Search

Head injury is one of the most prevalent events accounting for about one million of emergency visits in US and UK annually. It occurs in over the 50% of traumatic patients and is the leading cause of death and disabilities in children and younger adults all over the world (Holmes, et al., 2006; Kraus & Nourjah, 1998; Langlois, et al., 2006). Annually, traumatic brain injuries cause 435000 emergency department visits, 37000 hospital admissions, and 2685 deaths among children whose ages range from 0 to 14 in the USA (Jager et al., 2000; Langlois et al.,2004). While there has been an increase in the number of CT performed for traumatic patients, particularly those with a suspected head injury, different studies have estimated the prevalence of significant intracranial lesions on a CT to be something between 0.7% and 20% (Bordignon & Arruda 2002, Holmes et al., 2006, Mower 2005, Stiell 2001). Because most of these patients have insignificant injuries requiring no specific therapy, some authorities are reluctant to advocate CT studies in all such patients. In contrast, other authorities, concerned with the potentially dramatic consequences of a missed finding, tend to encourage the liberal use of brain CT in such patients bringing an estimated 750 million $ cost for health system (Borczuk, 1995; Jeret et al., 1993; Schynoll et al., 1993); however, it has been reported that reduction in the number of patients complicated due to head trauma is happening as a result of better control of developing seizure or raised intracranial pressure (Klauber et al. 1989). The majority of treated brain injuries are categorized as mild head injury (MHI) (Kraus & Nourjah,1988). While patients with moderate to severe head injury usually show obvious clinical signs, simplifying the decision to perform a head CT scan, there are controversies in the indications of CT scanning in MHI patients considering the fact that most of these patients represent minimal intracranial lesions, requiring no specific therapy (Shackford et al., 1992). This chapter will recap the application of CT scanning in MHI patients in adults and children.

Background and Aims: Tehran -the capital of Iran-with a population of approximately 7.9 million, only 30% of the days in a year profits healthy air quality. Critical air pollution happened in the J...

Summary BACKGROUND: Evaluating the effects of a commercially available synbiotic preparation (contains both prebiotic and probiotic elements) on functional constipation in males. METHODS: In a randomised controlled trial, a total of 66 adult men with functional constipation were equally allocated to receive a synbiotic mixture or a placebo. The synbiotic mixture or placebo was given as capsules with the same shape and colour, and patients received the capsules twice a day for 4 weeks. RESULTS: A total of 60 patients (31 in the synbiotic group) completed the study. At baseline evaluation, there was no significant difference between the mean stool frequency per week in synbiotic and placebo groups [mean difference of 0.11 times (95% CI: ‐0.31‐0.55), p = 0.58]. However, mean stool frequency increased significantly at weeks 2 [mean difference of 1.32 times (95% CI: 0.21‐2.43)] and 4 [mean difference of 1.58 times (95% CI: 0.18‐2.99)] in the synbiotic group compared with the placebo group (p = 0.02). A significant difference (p = 0.006) was found at weeks 2 [mean difference of 0.83 (95% CI: 0.20‐1.45)] and 4 [mean difference of 0.91 (95% CI: 0.32‐1.51)] between the synbiotic and placebo groups regarding the Bristol stool form score. No adverse effect was seen in the synbiotic group. CONCLUSION: The results of this study indicated that this specific commercial product seemed to be effective in increasing stool frequency and improving consistency in this sample of males with functional constipation. However, further studies with longer follow ups, and including females and elderly patients are required to confirm the efficacy of this product for treatment of functional constipation.

Background Spring cleaning is a popular tradition in Iran as well as in many other countries. The purpose of our study was to determine the pattern and compare the incidence of spring cleaning related injuries in Tehran, in the years 2007 and 2008. Methods In the year 2007, a household survey was performed in Tehran by random cluster sampling. The survey was repeated in May 2008 with the same clusters and starting points, but different households. The incidence of spring cleaning related injuries, the age and sex of injured person(s), the mechanism, type and cost of injuries were recorded through semi-structured interviews. The incidence rates of injuries and injuries leading to health visits (severe) according to sex and age groups were calculated. Data were analyzed using SPSS and STATA statistical softwares. Results The incidence of all and severe spring cleaning related injuries were 3.8 (3.0 - 4.8) and 1.6 (1.1-2.3) per 1000, respectively. The most common mechanisms of injuries were falls, followed by cutting and lifting heavy objects or overexertion. Falls were also the main mechanism of severe injuries. The most common injuries were open wounds, followed by superficial injuries (including contusions) and sprain and strain. Among severe injuries, the most frequent injuries were open wounds and contusions, followed by dislocations. The injuries were most common among women with an incidence of about 8.4 per 1000 in women older than 18 years of age (severe injuries: 3.4 per 1000 (2.2-5.1)). Conclusion The incidence of spring cleaning related injuries is high enough to raise concern in health system authorities. It could be estimated that about 23,927 to 38,283 persons get injured during the spring cleaning in Tehran at the beginning of every Persian new year. In addition, about 8,773-18,344 of these cases are expected to be severe enough to lead to medical attention (considering 7,975,679 as the population of Tehran at the time of study). Improving awareness of families, especially young women, regarding the scope and importance of spring cleaning safety can be suggested as the first population-based strategy to decrease the incidence of these injuries.

