 2003, 2004 and 2005 respectively, as a result of administering the treatments. Saffron yield as well as WUE and IWUE were found to respond to the various irrigation methods except in the first year. In total, maximum stigma dry weight and water use efficiencies were reached in the third growing season using the drip irrigation method. Judging by the results, the drip irrigation method for saffron production is to be preferred. Additionally, the quality level of saffron was found to be acceptable. However, due to higher crocin content, the quality of saffron irrigated by the sprinkler method was somewhat higher

Factors Influencing Prescribing Decisions of Physicians: A Review

BACKGROUND: The pharmaceutical bill is increasing at an alarming rate. The physician practice variation has a pronounced effect on healthcare spending. A number of factors can influence the prescribing behavior of physicians. The aim of this review was to identify the factors affecting the prescribing decision of physicians.METHODS: Electronic databases including Scopus, PubMed/MEDLINE CENTRAL, Cochrane Libraries and Google scholar were searched systematically for literatures on factors influencing prescribing decisions of physicians from 2000 to 2016. There was no restriction on the study designs.RESULTS: Thirty-three studies met the inclusion criteria from 1122 search results. A total of 33 factors were identified. The most frequent factors were patients’ clinical condition, pharmaceutical industries, physician attributes, patient preference and cost of medicine.CONCLUSION: Physicians’ personal attributes, cost of the medicine and pharmaceutical industries’ marketing and promotion strategies were mostly mentioned to influence prescribing decision. The identified factors showed that prescribing is not only geared for patient benefit, but also towards personal interest. The use of valid and reliable practice guidelines could reduce the negative impact of wide ranges of factors and promote the rational prescribing effectively.

Socioeconomic status and catastrophic health expenditure evaluation in IR Iran: A comparative study in 2004 and 2011

Background: Health equity is a main principle of all healthcare systems in the world. Family Physician (FP) program, as a health sector reform (HSR) in Iran, was executed to reduce households’ health care cost and to achieve health equity in 2004. Meanwhile, catastrophic health expenditure is known as an accepted indicator in HSR evaluation. In this context, after determining and comparing socioeconomic status (SES) among different periods, we made an attempt to evaluate households’ health financial protection in different quintiles after implementation of FP program.  Methods: The current cross-sectional study was based on the data obtained from Household Income and Expenditure Survey in 2004 and 2011. The health expenditures, catastrophic health expenditure (CHE), and SES were determined by this data during these years. Descriptive analyses and comparisons using Chi-squared test were carried out via SPSS, version 20.  Results: A total of 1716 households were included in the survey during 2004 and 2011. The highest proportion of households was related to quintiles very poor and poor with respect to each year. Moreover, it was observed that SES in 2011 had the worse situation compared to that in 2004; this situation was worse in urban areas. In the present study, CHE is related to poorer quintiles, and in rural areas no household was faced with CHE in 2011.  Conclusions: Implementation of FP program in rural areas with more primary care has prevented hospitalization. This was considerable for poorer quintiles and has led to financial protection for rural households

Is Albumin-based Resuscitation in Severe Sepsis and Septic Shock Justifiable? An Evidence from a Cost-effectiveness Evaluation

BACKGROUND: Fluid and antimicrobial therapy are the essential parts of sepsis management. The type of fluid to resuscitate with is an unsettled issue in the treatment of severe sepsis and septic shock. The objective of this study was to evaluate the cost effectiveness of albumin-based resuscitation over crystalloids.METHODS: A cost-effectiveness analysis was conducted by extracting data from a database of Sina Hospital, Islamic Republic of Iran. A decision tree was constructed by using Tree Age Pro2011. The patients were grouped based on the types of fluids used for resuscitation into crystalloid alone or crystalloid + albumin groups at the initial decision node. The patients were followed from the onset of severe sepsis and septic shock upto 28 days. The healthcare payers’ perspective was considered in constructing the model. The cost was measured in US dollars and the effectiveness was measured by life years gained.RESULTS: The addition of albumin during resuscitation of patients with severe sepsis and septic shock has an effectiveness gain of 0.09 life years and cost increment of 495.00 USD. The estimated ICER for this analysis was 5500.00 USD per life year gained. The probability that albumin is cost-effective at one GDP per capita is 49.5%.CONCLUSION: Albumin-based resuscitation is not cost-effective in Iran when a GDP per capita was considered for a life year gain. The cost-effectiveness was insensitive to the cost of standard care. We recomend the caustious use albumin as per the Surviving Sepsis Campaign guideline.

To Improve Total Knee Prostheses Performance Using Three-Phase Ceramic-Based Functionally Graded Biomaterials

One of the common issues that occur after total knee replacement surgery is the aseptic loosening. The problem usually occurs after about 15 years from the surgery. The destructive effects of residual particles due to wear, the stress shielding effect, and micro-movements are the causative factors for this type of loosening. In this research, using the advantages of functionally graded biomaterials (FGBM), it is tried to design a prosthetic system that can reduce the above-mentioned effects. For this purpose, the materials used in the most important part of the prosthesis system, i.e., the femoral part are redesigned so that the bioactivity between the prosthesis and bone, and the stress applied to the adjacent tissues increase simultaneously. In addition, to reduce the effect of wear at contact areas, wear-resistant biocompatible ceramics such as alumina and zirconia are used. The value of stress at the bone-prosthesis interface and adjacent tissues is the most important parameters. Two types of three-phase ceramic-based FGBMs are recommended. The prosthesis with three-phase hydroxyapatite-titanium-zirconia has increased the average stress in the bone tissues around high-risk areas up to 71.8% with respect to a commonly used Cr-Co prosthesis. The result for the prosthesis with three-phase hydroxyapatite-titanium-alumina is up to 65%, respectively. At bone-prosthesis interfaces, an increase of 92% in the stress for both zirconia-based and alumina-based is seen. Briefly, the recommended FGBMs can improve the bone-prosthesis performance in all desired indices

