Effect of physiological delivery program in mother-friendly hospitals on duration of labor

Introduction: Physiological delivery program was implemented in mother-friendly hospitals of Iran after 2008. The aim of present study is to assess the effect of physiological delivery program in a mother-friendly hospital on duration of active phase and second stage of labor.Methods: This study was a clinical trial that was conducted at the Sinaand Ommobaninmotherfriendly hospitals in Ahvaz, Mashhad, Iran, in 2016. The intervention group of 77 women was offered the childbirth preparation classes during pregnancy and physiological delivery program during labor and the control group of 77 women received routine care.Results: The results showed that after controlling the confounding factors, the active phase and second stage of labor were significantly shorter in the intervention group (p<0.001). Conclusion: Complete implementation of physiological delivery program can reduce the duration of labor pain.Key words: Natural Childbirth; Prenatal Education; non-pharmacologic approaches; First stage of labor; Labor duration; Second stage of labo

Cesarean delivery in Iran: a population-based analysis using the Robson classification system.

BACKGROUND: The rise of Cesarean Sections (CS) is a global concern. In Iran, the rate of CS increased from 40.7% in 2005 to 53% in 2014. This figure is even higher in the private sector. OBJECTIVE: To analyze the CS rates in the last 2 years using the Robson Classification System in Iran. METHODS: A retrospective analysis of all in-hospital electronically recorded deliveries in Iran was conducted using the Robson classification. Comparisons were made in terms of the type of hospital, CS rate, and obstetric population, and contributions of each group to the overall cesarean deliveries were reported. RESULTS: Two million three hundred twenty-two thousand five hundred women gave birth, 53.6% delivered through CS. Robson group 5 was the largest contributing group to the overall number of cesarean deliveries (47.1%) at a CS rate of 98.4%. Group 2 and 1 ranked the second and third largest contributing groups to overall CSs (20.6 and 10.8%, respectively). The latter groups had CS rates much higher than the WHO recommendation of 67.2 and 33.1%, respectively. "Fetal Distress" and "Undefined Indications" were the most common reasons for cesarean deliveries at CS rates of 13.6 and 13.4%, respectively. There was a significant variation in CS rate among the three types of hospitals for Robson groups 1, 2, 3, 4, and 10. CONCLUSION: The study revealed significant variations in CS rate by hospital peer-group, especially for the private maternity units, suggesting the need for further attention and audit of the Robson groups that significantly influence the overall CS rate. The study results will help policymakers identify effective strategies to reduce the CS rate in Iran, providing appropriate benchmarking to compare obstetric care with other countries that have better maternal and perinatal outcomes

A new semi-solid casting technique for fabricating SiC-reinforced Mg alloys matrix composites

The capability of the newly developed rheocasting (RC) technique in combination with the RheoMetal process for producing SiC particulate-reinforced AM50 and AZ91D matrix composites (Mg-based MMCs) was investigated. The quality of the MMCs was studied by analyzing the fraction of casting pores, number density of SiC clusters and the uniformity of SiC particles. Solid fraction, particle size and oxidation of SiC particles had strong impacts on the overall quality of the MMCs. The MMCs produced by 40% solid fraction and oxidized micron-sized SiC particles exhibited an excellent casting quality. A low-quality MMC was obtained when non-oxidized sub-micron sized SiC particles were employed. The results showed the formation of various types intermetallic particles and carbides such as MgO, Mg2Si, Al2MgC2, Mg2C3, Al4C3 as the interfacial reaction products of SiC/Mg alloy's melts. Mg hydride (alpha-MgH2) was also identified in inter-dendritic regions of the MMCs for the first time

Study on agricultural waste and brackish waters in Ahvaz and Khuramshahr to development aquaculture

