Spatially explicit modeling of disease surveillance in mixed oak-hardwood forests based on machine-learning algorithms.

Incidences of disease, dieback, decline or mortality, some of which induced or enhanced by climate change, threaten the sustainability of forest stands in many ecosystems. Spatially explicit prediction of disease onset remains challenging, however, due to the involvement of several causative agents. In this paper, we developed a generic framework based on machine-learning algorithms and spatial analyses for landscape-level prediction of oak disease outbreaks caused by the charcoal fungus Biscogniauxia mediterranea in a mixed-oak forest of Mediterranean climate. For prediction, we used a set of fifteen causative factors as a cross-function of soil, site and stand-related predictors. A total of 80 sample plots, including 1134 affected trees, were surveyed and used for the modeling process at the 5600-ha landscape level of the southern Zagros, Iran, where the disease occurs in roughly 25% of forest lands. Ten machine learning algorithms were explored and the performance of each algorithm to predict oak disease outbreak was evaluated. The modeling framework used maximum entropy to remove the least influential variables and build the status-quo management scenario to which the results of the prediction models were compared. Results showed that the random forests algorithm (AUC = 0.96: Precision = 0.71: Accuracy = 0.90: F-Measure = 0.70) achieved significantly better results than the status-quo management (Precision = 0.13: Accuracy = 0.67: F-Measure = 0.12) and any other algorithm. Soil chemical properties (NPK, organic carbon and EC) and landform predictors (slope, distance to roads, and TWI) were major forecasters of oak disease outbreak identified by the random forest algorithm. Geostatistical analysis enabled the creation of a map that identified sites at higher risk of infestation, allowing epidemiologists and forest managers to find sites likely to be infested. Consequently, financial resources can be allocated and management practices such as sanitation felling treatments applied across large forest landscapes to minimize the risk of spread and severity to uninfested high-value trees on nearby or adjacent land zones that are in the early stage of epidemics.

Emergency hospital admissions for cardiovascular diseases attributed to air pollution in Tehran during 2016-2019.

The burden of five main air pollutants, including CO, O3, NO2, SO2, and PM2.5, on the emergency department visits (EDVs) during January 2016-December 2019 due to all cardiovascular diseases was assessed in Tehran by using a time-series model. The pollutants data were collected from Iran Department of Environment including 10 air pollution monitoring stations for the period of our study. Cumulative relative risk and attributable number/fraction were calculated for each pollutants by a Quasi-Poisson time-series regression and distributed lag non-linear model (DLNM). The maximum lag was set to 14 days because harvesting effect is more likely happened during few days. We used percentile 25 as reference value in order to calculate cumulative relative risk and attributable fraction. About 69,000 patients with cardiovascular symptoms have been admitted into the hospital during 4 years. The cumulative relative risk during the 14 days was 1.13 (1.01, 1.26), 1.15 (1.02, 1.29), and 1.08 (1.01, 1.18) for CO, NO2, and PM2.5, respectively. The numbers attributed to all values of CO were more than others; about 3800 EDVs were significantly attributed to CO, of which over 3000 were significantly attributed to high values of the pollutant. Low values of all pollutants were, not surprisingly, responsible for low number of EDVs. PM2.5, CO, and NO2 were responsible to considerable attributable number of EDVs. Our study emphasizes the need for local authorities to establish a program to reduce the air pollution in Tehran.

Interaction of Safety Climate and Safety Culture: A Model for Cancer Treatment Centers

