mohammad reza maleki
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Background
The present study aimed to determine and compare the weight gain patterns of Iranian and Afghan pregnant women and investigate their relationship with neonatal anthropometric features.
MethodsIn this descriptive-analytical study, the health profiles of randomly selected Iranian and Afghan pregnant women referred to health centers in Semnan city, Iran, were reviewed. Data were collected following the guidelines recommended by the Institute of Medicine (IOM). Neonatal anthropometric measures were evaluated based on the reference values issued by the Iranian Ministry of Health (MOH). A statistical significance level of P < 0.05 was considered.
ResultsThe average age of Afghan mothers was 27.36 ± 5.46 years, while that of Iranian mothers was 29.13 ± 5.44 years. The average weight gain during pregnancy was slightly lower in Afghan mothers (OR = -0.88, 95% CI: 0.82 - 0.94). Although the average weight gain in both groups and the percentiles of neonatal anthropometric measures were within permissible limits, a regression model indicated that weight gain during pregnancy significantly affected neonatal birth weight only in Iranian mothers (β = -0.313, P ≤ 0.001). Logistic regression analysis revealed no significant difference in the impact of maternal weight gain on neonatal anthropometric measures between the Iranian and Afghan mothers.
ConclusionsThe findings of this study suggest that nationality (i.e., Iranian or Afghan) does not influence maternal weight gain or neonatal anthropometric measures. The establishment of guest houses and training programs, such as Behbakhsh initiatives for Afghan women, appears to have been effective in ensuring equitable access to health services for Afghan immigrants.
Keywords: Pregnancy Weight Gain, Anthropometric Measures, Pregnancy, Immigrant, Afghan, Iran, Refugee, Neonatal Parameters -
پیش زمینه و هدف
زردی نوزاد یک بیماری شایع است که اغلب نیاز به مداخله پزشکی دارد و تعویض خون یکی از تهاجمی ترین اقدامات درمانی است. بااین حال، این روش خطرات و عوارض قابل توجهی دارد. شناسایی عوامل خطر مرتبط با زردی شدید که منجر به نیاز به انتقال خون می شود، بسیار مهم است، زیرا این دانش می تواند به متخصصان مراقبت های بهداشتی کمک کند تا اقدامات پیشگیرانه را انجام دهند و این موارد را به طور موثرتری مدیریت کنند.
مواد و روش کاراین مطالعه طی سال های 1395 تا 1401 در بیمارستان قدس قزوین انجام شد و در این مدت 3266 نوزاد به دلیل زردی در بیمارستان بستری شدند که از این تعداد 49 نفر تحت تعویض خون قرار گرفتند. داده ها از پرونده پزشکی این نوزادان و پرسشنامه تکمیلی توسط مادران آن ها جمع آوری شد.
یافته هااز 49 نوزاد موردبررسی، 66 درصد پسر بودند. نوزادان نارس 36 درصد از جمعیت موردمطالعه را تشکیل می دادند. توزیع ترتیب تولد به این صورت بود: 49درصد فرزند اول، 5/26 درصد فرزند دوم، 4/18 درصد فرزند سوم و بقیه نوزادان فرزند چهارم یا بزرگ تر بودند. شایع ترین گروه خونی مادر O+ (20 نوزاد) و پس ازآن A+ (13 نوزاد) بود. شایع ترین گروه خونی نوزادان A+ (21 نوزاد) بود. درمجموع 4/71 درصد از نوزادان ناسازگاری گروه خونی با مادر و 1/6 درصد از نوزادان ناسازگاری Rh داشتند. هجده درصد از نوزادان کمبود آنزیم G6PD داشتند و 78 درصد نوزادان از والدین غیر فامیلی متولد شدند.
بحث و نتیجه گیریشایع ترین علل انتقال خون در این مطالعه ناسازگاری ABO (94/19 درصد)، ناسازگاری RH (6/1 درصد) و کمبود G6PD (18 درصد) بود. این یافته ها اهمیت شناسایی و مدیریت زودهنگام این عوامل خطر را برای جلوگیری از ایجاد زردی شدید و نیاز به تعویض خون نشان می دهد.
کلید واژگان: نوزاد, زردی, تعویض خون, کرنیکتروس, عامل خطرBackground & AimsJaundice is a common condition in newborns caused by bilirubin accumulation, which can lead to severe complications, including brain damage. This study aimed to identify risk factors for severe jaundice requiring blood transfusion, as such procedures carry potential risks.
Materials & MethodsData were reviewed for 3,266 infants admitted for jaundice at Quds Hospital in Qazvin from 2017 to 2022, of whom 49 required blood transfusions. Information was collected from medical records and maternal questionnaires.
ResultsAmong the 49 infants, 66% were male, 36% were preterm, and 49% were firstborn. The most common maternal blood type was O+ (20 cases), while A+ was the most frequent blood type among infants (21 cases). Notably, 71.4% of cases involved blood type incompatibility between the infant and mother. Delivery methods included 32 vaginal births and 17 cesarean sections. G6PD deficiency was present in 18% of the infants, and 78% of parents had no familial relationship.
ConclusionABO incompatibility was the primary cause of blood transfusion (19.94%), followed by Rh incompatibility (6.1%) and G6PD deficiency (5%). These findings highlight the importance of identifying and managing risk factors for severe jaundice to minimize the need for blood transfusion and its associated risks.
Keywords: Infant, Jaundice, Blood Exchange, Kernicterus, Risk Factors -
It has always been argued that countries should not be inactive about the quality of health services. Therefore, a clear policy needs to be created regarding how quality of health services should be. The present scoping review was aimed to identify and map the available evidence regarding the National Quality Policy and Strategy (NQPS) of the health services in health systems of developing countries, graphically and tabularly. We followed the published methodological guidance of the Joanna Briggs Institute reviews. Also, we employed a narrative thematic synthesis integrated with the systematic analysis using the World Health Organization’s approach of NQPS, and the multiple‑streams framework of Kingdon. We included 33 records that met the inclusion criteria; these records were published between 2010 and 2019. Meanwhile, government documents were the most frequent records (61%). Zimbabwe, Indonesia, and Sudan were the most frequent locations (each one 8%). The Ministry of Health was in charge of the ultimate responsibility for developing the NQPS in all identified countries. Besides, 82% of the countries were in the development phase of NQPS formulation, and convergence of three streams was observed in Indonesia, Sudan, and Tanzania. It seems that the African countries were informed about their quality issues, and the need for having NQPS have been more popular with them. We recommend that future research focuses on examining NQPS in terms of prioritizing in the agenda‑setting phase of the policy‑making cycle, and also, document analysis of all identified NQPS based on the core eight interdependent elements related to the NQPS approach.
Keywords: Developing Countries, Government Programs, Policy, Policy‑Making, Qualityimprovement, Quality Of Health Care -
Context: Our world is characterized by a dynamic landscape of variations, complexities, uncertainties, and ambiguities (VUCA). These elements manifest in various domains, including politics, economics, communication, information, science, and research, all of which significantly impact our lives. It is crucial for policymakers and managers to adopt a forward-thinking approach to comprehend these VUCA elements and their implications for the future. The future will undoubtedly differ from the present and the past. However, humans possess an inherent desire to understand and anticipate the future, particularly in the face of uncertainty. Therefore, exploring and understanding the future is not just a curiosity, but a necessity. Futures Studies can serve as a valuable tool in this context, enabling us to efficiently leverage opportunities and resources to navigate the chaotic environment. Review studies play a pivotal role in this process by reviewing existing work and synthesizing knowledge in a specific field. This study aims to collate findings related to the key concepts of Futures Research, thereby contributing to our collective understanding and preparation for the future.