Indices of ventricular repolarization heterogeneity are associated with future arrhythmias and sudden cardiac death. We investigated the effect of exercise-based cardiac rehabilitation (CR) on these indices in a sample of Iranian patients.Patients (N 122), who had undergone coronary artery bypass surgery (CABGS), were enrolled in this cohort study. Sixty patients attended 15 or more sessions of CR (CR group) and the remaining 62 patients attended 5 or fewer sessions of CR (control group). A standard 12-lead electrocardiogram was recorded for each patient. QT interval dispersion (QTd), RR interval variability (RRV), and heart rate-corrected QTd (QTc-d) were measured 3 times as follow: just before surgery, at the beginning of the first session of the CR program, and at the end of the 15th session for the CR group or the last session for the control group.Following completion of the exercise-training program, the CR group showed a significant decrease in QTd (Δ = -49.4%, P.0001) and QTc-d (Δ = 52.8%, P .0001), but not in the control group (Δ = 13.4% and 17.9%, respectively, P.05 for both). In both groups, no statistically significant change in RRV was observed. After adjustment for variables such as age, gender, digoxin use, β-blocker use, and prerehabilitation ejection fraction, CR remained the independent predictor of QTd and QTc-d.Results suggest that cardiac rehabilitation and exercise training programs significantly improve the indices of ventricular repolarization heterogeneity in patients with coronary artery disease who received CABGS.

Background Fatal injuries are at the top of the injury pyramid; however, non-fatal injuries are quite common and impose huge medical expenses on the population. Relying on hospital data will underestimate the incidence of non-fatal injuries. The aim of this study was to estimate the annual incidence and out of pocket medical expenses of all injuries in urban population of Tehran (the capital city of Iran). Methods Using the cluster random sampling approach, a household survey of residents of greater Tehran was performed on April 2008. At randomly selected residential locations, interviewers asked one adult person to report all injuries which have occurred during the past year for all household members, as well as the type of injury, place of occurrence, the activity, cause of accidents resulting in injuries, the amount of out of pocket medical expenses for injury, and whether they referred to hospital. Results This study included 2,450 households residing in Tehran during 2007-8. The annual incidence of all injuries was 188.7 (180.7-196.9), significant injuries needing any medical care was 68.8 (63.7-74.2), fractures was 19.3 (16.6 - 22.4), and injuries resulted in hospitalization was 16.7 (14.2 - 19.6) per 1000 population. The annual incidence of fatal injuries was 33 (7-96) per 100,000 Population. In children aged 15 or less, the annual incidence of all injuries was 137.2 (120.0 - 155.9), significant injuries needing any medical care was 64.2 (52.2 - 78.0), fractures was 21.8 (15.0 - 30.7), and injuries resulted in hospitalization was 6.8 (3.3 - 12.5) per 1000 population. The mean out of pocket medical expense for injuries was 19.9 USD. Conclusion This population based study showed that the real incidence of non-fatal injuries in the capital of Iran is more than the formal hospital-based estimates. These injuries impose non trivial medical and indirect cost on the community. The out of pocket medical expense of non-fatal injuries to Tehran population is estimated as 27 million USD per year. Effective strategies should be considered to minimize these injuries and decrease the great financial burden to public and the health system.

further studies are needed to investigate therates and to help the authorities in planning and monitoringprevention programmes. This study aimed to elucidate theepidemiological pattern of suicide attempts and suicide inIran.Therecordednational injurysurveillancesystem(ISS) datafrom 20 March 2005 to 19 March 2008 were used. ISS datainclude demographics, place of residence, type of trauma andemergency department (ED) deaths. Hospital-based ISS islimitedto injuredpatients who enterthe EDsof governmentalhospitals. These hospitals (68.9% of the 942 hospitals in Iran)are under the coverage of the Ministry of Health, whichcontrols medical education in the country. Their services arecheap and available for all people. These hospitals are in thesame geographical locations as other types of hospitals withsimilardistribution,andtheycoverthewholecountryandnotparticular locations. Therefore, everyone can use theirservices. As injured patients present at the ED, the afore-mentioned data are recorded in their medical records by themedicalstaff.ThepaperrecordsaresentfromhospitalstotheCentre for Disease Control and converted into electronicformat.Deathswereonlyregisteredasfatalinjuriesifthecase