Background: In health care institutions, safety culture is defined as the integrity of individual and group efforts to reduce the harms for the patients. This is possible through interactions, attitudes, and understanding of safety matters. On the other hand, one of the indicators of the safety culture is the safety climate. Objective: The aim of this study is to investigate the interaction between safety climate and safety culture using structural equation modeling in personnel of cancer treatment centers in Iran. Methods: In this study, 680 personnel of Iran's hospitals were chosen in a random manner. Demographic (9 questions), safety culture (42 questions) and safety climate (37 questions) questionnaires were filled. The data were inserted in SPSS 20 software. Descriptive statistics method and Pearson's correlation coefficient were used to describe the data and evaluate the relation between the variables, respectively. Structural equations model was developed using AMOS 22 software and fitness of the model was tested by χ2, RMSEA, GFI and NFI statistics. Results: The scores of safety climate and safety culture were 3.61 and 3.30, respectively, which imply that they are suiTable. The overall fitness of the model was accepTable. In this model, χ2 = 8637.17, df = 2964, χ2/df = 2.914, RMSEA = 0.058, NFI = 0.912, GFI=0.907, and CFI=0.875. In the regression analysis, there were positive significant relationships between safety climate and safety culture, safety climate and any of its components, and safety culture and any of the components. Conclusion: It was found that the safety climate and the safety culture had a positive impact on each other; so that with increasing safety climate, the safety culture also increases, and vice versa. Also, the level of education has a positive impact on safety culture and safety climate. So appropriate training can promote both variables in cancer treatment hospitals.

COMPARE CPM-RMI Trial: Intramyocardial Transplantation of Autologous Bone Marrow-Derived CD133+ Cells and MNCs during CABG in Patients with Recent MI: A Phase II/III, Multicenter, Placebo-Controlled, Randomized, Double-Blind Clinical Trial.

This article published in Cell J (Yakhteh), Vol 20, No 2, Jul-Sep 2018, on pages 267-277, four affiliations (1, 4, 5, and 10) were changed based on authors request.

COMPARE CPM-RMI Trial: Intramyocardial Transplantation of Autologous Bone Marrow-Derived CD133+ Cells and MNCs during CABG in Patients with Recent MI: A Phase II/III, Multicenter, Placebo-Controlled, Randomized, Double-Blind Clinical Trial.

OBJECTIVES: The regenerative potential of bone marrow-derived mononuclear cells (MNCs) and CD133+ stem cells in the heart varies in terms of their pro-angiogenic effects. This phase II/III, multicenter and double-blind trial is designed to compare the functional effects of intramyocardial autologous transplantation of both cell types and placebo in patients with recent myocardial infarction (RMI) post-coronary artery bypass graft. MATERIALS AND METHODS: This was a phase II/III, randomized, double-blind, placebo-controlled trial COMPARE CPM-RMI (CD133, Placebo, MNCs - recent myocardial infarction) conducted in accordance with the Declaration of Helsinki that assessed the safety and efficacy of CD133 and MNCs compared to placebo in patients with RMI. We randomly assigned 77 eligible RMI patients selected from 5 hospitals to receive CD133+ cells, MNC, or a placebo. Patients underwent gated single photon emission computed tomography assessments at 6 and 18 months post-intramyocardial transplantation. We tested the normally distributed efficacy outcomes with a mixed analysis of variance model that used the entire data set of baseline and between-group comparisons as well as within subject (time) and group×time interaction terms. RESULTS: There were no related serious adverse events reported. The intramyocardial transplantation of both cell types increased left ventricular ejection fraction by 9% [95% confidence intervals (CI): 2.14% to 15.78%, P=0.01] and improved decreased systolic wall thickening by -3.7 (95% CI: -7.07 to -0.42, P=0.03). The CD133 group showed significantly decreased non-viable segments by 75% (P=0.001) compared to the placebo and 60% (P=0.01) compared to the MNC group. We observed this improvement at both the 6- and 18-month time points. CONCLUSIONS: Intramyocardial injections of CD133+ cells or MNCs appeared to be safe and efficient with superiority of CD133+ cells for patients with RMI. Although the sample size precluded a definitive statement about clinical outcomes, these results have provided the basis for larger studies to confirm definitive evidence about the efficacy of these cell types (Registration Number: NCT01167751).

Evaluation of Bond Strength of Pressed and Layered Veneering Ceramics to Nickel-Chromium Alloy.

