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Water supply is a crucial concern for planners across all countries, especially in rural communities. This paper proposes a multidimensional approach to examining the effective criteria for water supply projects in rural areas of Iran. The study compares alternative methods of project implementation and employs three multi-criteria decision-making (MCDM) methods: analytical hierarchy process (AHP), Fuzzy-AHP, and technique for order preference by similarity to ideal solution (TOPSIS) to prioritize criteria, sub-criteria, and alternatives. The results indicate that, among the five options analyzed, diverting water from the river and constructing temporary storage dams are the highest priorities, while pipeline branching to the nearby city or village is given the lowest priority. The study reveals that environmental and economic criteria are more critical than social-security and technical-management criteria, while negative environmental impacts and the possibility of risk-taking by subversive agents are the most important among the 14 sub-criteria studied.

The determination of depth profiles across interfaces is of primary importance in many scientific and technological areas. Photoemission spectroscopy is in principle well suited for this purpose, yet a quantitative implementation for investigations of liquid-vapor interfaces is hindered by the lack of understanding of electron-scattering processes in liquids. Previous studies have shown, however, that core-level photoelectron angular distributions (PADs) are altered by depth-dependent elastic electron scattering and can, thus, reveal information on the depth distribution of species across the interface. Here, we explore this concept further and show that the anisotropy parameter characterizing the PAD scales linearly with the average distance of atoms along the surface normal. This behavior can be accounted for in the low-collision-number regime. We also show that results for different atomic species can be compared on the same length scale. We demonstrate that atoms separated by about 1~\AA~along the surface normal can be clearly distinguished with this method, achieving excellent depth resolution., Comment: Submitted to Phys. Rev. Lett

Background Many patients with American College of Cardiology/American Heart Association Stage D (advanced) heart failure are discharged home on chronic intravenous inotropic support (CIIS) as bridge to surgical therapy or as palliative therapy. This study analyzed the clinical trajectory of patients with advanced heart failure who were on home CIIS. Methods We conducted a single-institution, retrospective cohort study of patients on CIIS between 2010 and 2016 (n = 373), stratified by indication for initiation of inotropic support. Study outcomes were time from initiation of CIIS to cessation of therapy, time to death for patients who did not receive surgical therapy and rates of involvement with palliative care. Results Overall, patients received CIIS therapy for an average of 5.9 months (standard deviation [SD] 7.3). Patients on CIIS as palliative therapy died in an average of 6.2 months (SD 6.6) from the time of initiation of CIIS, and those on CIIS as bridge therapy who did not ultimately receive surgical therapy died after an average of 8.6 months (SD 9.3). Patients who received CIIS as bridge therapy were significantly less likely to receive palliative-care consultation than those on inotropes as palliative therapy, whether or not they underwent surgery. Conclusions In this large cohort of patients with advanced HF, patients who on CIIS as palliative therapy survived for 6.2 months, on average, with wide variation among patients. Patients who were on CIIS as bridge therapy but did not ultimately receive surgical therapy received less palliative care despite the high mortality rate in this subgroup.