Background The Disability-Adjusted Life Year (DALY) was designed by the World Health Organization (WHO) to measure, compare, and analyze the burden of various diseases. To the best of our knowledge, this is the first study on the assessment of burden of traumatic spinal fracture (TSF) in an Iranian community. We estimated burden of TSF includes both isolated (iTSF) and associated injuries related to traumatic spinal fractures (aTSF) in Tehran, the capital of Iran, for the year 2006-2007 using DALYs. Methods Burden of TSF was estimated based on information provided by the national data on Iranian trauma, data from the WHO, and literature data using disease modeling (DISMOD). Incidence of TSF and associated injuries were obtained from two population based studies and National Trauma Data Bank in Iran, while duration, and relative risk of mortality (RRM) were obtained from WHO data and the literature. The incidence, duration, and relative risk of mortality (RRM) were used to calculate DALY for TSF. To calculate DALY, the years of life lost because of premature mortality (YLL) were added to the number of years lost because of disability (YLD). DALYs were calculated separately for both iTSF and aTSF. In-hospital YLD and post-hospital YLL for iTSF and in-hospital YLL and YLD were calculated for aTSFs. Results TSF incidence was 16.35 (95%CI: 3.4-48.0) per 100,000. The incidence of TSF in males was more than twice that of females. The largest DALYs were seen in 15-29 years. The highest burden of associated injuries of TSF was related to spinal cord and head injury. DALYs for aTSF were estimated to be 2496.9 years (32.0 DALY/100,000 population). The YLD and YLL were almost similar. Total DALY for iTSF and aTSF was 2568.9 years (32.92 DALY/100,000 population). Based on the risk extracted from the literature, post-hospital increased risk of mortality was increased by 1318 DALY (16.89 DALY/100,000 population). Conclusion This study showed a considerable burden for TSFs mainly due to associated injuries and increased lifelong RRM in patients with TSF.

Background The purpose of this research was to examine whether waterpipe smokers experience increased risk of motor vehicle crashes. Methods In a telephone survey, a random sample of Iranian drivers were asked to report their age, gender, vehicle age, whether their vehicles were equipped with anti-lock braking system (ABS), average daily drive time (DDT), whether they smoked cigarette or waterpipe, whether they had diabetes mellitus (DM), number of traffic crashes during the last calendar year and whether the crash involved a pedestrian or another vehicle. Results A total of 2070 motor vehicle owners with the mean age of 41.6 ± 11.45 were interviewed. The annual incidence of Road Traffic Crashes (RTC) was 14.9%; 14.0% involved a collision/s with other vehicles and 0.9% with pedestrians. There was an association between the RTC and male gender, DDT, being a cigarette smoker, being a waterpipe smoker and DM in univariable analysis. The association between RTC and being a waterpipe smoker and also cigarette smoker was significant in multivariable analysis after adjustment for DDT. Conclusions Being waterpipe and/or cigarette smoker and DDT were the independent predictors of the number of traffic crashes in Poisson regression model. If the increased risk of RTC among waterpipe or cigarette smokers is seen in other studies, it would be beneficial to promote tobacco cessation and control strategies through injury prevention initiatives.

OBJECTIVES: To investigate the relationship between perceived risk and risk-taking behaviors during the Iranian Last Wednesday Eve Fireworks (ILWEF). METHODS: A random sample of 2475 Tehranian households were asked on perceived risk of injury, risk-taking behaviors, experience of injuries, and their perception of ability to manage the harmful events during the ILWEF. RESULTS: Lower perceived injury risk and higher perceived ability of managing an injured household member were associated with participation in fireworks practice and incidence of injury. CONCLUSION: These findings can be of practical importance to increase safety during festivals by improving risk perception in the community. Language: en

Iran has had the highest fatal road traffic injury (RTI) rate in the world. Evaluating Iran's fatal RTIs over the past 11 years (1997-2007) through retrospective analysis is the study objective. Out of a total of 232,841 RTI deaths from 1997 to 2007 (with a male/female victim ratio of 4.2/1), there was an increase in both fatal and non-fatal RTIs. There was, however, a 0.65% fatal RTI decline in 2006 and a 16.9% decline in 2007. Decline was significant for both genders. The decrease in RTI is difficult to attribute to specific factors, although one of the following may be involved: increased congestion in cities, helmet and seatbelt use, avoidance of high-risk driving behaviors, and improved safety of modern vehicles.

Object Pressure ulcers (PUs) are common complications in patients with complete spinal cord injury (SCI) or incomplete SCI in which sensory function is spared. Most studies analyzing associated factors of PU and SCI have been performed in cases of traumatic SCI and in just a few cases of nontraumatic SCI. This study was designed to look specifically at the differences in causative factors of PU in cases of traumatic and nontraumatic SCIs. Methods The authors performed a retrospective, cross-sectional study evaluating patients with complete and incomplete SCIs (American Spinal Injury Association Grades A and B) under the coverage of the financial, medicosocial, and rehabilitative support provided by the State Welfare Organization of Iran (SWOI). There were 3791 cases of traumatic SCI (63.2%) and 2110 cases of nontraumatic SCI (35.2%). For 94 patients (1.6%), sufficient data were not available. Results A PU was detected in 39.2% of all patients with an SCI (71.8% of those with traumatic SCI vs 28.2% of those with nontraumatic SCI). A univariate analysis showed a significant association between occupation, education, and the presence of PU in patients with a traumatic SCI (p < 0.05). This contrasted with nontraumatic SCI in which an association between PU and age was noted (p < 0.05). Using logistic regression, traumatic cause, older age, an interval less than 1 year since the onset of SCI, male sex, and single status were found to significantly increase the risk of PU in all patients with an SCI. However, a higher education level had a preventive effect on PU. Conclusions This study revealed some risk factors for PU in the authors' setting. The authors' findings suggest a possible difference between the risk factors for PU in patients with both types of SCI. Further study on the pathoetiology of these differences is paramount in the future.

