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This study is aimed at establishing the outcome of RSTI exposure to acetaminophen based on a decision tree algorithm for the first time. This study used the National Poison Data System (NPDS) to conduct a six-year retrospective cohort analysis, which included 4522 individuals. The patients had a mean age of 26.75 ± 16.3 years (1-89). 3160 patients (70%) were females. Most patients had intentional exposure to acetaminophen. Almost all the patients had acetaminophen exposure via ingestion. In addition, 400 (8.8%) experienced major outcomes, 1500 (33.2%) experienced moderate outcomes, and 2622 (58%) of the patients experienced mild ones. The decision tree model performed well in the training and test groups. In the test group, the accuracy was 0.813, precision of 0.827, recall being 0.798, specificity 0.898, and an F1 score 0.80. In the training group, accuracy was 0.831, recall was 0.825, precision was 0.837, specificity was 0.90, and F1 score was 0.829. Our results showed that serum liver enzymes being present at elevated levels (Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) greater than 1000 U/L followed by ALT, AST between 100 and 1000 U/L) , prothrombin time (PT) prolongation, bilirubin increase, renal failure, confusion, age, hypotension, other coagulopathy (such as partial thromboplastin time (PTT) prolongation), acidosis, and electrolyte abnormality were the effective factors in determining the outcomes in these patients. The decision tree algorithm is a dependable method for establishing the prognosis of patients who have been exposed to RSTI acetaminophen and can be used throughout the patients' hospitalization period.

Background Currently, few baseline imaging biomarkers can predict chemotherapy induced cardiotoxicity (CTx). The early identification of CTx is critically important as it determines the prospect of LV function recovery (1). Purpose We aimed to determine if baseline left atrial (LA) reservoir strain (LAS) is predictive of CTx. Methods We performed retrospective analysis of the SUCCOUR study, an international multicentre randomized controlled trial. CTx was defined as an asymptomatic drop of >10% in left ventricular ejection fraction (LVEF) compared to baseline to Results After excluding 78 with inadequate images, 229 were included in the analysis. Most participants were female (n=215, 94%), with a mean age of 54±12 years. Median follow up was 1.02 years (IQR 0.98–1.07). A smoking history was the commonest cardiac risk factor (n=68, 30%). Breast cancer was the main cancer type (n=205, 90%). The mean baseline 3D LVEF, LV global longitudinal strain (GLS), LAS, and LA volume index (LAVI) were 61±4%, 20.6±2.5%, 28.6±7.9%, and 28±9ml/m2, respectively. Participants that developed CTx had a lower LAS at baseline compared to those that did not (25.5±7.4% vs 29.0±7.9% respectively; p=0.027). At 1-year follow-up, 29 patients (13%) developed CTx. On univariable Cox proportional hazard analysis, higher baseline LAS was associated with a lower risk of CTx (HR 0.95, 95% CI 0.90–0.99; p=0.026) but other parameters including baseline GLS was not (p=0.17). In nested Cox models (Figure 1), adding LAS significantly improved the model's predictive accuracy for CTx compared to other clinical and imaging parameters. When LAS was added to the same models it showed improvements in the c-statistics and AIC score (Figure 1). Conclusion Baseline LAS is an independent and incremental predictor of CTx. LAS could be used for baseline risk stratification in oncology patients who receive potentially cardiotoxic chemotherapy. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): GE Healthcare

An amendment to this paper has been published and can be accessed via the original article.

Introduction: Snakebite is an urgent, unmet global medical need causing significant morbidity and mortality worldwide. Varespladib is a potent inhibitor of venom secretory phospholipase A2 (sPLA2) that can be administered orally via its prodrug, varespladib-methyl. Extensive preclinical data support clinical evaluation of varespladib as a treatment for snakebite envenoming (SBE). The protocol reported here was designed to evaluate varespladib-methyl for SBE from any snake species in multiple geographies. Methods and Analysis: BRAVO (Broad-spectrum Rapid Antidote: Varespladib Oral for snakebite) is a multicenter, randomized, double-blind, placebo-controlled, phase 2 study to evaluate the safety, tolerability, and efficacy of oral varespladib-methyl plus standard of care (SoC) vs. SoC plus placebo in patients presenting with acute SBE by any venomous snake species. Male and female patients 5 years of age and older who meet eligibility criteria will be randomly assigned 1:1 to varespladib-methyl or placebo. The primary outcome is the Snakebite Severity Score (SSS) that has been modified for international use. This composite outcome is based on the sum of the pulmonary, cardiovascular, nervous, hematologic, and renal systems components of the updated SSS. Ethics and Dissemination: This protocol was submitted to regulatory authorities in India and the US. A Clinical Trial No Objection Certificate from the India Central Drugs Standard Control Organisation, Drug Controller General-India, and a Notice to Proceed from the US Food and Drug Administration have been obtained. The study protocol was approved by properly constituted, valid institutional review boards or ethics committees at each study site. This study is being conducted in compliance with the April 1996 ICH Guidance for Industry GCP E6, the Integrated Addendum to ICH E6 (R2) of November 2016, and the applicable regulations of the country in which the study is conducted. The trial is registered on Clinical trials.gov, NCT#04996264 and Clinical Trials Registry-India, 2021/07/045079 000062.