BackgroundMany patients with advanced heart failure (HF) are administered chronic intravenous inotropic support (CIIS) as bridge to surgical therapy; some ultimately never receive surgery. We aimed to describe reasons patients “crossover” from CIIS as bridge therapy to palliative therapy, and compare end-of-life outcomes to patients initiated on CIIS as palliative therapy.MethodsSingle-institution, retrospective cohort study of patients on CIIS as bridge or palliative therapy between 2010 and 2016; data obtained through review of health records and multi-disciplinary selection meeting minutes, was analyzed using descriptive and inferential statistics.ResultsOf 246 patients discharged on CIIS as bridge therapy, 37 (16%) (male n = 28, 76%; African American n = 22, 60%) ultimately never received surgery. 67 matched patients on CIIS as palliative therapy were included for analysis (male n = 47, 70%; African American n = 47, 70%). The most common reasons for “crossover” from CIIS as bridge therapy to palliative therapy were frailty (n = 10, 27%), cardiac arrest (n = 5, 13.5%), and progressive non-cardiac illnesses (n = 6, 16.2%). A similar percentage of patients in the bridge (n = 28, 76%) and palliative (n = 48, 72%) groups died outside the hospital (P=0.66); however, fewer bridge patients received hospice care compared to the palliative group (35% vs 69%, P < 0.001). Comparing patients who died in the hospital, bridge patients (n = 9; 100%) were more likely to die in the intensive care unit than palliative patients (n = 8; 42%) (P < 0.001).ConclusionPatients on CIIS as bridge therapy who do not ultimately receive surgical therapy “crossover” to palliative intention due to frailty, or development of or identification of serious illnesses. Nevertheless, these “bridge to nowhere” patients are less likely to receive palliative care or hospice and more likely to die in the intensive care unit than patients on CIIS as palliative therapy.

In determining the quality of oils, heavy metal content, physical-chemical indices, and fatty acid profile, especially trans fatty acids are important factors. In this study, animal oil samples of different regions of Ilam province studied. After digestion and extraction by microwave-assisted acid digestion, the heavy metals content of the samples measured by an improved flame atomic absorption spectroscopy method. Moreover, after extraction and derivatization of the oils, the fatty acid profile was analyzed by gas chromatography. To facilitate the conclusion of the data obtained, samples of different regions of the province are divided into three parts: northern, southern, and central cities. According to the results, copper, cobalt, and chromium levels were reported in the range of 0.04-4.47, 0.02-2.33, and 0.02-3.54 mg/kg, respectively, which were below the maximum permissible levels. It was revealed that using the modified gas chromatography method, it is possible to separate and measure 27 fatty acids simultaneously. Besides, an acceptable degree of extraction of oleic and linoleic acid is extracted to calculate the cis and trans isomers, which was achieved.

Use of continuous intravenous inotropic support (CIIS) strictly as palliative therapy for patients with ACC/AHA Stage D (end-stage) Heart Failure (HF) has increased significantly. The harms of CIIS therapy may detract from its benefits. To describe benefits (improvement in NYHA functional class) and harms (infection, hospitalization, days-spent-in-hospital) of CIIS as palliative therapy. Methods: Retrospective analysis of patients with end-stage HF initiated on CIIS as palliative therapy at an urban, academic center in the United States between 2014-2016. Clinical outcomes were extracted, and data were analyzed using descriptive statistics. Seventy-five patients, 72% male, 69% African American/Black, with a mean age 64.5 years ( SD = 14.5) met study criteria. Mean duration of CIIS was 6.5 months ( SD = 7.7). Most patients (69.3%) experienced improvement in NYHA functional class from class IV to class III. Sixty-seven patients (89.3%) were hospitalized during their time on CIIS, with a mean of 2.7 hospitalizations per patient ( SD = 3.3). One-third of patients (n = 25) required at least one intensive care unit (ICU) admission while on CIIS therapy. Eleven patients (14.7%) experienced catheter-related blood stream infection. Patients spent an average of 20.6% ( SD = 22.8), approximately 40 days, of their time on CIIS admitted to the study institution. Patients on CIIS as palliative therapy report improvement in functional class, survive 6.5 months following initiation, but spend a significant number of days in the hospital. Prospective studies quantifying the symptomatic benefit and the direct and indirect harms of CIIS as palliative therapy are warranted.