Injuries are common and important problem in Tehran, capital of Iran. Although therapeutic centers are not essentially established following the constructional principles of developed countries, the present opportunities and equipments have to be used properly. We should recognize and reduce the deficits based on the global standards. This study deliberates the trauma resources and capacities in university hospitals of Tehran based on Arizona trauma center standards, which are suitable for the assessment of trauma centers.Forty-one university hospitals in Tehran were evaluated for their conformity with "Arizona trauma center standards" in 2008. A structured interview was arranged with the "Educational Supervisor" of all hospitals regarding their institutional organization, departments, clinical capabilities, clinical qualifications, facilities and resources, rehabilitation services, performance improvement, continuing education, prevention, research and additional requirements for pediatric trauma patients. Relative frequencies and percentages were calculated and Student's t test was used to compare the mean values.Forty-one hospitals had the average of 77.7 (50.7%) standards from 153 Arizona trauma center standards and these standards were present in 97.5 out of 153 (63.7%) in 17 general hospitals. Based on the subgroups of the standards, 64.8% items of hospital resources and capabilities were considered as a subgroup with the maximum criteria, and 17.7% items of research section as another subgroup with the minimum standards.On the basis of our findings, no hospital meet all the Arizona trauma center standards completely. The hospitals as trauma centers at different levels must be promoted to manage trauma patients desirably.

The removal of the saphenous veins in coronary artery bypass graft (CABG) surgery may cause leg edema. Compression therapy is often used to prevent postoperative edema. The objective of this study was to compare the efficacy of medical compression stocking (TED) and elastic bandage-type on donor limbs after CABG. The peripheries of lower limbs were measured at four regions (A: end of tarsal bones, H: heel , B: immediately above the ankle, C: largest circumference of the calf) at admission in 295 patients how CABG candidates and differences in these measurement points at discharge compared to measurements at admission time were calculated. The difference was considered as a measure of the effectiveness of two types of compression to prevent postoperative edema in donor limbs after CABG. The alterations of 396 donor limbs of 295 patients were examined after CABG at admission and discharge time. In 101 patients veins for graft were taken from both lower limbs. After analysis, if subjects had worn TED stockings, the peripheries of donor limbs at discharge were less than at admission time in the A and H regions compared to elastic bandage group (P(A) = 0/009), (P(H) = 0/012). The conclusion reached was that using the kind of knee length compression stocking (TED stocking , Kendall Co.) is more effective edema at foot and heel regions in donor limbs after CABG than elastic bandages.

The aim of this study was to develop a decision rule for physicians in developing countries to identify patients with minor head injury who will benefit from emergency brain CT scanning.Three hundred eighteen patients with a history of blunt head trauma and a Glasgow Coma Scale (GCS) scoreor= 13 who had presented within 12 hours of trauma underwent nonenhanced brain CT and were included in this prospective study. Computed tomography findings that necessitated neurosurgical care (either observation or intervention) were considered as positive findings. Logistic regression was used to develop the decision rule.Computed tomography scans were always normal in patients65 years old who did not have an obvious head wound, a raccoon sign, vomiting, memory deficit, or a decrease in their GCS score. Patients with 1 major criterion (GCS score14, raccoon sign, failure to remember the impact, age65 years, or vomiting) or 2 minor criteria (wound at the scalp or GCS score15) had an abnormal CT scan in 13% of the cases.The decision rule developed by the authors appears to be 100% sensitive and 46% specific for positive findings on brain CT and will, in developing countries, help clarify the decision to obtain scans.

Objectives:The semiprivate health system in Iran has created an opportunity for unnecessary uses of advanced medical equipments including magnetic resonance imaging (MRI). This study aimed to evaluate the evidence for MRI overuse in private diagnostic imaging centers in Tehran, Iran. The objectives of this study were to determine the frequency of use of MRI scans for different complaints and to explore frequency of normal MRI findings as a function of unnecessary MRI use.Methods:We conducted a survey among private MRI centers in Tehran, Iran, to study the proportion of MRI scans that may result in significant clinical finding. All MRI reports at a specific point in time at selected MRI centers were reviewed by a physician and the findings were recorded as normal, abnormal, or substantial changes.Results:Of all the MRI reports, 17.2 percent had resulted in normal findings; 9.8 percent ordered for examination of headache, and 4.8 percent for lower back pain.Conclusion:Unnecessary MRIs are most likely to result in normal finding; although not all the MRI with normal results could be identified as unnecessary. Negative findings from MRI scans may be reassuring to both clinicians and patients. The proportion of normal findings in MRI scans did not provide evidence of MRI overuse in Iran. The results of this study warrant formation of guidelines for the use of MRIs for headache and low back pain disorders.