This study was done in 2008 on agricultural sewage for aquaculture in six stations. Two stations were in Ahvaz Khorramshahr road near sugar cane plantation sewage in west Karoon, Two stations were in Ahvaz-Abadan road in sugar cane plantation sewage in east Karoon and Azadegan sewage and two stations were in agricultural sewage in the north of Ahvaz. Monthly Samplings of planktons, physical, chemical parameters were taken during Aprile to March 2008. In addition seasonal sampling of benthic fauna and fish were carried out. Heavy metal and toxic samples were done only one time during the study period. Measurement of some parameters such as temperature and pH were done during sampling procedure and other parameters were measured in laboratory based on standard methods. Heavy metal concentrations were measured with polarography and voltammetry techniques and toxic substances were extracted and concentrated to determine the concentration of them in water using GC device. For identifying phytoplanktons, 1 liter water from middle depth was sampled in each station and 4% formalin was added. Zooplankton were sampled monthly using 55µ plankton net. Fish samplings were done using cast net regarding regional condition, and sampling from benthic invertebrate of river were done using Petersen grab with 15.5cm*15.5cm. Results of water quality index (WQI) from Koushk Talaieh (station1), Artificial lake station (station 2), Farabi(station 3), and Azadegan aquaculture sewage station (station4) showed that water quality is in group four. WQS index was used for Maleh(station 5) and Pumping station (6 station) stations due to high levels of salinity. The WQS results showed that water quality of these stations were moderate to low. Heavy metals in water, the ordination is as follows: Ni>Zn>Pb>Cu>Co>Cd>Hg Mercury levels in all cases were less than the standard and all the elements have been somewhat less than chronic toxicity level. The values of all studied metals are lower than the WHO limit. The results indicated that chlorinated pesticides in all samples are at low level and they are at acceptable levels for aquaculture. In this study, 34 genus of phytoplankton from Bacilariophyceae (diatoms), Cyanophyceae, Chlorophyceae and Dinophyceae were present with 11, 8, 14 and one genus respectively and the percentage of frequencies were respectively 37.64, 34.26, 23.24 and 4.87%. In general phytoplanktons of wastewater were in modest condition for using in aquaculture. In this study, about 1,000 samples of zooplankton in 6 stations were identified and counted during the year. The high percentage of zooplankton were belonged to three groups of protozoa (mainly ciliates), Rotifer and copepods were. The Rotifers with more than 90 percent frequency had the maximum prevalence. The dominant rotifer species was Brachionus calciferous. Although in this study the dominant group of zooplanktons was rotifers but the frequency is not high. Therefore we cannot call this circumstance as eutrophic condition, however the growing trend of high food phenomenon has announced. High benthic diversity was observed in artificial lake wastewater station and Azadegan aquaculture sewage station. The most frequent taxa were in Azadegan aquaculture sewage station during autumn and winter which belonged to resistant Chironemidae larvae. In Koushk Talaieh, Farabi and Maleh stations, Chironemidae was dominanted and in Pumping station Coleoptera was dominant group. Hilsenhoff index showed that most of waste water stations were in poor to very poor condition, indicating that they were heavily contaminated. The data analysis of macrobenthose data in wastewaters based on Satropi and biological value (Z) showed that potential of fish production in Azadegan and artificial lake was high during the year. These two water sources have suitable situation for potential production and biological value, therefore with special plans for culturing low demand fish would be possible. In this study, 7 fish species belongs to 7 genera from 4 families were collected. Freshwater and marine water species was observed in the catch composition. According to the results of the four studied stations, artificial lake station and Farabi had the highest number of catch which mostly belonged to Acanttopetrus Latus and Liza Abuo. In general, based on biological parameters, such as zooplankton frequency, all stations had similar conditions but in terms of phytoplankton, Azadegan aquaculture sewage station, Pumping stations and Farabi wastewater have better condition for aquaculture. The FBI index showed that the artificial lake station and pumping station are more suitable for aquaculture activity. Low demand fish is recommended for Azadegan aquaculture sewage station. Artificial lake station had lower primary production but it is more suitable for aquaculture because of its lower FBI index value. Most of the fish presence was in the artificial lake station and Farabi wastewater which belonged to two predominant species of Acanttopetrus Latus and Liza Abuo. In general, based on biological and non-biological parameters, artificial lake station in the west Karoon and Azadegan aquaculture sewage station have better water quality than the other stations for aquaculture activities. This requires management action and special schemes

Immersed boundary-finite element model of fluid-structure interaction in the aortic root