Keywords: Futures Studies, Futures, Uncertainty, Futures Research, Futurism, Futurology -
Background
The present study investigated how a general hospital is restructured in Iran when transforming from a non-teaching into a teaching hospital.
MethodsThis applied study was conducted based on a mixed-method design from 2020 to 2021 using a systematic search and review, document analysis, comparative and cross-sectional design, multiple voting technique, and qualitative phenomenological method.
ResultsThe conceptual framework of the components of a hospital as a system includes inputs (governance and policy-making, goals and mission, clinical and support departments, physical space, clients, and human resources), processes (internal and external relations, key processes, type and level of services, and teaching mission systematization), and outputs (performance evaluation, internal and external customer satisfaction, human capital empowerment, organizational behavior, income-cost management, cost-effectiveness and efficiency, service quality, and legal and social responsibility).
ConclusionThe findings from the present study depicted how the components of teaching and non-teaching hospitals are restructured when changing their functions. Restructuring an established organization, such as a hospital, is very challenging and requires multiple changes. This study had some implications including highlighting the need to formulate protocols for restructuring non-teaching hospitals into teaching hospitals or constructing new teaching hospitals, classifying teaching hospitals and clarifying their differences, focusing on the teaching mission in hospitals, and reviewing and updating the integration of medical education in providing health services.
Keywords: Systems Integration, Teaching, Non-Teaching Hospitals, Healthcare System, Iran -
زیگموند فروید در تقابل با خوشبینی مارکسیست ها در پی ریزی بنای یک نظام حکمرانی با کمترین میزان درد و رنج، از تمدن سرکوبگر سخن می گوید. فروید این سرکوب را در دو ساحت فرد پیدایشی و نوع پیدایشی بررسی می کند. در ساحت فردی و با تحلیل دستگاه سه گانه ذهنی، از جانشینی اصل واقعیت به جای اصل لذت و تعویق در غرایز یاد می کند. در ساحت نوع پیدایشی نیز با شورش فرزندان علیه پدر نخستین و قتل او، احساس گناه ایجاد می شود و بذر اخلاق سرکوبگر غرایز جوانه می زند؛ در نتیجه، فروید سرکوبگری غرایز را لازمه تمدن می داند. در مقابل، شهید مطهری معتقد است که نه تنها تمدن فطرت بنیان سرکوبگری را به همراه نخواهد داشت، بلکه جامعه، تاریخ و فرهنگ انسانی به سوی تمدنی یگانه در حرکت است؛ زیرا مقوله فطرت، در سرشت و ذات انسانی همه انسان ها به ودیعت نهاده شده و انسان ها و به تبع آن جوامع، فرهنگها و تمدن، به سمت آن امری در حرکت خواهند بود که ذات انسانی به آن گرایش دارد؛ درنتیجه، پدیده سرکوبگری، نه ذاتی تمدن یا فرهنگ، بلکه امری عارضی و برخاسته از نقش و جایگاه غریزه در تمدن به انضمام عنصر «ضرورت بیرونی» است.
کلید واژگان: زیگموند فروید, شهید مطهری, فرهنگ سرکوبگر, فطرتSigmund Freud speaks of repressive civilization in opposition to Marxists' optimism in building a governance system with the least amount of pain and suffering. Freud examines this repression in the two fields of genesis and genesis type. In the individual field and by analyzing the triple mental apparatus, he mentions the substitution of the principle of reality instead of the principle of pleasure and postponement in instincts. In the field of genesis, with the rebellion of the children against the first father and his murder, a feeling of guilt is created and the moral seed of suppressing instincts sprouts. In this article, with a descriptive-analytical method, we will examine Freud's claim that "civilization is based on the repression of instincts" from the perspective of Shahid Motahari and we will show that in the eyes of the master of Shahid, not only nature-based civilization will not bring repression, but Human society, history and culture are moving towards a single civilization because the category of nature is deposited in the human nature and essence of all human beings, and humans and, accordingly, societies, cultures and civilizations, are moving towards that. They will be in motion, which human nature tends to, as a result, the repressive phenomenon is not inherent to civilization or culture, but rather a temporary thing arising from the role and place of instinct in civilization, as well as the element of "external necessity".
Keywords: Sigmund Freud, Morteza Motahhari, Fitrat, Repressive Culture -
اندازه گیری دبی جرمی بذر و کود در لوله سقوط خطی کارها یکی از ضروریات برای تشخیص میزان مصرف نهاده است. در پژوهش حاضر یک سامانه ی غیرتماسی خازنی برای پایش دبی جرمی مواد دانه ای در کارنده های بذر و کود اجرا شد. این مجموعه شامل یک مکانیسم تغذیه مجهز به موزع غلتکی شیاردار بود که سامانه اندازه گیری خازنی در یک لوله سقوط قرار گرفته شد. این مجموعه روی یک پایه ارتعاشی نصب شد تا شرایط مزرعه را در طول اندازه گیری شبیه سازی کند. سپس کود تریپل سوپرفسفات در 5 نرخ جریان جرمی از 22/1±42/3 تا 95/0± 3/19 گرم بر ثانیه، بذر گندم در 8 نرخ جریان جرمی از 23/0± 55/2 تا 86/0±02/19 گرم بر ثانیه و بذر یونجه در 7 نرخ جریان جرمی از 02/0± 42/0 تا 08/0±6/1 گرم بر ثانیه در مدت زمان 30 ثانیه برای هر نرخ در لوله سقوط خطی کار در هردو حالت استاتیکی و دینامیکی اندازه گیری شد. نتایج نشان داد که جریان جرمی به طور موثر با سیگنال های حسگر برای هر سه نوع مواد مورد بررسی همبستگی دارد. با این وجود حسگر خازنی نتوانست تغییرات لحظه ای نرخ جریان جرمی در یک نرخ مشخص را متناسب با تغییرات ترازوی دیجیتال اندازه گیری کند. این پدیده قابل پیش بینی بود، زیرا به ماهیت ترازوی دیجیتال نسبت داده می شود که همیشه با تاخیر اولیه همراه است. همچنین نتایج نشان داد که پایه ارتعاشی روی دقت حسگر تاثیری ندارد.
کلید واژگان: ابزار دقیق, حسگر, فناوری نرخ متغیر, کارنده ها, کشاورزی دقیقMeasuring the seed and fertilizer mass flow rate in drill delivery tubes is an essential tool for real-time monitoring of the application rates. In the present study, a non-contact capacitance measuring system was implemented to monitor the granular discharge rate in seed and fertilizer applicators. The set-up consisted of a fluted-roller feeding mechanism and the capacitance measuring system incorporated in the discharge tube. The set-up was mounted on a custom-built vibratory stand to simulate the field condition during the measurement. Then, triple super phosphate, wheat, and alfalfa granular discharge rates were measured over 30 s intervals in both static and dynamic conditions from 3.42±1.22 to 19.3±0.95 g/s in 5 rates, from 2.55±0.23 to 19.02±0.86 g/s in 8 rates, and from 0.42±0.02 to 1.6±0.08 g/s in 7 rates, respectively. The results revealed that the mass flow was effectively correlated with sensor signals for all examined materials. However, the capacitance sensor failed to measure the sudden change in mass flow rate synchronously with the digital scale. This phenomenon was predictable because it is attributed to the feature of a digital balance, which is always accompanied by an initial lag. Also, the results revealed that the vibrating stand had no effect on the sensor accuracy.