Fireworks are used worldwide during national and cultural celebrations. Iranians celebrate the last Wednesday of the Persian year (ILWEF) as an ancient custom. The aim of this study was to determine safety preparedness of inhabitation in Tehran, the capital city of Iran, for 2007 ILWEF fireworks. In this study, interviewers referred to randomly selected addresses after the end of ILWEF. They asked responders about source of information on how to use firework items and having education of safe use of fireworks. Also people were asked about having first aid kits and fire extinguisher at home. The study included 2475 families. To learn how to use fireworks, 1.3% had read brochures; the remainder of responders obtained their information from miscellaneous sources with unknown validity. Only 1.1% of them have had some sort of education on the safe use of fireworks. According to responders, 98.4% did not have any information about the safety standards of fireworks. We conclude that Tehranian households were not sufficiently prepared to guarantee a safe festival. It seems safety preparedness of the community to prevent firework related fires and injuries, by relevant education and promotion of fire safety equipments, needs to be reconsidered in Tehran. Considering the impaired safety preparedness of community for fireworks festival, individuals should attend public fireworks displays conducted by professionals rather than engage in personal use of fireworks. Restriction of the use of fireworks and banning firecrackers lacking appropriate insertions on safety instructions are other solutions to be considered.

This paper presents preliminary results on an intelligent mapping capability that generates high-confidence layouts of building interiors from limited exterior and interior structural observables. Such a capability could provide critical support to intelligence gathering and/or life-saving operations in the military, law enforcement, disaster response, and commercial sectors where rapid understanding of unknown interior layouts is required to save lives, maintain covertness, or minimize costs. The fundamental approach relies on an intelligent rule-based inferencing process which operates on limited structural observables. The rules are based on geo-specific design practices and building codes. The mapping capability has been demonstrated experimentally in a test-case building structure using a set of imaging sensors to scan the environment. Data was gathered at sparse locations within the building to represent a real-world rapid exploration scenario. Preliminary results show that this capability can successfully generate high-confidence interior layouts from limited structural observables. It is envisioned that this intelligent mapping capability could be integrated on unmanned ground vehicle platforms or in human-borne (soldier, SWAT, urban search-and-rescue personnel) systems.

Study Design This is a systematic review. Objective This study aims to compare effects of sequestrectomy versus conventional microdiscectomy for lumbar disc herniation. Summary of Background data Open surgery for LDH can be performed by sequestrectomy or conventional discectomy. Generally, it has been assumed that the former is associated with higher risk of recurrence and less radicular pain and low back pain after surgery. Methods We searched MEDLINE and EMBASE from 1980 to November 2014. We selected randomized controlled trials (RCTs) and prospective studies that compared conventional discectomy versus sequestrectomy for adult patients with LDH and evaluated the following primary outcomes: radicular pain or LBP as measured by a visual analogue scale, neurological deficit of lower extremity. We also evaluated the following secondary outcomes: complications of surgery, reherniation rate, duration of hospital stay, postoperative analgesic use, and health-related quality of life measures. Two authors independently reviewed citations and articles for inclusion. We assessed the risk of bias as well as the level of evidence for each study, and we used standard methodological procedures recommended by the Cochrane Collaboration. Results We identified five studies (746 participants) that met our inclusion criteria comparing sequestrectomy versus microdiscectomy. Comparison revealed that with low-quality evidence, there is no significant difference for radicular pain, LBP, functional outcome, complications, and hospital stay for 2 years. In addition, with moderate-quality evidence, there is no significant difference for recurrence rate. Meanwhile, there is very low-quality evidence that analgesic consumption is lower in sequestrectomy than micro/discectomy. Conclusion Both interventions had similar effect on pain after surgery, recurrence rate, functional outcome, and complications; however, sequestrectomy may be superior in terms of postoperative analgesic consumption.

Health monitoring and damage detection strategies for base-excited structures typically rely on accurate models of the system dynamics. Restoring forces in these structures can exhibit highly non-linear characteristics, thus accurate non-linear system identification is critical. Parametric system identification approaches are commonly used, but require a priori knowledge of restoring force characteristics. Non-parametric approaches do not require this a priori information, but they typically lack direct associations between the model and the system dynamics, providing limited utility for health monitoring and damage detection. In this paper a novel system identification approach, the Intelligent Parameter Varying (IPV) method, is used to identify constitutive non-linearities in structures subject to seismic excitations. IPV overcomes the limitations of traditional parametric and non-parametric approaches, while preserving the unique benefits of each. It uses embedded radial basis function networks to estimate the constitutive characteristics of inelastic and hysteretic restoring forces in a multi-degree-of-freedom structure. Simulation results are compared to those of a traditional parametric approach, the prediction error method. These results demonstrate the effectiveness of IPV in identifying highly nonlinear restoring forces, without a priori information, while preserving a direct association with the structural dynamics.