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Effect of different evaporation periods on microtensile bond strength of an acetone-based adhesive to dentin

Objective: Solvent content of a contemporary dental adhesive affect the bonding process, especially in the case of acetone based adhesives. The aim of this study was to evaluate the effect of different air-drying periods on microtensile bond strength (MTBS) of a total-etch adhesive to dentin. Materials and Methods: Prime & Bond NT (Dentsply-USA) was used with different air-drying periods (0, 2, 5, 10, 30sec) for bonding a composite resin to prepared dentin. The specimens were then subjected to a tensile force until fracture and the MTBSs of the samples were recorded. Failure modes of the fractured samples were also determined using stereomicroscope and scanning electron microscopy. Data were analyzed using ANOVA and Bonferroni tests (P = 0.05). Results: With increasing the air-drying periods, the MTBSs were increased until the 5 second air-blowing; after that, with increasing the air-drying periods, the MTBSs decreased. Both, the most complicated failure and the strongest bond were seen in the 5 sec air-drying group. Conclusion: There is an optimum air-drying time for acetone based adhesives which results in the strongest bond to dentin

Health Status and Quality of Life in Patients with Severe Hemophilia A: A Cross-Sectional Survey

Among different groups of hemophiliacs, those suffering from Severe Hemophilia A (SHA) are most vulnerable to the complications of the disease. This study investigated the Health-Related Quality of Life (HR-QoL) among adult patients with SHA. A cross-sectional study was designed to gather demographic and clinical information from adult patients with SHA. Patients with inhibitors were excluded. The remaining were asked to complete the HR-QoL questionnaire after being examined for joint health using the Hemophilia Joint HealthScore (HJHS). The HR-QoL and joint conditions were measured in 38 patients. The mean EQ-5D value scores were 0.46 (SD = 0.23) while the mean Visual Analogous Scale score was 50 (SD = 18.7). The clinical examination of patients indicated that the HJHS were as follows: eight patients had a score of 55–75, 12 patients had a score of 40–55, 7 of them (25–40) and 11 patients had a score of 10–25. The results obtained from this study showed that HR-QoL in hemophilia patients was considerably low. Pain, anxiety/depression, and motion limitations were the main causes of the disutility for these patients respectively

Effect of Curing Direction on Microtensile Bond Strength of Fifth and Sixth Generation Dental Adhesives

Background and Aims: Composite restorative materials and dental adhesives are usually cured with light sources. The light direction may influence the bond strength of dental adhesives. The aim of this study was to evaluate the effect of light direction on the microtensile bond strength of fifth and sixth generation dental adhesives.Materials and Methods: Prime & Bond NT and Clearfil SE bond were used with different light directions.Sixty human incisor teeth were divided into 4 groups (n=15). In groups A and C, Clearfil SE bond with light curing direction from buccal was used for bonding a composite resin to dentin. In groups B and D, Prime & Bond NT with light curing direction from composite was used. After thermocycling the specimens were subjected to tensile force until debonding occurred and values for microtensile bond strength were recorded. The data were analyzed using two-way ANOVA and Tukey post hoc test.Results: The findings showed that the bond strength of Clearfil SE bond was significantly higher than that of Prime&Bond NT (P<0.001). There was no significant difference between light curing directions (P=0.132).Conclusion: Light curing direction did not have significant effect on the bond strength. Sixth generation adhesives was more successful than fifth generation in terms of bond strength to dentin

The direct medical costs of outpatient cares of Type 2 diabetes in Iran: A retrospective study

Background: Diabetes mellitus is a chronic disease which many factors are involved and is developing considerably worldwide. Increasing aging population and obesity in the societies has improved the scale of the type 2 diabetes significantly. The aim of this study was to determine the direct medical costs of outpatient cares of diabetes in Iran. Methods: Active patients of Isfahan Endocrinology and Metabolism Research Center (IEMRC) by the end of March 2011 were employed for data extraction. Type 2 diabetics were classified into 4 groups based on their therapeutic regimens. Type and frequency of health care services were extracted from the patients′ profiles manually. The incidence of major diabetes complications were also examined from the subjects′ profiles. The numbers of services used by the patients in different treatment groups were multiplied by the desired medical tariffs to calculate the direct medical costs. Results: 2898 number of cases was reviewed in this study; 63.8 % women and 36.2% men. 4.3% of the patients were placed group I; 50.1% in group II, and 34.6% and 11% in groups III and IV respectively. The age distribution of the patients varied widely from 30 to 90 years; 5.8% between 30 and 39 years, 62.3% between 40 and 59, and 31.9% at 60 and over. Nephropathy (72.4%), and neuropathy (39%) were the most frequent adverse effect between the type 2 diabetics in Isfahan. The group III with spending $192.3 in total was absorbed the highest amount of the resources between the patients′ groups. The average direct medical cost of outpatient cares of diabetics per year was 155.8 US$. Conclusions: The direct medical cost of diabetes management is progressed sharply in past years in Iran. Pharmaceutical expenditures was the main cost component of outpatient cares for diabetes. It is estimated that the Iranians directly spend approximately $4.05 milliard annually to manage 5.2 million diabetics in the country