Keywords: Instrumentation, Sensor, Variable Rate Technology, Planters, Precision Agriculture -
تامین اجتماعی یکی از دستاوردها و هم زمان پیش نیازان توسعه است و در عین حال بخش مهمی از بار توسعه اقتصادی بر دوش فعالان کسب وکار است. ازاین رو مشکلات موجود هر دو بخش (تامین اجتماعی و فعالان کسب و کار) را در درازمدت با اختلال مواجه می کند و همین موضوع تعامل میان آن دو را در جامعه ضرورت می بخشد. هدف از این پژوهش، شناخت چالش های موجود در این تعامل با تکیه بر دیدگاه های بخش کارفرمایی است. روش شناسی پژوهش متکی بر تحلیل محتوای کیفی مصاحبه ها با خبرگان حوزه تامین اجتماعی و فعالان فضای کسب وکار است. یافته های پژوهش نشان می دهد چالش های مهم تعامل با سازمان تامین اجتماعی بدین قرار است: ضعف در فرایندهای مربوط به ثبت کارگاه، مشکلات مربوط به ارائه لیست بیمه، ضعف در وحدت رویه و شفافیت در محاسبه نرخ حق بیمه قراردادهای پیمانکاری، ضعف در فرایندها و ساختارهای مربوط به بازرسی از دفاتر، کم توجهی شعب سازمان به آرای هیئت های بدوی و تجدیدنظر و آرای دیوان عدالت اداری، ضعف در ساختارهای حقوقی، مالی و اداری و فرایند صدور مفاصاحساب. ازاین رو در بخش راهکارها کوشش شده تا هم عوامل درون زا و هم برون زا در نظر گرفته شود.
کلید واژگان: قراردادهای پیمان, کارفرمایان, سازمان تامین اجتماعی, سه جانبه گرایی, کسب وکارThe social security is one of achievements of development and business activists bear an important part of burden of economic development. Hence, in long term both sectors (the social security and business activists)would encounter some problems. This issue necessitates the interaction between them. The purpose of this study is to recognize challenges of the interaction relying on entrepreneurs’ viewpoints. Experts in social security field and business activists were interviewed. The qualitative data were analyzed. The findings show that the main challenges for interacting with the social security organization are as follows: weakness of processes related to incorporation of a company, problems related to present list of insurance, lack of unity in procedure and transparency in calculating insurance premiums for contractual agreements, weakness of processes and structures related to insurance inspection, lack of enough attention to branches and votes by boards, reconsideration of votes by Administrative Court of Justice, weakness of administrative, financial, and legal structures and process of account settling. Therefore, it has been tried to consider both exogenous and endogenous factors in solutions.
Keywords: Contracts, Entrepreneurs, The Social Security Organization, Tripartism, Business -
هدف این مقاله، تحلیل میزان اثرگذاری متقابل عوامل داخلی و خارجی توسعه پایدار در مناطق آزاد ایران است. شناسایی مهم ترین عوامل داخلی موثر بر مقرون به صرفه شدن بهبود عوامل خارجی و برعکس مد نظر است. برای این منظور، ارتباطات عوامل داخلی و خارجی توسعه پایدار در مناطق آزاد ایران از طریق تحلیل ساختار همبستگی میان آنها بررسی و تحلیل می شود. داده ها بر اساس پرسشنامه ای از عوامل داخلی و خارجی جمع آوری شدند. سپس از روش تحلیل همبستگی کانونی، روابط میان متغیرهای کانونی با عوامل داخلی و خارجی توسعه پایدار شناسایی و ضرایب همبستگی کانونی، بارهای عاملی، بارهای عاملی متقاطع کانونی و نیز نسبت واریانس تبیین شده عوامل داخلی و خارجی با متغیرهای کانونی تحلیل و تفسیر می شوند. یافته ها همبستگی کانونی بین عوامل داخلی و خارجی را نشان می دهند. سه تابع کانونی از چهار تابع کانونی حاصل معنادار می باشند. به علاوه، مطابق نتایج، هر دو دسته متغیرهای کانونی، همبستگی معناداری با عوامل متناظر دارند. حدود نیمی از مجموع واریانس های عوامل خارجی متغیرهای کانونی با عوامل داخلی تبیین می شود. در نقطه مقابل، بخش قابل توجهی از مجموع واریانس های عوامل داخلی مذکور عوامل خارجی را پوشش می دهند. مطابق تحلیل همبستگی کانونی، عوامل داخلی «رفاه و خدمات» و خارجی «فرهنگ سازی» بیشترین همبستگی را با هر دو دسته متغیرهای کانونی مربوط دارند.
کلید واژگان: توسعه پایدار, مناطق آزاد, رفاه و خدمات, فرهنگ سازیIntroductionThe article’s aim is to analyze the interaction of internal and external factors of sustainable development in the free zones of Iran. In other words, identifying the most important internal factors affecting the improvement of external factors and vice versa is considered. For this purpose, the relationships between internal and external factors of sustainable development in the free zones of Iran are analyzed through the analysis of the correlation structure between them. For the success of organizations in a dynamic and changing environment, managers must strive to improve processes and sustainability. Also, in the process of sustainable development, the impact of internal and external factors of sustainability should be examined and analyzed. Based on the importance of free zones in the country's economy, the issue of sustainable development of these zones needs to be considered from different angles and using scientific methods. Given that the multiple relationships between internal and external factors and the direct relationship between internal and external factors, the sustainable development of free zones has not been done with each other, and closing this gap is a necessity. Because, external factors of sustainable development are not within the authority of free zones and depend on organizations, companies and communities. Neglecting the impact of these factors on domestic factors can lead to more costs in achieving sustainable development of free zones. For this purpose, in this study, the relationships between internal and external factors are examined and analyzed to finally achieve sustainable development of free zones based on accurate information and analysis of various aspects to achieve the best achievement at the lowest cost in sustainable development of these zones.
MethodologyThe main method is the canonical correlation analysis method. Using questionnaires containing questions related to internal and external indicators, which are prepared in the form of a five-point Likert option, experts answer it in an online survey. The collected data from internal and external factor questionnaires are analyzed using SPSS 24 software. Then, canonical correlation analysis is performed to study the correlation between internal and external factors of sustainable development of free zones. This canonical correlation is made for the study between two data sets that include seven internal factors in the first set and four external factors in the second set. The statistical population of this study consists of specialists and professors of Payame Noor University and 184 randomly selected statistical sample participated.