In Reply: We appreciate the salient observations and comments by Hadda et al. It is our sincere hope that this response provides the necessary data and clarification to guide future applications of our study results in the care of patients with COPD. Although we concur that noninvasive

Recent developments in the new field of auto-adaptive materials offer promising opportunities for developing radically new fastening mechanisms. One of the classes of materials in this category is Shape Memory Alloys (SMAs). SMAs are very attractive for structural application because of their major constitutive behaviors such as pseudoelastic characteristic. Pseudoelastic behavior of NiTi SMAs is a unique hysteretic energy dissipation behavior that combined with a very long fatigue life makes SMAs a viable candidate for developing new fasteners. Pseudoelastic behavior of Shape Memory Alloys, particularly NiTI, can be used for developing passive fastening-mechanisms and tendon-systems. In case of coastal structures, where hurricane destruction inflicted upon residential structures results in million of dollar in financial damages and loss of lives each year, development of more effective fastening-mechanisms and tendon-systems for the connections between the walls and the roofs will aid in damage reduction. A study carried out by the authors has shown that the extent of damping effect of a hybrid tendon-system, made of rigid NiTi sections directly depends on the length-ratio of the rigid NiTi section, tendon diameter and the amount of pre-strain on the tendon. Moreover, because of tendon-system passive design the nature of excitation has a profound effect on its activation and damping capability. In this paper effectiveness of a hybrid NiTi tendon-system for damage mitigation of coastal structures and optimal hybrid tendon length-ratio are studied.© (2001) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

This paper shows how hospital data seriously underestimates the incidence of non-fatal injuries in Iran. This paper uses a household survey to estimate the annual incidence and out of pocket medical expenses of non-fatal injuries in the capital of Iran, which has a population of 7.9 million. A random sample of Tehran households was selected by clustered sampling. The households were asked to report injuries that happened to household members during the last year and also to report related out of pocket medical expenses. The clustered structure of sampling was taken into account during the analysis; and the confidence intervals were calculated assuming Poisson distribution. The study included 9,100 inhabitants and the annual incidence of all injuries was 188.7 (179.9 to 197.8), the number of injuries needing medical care was 68.8 (63.5 to 74.4), fractures was 19.3 (16.6 to 22.4) and injuries resulting in hospitalization was 16.7 (14.2 to 19.6) per 1,000 population. The annual incidence of fatal injuries was 33 (7–96) per 100,000 of the population. The injury pyramid was 1/50/646 (Death/Hospital admission/All injuries). The mean out of pocket medical expense for injuries was 16.1 USD. Home was the place that most of injurious accidents had happened and the injuries needing medical care mostly happened in the streets and highways. Falls followed by transport accidents were the most common causes of significant injuries. Non-fatal injuries impose about 27 billion USD out of pocket medical costs to the Tehran population annually. Mandatory safety standards for houses should be considered by civil authorities.

Shape memory alloys (SMAs) are identified with two main characteristics; shape memory effect, and pseudoelasticity; temperature and stress induced phase transformations respectively. By pseudoelasticity, SMAs sustain large amount of strain, without permanent plastic deformation, and recover it upon heating. Constitutive models have been proposed for single/polycrystalline SMAs. The first practical model, was proposed by Tanaka (1985, 1986). That consisted of one equation for stress vs strain, temperature, and martensitic phase fraction (MPF), and a set of kinetic relations, for MPF during phase transformations. Liang and Rogers (1990) proposed a model utilizing a simpler kinetic relation. Brinson (1993) developed a more versatile and realistic model, by incorporating the temperature and stress induced MPF into the kinetic relations. That predicts the material behavior throughout the entire temperature range. This paper presents a comprehensive understanding of temperature and stress induced phase transformation. A thorough interpretation of MPF and critical stresses of phase transformation versus temperature are discussed and capabilities of Brinson's model in reproducing the SMA characteristics under quasi-static thermomechanical loading are demonstrated. Such in-depth elaboration of these relationships has not been reported in the literature; yet is it is essential for capturing the nature of superelasticity. Exploring the capabilities of Brinson's model facilitates applications of autoadaptive materials in structural or mechanical systems.© (1999) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

Drs Rathore and Mansoor raised several important issues when considering pressure ulcer (PU) in spinal cord-injured patients. We would like to propose the following comments.

