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Introduction Although a number of contraception methods exist, long-acting reversible contraceptives have been recommended for female adolescents owing to their low failure rates. However, concern exists that the increasing use of long-acting reversible contraceptive among female adolescents may have unintended consequences of decreasing condom use for the prevention of sexually transmitted infections. Despite this concern, few studies have directly explored the relationship between the use of long-acting reversible contraceptive versus other forms of contraception and diagnosis of sexually transmitted infections in female adolescents. This study compares the rates of sexually transmitted infection diagnosis following various forms of contraceptive use. Methods This study was an archival data analysis of single state Medicaid claims retrieved for female adolescents, aged 14–19 years, who received a contraceptive prescription and had 1 year of follow-up data available (n=62,550) between 2011 and 2015. Incidence of sexually transmitted infections was the outcome of interest. Data analysis was conducted in 2018. Results Compared with the contraceptive pill, hormonal implant (a form of long-acting reversible contraceptives) was associated with significantly lower risk of sexually transmitted infections (hazard ratio=0.81; 95% CI=0.70, 0.93; p=0.004), and hormonal injection was associated with higher risk of sexually transmitted infections (hazard ratio=1.08; 95% CI=1.00, 1.16; p=0.040). Conclusions This analysis provides strong evidence that the risk for the acquisition of sexually transmitted infections is no higher for long-acting reversible contraceptives than for other forms of contraception. These results support the use of long-acting reversible contraceptive in female adolescents, as proposed and reaffirmed by the American College of Obstetricians and Gynecologists and American Academy of Pediatrics.

Prevention of unintended pregnancy relies on access to affordable, effective contraception, yet many structural and individual barriers to use have been identified. This article documents h...

BACKGROUND: Clinical imaging studies have demonstrated a strong direct correlation between epicardial fat and abdominal visceral adiposity. There are several studies about positive correlation of epicardial fat and atherosclerotic coronary disease in general population. This study aimed to evaluate the association of epicardial fat thickness with atherosclerotic coronary disease in patients with diabetes mellitus type II.METHODS: This cross-sectional observational study involved 80 patients with diabetes mellitus type II. The patients were chosen using simple sampling method from patients with diabetes mellitus who were referred for angiography because of suspected coronary artery disease. The severity of coronary atherosclerotic lesions was evaluated using modified Gensini scoring system. Epicardial fat thickness was measured by transthoracic echocardiography within 90 days after coronary angiography. Multiple linear regression method was used to evaluate the association between mean epicardial fat thickness and Gensini score.RESULTS: After adjustment for the effects of body mass index (BMI), age, angina, and sex, there was a significant association between Gensini score and epicardial fat thickness (β = 0.825; P < 0.001). Patients with higher blood pressure and higher body mass index also had a higher Gensini score (P < 0.010)CONCLUSION: In patients with diabetes mellitus type II, there is a positive association between epicardial fat thickness and severity of coronary artery disease. So, by echocardiography evaluation of epicardial fat thickness, we could have an estimation of the severity of coronary arteries diseases before using more invasive techniques.

This study examined the relationship between leisure time and self-regulation and goal orientation among professional athletes. This study was an applied research using survey to collect data. Standard questionnaires were used to measure leisure time, self-regulation and goal orientation. The studied samples included 100 Iranian professional athletes in individual sports (judo and jujutsu) and team sports (handball and basketball) who were selected by selective sampling method. Data was analyzed by descriptive and inferential statistics, one-sample t-test, Pearson correlation and linear regression. Results showed a significant relationship between leisure time and self-regulation and goal orientation of professional athletes. The coefficient of correlation showed a very high and positive relationship between leisure time and self-regulation (α=0.915), between leisure time and goal orientation (α=0.884), and between self-regulation and goal orientation (α=0.921). Considering the significant relationship between these three parameters, it can be concluded that management of leisure time is an important factor in the career of professional athletes. For this purpose, opportunities can be provided for professional athletes to recognize different aspects of leisure time and use them in order to achieve better outcomes.

BACKGROUND: Spasticity is a common, serious symptom after stroke. Extracorporeal shock wave therapy (ESWT) has been suggested for the treatment of muscle spasticity. OBJECTIVE: To investigate the effects of ESWT on post stroke wrist flexor spasticity. METHODS: Fifteen patients with poststroke wrist flexor spasticity (12 male and 3 female with a mean age of 54 years) were enrolled. Patients received 1 sham ESWT followed by 1 active ESWT 1 week later. The outcome measures were the Modified Modified Ashworth Scale (MMAS), the Hmax/Mmax ratio, and the Brunnstrom motor recovery stage. RESULTS: The sham ESWT had not effects on the outcome measures. After active ESW, the MMAS scores of spasticity and the Hmax/Mmax ratio improved. The improvements were maintained 5 weeks after active ESWT. No significant improvements were observed for the motor recovery after sham or active ESWT. CONCLUSIONS: In adult patients after stroke, a single session of active ESWT resulted in significant improvement in the wrist flexor spasticity and alpha motor neuron excitability.

