Enhancing community based health programs in Iran: a multi-objective location-allocation model.

Community Based Organizations (CBOs) are important health system stakeholders with the mission of addressing the social and economic needs of individuals and groups in a defined geographic area, usually no larger than a county. The access and success efforts of CBOs vary, depending on the integration between health care providers and CBOs but also in relation to the community participation level. To achieve widespread results, it is important to carefully design an efficient network which can serve as a bridge between the community and the health care system. This study addresses this challenge through a location-allocation model that deals with the hierarchical nature of the system explicitly. To reflect social welfare concerns of equity, local accessibility, and efficiency, we develop the model in a multi-objective framework, capturing the ambiguity in the decision makers' aspiration levels through a fuzzy goal programming approach. This study reports the findings for the real case of Shiraz city, Fars province, Iran, obtained by a thorough analysis of the results.

Electrospinning of continuous poly (L-lactide) yarns: Effect of twist on the morphology, thermal properties and mechanical behavior.

Electrospinning PLLA solutions from two oppositely charged nozzles gives a triangle of fibers, also called E-triangle, that assemble into yarns at the convergence point. The formed yarn at the E-triangle was taken up by a unit comprising a take up roller and coupled twister plate, which twist rate can be varied. At all twist rates, uniform and smooth fibers without any beads were formed. The apex angle of the deposited fibers at the E-triangle was larger at higher twist rates. By increasing the twist rate from 80rpm to 320rpm the orientation angle of fibers in the yarn changes from 18.8° to 41.5°. Increasing the twist rate revealed a higher polymer crystallinity likely due to the polymer orientation by the applied tension to the fibers. The ultimate strength and modulus of electrospun yarns were higher when prepared at higher twist rates. However, at the highest twist rates, the strength and modulus of electrospun yarns leveled off and even decreased slightly. The results revealed that the mechanical properties not only depend on the polymer crystallinity but also on the alignment of the fibers in the yarn and the angle at which they were deposited. These biodegradable materials are promising materials to be used in a wide range of applications where environmentally friendly products are required.

Drug release behavior of electrospun twisted yarns as implantable medical devices.

In this study, twisted drug-loaded poly(L-lactide) (PLLA) and hybrid poly(L-lactide)/poly(vinyl alcohol) (PLLA/PVA) yarns were produced using an electrospinning technique based on two oppositely charged nozzles. Cefazolin, an antibiotic drug was incorporated in the yarn fibers by addition to the PLLA electrospinning solution. Morphological studies showed that independent of the twist rate, uniform and smooth fibers were formed. The diameter of the electrospun fibers in the yarns decreased at higher twist rates but produced yarns with larger diameters. At increasing twist rates the crystallinity of the fibers in the yarns increased. In the presence of cefazolin the fiber diameter, yarn diameter and crystallinity were always lower than in the non-drug loaded yarns. In addition the yarn mechanical properties revealed a slightly lower strength, modulus and elongation at break upon drug loading. The effect of the twist rate on the cefazolin in vitro release behavior from both PLLA and hybrid yarns revealed similar profiles for both types of drug-loaded yarns. However, the total amount of drug released from the hybrid PLLA/PVA yarns was significantly higher. The release kinetics over a period of 30 d were fitted to different mathematical models. Cefazolin release from electrospun PLLA yarns was governed by a diffusion mechanism and could best be fitted by Peppas and Higuchi models. The models that were found best to describe the drug release mechanism from the hybrid PLLA/PVA yarns were a first-order model and the Higuchi model.

Subclinical eating disorder, polycystic ovary syndrome- is there any connection between these two conditions through leptin- a twin study.

The genetic property of subclinical eating behaviour (SEB) and the link between SEB and polycystic ovary syndrome (PCOS) has been studied before but the role of leptin within this connection has never been investigated. The objective of this study was 1). to study the genetic property of SEB. 2). To find a link between leptin, SEB and PCOS. One hundred and fifty four (77 pairs) female-female Iranian twins including 96 MZ individuals (48 pairs) and 58 DZ individuals (29 pairs) participated in the study. Clinical, biochemical and ultrasound tools were used to diagnose polycystic ovary syndrome. BITE questionnaire was filled out for subjects. Eight percent of subjects were diagnosed for subclinical eating disorder. No significant difference was found between intraclass correlation of MZ and DZ (z = 0.57, P = 0.569). Serum leptin level correlated significantly with bulimia score (P < 0.007). The mean (+/-SD) value for bulimia score was found to be higher among PCOS(positive) subjects (3.27 +/- 5.51) in comparison with PCOS(negative) subjects (2.06 +/- 4.48) (P < 0.001). The genetic property of subclinical eating disorder was not confirmed as shared environment might have played a major role in likeliness of DZ twins as well as MZ. Leptin is linked with both subclinical eating disorder and PCOS.

Influence of the solvent type on the morphology and mechanical properties of electrospun PLLA yarns.