Results and DiscussionAfter performing the canonical correlation analysis method, the findings related to the correlation between canonical variables, the proportion of variance of internal and external factors explained by the first and second set canonical variables, canonical factor loads, and canonical cross-factor loads were obtained. The results, based on the Fisher test show that the correlation of three pairs of canonical variables among the four possible pairs is confirmed at the significance level of 0.05. The correlation of the first canonical pair is equal to 0.994 with a specific value of 9.039. Also, the correlations of the second and the third canonical pair are equal to 0.705 and 0.659, respectively, with special values of 0.989 and 0.767. The calculated values show that 90, 49.7 and 43.4% of the variance in the canonical variables related to external (internal) factors are explained by the canonical variables related to internal (external) factors, respectively. The set of canonical variables related to internal factors represents 65.9% of the sample dispersion of the sample of internal factors, while the three identified canonical variables related to external factors cover 93% of the sample dispersion of the sample of external factors. Also, the proportion of variance of the canonical variables of the first group to the total dispersion of the four external factors was equal to 46.3%, while 69.3% of the variance of the seven internal factors is explained by the canonical measures of the second set.
ConclusionThe results show that the proportion of variance in the set of internal factors that is explained by the canonical variables of the first set is less than the proportion of variance identified in the set of external factors that is explained by the canonical variables of the second set. Also, the proportion of variance of the four external factors explained by the canonical variables of the first set is less than the proportion of variance of the seven internal factors covered by the canonical variables of the second set. Based on the calculated factor load values, it was shown that the canonical variables of the first set generally have significant factor loads with all internal factors, including 1) welfare and services, 2) support and regulation, 3) pollution control, 4) protection and prevention 5) Productivity, 6) green operation and 7) infrastructure and facilities. Similarly, it was observed that the values of the factor load of the second set, canonical variables on all four external factors, including 1) culture building, 2) environmental measures, 3) knowledge and communication, and 4) local community support are significant. In this context, the internal factors of "welfare and services" and the external factors of "culturalization" have the most factor factors with the canonical variables of the first and second categories, respectively. The calculated values for cross-factor loads showed that changes in the four internal factors "welfare and services", "support and regulation", "green operation" and "infrastructure and facilities" will have the greatest effect on canonical variables derived from external factors. In addition, cross-factor loads are significant for all external factors other than "knowledge and communication", the largest of which is related to the "culture-building" factor. In general conclusion, it can be said that internal and external factors of sustainable development of free zones significantly affect each other.
Keywords: Sustainable Development, Free Zones, Internal, External Factors, Welfare, Services, Culture-Building -
سالانه بخش قابل توجهی از محصولات میوه و تره بار به دلیل نامناسب بودن سیستم حمل و نقل و امکانات ذخیره سازی در کشور تلف می شود. ضایعات محصولات توت فرنگی و سیب در ایران به ترتیب 40% و 31% تخمین زده می شود که می تواند به عنوان منبع زیست توده در تولید بیوانرژی در نظر گرفته شود. ضایعات میوه با وجود پتانسیل مناسب در تولید بیوگاز، به دلیل داشتن مواد لیگنوسلولزی برای کاهش زمان تجزیه بیولوژیکی به پیش تیمار نیاز دارند. در این پژوهش تاثیر پیش تیمار های مکانیکی، شیمیایی و حرارتی بر تجزیه پذیری ضایعات میوه و میزان تولید بیوگاز از هضم ترکیبی آن با فضولات دامی بررسی شد. پیش تیمار مکانیکی با خرد کردن ضایعات سیب و توت فرنگی به قطعات 5، 10 و 15 میلی متر، پیش تیمار شیمیایی با قرار دادن ضایعات میوه در محلول هیدروکسیدسدیم (NaOH) به غلظت های 6، 8 و 10 درصد به مدت 3 ساعت و تیمار حرارتی با قرار دادن ضایعات به همراه آب مقطر در داخل مایکروویو در توان 800 وات به مدت 10، 20 و 30 دقیقه انجام شدند. ضایعات پیش فرآوری شده با فضولات دامی ترکیب شده و در شرایط هضم بی هوازی به مدت 25 روز داخل هاضم های ناپیوسته تغذیه شدند. نتایج نشان داد که پیش تیمارهای های خرد کردن، هیدروکسید سدیم و مایکروویو میزان تولید بیوگاز را نسبت به حالت شاهد به ترتیب 5%، 9/50% و 3/27% افزایش دادند. روش پیش فرآوری شیمیایی با هیدروکسید سدیم بیشترین تاثیر را بر میزان بیوگاز تولیدی داشت و می تواند به عنوان روشی مطلوب برای پیش فرآوری ضایعات مذکور پیشنهاد شود.
کلید واژگان: توت فرنگی, خرد کردن, مایکروویو, هضم بی هوازی, هیدروکسید سدیمEvery year, a significant part of fruit and vegetable products is lost due to the country's inappropriate transportation systems and storage facilities. The waste of strawberry and apple products in Iran is estimated at 40% and 31%, respectively; which can be considered as a source of biomass in bioenergy production. Despite the good biogas production potential, fruit waste requires pretreatment due to lignocellulosic matter to reduce biological decomposition time. This research investigated the effect of mechanical, chemical and thermal pretreatments on the degradability of fruit waste and the amount of biogas production from its co-digestion with cow manure. Mechanical pretreatment was by crushing apple and strawberry waste into pieces of 5, 10 and 15 mm, chemical pretreatment was by placing fruit waste in sodium hydroxide solution (NaOH) at concentrations of 6, 8 and 10% for 3 hours and heat treatment was done by putting waste together with distilled water inside the microwave at 800 watts for 10, 20 and 30 minutes. The pretreated wastes were co-digested with cow manure and were fed into the batch digesters under anaerobic digestion conditions for 25 days. The results showed that the pretreatments of crushing, sodium hydroxide and the microwave increased biogas production compared to the control by 5%, 50.9% and 27.3%, respectively. Chemical pretreatment can be suggested as a preferred method of pretreatment of the identified wastes.
Keywords: Anaerobic Digestion, Crushing, Microwave, Sodium Hydroxide, Strawberry -
Ascites is a prominent example of the pathophysiological interaction between the heart and lungs in broilers. Previous experiments have shown that the amount of apoptosis increases in heart failure and pulmonary hypertension. In the current study, the effect of vitamin C on apoptosis was investigated by measuring the expression of the CASP3 gene in the heart and lungs of chickens with ascites. For this purpose, 90 one-day-old meat-type chickens were divided into three groups (sham (basal diet), control (basal diet +1.5 mg/kg of triiodothyronine (T3)), and treatment group (basal diet + 1.5 mg/kg of T3 + 1200 ppm of vitamin C)) and bred for 49 days. On the 21st and 49th days after rearing, 15 chickens from each group were selected randomly, and the right ventricle/ total ventricle weight ratio (RV/TV), as well as the expression level of CASP3 genes in the lung and right ventricle of all groups were measured and compared. The amount of mRNA related to CASP3 gene at the age of 21 and 49 days demonstrated a meaningful decrease in the treatment group compared to the control group (P<0.05). This significant difference indicates the reduction of apoptosis in the group treated with vitamin C. Also, RV/TV as an index of the induction of this syndrome improved in the treatment group at the age of 21 and 49 days (P<0.05). Finally, according to the current study's findings, vitamin C has ameliorating effects in treating ascites in meat-type chickens.
