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Objectives: The ratio of observed to expected mortality (standardized mortality ratio, SMR), is a key indicator of quality of care. We use PreControl Charts to investigate SMR behavior over time of an existing tree-model for predicting mortality in intensive care units (ICUs) and its implications for hospital ranking. We compare the results to those of a logistic regression model.Methods: We calculated SMRs of 30 equally-sized consecutive subsets from a total of 12,143 ICU patients aged 80 years or older and plotted them on a PreControl Chart. We calculated individual hospital SMRs in 2009, with and without repeated recalibration of the models on earlier data.Results: The overall SMR of the tree-model was stable over time, in contrast to logistic regression. Both models were stable after repeated recalibration. The overall SMR of the tree on the whole validation set was statistically significantly different (SMR 1.00 ± 0.012 vs. 0.94 ± 0.01) and worse in performance than the logistic regression model (AUC 0.76 ± 0.005 vs. 0.79 ± 0.004; Brier score 0.17 ± 0.012 vs. 0.16 ± 0.010). The individual SMRs' range in 2009 was 0.53-1.31 for the tree and 0.64-1.27 for logistic regression. The proportion of individual hospitals with SMR >1, hinting at poor quality of care, reduced from 38% to 29% after recalibration for the tree, and increased from 15% to 35% for logistic regression.Conclusions: Although the tree-model has seemingly a longer shelf life than the logistic regression model, its SMR may be less useful for quality of care assessment as it insufficiently responds to changes in the population over time. [ABSTRACT FROM AUTHOR]

Introduction: About 30 percent of the worldwide death is due to cardiovascular diseases. Clinical simulation is a promising filed that can help to understand diseases, their nature and intervention's effects. The simulated models are flexible and make it easy to study the changes' effects and help to select the appropriate interventions. This narrative review aims to report common methods for the clinical simulation and its merits focusing on the cardiovascular field especially those pertaining to the aortic valve. Method: The search was conducted on google scholar and PubMed in August and September of 2014 with three queries' categories. We searched among English papers with no limitation on the published year. A qualitative-interpretive approach was used for data extraction. Results: Computational fluid dynamic (CFD) is used to simulate and study body structures, systems and their common phenomena. Its two common methods for cardiovascular simulations are Finite Element Method (FEM) and Finite Volume Method (FVM). There were two kinds of the aortic valve simulation: dry models and Fluid-Structure Interaction (FSI) models. Unlike the dry model, FSI models consider the interaction between blood flow and tissue. Clinical simulation is a promising field allowing statistical analysis and can be used in clinical decision support systems (CDSS) or as a virtual experimental platform as a training system. [ABSTRACT FROM AUTHOR]

Objective: To compare clinical and bacteriologic responses to intramuscular benzathine penicillin G (BPG) and single dose of amoxicillin in Group A streptococcal (GAS) pharyngitis. Design: This study included 571 children from 6 to 15 years old age, with pharyngitis, who were admitted to 45 elementary and guidance schools from 7 regions of Education Organization in North-East of Iran, Mashhad. They were screened for enrollment and if he/she presented pharyngitis with clinical criteria of sore throat, erythema, exudate and tender or enlarged anterior cervical lymph nodes. Exclusion criteria included reports of antibiotic use, negative throat culture for GAS and history of allergy to the drugs. Clinical and bacteriologic responses to BPG and once daily orally amoxicillin were considered and compared. Results: In the amoxicillin group, treatment failure was more than the penicillin group (18.9% vs. 6.4%, respectively) but the difference was not statistically significant (p < 0.05). Both drugs were significantly effective in reducing pharyngitis manifestations but penicillin was significantly more effective in reducing exudate than amoxicillin. Conclusion: Our study was in line with studies comparing the two drugs. The results show that once-daily therapy with amoxicillin is as effective as intramuscular benzathine penicillin G for the treatment of GAS pharyngitis, but penicillin was significantly more effective in reducing exudate and concurrent signs vs. amoxicillin. [ABSTRACT FROM AUTHOR]

Penetrating atheromatous ulcer is the condition in which ulceration of an aortic atherosclerotic lesion penetrates the internal elastic lamina into the media. Differentiation of penetrating atheromatous ulcer from other causes of acute aortic syndrome such as intramural haematoma and aortic dissection is difficult. The main symptom is a severe, acute chest pain radiating to the inter-scapular area, similar to classical acute aortic dissection of the thoracic aorta. In present article a case of a 52 years old woman with long- standing retrosternal chest pain and with penetrating atherosclerotic aortic ulcer in descending aorta was reported. Unlike the predominant picture of this disease,associated intramural hematoma was not seen. [ABSTRACT FROM AUTHOR]

Temporary pace marker (TPM) usually has been used in emergency conditions. Insertion of TPM is accompanied with vein thrombosis and pulmonary Emboli. TPM was inserted via right femoral vein in 73 years male due to complete heart block. Thereafter, he was suffered from deep vein thrombosis. Echocardiography revealed multiple mobile clots in right atrium, ventricle and impending pulmonary thromboemboli following insertion of permanent pacemaker. Despite of contraindication for the application of thrombolytic agents due to surgical incision for permanent pacemaker and presence of patent foramen oval, the patient survived from massive pulmonary thromboemboli and death due to rapid diagnosis and on time treatment with anticoagulation agents without performing surgery. [ABSTRACT FROM AUTHOR]

E brahimi E & E slami SV (2011). Effect of environmental factors on seed germination and seedling emergence of invasive Ceratocarpus arenarius. Weed Research 52, 50-59. Summary Ceratocarpus arenarius is a problematic and noxious weed of dryland farming in North Khorasan, Iran. Experiments were conducted to investigate the mechanism of seed dormancy, as well as the effect of environmental factors on germination and emergence of this species. Results showed that the pericarp is the major obstacle to seed germination; seeds without an intact pericarp had germination rates exceeding 90%. Ceratocarpus arenarius had identical germination rates in either light/dark and continuous dark conditions, indicating that this weed species is non-photoblastic. Germination was >35% over a range of alternating light/dark temperatures (10/5, 20/10, 25/15, 30/20 and 35/25°C), with maximum germination (96%) at 25/15°C. Ceratocarpus arenarius seeds germinated at rates >20% in high levels of salinity (800 m m) and osmotic potential (−1 MPa), indicating that this species is tolerant to saline conditions and drought stress during germination and early seedling growth. Maximum germination of C. arenarius seeds occurred at a pH range of 7-9. Seedlings emerged from burial depths ranging from 0 (without covering with filter paper) to 6 cm, and the maximum emergence (94%) was observed in seeds placed on the soil surface covered with three layers of filter paper. This suggests that minimum- and no-till systems would increase seedling emergence of this species through maintaining crop residues and seeds on the soil surface. These attributes, coupled with tolerance to salinity and drought stress during germination, should be taken into account when managing C. arenarius. [ABSTRACT FROM AUTHOR]