An electrospinning technique based on the use of two oppositely charged nozzles was applied to fabricate continuous twisted yarns of poly(L-lactide) (PLLA) nano/micro fibers. In this study, the effect of solvent on the electrospinning of PLLA fibrous yarns was investigated. For this purpose, yarns were electrospun using chloroform, dichloromethane or 2,2,2-trifluoroethanol as solvents at a PLLA concentration of 7 wt%. The analysis of the morphology, diameter, crystallinity and mechanical properties of electrospun yarns revealed that the vapor pressure of the solvent plays an important role. Whereas the fiber diameter decreased, the crystallinity of the fibers increased using a solvent with lower vapor pressure. In addition, mechanical properties (e.g., tensile strength and modulus) revealed that the yarns composed of fibers with smaller diameters showed higher tensile strength and modulus. In summary, fine-tuning solvent properties resulted in a modulation of fiber diameter, crystallinity, and thereby yarn mechanical properties, and are important factors to consider in the fabrication and application of electrospun yarns.

Evaluation of shear stress accumulation on blood components in normal and dysfunctional bileaflet mechanical heart valves using smoothed particle hydrodynamics.

Evaluating shear induced hemodynamic complications is one of the major concerns in design of the mechanical heart valves (MHVs). The monitoring of these events relies on both numerical simulations and experimental measurements. Currently, numerical approaches are mainly based on a combined Eulerian-Lagrangian approach. A more straightforward evaluation can be based on the Lagrangian analysis of the whole blood. As a consequence, Lagrangian meshfree methods are more adapted to such evaluation. In this study, smoothed particle hydrodynamics (SPH), a fully meshfree particle method originated to simulate compressible astrophysical flows, is applied to study the flow through a normal and a dysfunctional bileaflet mechanical heart valves (BMHVs). The SPH results are compared with the reference data. The accumulation of shear stress patterns on blood components illustrates the important role played by non-physiological flow patterns and mainly vortical structures in this issue. The statistical distribution of particles with respect to shear stress loading history provides important information regarding the relative number of blood components that can be damaged. This can be used as a measure of the response of blood components to the presence of the valve implant or any implantable medical device. This work presents the first attempt to simulate pulsatile flow through BMHVs using SPH method.

Twenty-two cases of autotransfusion.

Twenty cases of ruptured ectopic pregnancy and two cases of haemothorax which have been given autotransfusion by a simple technique are reported. No deaths or complications occurred. The advantages of autotransfusion particularly in circumstances where laboratory facilities are minimal are discussed. Haemoglobin levels before and after transfusion and other investigations are recorded.

Leptin and its association with polycystic ovary syndrome: a twin study.

Polycystic ovary syndrome (PCOS) is a common endocrinopathy with symptoms such as obesity, insulin resistance and hyperandrogenemia. PCOS might be the result of a genetic disorder. Genetic discrepancy in the production of leptin, a product of the obesity gene, may lead to various endocrinopathies such as PCOS. The objective of this study was first, to ascertain the incidence of PCOS, using the gold standard; second, to ascertain the genetic property of leptin; and third, to evaluate the association between leptin concentration and PCOS. A total of 154 Tehran-resident female-female twins were studied. They included 48 pairs of monozygotic (MZ) and 29 pairs of dyzygotic (DZ) twins, aged 15-45 years. Clinical, ultrasound and biochemical findings were used to diagnose PCOS. The incidence of PCOS using biochemical and clinical features was 16.2%. The correlation coefficient between serum leptin levels of MZ twins was higher than that of the DZ twins. The serum level of leptin was similar between subjects with or without PCOS, irrespective of their zygosity. It was concluded that the incidence of PCOS is high among twins, and that leptin is likely to be genetically determined, although the effect of environmental factors cannot be denied. This study did not find any association between the diagnosis of PCOS and leptin level. However, the link between the two may lie with other entities such as eating disorders and/or obesity.

Expressed emotion and the course of schizophrenia in Iran.

BACKGROUND: The influence of expressed emotion (EE) on the course of the schizophrenia has been studied in different countries. Cultural influence on the level of EE has shown the importance of examination of EE in different cultures. The present study examined the distribution of components of EE and influence of EE on the course of schizophrenia in Iran. METHODS: Two psychiatric centers from two dissimilar cities, Tehran and Hamedan, were chosen. Seventy-eight patients who suffered from schizophrenia based on the diagnostic criteria of DSM-III-R were selected. Interviews with 97 key family members were conducted using the Camberwell Family Interview. Psychiatrists who were blind to the EE status of the family household evaluated patients' symptoms based on a cohort study design during the 9-months follow-up. RESULTS: Sixty percent of the patients were living in a high EE household. The relapse rate in the high EE group was higher, but did not reach statistical significance. However, male patients as well as chronic patients were significantly more likely to relapse in the high EE group (P = 0.05). CONCLUSIONS: The results suggested that high EE is a risk factor on the course of schizophrenia in Iran. The distribution of the components of EE showed differences compared to other cross-cultural studies. The results of this study can be used in planning appropriate psychoeducational programs for families of patients in Iran and culturally similar populations.