Keywords: Ascites, Apoptosis, Broiler, Caspase-3, Triiodothyronine, Vitamin C -
سابقه و هدف
دانش آموزان با تغییر عقاید زیست محیطی، تقویت مسئولیت پذیری و خودکارآمدی می توانند نقش موثری در حفاظت از محیط زیست داشته باشند. استفاده از مدل های تغییر رفتار رویکردی معقول برای شناسایی متغیرهای موثر بر رفتارهای زیست محیطی و ضرورتی انکارناپذیر قبل از طراحی مداخلات آموزشی است. هدف مطالعه ی کنونی تعیین متغیرهای موثر بر رفتارهای حامی محیط زیست در دانش آموزان مدارس ابتدایی شهر قزوین با استفاده از تئوری رفتار برنامه ریزی شده (TPB) بود.
مواد و روش هابا استفاده از روش نمونه گیری چندمرحله ای، 184 نفر از دانش آموزان پنجم و ششم دوره ی دوم ابتدایی مدارس دولتی شهر قزوین در مطالعه ای توصیفی مقطعی (Cross-Sectional Study) در سال 1401 شرکت کردند. ابزار گردآوری داده ها پرسش نامه ی خودگزارشی شامل اطلاعات دموگرافیک، پرسش نامه ی آگاهی، پرسش نامه ی 20سوالی ثبت رفتارهای حامی محیط زیست و خرده مقیاسه ای TPB بود. داده ها با استفاده از نرم افزار لیزرل 8/80 و آزمون های آماری کای اسکوئر، تی مستقل، آنالیز واریانس یک طرفه، هم بستگی پیرسون و آنالیز مسیری در سطح کمتر از 0/05 آنالیز شدند.
یافته هاوضعیت رفتارهایی مانند تذکر درباره ی مسائل زیست محیطی، کنترل میزان دمای محیط، استفاده از وسایل حمل ونقل عمومی و نحوه ی تماشای برنامه های تلویزیونی نامناسب بود. قوی ترین ضرایب هم بستگی بین آگاهی و نگرش (0/05>P، 0/675=r) و ضعیف ترین بین هنجارهای انتزاعی و رفتار (0/01>P، 0/235=r) گزارش شد. همچنین، کنترل رفتاری درک شده (0/05>P، 0/49=β) و نگرش (0/05>P، 0/31=β) مهمترین سازه های تاثیرگذار بر قصد بودند و به ترتیب، 66/7 و 28/5 درصد از واریانس قصد و رفتارهای حامی محیط زیست را سازه های TPB توصیف کردند.
نتیجه گیریتئوری TPB چهارچوب نظری منطقی و مناسبی در راستای درک و ارزیابی متغیرهای روان شناختی موثر بر رفتارهای حامی محیط زیست در دانش آموزان محسوب می شود و تمرکز بر سازه های نگرش و کنترل رفتاری درک شده در طراحی مداخلات آموزشی به منظور تشویق رفتارهای زیست محیطی در دانش آموزان توصیه می شود.
کلید واژگان: دانش آموزان, خودکارآمدی, آگاهی, هنجارهای اجتماعی, بازیافت, اکوسیستمBackground and ObjectivesStudents can play an effective role in protecting the environment by changing environment-related beliefs and strengthening responsibility and self-efficacy. The use of behavior change models is a reasonable approach to identifying psychological factors effective on pro-environmental behavior (and is an undeniable necessity before designing cognitive-behavioral interventions. The current study aimed to determine the variables affecting pro-environmental behaviors in elementary school students in Qazvin City using the theory of planned behavior (TPB).
Materials and MethodsUsing a multi-stage sampling method, 184 fifth- and sixth-grade students of public elementary schools participated in a cross-sectional study in 2022-2023. The data collection tool was a self-report questionnaire including demographic information, a knowledge scale, and a 20-item questionnaire to assess pro-environmental behaviors and TPB-related subscales. The data were analyzed using LISREL 8.80 software and statistical tests, such as the Chi-square test, independent T-test, one-way ANOVA, Pearson correlation, and path analysis at a significant level of less than 0.05.
ResultsThe status of some behaviors, such as warning about environmental issues, controlling the ambient temperature, using public transportation, and the pattern of watching TV programs were inappropriate. The strongest correlation coefficient was reported between knowledge and attitude (r=0.675, P<0.05) and the weakest between subjective norms and behavior (r=0.235, P<0.01). Moreover, perceived behavioral control (β=0.49, P<0.05) and attitude (β=0.31, P<0.05) formed the most important constructs affecting intention, and 66.7% and 28.5% of the variance of pro-environmental intentions and behaviors was explained by TPB, respectively.
ConclusionThe TPB is considered a suitable and logical theoretical framework for understanding and evaluating psychological variables effective on pro-environmental behavior in students. It is recommended to focus on attitude and perceived behavioral control in designing educational interventions to encourage pro-environmental behaviors.
Keywords: Ecosystem, Knowledge, Recycling, Self-Efficacy, Social Norms, Students -
International Journal of Management and Business Research, Volume:7 Issue: 1, Winter 2023, PP 121 -141Introduction
The rapidly changing world, necessitates new demands which forces the governments to change the game in terms of policies to support entrepreneurs to fasten the development of new technologies in response to the needs. The success rates of the policies are monitored and reported by GEM. Iran’s entrepreneurship development indicators have a downward trend in recent years. This study is conducted to analyze the content of Iran's entrepreneurship development policies to uncover the weaknesses for policymaker.
MethodsQuantitative and qualitative content analysis of Iran’s entrepreneurship development policies (2016) is the focus of our criticism; using the basic theory of the global alphabet model of entrepreneurship as our target. The data is analyzed by Max QDA 2020 software.
ResultsThe regulatory policies in Iran's entrepreneurship development document are not consistent with the global alphabet model of entrepreneurship quantitatively and qualitatively. The most attention has been paid to behavior instead of perception and attitude and no policy has been formulated in the field of entrepreneurial intention, innovation for production of goods and qualified services.
ConclusionThere is an asymmetry in dealing with entrepreneurial ecosystem which is probably one of the most important causes of our failure and breakdown.
Keywords: Alphabet Model, Iran’ S Entrepreneurship Development Document, Content Analysis -
Context:
Growing needs mandates economic growth. Entrepreneurship policies play a significant role in achieving productive employment and sustainable development for the health and wealth of society. Aims: This study is conducted to find the accordance of this document with the basic theory of the global alphabet model of entrepreneurship on the one hand and a comparison to the real entrepreneurial and economic achievements as social determinants of health (SDOH) on the other hand.
Methods and Material:
This research is a quantitative and qualitative content analysis of entrepreneurship documents in the health sector of Iran, using the basic theory of the global alphabet model as our target. We reviewed the Work Bank and Global Entrepreneurship Monitor (GEM) reports as world indicators to compare whether our entrepreneurship policies have been successful.
Statistical Analysis:
MAXQDA is a software program designed for computer-assisted qualitative and mixed methods data, text and multimedia analysis in academic, scientific, and business institutions.
Results:
The findings showed that the retelling of the word employment is more dominant than entrepreneurship. Imbalanced attention is paid to the components of the standard global alphabet model, and a downhill regression is seen in almost all aspects of entrepreneurial results.
Conclusions:
The written health policies have not been effective in promoting the development of health by wealth.