Background Injuries continue to be significant health problems and leading causes of death and disability in many populations. Aims A household survey was conducted to determine the external causes of injuries among people living in Tehran, Iran. Methods Using cluster random sampling approach, a household survey was conducted in April 2007, seeking information about external causes and severity of injuries occurred within families in past Persian year. External causes were classified according to ICD-10 and analysed using SPSS 16. Results Out of 9173 household participants, 765 ones (8.3%) had injuries with male to female ratio of 0.54 : 1 during the past Persian year. Injuries occurred mostly due to ‘exposure to the inanimate mechanical forces’, while the second and third causes were ‘contact with heat or hot substances’ and ‘falls’, respectively. When it comes to required attention injuries, the incidence rate was 175.5 per 10 000 person per year with male to female ratio of 2.37 : 1 and mostly associated with ‘falls’ and ‘transport accidents’. Exposure to inanimate mechanical forces and also burns mostly occurred among middle aged women at home and leaded to open wounds and superficial burns respectively. Young boys were more vulnerable to falls which mostly took place at home and sport places and frequently resulted in superficial injuries and fractures. Traffic accidents mostly took place among middle aged men and leaded to fractures and superficial injuries. Contribution to the Field The priority in injury prevention programme should be given based on common external causes and to traffic and home injuries.

Introduction Smokers are at risk for the chronic diseases, and they experience increased risk of road traffic crash (RTC), compared to non-smokers. Waterpipe smoking is sort of tobacco use with an estimated 100 million daily smokers through the world including the USA, UK, Australia, Germany, Canada and Middle East. The purpose of this research was to examine whether waterpipe smokers experience increased risk of RTC. Methods A telephone survey was arranged over a random sample of Iranian drivers. Using a Poisson regression analysis, the association of number of RTC during the last year and the drivers9 characteristics (age, gender, diabetes, cigarette or waterpipe smoking, average daily drive time [DDT]) and vehicle characteristics (vehicle age, antilock braking systems) was evaluated. Results A total of 2070 drivers were included. 14.9% reported at least one RTC during the last year. There was significant association between number of RTCs and DDT, cigarette smoking and waterpipe smoking after adjustment for other variables. The association of RTC with waterpipe smoking was stronger than cigarette smoking. The prevalence of RTC in drivers who reported smoking cigarette and waterpipe was more than those who reported only waterpipe smoking which was itself more than those who smoked only cigarette. Conclusion Our study is among the first to show the association between waterpipe smoking and the risk of RTC, yet the mechanisms of actions need to be studied further. Public health initiatives to increase awareness on harms of waterpipe smoking among male youngsters can decrease the burden of RTC.

Objective To compare fatalities and injuries in road traffic crashes (RTC) in Iran with other countries. Methods Data were obtained from national health sources of Iran. These data included population number, registered motor-vehicles number, number of RTCs and consequent fatalities and injuries from 1997 to 2006. Results RTC fatality and injury rates increased from 1997 to 2005, but decreased in 2006. The over all men/women ratio in the RTC fatalities was 4.2:1. High RTC fatality rate of 39 per 100 000 population in Iran was almost the same as some other developing countries. In Iran, RTC fatalities in recent years were almost twice as much as the highest rate among the European countries. Conclusions This investigation shows that in spite of reduction of RTC fatality in Iran in 2006, it is still one of the highest in the world. Moreover, this paper describes the state of RTC-related parameters in a developing country in comparison with the developed countries.

Background Road traffic injuries are a serious public health problem worldwide. The incidence rate of fatal road traffic injuries is 26.4 per 100000 in the Eastern Mediterranean Region. Road traffic injuries are a major public health problem in Iran. Different routine sources are available for road traffic injuries in Iran, but they present several limitations. This study aimed to determine the epidemiology of road traffic injuries in greater Tehran, using a population-based approach which is less prone to under-estimation compared to service-based data. Methods In the year 2008, 2488 households were randomly selected for a face to face interview. Trained interviewers referred to the selected households to collect the subjects' demographic information, as well as their motor vehicle utilization and traffic injuries during the year prior to data collection. All interviews were recorded using a digital voice recorder and reviewed by a quality control team the day after the interview. The Student's t-test and ANOVA were used to analyze continuous variables. Chi-square test -including a test for trend for ordinal data- was used to analyze categorical variables. Ninety-five percent confidence interval was calculated for point estimates of incidences using Poisson or binomial distribution assumptions accordingly. Results There were 119 traffic injury cases including 3 deaths (33 per 100 000) in the survey sample (n = 9100). The annual incidence of all traffic injuries for 1000 population was 13.1 (95% CI: 10.8 - 15.6), and that of fatal traffic injuries was 33.0 per 100 000 population (95% CI: 6.80 - 96.32). The annual incidence of collision traffic injury for 1000 motorcycles was 95. Conclusion This population-based study demonstrates that the morbidity rate of RTIs is about ten times higher than the national figures reported by other available sources; and this can serve as an important warning to countries like Iran to prioritize this issue in their public health activities. To ensure more safety on our roads, we need to establish an injury surveillance system, and a more accurate national data capture system on RTIs.