Tissue culture of hazelnut (Corylus avellana L.) represented the promising strategy for production of its valuable compound, paclitaxel, but one of the most important problems is initial callus browning in its callus culture. To obtain healthy callus cells of C. avellana, three different culture media, Murashige and Skoog (MS), Nas and Read (NRM), and Driver and Koniuki (DKW), in combination with 500 mg dm-3 citric acid, 500 mg dm-3 acetic acid, and 500 mg dm-3 polyvinylpyrrolidone (PVP) were applied. These cultures were passed two sub-cultures in the same media. Also, a novel modified sub-culture system was designed and compared to routine techniques. The sub-culture system was changed as following: the induced calli were transferred to a liquid media with the same composition and after developing the cell suspension, the cells were immobilized on a solid medium. In the first experiment, it was demonstrated that the medium compositions had an effect on the growth rate and callus browning reduction although they could not eliminate the browning. The results have shown that the highest growth indices were related to NRM with 500 mg dm-3 acetic acid + 500 mg dm-3 citric acid and to NRM with 500 mg dm-3 PVP in the first culture. These media had the least amount of browning (9.15 %). In the two next sub-cultures, NRM without additives had the maximum growth rate and the lowest browning was observed on the same media as in the first subculture (13.3 %). The technique of modified sub-cultures increases growth rate ten times in comparison with routine cultivation method.

The most desired target of orthodontic treatment is tooth movement as a result of application of efficient force system. In this study, effect of tooth loading is studied on temperature profile around the tooth at early stages of treatment. The basis of temperature variation is increase of cell number and activities in periodontium as a result of compression and tension of this layer. Highest cellular activities occur in the beginning of loading procedure and aim to reduce mechanical stress in the periodontium which finally ends up with orthodontic tooth movement during couple of years. To find out the correlation between temperature variation and the applied force, in vivo experiments are conducted on ten rats and temperature is measured in specific time periods. It is observed that temperature is higher in direction of the net force about 0.3℃. Next, numerical finite element analysis is carried out on the rat tooth model. Mechanical stress results show that regions with compressive stress have rather high temperature in the experiments. Mechanical stress on periodontium-bone interface is multiplied by a coefficient to simulate cellular activities on this boundary as a heat source and thermal analysis is carried out to obtain temperature profile. The thermo-mechanical coefficient is identified for each rat by imposing the experimental temperatures on numerical outputs. For assessment of a treatment efficiency and deduction of the applied force, temperatures could be measured experimentally and compared with the corresponding numerical analysis temperature result obtained by employing the thermo-mechanical coefficient found earlier for each rat.

The impact of growth conditions on indium segregation in metal-polar In0.17Al0.83N lattice-matched to GaN grown by plasma assisted molecular beam epitaxy is reported. A series of lattice-matched InAlN films was systematically grown over a wide range of temperatures and active nitrogen fluxes. The growth conditions include those reported in the literature as conducive to homogeneous In0.17Al0.83N (Kaun et al., 2014). However, honeycomb indium composition modulation was found in all InAlN films. For samples grown at the highest temperature and nitrogen flux, InAlN layers exhibit larger and more irregular cells with emergence of open cell boundaries. We conclude that the studied growth conditions alone are not sufficient to eliminate the ‘honeycomb’ structure in metal-polar InAlN lattice-matched to GaN, and that the physical process necessary for reproducible growth of homogeneous In0.17Al0.83N requires further clarification.

The aim of this study was to evaluate the blood levels of folic acid, vitamin B12, and 25-hydroxyvitamin D (25-OHD) in patients with lead poisoning compared with control subjects in Eastern Iran. This analytical case-control study was conducted on 40 lead-poisoned patients who were referred to Imam Reza Hospital in Birjand from 2018 to 2019. Blood samples were collected from an additional 40 individuals without lead poisoning as a control group. The results indicated that the mean vitamin B12, vitamin D, and folic acid levels for the case group were 356.5 ± 200.1 pg/ml, 24.38 ± 9.5 ng/ml, and 7.4 ± 3.7 ng/ml, respectively. Mean folic acid level in the case group was significantly lower than control group (7.4 ng/ml vs. 12.70 pg/ml, P = 0.001), whereas the mean of the vitamin D levels at the case group was significantly higher than that of the control group (24.3 ng/ml vs. 20.1 ng/ml, P = 0.03). Moreover, mean vitamin B12 levels were significantly lower in the case group in comparison with the control group (356.5 pg/ml vs. 500.8 pg/ml) (P 0.001). In the control group, 3 patients had folic acid below normal level ( 6 ng/mL) while 12 cases had folic acid below normal (P 0.05). Also, none of the control group had low vitamin B12 concentrations ( 180 pg/ml), while 7 cases had vitamin b12 below normal (P 0.05). Our results suggest that lead may induce folate and vitamin B12 dysregulation. Although we found that vitamin D levels were insufficient in both case and control groups, they were significantly higher in the case group. The interpretation of this result is unclear given inconsistent literature reports on this relationship.