Background: Liver transplantation has improved patients' survival rates and quality of life (QoL). This study investigated the effect of liver transplantation and model for end-stage liver disease (MELD) score on patients' QoL at Shiraz Organ Transplantation Center. Materials and Methods: This perspective longitudinal study was conducted among 40 liver transplant candidates at Shiraz Organ Transplant Center. Inclusion criteria were patients who were 12 years or older, able to answer the questions and willingness to participate. If they had received multi-organ transplant and had mental or physical disabilities, we excluded them from the study. They were interviewed by the same researcher in the transplant clinic before transplantation, 1 and 6 months after transplantation. The participants completed the data collection form and Short Form-36 questionnaire via face-to-face interview. The data collecting form consist of demographic and medical information. Medical information was collected from Shiraz Organ Transplant Center. Results: Mean age of participants was 41.18 ± 14. By comparing QoL dimensions, a significant difference was found between before and after transplantation (P < 0.001), except in General Health dimension (P = 0.711). There was no statistically significant relationship between MELD score and QoL after liver transplantation (P > 0. 05). Conclusion: Liver transplantation improves patients' quality life with end-stage liver disease. MELD scores do not depict QoL after liver transplantation.

The aim of this study was to determine genome-wide haplotype block structure, extent of linkage disequilibrium (LD) and effective population size using the information obtained from 243 Azerbaijani buffalo (Axiom® Buffalo Genotyping 90 K) using a high density SNP panel. After quality control, 62,141 SNP markers remained for population structure analysis and identification of haplotype blocks. The extent of LD was measured by the square of correlation coefficient (r2) between alleles. The maximum LD varied from 0.25 to 0.29 at a distance of

Background & Aims: Communication skills are the foundation of clinical capabilities in healthcare providers. The process of delivering bad news is one of the most challenging aspects of clinical communication in health care, which has subtle psychological details. The present study aimed to assess the knowledge of nursing students regarding the conveying of bad news to patients and their companions in the hospitals affiliated to Bushehr University of Medical Sciences, Iran. Materials & Methods: This cross-sectional, descriptive-analytical study was conducted in 2017 in order to assess the knowledge of nursing students at Bushehr University of Medical Sciences regarding the delivery of bad news to patients and their companions. Data were collected using a valid and reliable researcher-made questionnaire. Data analysis was performed in SPSS version 18 using descriptive and analytical statistics. Results: The nursing students had moderate to high knowledge of delivering bad news to patients. In addition, significant associations were observed between the knowledge level, passing the courses of nursing ethics and professional communication (P=0.011), and academic year of education (P=0.037), so that the students who had passed the courses and were in inferior academic years had higher knowledge levels in this regard. However, no significant correlation was observed between the knowledge level, gender (P=0.550), and interest in the academic discipline (P=0.546). Conclusion: Adequate knowledge of professional ethics and effective communication is an advantage for healthcare providers. Based on the obtained results, presenting additional courses on professional ethics and communication skills in nursing education, as well as related training programs, by medical education authorities could lead to better outcomes in this regard.

Background & Aims: Medication errors are major healthcare concerns across the world, which cause mortality and physical and psychological complications in patients, their families, and the community every year. Considering the key role of nurses in direct patient care, the present study aimed to investigate the prevalence, barriers to medication error reports, and influential factors in medication errors in the viewpoint of nurses. Materials & Methods: This cross-sectional, descriptive-analytical study was conducted on 140 nurses employed in the teaching hospitals in Bojnurd, Iran in 2017. Data were collected using a questionnaire consisting of four sections, including the demographic data, evaluation of the type of medication errors, cause of not reporting medication errors, and their influential factors. Data analysis was performed in SPSS version 16. Results: The most important causes of medication errors included ward-related factors (3.40±0.69), factors related to nursing management (3.31±0.91), and nurse-related factors (3.16±0.78). In addition, the most important cause of not reporting medication errors was the process of error reports. Significant associations were also observed between the demographic characteristics of the nurses, medication errors, medication protocols, nurse-related factors, ward-related factors, fear of the consequences of error reporting, factors related to the error report process, and fear of the managerial factors. Conclusion: Considering that most medication errors were correlated with ward-related and managerial factors, nursing managers must focus on correcting the influential processes in medication errors and their reporting, simultaneously seeking strategies to control and mitigate these errors.