Keywords: Entrepreneurship, Iran’s health sector, policies -
This article develops an integrated model of transmitting strategies and operational activities to enhance the efficiency of supply chain management. As the second objective, this paper aims to improve supply chain performance management (SCPM) by employing proper decision-making approaches. The proposed model optimizes the performance indicator based on SCOR metrics. A process-based method is utilized for high-level decisions, while a mathematical programming method is proposed for low-level decisions. The suggested operational model takes some major supply chain properties such as multiple suppliers, multiple plants, multiple materials, and multiple produced items over several time periods into account. To solve the operational multi-objective optimization model, a goal programming approach is applied. The computational results are explained in terms of a numerical example, and a sensitivity analysis is performed to investigate how the performance of the supply chain is influenced by strategic scenario planning.
Keywords: Decision Alignment, Supply Chain Management, Performance Measurement, Goal Programing, SCOR Model, Decision alignment, Multi objective -
Background
The high reliance on out-of-pocket (OOP) payments for health financing in Iran have been led to different inequity problems such as catastrophic health expenditure (CHE) and impoverishment. This scoping review has been conducted to understand the variations in CHE and impoverishment, the underlying determinants of CHE, and its inequality in the past 20 years.
MethodsThis scoping review is guided by Arksey and O’Malley’s scoping review framework. systematically PubMed, Scopus, Web of Science, ProQuest, Scientific Information Database, IranMedex, IranDoc, Magiran Science, Google Scholar, and grey literature were searched systematically from 1 January 2000 to August 2021. We included studies that reported the rate of CHE, impoverishment, inequality, and its influencing factors. Simple descriptive statistics and narrative synthesis were used to present the review findings.
ResultsFrom 112 included articles, the average incidence of CHE was 3.19% at the 40% threshold, and about 3.21% of the households had impoverished. We found an unfavorable status of health inequality indices, including the average of fair financial contribution (0.833), concentration (-0.01), Gini coefficient (0.42), and Kakwani (-0.149). The most widely applied key drivers influencing the rate of CHE in these studies were household economic status, place of residence, health insurance status, household size, head of the household’s gender, education level and employment status, having a household member under 5/ above 60 years old, with chronic diseases (in particular cancer and dialysis), disability, using inpatient and outpatient and dentistry services, medicines and equipment, and low insurance coverage.
ConclusionThe result of this review calls for intensifying health policies and financing structures in Iran to provide more equitable access to all populations, especially the poorest and vulnerable. Moreover, the government is expected to adopt effective measures in inpatient and outpatient care, dental services, medicines, and equipment.
Keywords: Catastrophic healthcare expenditures, Impoverishment, Health equity, Out-of-Pocket, Iran -
The aim of this research was to develop a model for the professional development of pre-school principals in the education. The study used a qualitative approach with a grounded theory approach. A group of experts, including senior education managers, university professors in the field of educational management, and prominent human resources consultants, were selected using the snowball sampling method. The selection of experts and interviews with them continued until theoretical saturation was reached, which occurred after the eleventh interview. The method of data collection was semi-structured interviews. Based on open, axial, and selective coding of the data, the research model was developed. In the developed model, the professional development of pre-school principals was identified as the core central concept. Causal conditions included the internal motivation of pre-school principals for professional development, their job commitment, ethical behavior, and their level of education and qualifications. The research results also showed that psychological and technical empowerment of education principals, satisfaction of pre-school education staff, parents, and students were identified as strategies and outcomes, respectively. In the developed model, parental concerns about the quality of pre-school educational management and competition between pre-school centers were identified as contextual variables, while standardization and updating of the conditions for the appointment of pre-school principals and the requirements of higher-level organizations for the professional development of pre-school principals were identified as intervention factors. The findings provide practical implications for the designing the professional development programs for pre-school principals.
Keywords: Professional development, Principals, Pre-school, Grounded theory -
Background
Within the public sector, health managers occupy positions that are typically filled by individuals with a medical, clinical, or nursing experience who are entrusted with assuming an additional role. The primary objective of this study was to employ a scoping review methodology to ascertain a cluster of prevalent subjects encompassing the development of a proficient health care manager.
MethodsThe purpose of this scoping review study was to identify critical components in the field of management professionalization, as described by Arksey and O'Malley. A total of 13 studies, characterized by predefined keywords, were meticulously culled from Scopus, Web of Science, PubMed, and Embase, Magiran, and SID databases. The inclusion and exclusion criteria considered factors such as language, temporal relevance, redundancy, thematic alignment with the professionalization domain, and congruence with the overarching objectives and methodologies of the present investigation. Subsequently, the contents of the selected studies were subjected to rigorous thematic analysis and judicious categorization using a framework analysis approach.
ResultsFrom a total of 10,117 articles, a rigorous selection process yielded 13 articles to be included in this study. The identified dimensions are classified and elucidated across 6 overarching domains; namely, the science of management, educational trajectory, and curriculum, cultural infrastructure and ideologies, standards, professional institutions and associations, and licenses and certifications.
ConclusionTo enhance the efficacy of health management, policymakers and planners ought to adeptly incorporate these dimensions within the framework of the country's health system.
Keywords: Professionalism, Professionalization, Profession, Organization, Administration, Professional Competence -
In some applications, the number of quality characteristics is larger than the number of observations within subgroups. Common multivariate control charts to monitor the variability of such high-dimensional processes are unsuitable because the sample covariance matrix is not positive semi-definite and invertible. Moreover, the impact of gauge imprecision on detection capability of multivariate control charts under high-dimensional setting has been clearly neglected in the literature. To overcome these shortcomings, this paper develops a ridge penalized likelihood ratio chart for Phase II monitoring of high-dimensional process in the presence of measurement system errors. The developed control chart departures from the assumption of sparse variability shifts in which the assignable cause can only affects a few elements of the covariance matrix. Then, to compensate for the adverse impact of gauge impression, the developed chart is extended by employing multiple measurements on each sampled item. Simulation studies are carried out to study the impact of imprecise measurements on detectability of the developed monitoring scheme under different shift patterns. The results show that the gauge inability negatively affects the run-length distribution of the developed control chart. It is also found that the extended chart under multiple measurements strategy can effectively reduce the error impact.
