ABSTRACT
BACKGROUND: High toll of traffic-related injuries, climate change, natural disasters, population aging, as well as chronic diseases have all made considerable demands on receiving physiotherapy services in Iran. Nevertheless, there is an assortment of complications facing utilization of such services, particularly poor insurance coverage. Therefore, the present study investigated and identified gaps in insurance coverage in order to inform future policy reforms and the design of a more comprehensive and universal benefits package for physiotherapy services in Iran. METHODS: This project was carried out in Iran, using a mix-methods (viz. qualitative-quantitative) approach. Within the first phase, a qualitative study was completed to find policy recommendations. Such recommendations were then prioritized through the Analytical Hierarchy Process (AHP), in the second phase, based on effectiveness, acceptability, cost, fairness, feasibility, and time. RESULTS: Within the first phase, a total number of 30 semi-structured interviews with health policy-makers, health insurers, faculty members, rehabilitation experts, and physiotherapists were completed. Several policy recommendations were also proposed by the study participants. Following the second phase, prioritized recommendations were provided to promote stewardship (e.g., informing policy-makers about physiotherapy services), collection of funds (e.g., placing value-added taxes on luxury goods and services), pooling of funds (e.g., moving allocated resources towards insurance (viz. third-party) mechanism), purchasing (e.g., using strategic purchasing), and benefit package (e.g., considering preventive interventions) as the main components of insurance coverage. CONCLUSION: The study findings provided a favorable ground to improve insurance coverage for physiotherapy services in Iran. As well, decision- and policy-makers can place these recommendations on the agenda in the health sector to protect population health status, especially that of groups with disabilities.
ABSTRACT
Abstract Background: Fertility and health traits, other than production traits, have a major role in the profitability of dairy cattle. Therefore, it seems necessary to include the afore mentioned traits in breeding programs. Hence, genetic parameters are needed to establish breeding plans. Objective: To estimate heritabilities as well as genetic and environmental relationships among total milk yield (TMY), persistency of milk yield (PMY), mean somatic cell count (SCC), mean loge somatic cell count (LnSCC), standard deviation of somatic cell count (stdSCC), and calving interval (CI) using two-trait and multi-trait analyses in Iranian Holstein. Methods: The dataset consisted of 25,883 first lactation records collected from 2002 to 2007 in 97 Holstein dairy herds in Iran. Four criteria of persistency of milk yield (PMY) were calculated using the Wood's gamma function. The WOMBAT1.0 software was used to estimate the (co)variance components using the Average Information Restricted Maximum Likelihood algorithm. Results: Total milk yield (TMY) resulted in the highest heritability estimate (0.29). Heritability estimates for different criteria of persistency of milk yield (PMY) ranged from 0.05 to 0.10. The unfavorable genetic correlation between TMY and calving interval (CI) was 0.71, while that of PMY with CI was 0.46. The estimated environmental correlations were lower than the genetic correlations for all traits, but the trends were generally similar. Conclusion: The results indicate that including PMY in the breeding goals could increase TMY and CI, and decrease somatic cell count (SCC).
Resumen Antecedentes: Las características de fertilidad y salud, además de las de producción, tienen un papel importante en la rentabilidad de los hatos lecheros. Por lo tanto, parece necesario incluir los rasgos mencionados en los sistemas de mejoramiento. Por ende, los parámetros genéticos son necesarios para establecer planes de cría. Objetivo: Estimar la heredabilidad, así como las relaciones genéticas y ambientales entre el rendimiento total de leche (TMY), la persistencia del rendimiento lechero (PMY), el recuento medio de células somáticas (SCC), el recuento de células somáticas de loge promedio (LnSCC), la desviación estándar del recuento de células somáticas (stdSCC) y el intervalo de partos (CI) en vacas Holstein mediante análisis de dos rasgos y análisis múltiples. Métodos: Se analizaron registros de primera lactancia de 25.883 vacas Holstein, recolectados entre 2002 y 2007 en 97 rebaños lecheros de Irán. Se calcularon cuatro criterios de persistencia del rendimiento lácteo utilizando la función gamma de Wood. El software Wombat1.0 se utilizó para estimar los componentes de (co)varianza que emplean el algoritmo de máxima verosimilitud restringida de información promedio. Resultados: El rendimiento de leche (TMY) obtuvo la mayor heredabilidad estimada (0,29). Las estimaciones de heredabilidad para diferentes criterios de persistencia del rendimiento de la leche variaron de 0,05 a 0,10. La correlación genética desfavorable entre TMY e intervalo entre partos fue 0,71, mientras que la de PMY con el CI fue de 0,46. Las correlaciones ambientales estimadas fueron inferiores a las correlaciones genéticas para todos los rasgos, pero las tendencias fueron, en general, similares. Conclusión: Incluir el PMY en la meta de cría podría aumentar el TMY y CI, además de disminuir el recuento de células somáticas (SCC).