STATEMENT OF THE PROBLEM: The success of metal- ceramic- restorations (MCR) depends on the presence of strong bond between porcelain and metal substructure. PURPOSE: The purpose of this study was to evaluate the effect of hot pressing technique on the bond strength of a metal-porcelain composite in comparison to layering technique. MATERIALS AND METHOD: Thirty Nickel-Chromium specimens were produced by two methods; conventional porcelain layering on metal and hot pressing (n=15). Bond strengths of all specimens were assessed by the means of three-point bending test according to ISO 9693: 1999 (E) instructions. The data were analyzed using Students t-test (p< 0.001). RESULTS: The mean ± SD bond strength of conventional and hot pressing technique was 48.29 ± 6.02 and 56.52 ± 4.97, respectively. Therefore, the conventional layering technique yielded significantly lower mean bond strength values than hot pressing technique (p< 0.001). CONCLUSION: This study showed that it is possible to improve metal-porcelain bond strength significantly by applying an overpressure during porcelain firing.

Up regulation of Bax and down regulation of Bcl2 during 3-NC mediated apoptosis in human cancer cells.

BACKGROUND: Recently, we have reported the induction of apoptosis by 2-amino-4-(3-nitrophenyl)-3-cyano-7-(dimethylamino)-4H-chromene (3-NC) in HepG2, T47D and HCT116 cells with low nano molar IC50 values. In this study, anti-proliferative effects of modified 4-aryle-4H-chromenes derivatives; 2-amino-4-(3-bromophenyl)-3-cyano-7-(dimethylamino)-4H-chromene (3-BC), 2-amino-4-(3-trifluoromethylphenyl)-3-cyano-7-(dimethylamino)-4H-chromene (3-TFC) and 2-amino-4-(4,5-methylenedioxyphenyl)-3-cyano-7-(dimethylamino)-4H-chromene (4, 5-MC) were investigated in three human cancer cell lines. Compared to 3-NC none of the compounds displayed better anti-proliferative effect, although 3-BC appeared somewhat similar. Therefore 3-NC was selected for further studies. METHODS AND RESULTS: Treatment of HepG2, T47D and HCT116 cells with this compound induced apoptosis as visualized by fluorescence microscopic study of Hoechst 33258 stained cells. Induction of apoptosis was quantified by Annexin V/PI staining using flow cytometry. Western blot analysis also revealed that 3-NC down-regulated the expression of anti-apoptotic protein Bcl2 and up-regulated pro-apoptotic protein Bax, in all of the cell lines. Nonetheless, HepG2 cell line was the most responsive to 3-NC as Bax and Bcl2 showed the most dramatic up and down regulation. CONCLUSION: Our previous finding that 3-NC down regulates Inhibitor of Apoptosis Proteins (IAPs) and the present observation that Bax is upregulated and Bcl2 is down regulated upon 3-NC treatment, this chromene derivative has the potential to overcome chemotherapy resistance caused by up regulation of these proteins.

Behavioral determinants of cardiovascular diseases risk factors: A qualitative directed content analysis.

BACKGROUND: The PRECEDE model is a useful tool for planers to assess health problems, the behavioral and environmental causes of the problems, and their determinants. This study aims to understand the experiences of patients and health care providers about the behavioral causes of cardiovascular diseases (CVDs) risk factors and their determinants. METHODS: This qualitative study utilized content analysis approach based on the PRECEDE model. The study was conducted for over 6 months in 2012 at the diabetes units of health centers associated with Alborz University of Medical Sciences, which is located in Karaj, Iran. Data were collected using individual semi-structured interviews with 50 patients and 12 health care providers. Data analysis was performed simultaneously with data collection using the content analysis directed method. RESULTS: Stress, unhealthy eating, and physical inactivity were the behaviors, which predict the risk factors for CVD. Most of the patients considered stress as the most important underlying cause of their illness. In this study, 110 of the primary codes were categorized into seven subcategories, including knowledge, attitude, perceived susceptibility, severity, perceived benefits, barriers, and self-efficacy, which were located in the predisposing category of the PRECEDE model. Among these determinants, perceived barriers and self-efficacy for the mentioned behaviors seemed to be of great importance. CONCLUSION: Identifying behavioral determinants will help the planners design future programs and select the most appropriate methods and applications to address these determinants in order to reduce risky behaviors.