Keywords: High-dimensional process, Covariance matrix, Measurement errors, Ridge penalized likelihood ratio statistic, Multiple measurements per item -
مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد، سال شصت و ششم شماره 3 (پیاپی 189، امرداد و شهریور 1402)، صص 426 -439مقدمههایپربیلی روبینمی شایعترین علت بستری نوزادان در ماه اول پس از تولد است. شناخت عوامل زمینه ای ایجاد زردی به شناسایی سریعتر نوزادان در معرض خطر کمک می کند. هدف تعیین فراوانی زردی در نوزادان با مادران دیابتی در روز سوم تا پنجم نوزادی است.مواد و روش ها120 مادران باردار 40-18 ساله که در طی بارداری دارای دیابت بوده (دیابت فامیلیار یا دیابت حاملگی) و تحت درمان با انسولین هستند در این مطالعه اپیدمیولوژیک توصیفی شرکت کردند. کلیه اطلاعات دموگرافیک مادر و نوزاد در چک لیست ها ثبت شد و پس از زایمان، به مادران توصیه شد روز سوم تا پنجم پس از تولد در صورت علایم بالینی زردی (زردی قابل مشاهده در صلبیه چشم) جهت معاینه روتین به درمانگاه مراجعه کنند. پس از معاینه کامل نوزادان، آزمایش بیلی روبین تام انجام شد.یافته هااز 120 نوزاد مادران دیابتی،54 نوزاد (45٪) بدون زردی، 24 نوزاد (20%) دارای زردی بالینی و 42 نوزاد (35%) نیاز به درمان فتوتراپی داشتند. آنالیز آماری نشان داد بین سه گروه بدون زردی، زردی بالینی و نیازمند به فتوتراپی اختلاف آماری معنی داری از نظر جنسیت، سن حاملگی و ناسازگاری فاکتور Rh وجود ندارد ولی با نوع تغذیه، وزن در زمان تولد و ناسازگاری سیستم ABO اختلاف آماری معنی داری دیده می شود. بررسی های بیشتر آماری نشان داد فقط عوامل وزن در زمان تولد و ناسازگاری گروه خونی با ایکتر ارتباط دارند.نتیجه گیریبه نظر می رسد دیابت مادر و زردی نوزادان همراهی دیده می شود.کلید واژگان: دیابت مادر, زردی نوزادان, زردی فیزیولوژیکIntroductionHyperbilirubinemia is the most common cause of neonatal hospitalization in the first month after birth. Understanding the underlying causes of jaundice helps identify newborn at risk faster. The aim of this study was to determine the prevalence of jaundice in neonates with diabetic mothers on the 3rd to 5th day of after birth.Materials and Methods120 pregnant mothers aged 18 to 40 years who had diabetes during pregnancy (familial or gestational diabetes) and were treated with insulin were included in this descriptive epidemiological study. All demographic information of the mother and infant is recorded in the checklists and after delivery, mothers are advised to visit the clinic on a routine checkup for jaundice (jaundice visible in the sclera) on the third to fifth day after birth. After a thorough neonatal examination, a total bilirubin test will be performed.ResultsOf 120 diabetic mothers, 54 (45%) had no jaundice, 24 (20%) had clinical jaundice, and 42 (35%) needed phototherapy. Statistical analysis showed that there were no significant differences between the three groups without jaundice, clinical jaundice and need for phototherapy in terms of gender, gestational age and Rh factor incompatibility but there was a significant difference between type of feeding, birth weight and incompatibility of ABO system. . Further statistical analysis showed that only birth weight factors and blood group incompatibility were associated with icterus.ConclusionMaternal diabetes and neonatal jaundice appear to be associated.Keywords: Mother diabetes, neonatal icterus, Physiological jaundice
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در خطی کاری پایش دقیق دبی بذر و کود مشکل است، زیرا دانه ها به صورت توده ای و نزدیک به هم حرکت می کنند. هدف از انجام این پژوهش پایش جریان جرمی مواد دانه ای در لوله سقوط خطی کارها با استفاده از یک حسگر پیزوالکتریک بود. سامانه آزمایشگاهی شامل مخزن، موزع، لوله سقوط و یک حسگر پیزوالکتریک بود. برای اینکه نوسانات حرکت خطی کار در مزرعه شبیه سازی شود، یک پایه ارتعاشی که در دو راستای عمود بر هم حرکت می کرد طراحی شد. بیشترین دامنه حرکت پایه ارتعاشی 99/8 سانتی متر متناسب با پستی و بلندی مزرعه پس از خاک ورزی در نظر گرفته شد. حسگر در دو حالت استاتیکی و دینامیکی برای بذر گندم، بذر یونجه و کود تریپل سوپرفسفات مطابق با نرخ کاشت معمول خطی کارها مورد ارزیابی قرار گرفت. نتایج نشان داد، سیگنال خروجی حسگر متناسب با تمامی نرخ های مختلف جریان جرمی در هر دو حالت استاتیکی و دینامیکی بود. ضریب تبیین در حالت استاتیکی برای بذر گندم، بذر یونجه و کود تریپل سوپرفسفات به ترتیب 95/0، 99/0 و 98/0 بود. ضریب تبیین در حالت دینامیکی برای بذر گندم، بذر یونجه و کود تریپل سوپرفسفات به ترتیب 93/0، 86/0 و 98/0 بود. به علاوه، حسگر پیزوالکتریک به خوبی تغییرات لحظه ای جریان جرمی در هر نرخ را متناسب با خوانش ترازوی دیجیتال پایش نمود. نتایج نشان داد که حسگر توسعه یافته را می توان برای پایش نرخ جریان جرمی بذر و کود در لوله سقوط کارنده ها استفاده کرد تا به صورت برخط میزان اعمال نهاده در واحد سطح محاسبه شود.کلید واژگان: تشخیص نرخ جریان جرمی, حساسیت حسگر, سنجش تماسی, کشاورزی دقیق, واحد سنجشIt is difficult to accurately measure the flow rate of seeds and fertilizers in grain drills, because the granules move in a continuous dense state. The purpose of this research was to monitor the mass flow of granular materials in the fall tube of the drill using a piezoelectric sensor. The laboratory system consisted of a repository box, a fluted roller metering device, a fall tube, and a piezoelectric sensor. To simulate the drill movement in the field, a vibrating stand was designed to oscillate the set-up in two perpendicular directions. The maximum amplitude stand was 8.99 cm according to the peaks and depressions available in a field after plowing. The sensor was evaluated in two static and dynamic modes for wheat seed, alfalfa seed, and triple superphosphate fertilizer with the usual drilling rate. The results showed the output signal of the sensor was proportional to all different mass flow rates in both static and dynamic states. The correlation coefficient was 0.95, 0.99, and 0.98 in static mode and 0.93, 0.86, and 0.98 in dynamic mode for wheat, alfalfa seed, and triple superphosphate fertilizer, respectively. In addition, the piezoelectric sensor could instantaneously monitor the sudden changes in the mass flow according to the reading of the digital scale. The results showed that the developed sensor can be used to monitor the mass flow rate of seeds and fertilizers in drills for calculating the drilling rate in real time.Keywords: Contact sensing, Precision Agriculture, Seed flow rate detection, Sensing unit, Sensor sensitivity
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مجله دانشکده پزشکی دانشگاه علوم پزشکی مشهد، سال شصت و ششم شماره 2 (پیاپی 188، خرداد و تیر 1402)، صص 166 -177مقدمه
زردی نوزادی از مشکلات شایع دوران نوزادی است که منجر به مشکلات عدیده ای از قبیل انسفالوپاتی ناشی ازهایپر بیلی روبینمی, کرن ایکتروس و مرگ میشود. با توجه به اهمیت تشخیص زودهنگام هیپر بیلی روبینمیمطالعه حاضر جهت تعیین سطح بیلی روبین توتال بند ناف در نوزاد و مقایسه با بیلی روبین 3 روز بعد از تولد در بیمارستان کوثر قزوین انجام شد.