Background: Probable effects of living donor liver transplantation on the wellbeing of the donor and psychological difficulties are necessary to be understood. Objective: To assess the quality of life of living donors after liver donation. Methods: 140 living donors who underwent hepatectomy between 2012 and July 2015 were enrolled in this study. Donors were asked to complete the Short Form 36-question Health Survey (SF-36) through face to face or by telephone interview. Results: The mean±SD age of donors at transplantation was 32.1±7.3 years; 83 (59.3%) of donors were female. 134 (95.7%) were married. The mean±SD BMI was 23.8±3.5 (kg/m2). “Mother-to-child” was the most frequent relationship (n=79, 56.4%). 22 (15.7%) complications were reported by participants. The mean±SD score of Physical Component Summary and Mental Component Summary were 48.8±14.6 and 50.1±6.9, respectively. Conclusion: Most living donors sustain a near average quality of life post-donation. It seems that living donation does not negatively affect the quality of life.

The relation between microstructure and the fracture mechanisms of δ-TRIP steel with different Nb-content has been investigated using complementary methods of light microscopy, SEM, EDS, EBSD, X-ray phase analysis and tensile test. The results revealed a close dependency between the presences of constitutive phases i.e. ferrite, bainite, retained austenite and martensite and the mode and characteristics of fracture. All samples revealed almost different fractography pattern which could be associated to the effect of Nb microalloying element. The different fractography patterns were consisted of dimple rupture, riverside and Wallner lines pattern. The proportion of the cleavage fracture in comparison of dimple rapture increased by increasing the Nb-content due to the increase of primary martensite in the microstructure. &nbsp

Background The liver transplant recipients are often subjected to excessive therapy by immunosuppressive drugs which produce several complications. Consequently, the minimization or even withdrawal of immunosuppression in selected patients is an attractive alternative. We investigated the frequency and characteristics of these near (or prope from Latin) tolerance in liver transplant recipients in Shiraz Organ Transplant Center. Material and methods We reviewed the medical records of over 3800 adult liver transplant recipients to select a group treated with a low-dose tacrolimus monotherapy (n = 90) between 1994 and 2017 in our transplant center. The patients with the best liver function parameters were selected; then, the clinician arbitrarily decided to withdraw steroids first and then mycophenolate mofetil and maintain each patient on a low dose tacrolimus. We compared the characteristics of prope tolerant recipients on a low-dose tacrolimus with those on standard immunosuppression, namely full-dose tacrolimus plus steroids and mycophenolate mofetil (n = 233). Data were analyzed by t-test, chi-square test using SPSS software version 16. Results Out of over 3800 liver transplant patients, 90 (2.34%) recipients were treated with a minimum dose of tacrolimus monotherapy. These recipients were compared to a selected group of 233 (6.1%) recipients treated with full-dose tacrolimus plus steroids and mycophenolate mofetil. In a prope tolerant group, there were 55 males (61.1%) and 35 females (38.9%) recipients. Mean age at the time of transplant was 39.92 ± (SD = 13.40) years with an average time from the transplantation time to completed weaning from triple immunosuppression to low-dose monotherapy of 41.35 months (SD = 17.27). The most common etiology of liver disease among both groups was viral hepatitis. Conclusion The achievement of prope (almost) immune tolerance was possible only in some liver transplant recipients with a relatively low risk of rejection. Our analysis suggests that there is a difference in the underlying diseases and recipients' age and the number of rejections between the two groups.