Resumo Antecedentes: As características de fertilidade e saúde, além das características de produção, têmum papel importante narentabilidade das vacas leiteiras. Por isso, parece necessário incluir as características já mencionadas nos sistemas de melhoramento genético. Assim, são necessários parâmetros genéticos para estabelecer planos de melhoramento genético. Objetivo: Estimar herdabilidade, bem como as relações genéticas e ambientais entre a produção total de leite (TMY), persistância da produção de leite (PMY), contagem médiade células somáticas (SCC), contagem média de células somáticas loge (LnSCC), desviopadrao da contagem média de células somáticas (stdSCC) e intervalo de pertosem (CI) vacas Holstein por duas análises de características e traços multiplos. Métodos: O conjunto de dados consistiuem registros de 25.883 vacas Holstein de primeira lactação coletadas de 2002 a 2007 em 97 rebanhos leiteiros em Iran. Foram calculados quatrocritérios de persistência da produção de leite utilizando a função gama de Wood. O software Wombat1.0 foi usado para estimar os componentes de (co)variância que empregam o algoritmo de máxima verossimilhança com informações restritas. Resultados: A maior herdabilidade (0,29) foi estimada para produção de leite. As estimativas de herdabilidade para diferentes critérios de persisténcia da produção de leite variaram 0,05 a 0,10. A correlação genética desfavorável entre o intervalo TMY eo intervalo de parto foi de 0,71 enquanto que a de PMY com CI foi de 0,46. As correlações ambientais estimadas foram inferiores às correlações genéticas para todos os traços, mas as tendencias foram geralmente semelhantes. Conclusão: Os resultados indicaram que a inclusão de PMY na meta de reprodução poderia aumentar TMY e CI, no entanto, diminuir a contagem de células somáticas.
ABSTRACT
PURPOSE: The goal of this study was to compare the cheese-wiring effects of three sutures with different coefficients of friction. MATERIALS AND METHODS: Sixteen human cadaveric shoulders were dissected to expose the distal supraspinatus and infraspinatus muscle tendons. Three sutures were stitched through the tendons: #2 Orthocord(™) suture (reference #223114, DePuy Mitek, Inc., Raynham, MA), #2 ETHIBOND* EXCEL Suture, and #2 FiberWire(®) suture (FiberWire(®), Arthrex, Naples, FL). The sutures were pulled by cyclic axial forces from 10 to 70 N at 1 Hz for 1000 cycles through a MTS machine. The cut-through distance on the tendon was measured with a digital caliper. RESULTS: The cut-through distance in the supraspinatus tendons (mean ± standard deviation, n = 12) were 2.9 ± 0.6 mm for #2 Orthocord(™) suture, 3.2 ± 1.2 mm for #2 ETHIBOND* suture, and 4.2 ± 1.7 mm for #2 FiberWire(®) suture. The differences were statistically significant analyzing with analysis of variance (P = 0.047) and two-tailed Student's t-test, which showed significance between Orthocord(™) and FiberWire(®) sutures (P = 0.026), but not significant between Orthocord(™) and ETHIBOND* sutures (P = 0.607) or between ETHIBOND* and FiberWire(®) sutures (P = 0.103). CONCLUSION: The cheese-wiring effect is less in the Orthocord(™) suture than in the FiberWire(®) suture in human cadaveric supraspinatus tendons. CLINICAL RELEVANCE: Identification of sutures that cause high levels of tendon cheese-wiring after rotator cuff repair can lead to better suture selection.
ABSTRACT
BACKGROUND: Persistent angular deformities around the knee can lead to growth-plate damage in childhood and osteoarthritis in adulthood. The treatment options include osteotomy and hemiepiphysiodesis. Tension-band plate hemiepiphysiodesis with 8-plate is an effective way to correct these deformities. However, its high cost makes it less available in many countries. In the present series, we have used 3.5 mm reconstruction plates for tension-band temporary hemiepiphysiodesis. METHODS: Twenty-one patients with bilateral angular deformities of the knee (42 extremities) underwent temporary hemiepiphysiodesis with 3.5 mm reconstruction plates. The diagnosis, BMI, weight, amount of correction of the deformity age, and device failure were analyzed. The mean follow-up period after plate removal was 17 months (ranging from 8 to 24 mo). RESULTS: The mean age of the patients was 10 years and 3 months (± 2 y and 10 mo). Complete correction of the deformities was achieved in 86% of patients. Of the 58 plate and screw constructs, 10% had screw breakage. Patients with genu valgum had 2 screw failures (6.25%), but in the genu varum group there were 4 screw failures (40%). Of the 3 patients who did not have complete correction of the deformities, 2 had mucopolysaccharidosis and 1 was nearing skeletal maturity (16 y old). The age of the patient, body weight, BMI, and degrees of angulation did not have any statistically significant correlation with the screw failure. Screw failures in female patients were more common than in male patients. All implant failures occurred in idiopathic patients. CONCLUSIONS: The efficacy of 3.5 mm reconstruction plates for temporary hemiepiphysiodesis around the knee is similar to that of 8-plates. However, the reconstruction plates have a lower cost and are easily available. Noncanulated 3.5 or 4.5 mm cortical screws seem to be superior to 4 mm noncanulated cancellous screws. LEVEL OF EVIDENCE: Level 3.