روش کاردر این مطالعه مقطعی آینده نگر تعداد 100 نوزاد سالم و ترم متولد شده در زایشگاه بیمارستان کوثر مورد بررسی قرار گرفتند. دادهها در چک لیست حاوی متغیرهای مورد بررسی در مادر (گروه خونی، سابقه مصرف دارو) و اطلاعات نوزاد (نام، جنس، وزن تولد، سن حاملگی، نوع تغذیه، آپگار، میزان بیلی روبین خون بندناف و میزان بیلی روبین سرم روز سوم پس از تولد) با اخذ رضایت آگاهانه، جمع آوری شده و نمونه خون بند ناف جهت اندازه گیری میزان بیلی روبین و تعیین گروه خونی نوزاد و نیز نمونه خون وریدی در روز سوم پس از تولد گرفته شد. جهت تجزیه و تحلیل دادهها از آزمونهای توصیفی و تحلیلی استفاده شد (p<0.05).
نتایجمیانگین سطح بیلی روبین توتال و مستقیم در نوزادان به ترتیب در روز تولد 0.9±2.8 و 0.10±0.31 و در روز سوم 2.53±13.13 و 0.14±0.29 میلی گرم بر دسی لیتر بود. همچنین میزان آلبومین بند ناف ±0.643.2 گرم بر دسی لیتر گزارش گردید. میانگین سطح بیلی روبین توتال هنگام تولد و روز سوم بین دختر و پسر تفاوت معنی داری نداشت(p.value=0.92) . از میان متغیرهای کمیمورد مطالعه سن مادر با سطح بیلی روبین توتال بند ناف همبستگی معنی دار و مستقیم (p.value=0.04) و میزان سطح بیلی روبین توتال روز سوم تولد با تعداد سقط همبستگی معنی دار و مستقیم نشان داد(p.value=0.05). همچنین میزان سطح بیلی روبین توتال بند ناف و روز سوم تولد با میزان آلبومین همبستگی معکوس نشان داد. در این مطالعه سطح بیلی روبین توتال بند ناف با بیلی روبین توتال در روز سوم همبستگی معنی دار نشان داد (p.value=0.02).
نتیجه گیرینوزادان در معرض خطر نیاز به پیگیری دقیق تر از نظر زردی دارند چراکه تشخیص به موقع و با درمان بسیار ساده میتوان موجب کاهش خطرات احتمالی زردی نوزادی شد. مطالعه حاضر نشان داد که سطح بیلی روبین توتال بند ناف در مقایسه با بیلی روبین 3 روز بعد از تولد میتواند به عنوان یک معیار تشخیصی مناسب جهت پیگیری دقیق نوزادان در معرض خطر زردی استفاده کرد.
کلید واژگان: هیپربیلی روبینمینوزادی, نوزادی, بیلی روبینIntroductionNeonatal jaundice is a common problem that leads to many problems such as encephalopathy and hearing loss, kernicterus and death. Due to the importance of preventing the potential complications of hyperbilirubinemia, the present study was performed to determine the level of total cord bilirubin in neonates and to compare with bilirubin three days after birth in Kowsar hospital in Qazvin.
Material and MethodIn this prospective cross-sectional study, 100 neonates were evaluated in Kowsar hospital maternity ward and required information was prepared in checklists containing maternal variables (blood group,taking medicine) and the infant's data (name, sex, birth weight, gestational age, breast feeding and formula milk feeding, Apgar score, cord blood bilirubin level, and serum bilirubin level on the third day after birth) were obtained with informed consent and entered into a file by a trained individual. Cord blood samples were also taken to measure the level of bilirubin and to determine the blood group of neonates and venous blood samples were taken on the third day after birth. Data analysis was performed by using descriptive and statistical analysis(P<0.05).
ResultsThe mean levels of total and direct bilirubin of neonates in birthday and third day were 2.8 ±1.00 and 0.31±0.10 and 13.13±2.53 and 0.29±0.14 mg/dl, respectively. In addition, cord albumin was also reported to be 3.2±0.64. The mean level of total bilirubin at birth and third day was not significantly different between boys and girls (p.value=0.92). There was a significant and direct correlation between maternal age and total cord blood bilirubin level (p.value=0.04), and also total bilirubin level at the third day of birth had a significant and direct correlation with the number of abortions (p.value=0.05). Moreover, the level of total bilirubin and third day of birth were inverse correlated with albumin level.
ConclusionHigh risk neonates need more accurate follow-up for jaundice, because timely diagnosis and very simple treatment can reduce the potential risks of neonatal jaundice. The present study showed that cord total bilirubin levels compared with bilirubin three days after birth can be used as a suitable diagnostic method to accurately track neonates at risk of jaundice.
Keywords: Neonatal hyperbilirubinemia, Jaundice, bilirubin, Kernicterus -
Background
In recent years, there have been many non-teaching hospitals that have become teaching hospitals. Although the decision to make this change is made at the policy level; But the unknown consequences can create many problems. The present study investigated the experiences of hospitals in changing the function of a non-teaching to a teaching hospital in Iran.
MethodsA Phenomenological qualitative study was conducted using semi-structured interviews with 40 hospital managers and policy makers who had the experience of changing the function of hospitals in Iran through a purposive sampling in 2021. Thematic analysis using inductive approach and MAXQDA 10 was used for data analysis.
ResultsAccording to the results extracted 16 main categories and 91 subcategories. Considering the complexity and instability of command unity, understanding the change of organizational hierarchy, developing a mechanism to cover client’s costs, considering increase management team’ legal and social responsibility, coordinating policy demands with Providing resources, funding the teaching mission, organizing the multiple supervisory organizations, transparent communication between hospital and colleges, understanding the complexity of processes, considering change the performance appraisal system and pay for performance were the solutions for decrease problems of changing the function of non-teaching to teaching hospital.
ConclusionImportant matter about the improvement of university hospitals is evaluating the performance of hospitals to maintain their role as progressive actors in hospital network and also as the main actors of teaching future professional human resources. In fact, in the world, hospital becoming teaching is based on the performance of hospitals.
Keywords: teaching hospitals, Systems Integration, Health Systems Agencies, university hospitals -
Background
Infectious hospital waste, including needles and sharp instruments, is one of the most important causes of needle sticks.
ObjectivesThe study aimed to investigate the factors affecting the disposal of special medical waste with needle sticks among healthcare workers in hospitals at the Iran University of Medical Sciences.
MethodsThis descriptive-analytical, retrospective, and cross-sectional study were done regarding the data in the autumn of 2019. Among 6119 medical-service staff, 180 subjects have been exposed to the needle stick at least once. Data were collected in two parts. The data were analyzed using correlation tests by SPSS software version 25.
ResultsThe most devices leading to injury were needles (58%), angiocatheter (21%), ampoules (17%), suture needles (12%), scalpels (9%), other tools (8%), and razor blades (7%). The five wards with the highest needle sticks were the operating room (24.44%), surgery (22.22%), emergency (15%), internal wards (10%), and paraclinical (8.33%). Also, several factors, such as work shifts and the amount of work experience of individuals, can play an essential role in the rate of needle stitching of medical personnel. Importantly, we found a significant relationship between the volume of medical waste and employee needlestick rates.
ConclusionsAccording to the results, we found a significant positive relationship between the volume of medical waste and employees' needle sticking rate. The observance of standard guidelines and the development and increase of occupational safety protection training courses have the most significant role in reducing needle sticks.
Keywords: Waste Disposal, Needle Stick, Hospital Staff, Iran University of Medical Sciences
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