It has long been recognized that aortic root elasticity helps to ensure efficient aortic valve closure, but our understanding of the functional importance of the elasticity and geometry of the aortic root continues to evolve as increasingly detailed in vivo imaging data become available. Herein, we describe fluid-structure interaction models of the aortic root, including the aortic valve leaflets, the sinuses of Valsalva, the aortic annulus, and the sinotubular junction, that employ a version of Peskin's immersed boundary (IB) method with a finite element (FE) description of the structural elasticity. We develop both an idealized model of the root with three-fold symmetry of the aortic sinuses and valve leaflets, and a more realistic model that accounts for the differences in the sizes of the left, right, and noncoronary sinuses and corresponding valve cusps. As in earlier work, we use fiber-based models of the valve leaflets, but this study extends earlier IB models of the aortic root by employing incompressible hyperelastic models of the mechanics of the sinuses and ascending aorta using a constitutive law fit to experimental data from human aortic root tissue. In vivo pressure loading is accounted for by a backwards displacement method that determines the unloaded configurations of the root models. Our models yield realistic cardiac output at physiological pressures, with low transvalvular pressure differences during forward flow, minimal regurgitation during valve closure, and realistic pressure loads when the valve is closed during diastole. Further, results from high-resolution computations demonstrate that IB models of the aortic valve are able to produce essentially grid-converged dynamics at practical grid spacings for the high-Reynolds number flows of the aortic root

Survey on ecological characteristicsof Horolazim wetland in Khouzestan (2012-2013)

Rregarding the potential and capabilities of different socio-economic, ecological and recreational, Hurolazim wetland is allocated as a special place in the collection of ecosystems and environment and the study of existing ecological conditions is necessary to protect and restoring management. In this study, monthly Samples of four stations (stations north of the road, Imam Reza (1) and south of the road, Imam Reza (2), in the Rofayeh area and stations Tabor (3) and the Shatt Ali (4), in the Shatt Ali area) were taken during the year from April to March 2012. Samples included physical and chemical parameters, phyto and zoo planktons, benthos, fish, and fishing status. Phytoplankton samples using sampling bottles from 0.5 meters below the surface were taken and counted based on alive unit. Zooplankton samples were collected by 100 micron mesh size plankton net from a depth of 1.5-2 meters. Benthic animals and sediment were sampled by Van Vin grab(0.125 square meters). One sample for benthos and one sample for grain size analysis and percentage of organic matter were sampled from each stations. In order to estimate the monthly depleted catches, data collected from the census in place and sampling was done at the time. Three fishing area has inspected randomly once every 15 days and active fishermen and caches were recorded in the prepared forms during the day. In this way, the number of observed boats, the average boat per day, the catches of the boats and CPUE were registered and total fishing effort was calculated monthly. In this study, 194 species of phytoplankton were identified. Diatoms with 85 species, Cyanophyta with 59 species, Chlorophyta with 31 species, Euglenophyta and Dinophyta with 18 and one species were observed respectively. The highest abundance frequency of phytoplanktons with 38.96 percent were observed in Tabar station (3), Diatoms with 46% has shown the highest frequency and then Cyanophyta (34.17%), Chlorophyta (16.39%), Euglenophyta (1.6 %) and Dinophta (1.58%) were included of the total abundance respectively. In the summer colonies of Cyanophyta were in high density. A total of 35 species of zooplankton have been identified. from Rizopoda, the species of Arcellidae and Centripyxidae families, from Rotifera, the species of Brachionidae, Lecanidae, Asplanchnidae and Philodinidae families, from Cladocera ,the species of Daphnidae, Sisidae and Chydoridae families and from copepods, Cyclopoda families have been observed that included about 98 percent of identified zooplankton. Respectively, Copepoda (39.9 %), Rotifera (34.71 %), Cladocera (22.38 %) and Rizopoda (0.843 %) were dominant groups. The species Brachionus urceolaris with average density of 7.29 individual per liter, is the most abundant species that included 17 % of total abundance frequency in the wetland. The higher frequency of crustacean zooplankton such as Copepoda and Cladocera could be indicated an environment more favorable conditions and expected to be good status of food in the Horolazim wetland. Among the known benthic groups, families, Tephritidae (85%) and Chironomidae (7 %) of the order Diptera and Ostracoda (2 %) from crustacean, were the dominant macrobentic groups Among the studied stations, Station South Road Imam Reza (2), and the station Shatt Ali (4), were the highest and the lowest abundance respectively. The mean abundance of macrobenthos in different seasons showed the lowest and the highest abundance frequency in summer and winter respectively. According to diversity indices, The stations Tabar (3) was the highest and the Station South Road Imam Reza (2), was the lowest value of diversity index. The results showed the higher than 71.84 % of Silt-Clay percentage in all stations, The highest value of sediments TOM in the Station South of the Road Imam Reza(2) in the winter and the lowest in station Shat Ali(4) in summer were recorded. Based on HFBI index the stations north of the road Imam Reza (1) and the station Shatt Ali (4) in moderate status and the stations south of the road Imam Reza (2) and Tabar (3) in good status were classified. In this study, 15 species of fishes belonging to 8 genera and 3 families were identified. It was noticed that 87.4 percent of all identified species in the wetland belonged to the Cyprinidae family. The results of previous studies in 2006 and 2008 in the Iraqi part of Hawizeh wetland showed that the most common fish species belonged to Biah, Karas, Hemry and Shelej that included 89.3 percent of total fishing in the current study .Finally, It is evaluated that changes in water regime of freshwater wetlands, controlled the environmental characteristics and conditions. That means water plays a decisive role in the vital characteristics of wetlands. Changes of quantity and quality of water may be associated with changing the quantity and quality of biotic fauna in wetland system. In the management and protection of a wetland system, it is necessary to adopt measures based on scientific principles and reasonable methods in order to protect water quality