Aims: Epilepsy is one of the most prevalent childhood neurological disorders. As the primary caregivers, the mothers of epileptic children undergo different psychological pressures. The aim of the study was to investigate the effects of empowerment on the self-efficacy of the mothers of the epileptic children, concerning psychological adaptation, gaining support, and receiving information. Materials & Methods: In the controlled two-group random clinical trial with pretest and posttest steps, 100 mothers of epileptic children hospitalized in the Neurology Ward of Ghaem Hospital of Mashhad were studied in 2014. The subjects, selected via convenience sampling method, were randomly divided into two groups including experimental (n=50) and control (n=50) groups. Data was collected using the caregiver’s self-efficacy questionnaire. Only experimental group received the empowerment program, and no intervention was conducted in control group. The mothers’ self-efficacy was measured before and after the intervention in both groups. Data was analyzed by SPSS 11.5 software using independent T, paired T, Chi-square, Fisher’s exact, and covariance tests. Findings: The mean scores of self-efficacy, including psychological adjustment, gain a support, and receiving information, were not significantly different between the groups before the intervention (p>0.05). Nevertheless, the groups were significantly different after the intervention (p

Investigation of changes in rainfall and runoff patterns in various regions and determining their relationship in the sense of hydrology and climatology are of great importance, considering those patterns efficiently reveal the human and natural factors in this variability. One of the mathematical methods to recognise and model these fluctuations is Wavelet Analysis. This is a spectral method used in multivariate analysis and also tracing fluctuations in temporal series. In this study, continuous wavelet transformation is used to identify temporal changes in rainfall–runoff patterns. The hydrological and rain gauge data were collected from in situ measurements of Kermanshah province located in the western border of Iran. Precipitation anomalies were reconsidered in a number of stations, including Kermanshah, for a period of 55 years (1955–2010) and discharge of Gamasiab River in Polchehr station, discharge of Khoram Rood River in Aran-Gharb station and discharge of Gharasoo River in Polekohne station. In addition, anomalies of the climatic teleconnections were studied to emphasise the climatological effects on the runoff pattern in the region. The role of natural and anthropogenic effects (land use changes) has been distinguished and identified, using the comparison of the teleconnections and hydrological data. The results achieved from three stations show that there was an approximate correlation between rainfall, runoff and teleconnections until the year 1995; however, after 1995, a great difference appeared among them, specifically for the Aran-Gharb station (Khoram Rood River). The post-1995 slope of cumulative standardised anomaly is much steeper in the case of runoff compared to rainfall. As there were no significant climate changes in the region, it could be concluded that the runoff decrease is not caused by climate changes, but by anthropogenic effects, human interventions and extra water usage from the surface and underground water resources for agriculture and economic purposes.

Introduction: By appropriate method can be recycled more than 95 percent effluent backwashing the filter. This study aimed to examine the efficiency of the electrocoagulation process on turbidity and suspended solids removal from backwash effluent of rapid sand filter of water treatment plants No 1 in Karaj. Methods: This bench-scale experimental study was carried out on the samples of backwash effluent in a batch system. The Plexiglas tank with a volume of 4 liters, containing of 4 plate electrodes made of aluminum and iron was connected to a direct current power supply. Samples every 15 minutes to measure turbidity and suspended solids collected in the middle of the reactor and examined. Effect of several parameters such as current density, reaction time and voltage were studied. The total number of samples tested were 48. Turbidity and total suspended solids was measured by nephlometry and gravimetric method, respectively. Results: The highest removal efficiency of turbidity and suspended solids in reaction time of 60 minutes, current density of 2 mA and a voltage of 45 mV was observed. The highest removal efficiency of turbidity in aluminum and iron electrodes were 96.83 and 83.77 %, respectively. Also The highest removal efficiency of suspended solids were 96.73 and 86.22 %, respectively. Conclusion: The results showed that electro- coagulation process can be a good choice to remove turbidity and suspended from backwash of rapid sand filter. Aluminum electrode efficiency in the removal of turbidity and suspended solids was greater than the iron electrode.