Environmental determinants of cardiovascular diseases risk factors: a qualitative directed content analysis.

BACKGROUND: Cardiovascular diseases (CVDs) are the number one cause of death in the world. In most analyses of health problems, environment plays a significant and modifiable role in causing the problem either directly or indirectly through behavior. OBJECTIVES: This study aims to understand the patients and healthcare providers' experiences about the environmental determinants of CVD risk factors based on the Precede Model. PATIENTS AND METHODS: This qualitative study conducted over six months in 2012 at Diabetes Units of Health Centers associated with Alborz University of Medical Sciences and Health Services which is located in Karaj, Iran. The data were collected based on individual semi-structured interviews with 50 patients and 12 healthcare providers. Data analysis was performed simultaneous with data collection using the content analysis directed method. RESULTS: Lack of behaviors like stress control, healthy eating and physical activity were the roots of the risk factors for CVD. The environmental factor is one of the barriers for conducting these behaviors. The environmental barriers included of structural environment including "availability and accessibility of health resources", "new skills", and "law and policies" which are located in enabling category and social environment including "social support", "motivation to comply" and "consequences of behavior" which are located in reinforcing category. The most barriers to performing health behaviors were often structural. CONCLUSIONS: The environmental factors were barriers for doing healthy behaviors. These factors need to be considered to design health promotion interventions. Policymakers should not only focus on patients' education but also should provide specific facilities to enhance economic, social and cultural status.

Neonatal bacteriemia isolates and their antibiotic resistance pattern in neonatal insensitive care unit (NICU) at Beasat Hospital, Sanandaj, Iran.

Bacteremia continues to result in significant morbidity and mortality, particularly among neonates. There is scarce data on neonatal bacteremia in among Iranian neonates. In this study, we determined neonatal bacteremia isolates and their antibiotic resistance pattern in neonatal insensitive care unit at Beasat hospital, Sanandaj, Iran. During one year, all neonates admitted to the NICU were evaluated. Staphylococcal isolates were subjected to determine the prevalence of MRS and mecA gene. A total of 355 blood cultures from suspected cases of sepsis were processed, of which 27 (7.6%) were positive for bacterial growth. Of the 27 isolates, 20 (74%) were Staphylococcus spp as the leading cause of bacteremia. The incidence of Gram negative bacteria was 04 (14.8%). The isolated bacteria were resistant to commonly used antibiotics. Maximum resistance among Staphylococcus spp was against Penicillin, and Ampicillin. In our study, the isolated bacteria were 7.5 % Vancomycin and Ciprofloxacin sensitive. Oxacillin disk diffusion and PCR screened 35% and 30% mec a positive Staphylococcus spp. The spectrum of neonatal bacteremia as seen in NICU at Beasat hospital confirmed the importance of pathogens such as Staphylococcus spp. Penicillin, Ampicillin and Cotrimoxazol resistance was high in theses isolates with high mecA gene carriage, probably due to antibiotic selection.

The evaluation of perioperative safety of local anesthesia with lidocaine containing epinephrine in patients with ischemic heart disease.