In this paper, we present an application of ${{\mathcal L}_1}$ adaptive control for the vehicle lateral control problem. The main objective is to design a controller that ensures the vehicle follows the reference trajectory (center of the lane) with robustness to uncertain parameters of the vehicle lateral dynamics. The designed ${{\mathcal L}_1}$ adaptive control signal compensates the uncertainties and variations in model parameters in the presence of disturbances. A bicycle model for vehicle lateral dynamics is considered. We will demonstrate the desirable performance of the proposed adaptive controller at steady-state as well as the transient response. The simulation results confirm that the controller significantly improves the transient response of the vehicle lateral controller in the presence of wind gusts, road bank angle, icy or slippery road conditions, and other parameter uncertainties and unknown disturbances.

This chapter argues that after being selected as the Persian capital in 1788, Tehran’s development was primarily and predominantly a modern project aiming at meeting the requirements of the modern world and a changing society. Based on a critical reading of major moments of urban modernity from the mid nineteenth century onwards, it discusses how, despite the strong presence of anti-Western discourse at various times (more evidently in the post-Revolution period), a modernist, technocratic, and technologised attitude towards city-making remained dominant. Attempts to establish a critical or anti-Western trend in urban planning and architecture against the dominant modernisation project either remained as abortive rhetoric or remained marginalised and due to political changes failed to be consolidated into a competing discourse. The making of Tehran has been, and continues to be, an incremental encroachment of modernity that struggles for contemporisation.

Background: Bandl’s ring is a pathologic contraction ring of the uterus that is associated with obstructed labor. Case: A 35-year-old with an uncomplicated past medical history was found to have a Bandl’s ring in her first pregnancy during a cesarean section for failure to progress. During her subsequent pregnancy, what appeared to be a Bandl’s ring was again found during repeat cesarean section after spontaneous labor.

Background & Aim: Increasing the population growth and the number of health care facilities Lead to use of disposable medical equipment, so it caused increasing the medical waste production. Improper disposal of medical waste poses a serious threat to the environment and public health. Thus the aim of the present study was to determine awareness of the nurses about medical waste management. Material & Methods: This is a descriptive - analytic study with participation of 268 nurses employed in hospitals affiliated to Isfahan University of Medical Sciences in 2014. Data collection performed using a researcher constructed questionnaire. Sampling method was simple nonrandom. Data analysis performed by descriptive and analytical statistical test and SPSS statistical software, version 14. Results: The study results showed that there were significant differences between the awareness of nurses and their position in the phase separation, packing and collecting and the waste transportation, also the head nurses had higher score. It was not significant in the maintenance, disinfecting, refining and elimination phases. Also, the awareness of nurses’ scores in separation, packing and collecting, maintenance disinfecting, refining and elimination phases were higher in the nurses who participated in the waste management in-service training courses in versus those that did not precipitate. There was no significant difference in the transportation phase. Conclusion: Developing and implementation of continuing education and in service programs in the waste management encourage nurses to continuous learning to improve knowledge, attitude and skills it can help in proper waste disposal management. Establish waste disposal management workgroup in the health care centers could be an effective step in this regard.

Introduction: Educational Development Centers (EDCs), as the coordinator in education development in Medical Sciences universities, in order to improve their quality should evaluate their activities. In spite of remarkable performance of Tehran University of Medical Sciences (TUMS) EDC in previous national rankings, but it faces many challenges and problems. This paper provided the process, results and lessons learned from a self-evaluation experience conducted at TUMS EDC based on accreditation standards. Method: The present study is an Institutional self-evaluation study based on the national accreditation standards of EDCs (2012). Data were gathered using an open-ended questionnaire developed on the basis of the SWOT format. A directional content analysis applied to analyze the data. Results: In total, 84 point of strengths, 87 weaknesses, 15 opportunities, 24 threats and also 99 recommendations for quality improvement were reported. The most important strengths of the center were the existence of an established mechanism regarding research process in education and scholarship of education, holding various faculty development courses and training standardized patient. The most important weaknesses were the lack of specified procedures in some areas such as monitoring the planning and reviewing of educational programs in the field of educational programs and evaluation of empowerment courses. Conclusion: The present evaluation results will be useful in directing future policies of TUMS EDC such as revising its strategic planning. We hope that the current experience can be helpful for administrators in EDCs in the Ministry of Health and Medical Education and also other Medical Sciences Universities.