Toxoplasma gondii (T. gondii) as an obligate intracellular protozoan with a worldwide distribution can infect virtually all warm-blooded animals and humans. This study aims to provide a summary of the available data on genotypes of T. gondii in human. Five databases including MEDLINE in PubMed, Scopus, Science Direct, Web of Science and Google Scholar were searched for the T. gondii genotyping in human during 1995–August 2017. Next, we screened all the articles based on the inclusion and exclusion criteria. Overall, 26 studies were eligible regarding genotyping T. gondii in human samples. In clonal genotyping, 167 out of 286 cases (58%) were infected with type II. Genetic characterisation of T. gondii isolates displayed that type II was the most predominant genotype in human with the prevalence of 64.3%, 62.1% and 41.7% in patients with AIDS, congenital and ocular toxoplasmosis, respectively. In ToxoDB genotyping, most individuals were infected with genotypes #9 and #65 (21.2%). Based on these results, genotype profile of T. gondii isolates is different throughout the world. The strains in Asian and African countries are characterised by low genetic diversity, while in North and South America a wide diversity of this parasite is found. In countries without any data (e.g. Australia, Western and Southern Africa and Western Asia), identification of T. gondii genotypes might discover higher genetic diversity.

There is a clinical need to identify novel biomarkers to improve diagnostic accuracy for the detection of urothelial tumors. The current study aimed to evaluate keratin 17 (K17), an oncoprotein that drives cell cycle progression in cancers of multiple anatomic sites, as a diagnostic biomarker of urothelial neoplasia in bladder biopsies and in urine cytology specimens. We evaluated K17 expression by immunohistochemistry in formalin-fixed, paraffin embedded tissue specimens of non-papillary invasive urothelial carcinoma (UC) (classical histological cases), high grade papillary UC (PUC-LG), low grade papillary UC (PUC-HG), papillary urothelial neoplasia of low malignant potential (PUNLMP), and normal bladder mucosa. A threshold was established to dichotomize K17 status in tissue specimens as positive vs. negative, based on the proportion of cells that showed strong staining. In addition, K17 immunocytochemistry was performed on urine cytology slides, scoring positive test results based on the detection of K17 in any urothelial cells. Mann–Whitney and receiver operating characteristic analyses were used to compare K17 expression between histologic diagnostic categories. The median proportion of K17 positive tumor cells was 70% (range 20–90%) in PUNLMP, 30% (range 5–100%) in PUC-LG, 20% (range 1–100%), in PUC-HG, 35% (range 5–100%) in UC but staining was rarely detected (range 0–10%) in normal urothelial mucosa. Defining cases in which K17 was detected in ≥10% of cells were considered positive, the sensitivity of K17 in biopsies was 89% (95% CI: 80–96%) and the specificity was 88% (95% CI: 70–95%) to distinguish malignant lesions (PUC-LG, PUC-HG, and UC) from normal urothelial mucosa. Furthermore, K17 immunocytochemistry had a sensitivity of 100% and a specificity of 96% for urothelial carcinoma in 112 selected urine specimens. Thus, K17 is a sensitive and specific biomarker of urothelial neoplasia in tissue specimens and should be further explored as a novel biomarker for the cytologic diagnosis of urine specimens.

Introduction: For a therapy to become an important part of a provider armamentarium it must be safer or better than existing therapies and be durable. The prostatic urethral lift offers rapid improvement in lower urinary tract symptoms associated with benign prostatic hyperplasia with minimal side effects. We report 2-year results of a multicenter, randomized, blinded trial of the prostatic urethral lift. Methods: A total of 206 men 50 years old or older with an AUA-SI of 13 or greater, a peak flow rate of 12 ml per second or less and a 30 to 80 cc prostate were randomized 2:1 between the prostatic urethral lift and sham treatment. The prostatic urethral lift is performed by placing permanent transprostatic implants to lift apart the prostate lobes and reduce urethral obstruction. Sham treatment entailed rigid cystoscopy, a blinding screen and sounds that mimicked those of the prostatic urethral lift procedure. Patients were assessed for lower urinary tract symptoms, peak flow rate, quality of life and sexual function. Results: The prostatic urethral lift reduced the AUA-SI 88% more than sham treatment (� 11.1 vs � 5.9, p ¼ 0.003). Patients with the prostatic urethral lift experienced an AUA-SI reduction from 22.1 at baseline to 18.0 (� 17%), 11.1 (� 50%), 11.4 (� 48%) and 12.5 (� 42%) at 2 weeks, 3 months, and 1 and 2 years, respectively (p