The use of local anesthesia with lidocaine containing epinephrine in patients with cardiac disease is controversial in the literature. The aim of our study was determining the safety of use the local anesthesia contain epinephrine in patients with ischemic heart disease that undergoing reconstructive surgery. Thirty two patients that had known ischemic heart disease and candidate to undergo reconstructive surgery for skin tumor enrolled in this study.  All patients continued their medication for cardiac disease till morning of the operation. 10 ml lidocaine 2% containing 1:100,000 epinephrine was injected in patients for local anesthesia. The hemodynamic changes and electrocardiographic variables before injection were compared with them after injection, during surgery and till 6 hours postoperation period. A 12 lead electrocardiogram was recorded in all our cases for detection of myocardial ischemic changes. The mean age, weight and height were 58.2±10.4, 74.8.±14.4 kg and 164.5± 8 cm respectively. Twelve patients (37.5%) were diagnosed with systemic hypertension and 10 patients with diabetes (31.2%). The comparison of change of systolic, diastolic and mean blood pressure between baseline, during procedure and after operation defined that our subjects did not have any significant disturbance in blood pressure in perioperative period. The comparison of baseline heart rate with heart rate after injection, during procedure and in postoperation period indicated a significant changes in this variable (P=0.044). The heart rhythm during the perioperative period also failed to exhibit alterations. The ischemic change was not recorded in our patients before injection compared to after injection. None of our patients have any early complications because of infiltration of local anesthetic containing epinephrine in our patients. The use of 10 ml 2% lidocaine with epinephrine 1:100,000 in patients with cardiac disease represent a safe anesthetic procedure. These patients experienced a more profound anesthesia with hemodynamic stability and without myocardial ischemic changes.

Genetic Variation and Selection of Domain I of the Plasmodium vivax Apical Membrane Antigen-1(AMA-1) Gene in Clinical Isolates from Iran.

BACKGROUND: Apical Membrane antigen 1 (AMA-1) is positioned on the surface of merozoite and it may play a role in attack to red blood cells. The main aim of present study was to determine the genetic variation, as well as, to detect of selection at domain I of AMA-1 gene Plasmodium vivax isolates in Iran. METHODS: Blood samples were collected from 58 patients positive for P. vivax, mono infection and the domain I of AMA-1 gene was amplified by nested PCR and then sequenced. RESULTS: A total 33 different haplotypes were identified among 58 Iranian sequences. The 23 new haplotypes were determined in this study that was not reported previously in other regions of the world. There were totally observed 36 point mutations at the nucleotide level in the analyzed sequences. Sequences analyses indicated 25 amino acid changes at 20 positions in which 5 sites demonstrated thrimorphic polymorphism and the others were dimorphic in the domain I of the Iranian PvAMA-1 isolates. CONCLUSION: Our findings indicated relatively high level of allelic diversity at the domain I of PvAMA-1 among P.vivax isolates of Iran. Since, PvAMA-1 is considering as vaccine candidate antigen, these data provide valuable information for the development of a PvAMA-1 based malaria vaccine.

Coincidence of free-floating thrombus in the aortic arch, severe mitral stenosis, and left atrial appendage clot.

We describe the surgical management of a free-floating thrombus in the aortic arch in a patient with severe mitral stenosis, a left atrial appendage (LAA) clot, and an iliac artery thrombus. A 60-year-old woman complaining of dyspnea and pain in her right leg was referred to our multidisciplinary clinic. After a brief history was taken, an electrocardiography evaluation showed atrial fibrillation. Color Doppler sonography of the lower limb arteries showed decreased blood flow in distal branches of the internal iliac artery of the right leg. Transthoracic and transesophageal echocardiography evaluations revealed severe mitral stenosis, a large LAA clot, and a large mobile mass (2 × 1.5 × 1.5 cm) in the distal aortic arch. Additional investigations with computed tomographic angiography revealed that the thrombus extended from the aortic arch to the subclavian artery. Another bulky thrombus in the right iliac artery was also found. Given this complicated medical situation, emergency cardiac surgery was performed, and the clot was removed. The stenotic mitral valve was replaced with a prosthetic valve, The LAA was closed after clot removal, and the bulky thrombus was extracted from the right iliac artery. Transesophageal echocardiographic data were obtained postoperatively, and the patient's course in the intensive care unit was favorable. She was discharged from the hospital in good condition on warfarin, digoxin, aspirin, and metoprolol.

Diagnosis and treatment of disseminated intravascular coagulation: a case report.

Disseminated intravascular coagulation is a pathologic syndrome with different medical disorders. Diagnosis and treatment of this syndrome is one of the difficult managements in medical science. Thromboelastogram is the only guide for early diagnosis and precise management of this syndrome. We describe a patient who developed disseminated intravascular coagulation due to endocarditis and spleen abscess. She was diagnosed by thromboelastography and treated successfully.