Hookah smoking is strongly associated with diabetes mellitus, metabolic syndrome and obesity: a population-based study

Objectives The adverse effects of cigarette smoking have been widely studied before, whilst the effects of hookah smoking has received less attention, although it is a common habit in the Middle East. Here we have investigated the effects of cigarette and hookah smoking on biochemical characteristics in a representative population sample derived from the Mashhad stroke and heart atherosclerotic disorder (MASHAD) cohort study, from Northeastern Iran. Study design A total of 9840 subjects from the MASHAD population study were allocated to five groups; non-smokers (6742), ex-smokers (976), cigarette smokers (864), hookah smokers (1067), concomitant cigarette and hookah smokers (41). Methods Baseline characteristics were recorded in a questionnaire. Biochemical characteristics were measured by routine methods. Data were analyzed using SPSS software and p < 0.05 was considered significant. Results After adjustment for age and sex; the presence of CVD, obesity, metabolic syndrome, DM and dyslipidemia were significantly (p < 0.001) related to smoking status. After multivariate analysis, HDL (p < 0.001), WBC (p < 0.001), MCV (p < 0.05), PLT (p < 0.01) and RDW (p < 0.001), and the presence of CVD (p < 0.01), obesity (p < 0.001), metabolic syndrome (p < 0.05) and DM (p < 0.01) remained significant between cigarette smokers and non-smokers. Between hookah smokers and non-smokers; uric acid (p < 0.001), PLT (p < 0.05) and RDW (p < 0.05), and the presence of obesity (p < 0.01), metabolic syndrome (p < 0.001), diabetes (p < 0.01) and dyslipidemia (p < 0.01) remained significant after logistic regression. Conclusion There was a positive association between hookah smoking and metabolic syndrome, diabetes, obesity and dyslipidemia which was not established in cigarette smoking

Identifying outcome-based indicators and developing a curriculum for a continuing medical education programme on rational prescribing using a modified Delphi process

<p>Abstract</p> <p/> <p>Background</p> <p>Continuing medical education (CME) is compulsory for physicians in Iran. Recent studies in Iran show that modifications of CME elements are necessary to improve the effectiveness of the educational programmes. Other studies point to an inappropriate, even irrational drug prescribing. Based on a needs assessment study regarding CME for general physicians in the East Azerbaijan province in Iran, rational prescribing practice was recognized as a high priority issue. Considering different educational methods, outcome-based education has been proposed as a suitable approach for CME. The purpose of the study was to obtain experts' consensus about appropriate educational outcomes of rational prescribing for general physicians in CME and developing curricular contents for this education.</p> <p>Methods</p> <p>The study consisted of two phases: The first phase was conducted using a two-round Delphi consensus process to identify the outcome-based educational indicators regarding rational prescribing for general physicians in primary care (GPs). In the second phase the agreed indicators were submitted to panels of experts for assessment and determination of content for a CME program in the field.</p> <p>Results</p> <p>Twenty one learning outcomes were identified through a modified Delphi process. The indicators were used by the panels of experts and six educational topics were determined for the CME programme and the curricular content of each was defined. The topics were 1) Principles of prescription writing, 2) Adverse drug reactions, 3) Drug interactions, 4) Injections, 5) Antibiotic therapy, and 6) Anti-inflammatory agents therapy. One of the topics was not directly related to any outcome, raising a question about the need for a discussion on constructive alignment.</p> <p>Conclusions</p> <p/> <p>Consensus on learning outcomes was achieved and an educational guideline was designed. Before suggesting widespread use in the country the educational package should be tested in the CME context.</p