To report the five year results of a prospective, multi-center, randomized, blinded sham control trial of the Prostatic Urethral Lift (PUL) in men with bothersome lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH).At 19 centers in North America and Australia, 206 subjects ≥ 50 years old with International Prostate Symptom Score (IPSS )12, peak flow rate (Qmax) ≤ 12 mL/s, and prostate volume 30 cc-80 cc were randomized 2:1 to the PUL procedure or blinded sham control. In PUL permanent UroLift implants are placed to hold open the lateral lobes of the prostate to reduce urinary obstruction. After randomized comparison at 3 months and the only opportunity to add more PUL implants, PUL patients were followed to 5 years. LUTS severity (IPSS), quality of life (QOL), BPH Impact Index (BPHII), Qmax, sexual function, and adverse events were assessed throughout follow up.IPSS improvement after PUL was 88% greater than that of sham at 3 months. LUTS and QOL were significantly improved by 2 weeks with return to preoperative physical activity within 8.6 days. Improvement in IPSS, QOL, BPHII, and Qmax were durable through 5 years with improvements of 36%, 50%, 52%, and 44% respectively. No difference was seen between Intent to Treat and Per Protocol populations. Surgical retreatment was 13.6% over 5 years. Adverse events were mild to moderate and transient. Sexual function was stable over 5 years with no de novo, sustained erectile or ejaculatory dysfunction.PUL offers rapid improvement in symptoms, QOL and flow rate that is durable to 5 years. These improvements were achieved with minimal use of a postoperative urinary catheter, rapid return to normal, and preservation of both erectile and ejaculatory function. Symptom improvement was commensurate with patient satisfaction. PUL offers a minimally invasive option in the treatment of LUTS due to BPH.

Purpose: The aim of this study was to evaluate and analytically compare different calculation algorithms applied in our country radiotherapy centers base on the methodology developed by IAEA for treatment planning systems (TPS) commissioning (IAEA TEC‐DOC 1583). Material & Methods: Thorax anthropomorphic phantom (002LFC CIRS inc.), was used to measure 7 tests that simulate the whole chain of external beam TPS. The dose were measured with ion chambers and the deviation between measured and TPS calculated dose was reported. This methodology, which employs the same phantom and the same setup test cases, was tested in 4 different hospitals which were using 5 different algorithms/ inhomogeneity correction methods implemented in different TPS. The algorithms in this study were divided into two groups including correction based and model based algorithms. Results: A total of 84 clinical test case datasets for different energies and calculation algorithms were produced, which amounts of differences in inhomogeneity points with low density (lung) and high density (bone) was decreased meaningfully with advanced algorithms. The number of deviations outside agreement criteria was increased with the beam energy and decreased with advancement of the TPS calculation algorithm. Conclusion: Large deviations were seen in some correction based algorithms, so sophisticated algorithms, would be preferred in clinical practices, especially for calculation in inhomogeneous media. Use of model based algorithms with lateral transport calculation, is recommended. Some systematic errors which were revealed during this study, is showing necessity of performing periodic audits on TPS in radiotherapy centers.