Background Spinal cord-injured (SCI) patients experience poor health-related quality of life (HRQOL) and they usually report lower HRQOL than the general population or population subgroups in Iran and elsewhere. The aim of this study was to compare HRQOL between veterans and non-veterans with SCI in Iran. Methods This was a cross-sectional study. HRQOL was measured using the 36-item Short Form Health Survey (SF-36). Thirty-nine male veterans and 63 non-veteran males with SCI were included in the study. Regression analyses were applied to determine the variables affecting physical and mental health-related quality of life among the patients. Results The male veterans had a lower HRQOL than the non-veterans with SCI. The differences were significant for all measures except for physical and social functioning. The greatest difference was observed for bodily pain (P = 0.001). The regression analysis results indicated that a longer time since injury was associated (P = 0.01) with better physical health-related quality of life (PCS), while being a veteran (P < 0.001) and having a spinal lesion in the cervical region (P = 0.001) were associated with poorer PCS. Older age (P < 0.001) and higher education (P = 0.01) were associated with better mental health-related quality of life (MCS), while being a veteran and having a spinal lesion in the cervical region (P = 0.02) were associated with poorer MCS. Conclusion The study findings showed that veterans with SCI experienced lower HRQOL than their non-veteran counterparts. A qualitative study is recommended to evaluate why HRQOL was lower in veterans than in non-veterans with SCI although veterans had higher incomes as a result of their pensions and increased access to equipment, and medications. To improve quality of life in both veterans and non-veterans with spinal cord injuries, policy changes or implementation of new interventions may be essential so that veterans could receive additional support (e.g. counseling, recreation therapy, vocational therapy, etc.) and non-veterans could meet their basic needs.

To determine the prevalence of traumatic spinal cord injury (SCI) in Tehran, Iran.A population-based study was performed. In a random cluster sampling, 100 addresses were selected as the starting point of the survey for each cluster consisting of 25 households. To expand the geographic dimension of each cluster, the interviewers skipped 3 of 4 houses in gathering data for each study unit. Each person with traumatic SCI was evaluated initially by a nurse and then by a neurosurgeon by physical examination and spinal imaging at the hospital or at home.Ninety-seven percent of all surveyed agreed to participate in the study (2425 households, or 9006 persons). Four cases of SCI were identified. The point prevalence of SCI was 4.4 [95% CI = 1.2-11.4] per 10,000 people. Over the 5-year period from january 2003 through January 2008, the reported incidence rate of SCI was 2.2 (95% CI = 0.27-8.00) per 10,000 people.In this, the first published population-based study from Iran, the prevalence of traumatic SCI in Tehran ranged from 1.2 to 11.4 per 10,000 people. More research is required to determine the patterns and causes of SCI. Development of a nationwide SCI registry or surveillance system is fundamental to an understanding of the epidemiology, and hence the prevention, of this costly health problem.

Background There is no clear evidence that early decompression following spinal cord injury (SCI) improves neurologic outcome. Such information must be obtained from randomized controlled trials (RCTs). To date no large scale RCT has been performed evaluating the timing of surgical decompression in the setting of thoracolumbar spinal cord injury. A concern for many is the ethical dilemma that a delay in surgery may adversely effect neurologic recovery although this has never been conclusively proven. The purpose of this study is to compare the efficacy of early (before 24 hours) verse late (24–72 hours) surgical decompression in terms of neurological improvement in the setting of traumatic thoracolumbar spinal cord injury in a randomized format by independent, trained and blinded examiners. Methods In this prospective, randomized clinical trial, 328 selected spinal cord injury patients with traumatic thoracolumbar spinal cord injury are to be randomly assigned to: 1) early surgery (before 24 hours); or 2) late surgery (24–72 hours). A rapid response team and set up is prepared to assist the early treatment for the early decompressive group. Supportive care, i.e. pressure support, immobilization, will be provided on admission to the late decompression group. Patients will be followed for at least 12 months posttrauma. Discussion This study will hopefully assist in contributing to the question of the efficacy of the timing of surgery in traumatic thoracolumbar SCI. Trial Registration RCT registration number: ISRCTN61263382

Introduction: Globally, it is estimated that around 5.8 million people die annually as result of injuries, which causes 10% of all deaths and 16% of disability adjusted life years lost worldwide. This study aimed to determine the epidemiology of injuries in emergency departments in Iran.Method: This cross sectional study was carried out using national injury surveillance data registry from 21 March 2009 to 20 March 2014.Results: 7,176,344 patients with the mean age of 27.5 ± 17.8 years were registered to 657 EDs (70.6% male). Road Traffic Crash (RTC) was the most common cause of injury (31.0%) followed by hit (28.2%) and fall (10.1%). While roads were the commonest place of injuries, 34.0% of patients have been injured at home. More than 90% of injuries were unintentional. Assault and suicide attempt were causes of injury in 5.6% and 3.9% of patients, respectively.Conclusion:This paper addresses where prevention measures are most urgently needed and offers insights which could be useful for injury prevention programs in Iran and other developing countries.