We report the first multicenter randomized blinded trial of the prostatic urethral lift for the treatment of lower urinary tract symptoms secondary to benign prostatic hyperplasia.Men at least 50 years old with AUASI (American Urological Association Symptom Index) 13 or greater, a maximum flow rate 12 ml per second or less and a prostate 30 to 80 cc were randomized 2:1 between prostatic urethral lift and sham. In the prostatic urethral lift group small permanent implants are placed within the prostate to retract encroaching lobes and open the prostatic urethra. Sham entailed rigid cystoscopy with sounds mimicking the prostatic urethral lift. The primary end point was comparison of AUASI reduction at 3 months. The prostatic urethral lift arm subjects were followed to 1 year and assessed for lower urinary tract symptoms, peak urinary flow rate, quality of life and sexual function.A total of 206 men were randomized (prostatic urethral lift 140 vs sham 66). The prostatic urethral lift and sham AUASI was reduced by 11.1±7.67 and 5.9±7.66, respectively (p=0.003), thus meeting the primary end point. Prostatic urethral lift subjects experienced AUASI reduction from 22.1 baseline to 18.0, 11.0 and 11.1 at 2 weeks, 3 months and 12 months, respectively, p0.001. Peak urinary flow rate increased 4.4 ml per second at 3 months and was sustained at 4.0 ml per second at 12 months, p0.001. Adverse events were typically mild and transient. There was no occurrence of de novo ejaculatory or erectile dysfunction.The prostatic urethral lift, reliably performed with the patient under local anesthesia, provides rapid and sustained improvement in symptoms and flow, while preserving sexual function.

Frequently, a certain solution of a nonlinear wave equation is of interest, but no analytic form is known, and one must work with approximations. We introduce a search strategy to find solutions of the propagation of soliton molecules in a dispersion-managed optical fiber and to determine their shape with some precision. The strategy compares shapes before and after propagation and invokes an optimization routine to minimize the difference. The scheme is designed to be implemented in an experiment so that all fiber parameters are taken into account. Here, we present a full numerical study and a verification of convergence; we validate the method with cases of known solutions. We also compare the performance of two optimization procedures, the Nelder–Mead simplex method and a genetic algorithm.

Methyl tertiary-butyl ether (MTBE) is used to reduce carbon monoxide and ozone in urban air and to boost fuel octane. There is a lack of knowledge in the literature about the histomorphometric changes of the testis following exposure to MTBE. Therefore, this experimental study was performed to determine the effect of oral exposure to MTBE on histologic and histomorphometric changes of testis in adult rat. A total of 25 adult male Sprague-Dawley rats were randomly divided into five equal experimental groups: control, almond oil and three treatment groups which received 400, 800 and 1600 mg/kg/day MTBE in almond oil by gavages for 30 consecutive days. Histomorphometric analysis showed no significant difference in absolute and relative testis weight, connective tissue thickness, germinal epithelium height, tunica albuginea thickness and Sertoli cell numbers between experimental groups (P>0.05). However, trend analysis showed that the seminiferous tubule diameter increased and interstitial cell numbers as well as spermatocyte and spermatid cell numbers decreased significantly in MTBE treated groups (P

Noncardiac surgery in patients with hypoplastic left heart syndrome has been associated with significant morbidity and mortality in case reports and small series.A retrospective study to review the anaesthetic care and outcomes of patients with hypoplastic left heart syndrome undergoing noncardiac surgery.The medical records of patients undergoing anaesthesia for noncardiac surgery were reviewed, including anaesthesiology records, operative notes, admission history, physical examination records and discharge summaries. Data were collected on patient characteristics, co-morbidities, surgical procedure, anaesthetic and monitoring techniques, intraoperative and postoperative complications and admission status.A tertiary medical centre with a high volume of congenital heart disease.Seventy-three procedures performed in 40 patients with hypoplastic left heart syndrome undergoing noncardiac surgery between July 2002 and May 2008.Thirty-three procedures were performed on an outpatient basis without invasive monitoring or complications. Adverse events occurred in 11 (15%) cases, including cardiovascular and respiratory instability, airway obstruction and postoperative stridor, with 13 (18%) patients admitted to the ICU postoperatively.Given the high incidence of adverse events in this patient population, it is imperative that perioperative care be individualised based on the presence of known risk factors such as the stage of palliation, residual cardiac disease and severity of planned surgery.