Vehicles are assemblies of subsystems or modules, which are developed in parallel at multiple locations and often for more than one vehicle. CAE software provides the integration of modules in a complete vehicle in parallel; however the whole system requires final adjustments and tunings. These adjustments, especially in suspensions and mounting systems are very time consuming and are generally based upon trial and error techniques. To reduce the number of trials, usually noise path analysis (NPA) is used. In this technique, the noise and vibration paths for each mount to the objective point are measured. Using the measured data, the dominant path is detected. A highly experienced NVH engineer now can use the information to tune the mount to satisfy the target response. This technique is appropriate if the subsystems are weakly coupled. This situation is not usually the case in engine mounting systems where any modification in one of the mounts may change the dominant path. An important step to reduce refinement time is to develop a method to obtain the overall model of the whole vehicle. In this paper, we introduce a new approach in vehicle’s NVH development. In this approach, the model of the vehicle for mounting system optimization is obtained based on the FRF synthesis. A hybrid analytical/experimental model of the vehicle is developed to predict the NVH response of the vehicle for any given mounting system. This model along with an optimization technique is used to arrive at the optimum mounting system for any objective function. The optimization method is linked with the noise path analysis (NPA), which is used to specify the dominant directions that the noise/vibration is transferred to the response point. These directions are used in the optimization procedure to find the optimum mounting system with minimum calculation time. Experimental results on a full size car are presented to evaluate new approach.Copyright © 2003 by ASME

Composite materials are being extensively used in primary and secondary aerospace structures due to high specific strength and stiffness as well as low weight. In this study finite element (FE) and boundary element (BE) are used to study acoustical performance of honeycomb type structures subjected to common excitation sources in flight. Coupled FE‐BE is applied to predict transmission loss (TL) of honeycomb type structure, excited by diffuse acoustic field and turbulent boundary layer. Structural FE model correlation is performed using experimental modal analysis. Transmission loss of honeycomb panel was measured at the GAUS TL Lab using diffuse acoustic field. TL results are used to validate coupled FE‐BE vibro‐acoustic model of a curved honeycomb panel. Correlated model is used to predict response of structure to TBL source. Effect of noise control treatments in reducing radiated noise from honeycomb panel excited by TBL and diffuse field are studied.

Engine and body mount systems play a crucial role in vehicles' comfort. Engine mounts protect the engine from excessive movement and forces due to low frequency road and high frequency engine excitations. On the other hand, body mounts protect the cabin from vibration forces exerted by the body. Normally, a complete set of mounts is conceived at early stages of design, subsequently the set is tuned in the refinement stage to improve the vehicle's noise, vibration, and harshness (NVH) response. Currently, noise path analysis (NPA) is used for mount tuning. This method is helpful, but it is based mostly on trial and error, and it does not lead to an optimum mounting set. In this work, a new technique is implemented to simplify vehicles' mount optimisation. This technique employs substructuring synthesis and standard NVH testing to obtain frequency response function (FRF) model of a vehicle. The model is linked to several optimisation routines to predict the optimum set of mounts for a desired objective function. For verification and evaluation, the method is applied to tuning the mounting set of a pick-up truck. Experimental measurements showed good correlation with optimised response.

Background: The aim of this study was to determine the efficacy of two methods of colon preparation for colon cleansing in a randomized controlled trial. Methods: In this prospective randomized investigator-blinded trial, consecutive outpatients indicated for elective colonoscopy were randomized into two groups. Patients in Senna group took 24 tablets of 11 mg Senna in two divided doses 24 hour before colonoscopy. In Poly Ethylene Glycol (PEG) group they solved 4 sachets in 4 liters of water the day before the procedure and were asked to drink 250 ml every 15 minutes. The overall quality of colon cleansing was evaluated using the Aronchick scoring scale. Difficulty of the procedure, patients′ tolerance and compliance and adverse events were also evaluated. Results: 322 patients were enrolled in the study. There was no significant difference in the quality of colon cleansing, patients′ tolerance, compliance and the difficulty of the procedure between two groups (p > 0.05). The incidence of adverse effects was similar between two groups except for abdominal pain that was more severe in Senna group (p < 0.05) and nausea and vomiting that was more common in PEG group (p < 0.05) Conclusions: In conclusion we deduce that Senna has the same efficacy and patient′s acceptance as Polyethylene glycol-electrolyte solution (PEG-ES) and it could be prescribed as an alternative method for bowel preparation.

Background: The Rome II and III diagnostic criteria for dyssynergic defecation recommended the exclusion of irritable bowel syndrome (IBS). This study determined the effect of biofeedback therapy on dyssynergic constipation in patients with or without IBS. Materials and Methods: This study was a nonrandomized, single blinded, semi experimental study. Dyssynergic defecation patients with and without IBS were asked to undergo biofeedback therapy 8 sessions. The defecation dynamics and balloon expulsion time were evaluated before, at the end and 1 month after the biofeedback therapy. IBS symptoms were graded using a 4-point Likert scale. Mann-Whitney U-test, Wilcoxon test and Friedman test were applied to analyze data using SPSS software package (SPSS Inc., Chicago, IL, USA). Results: After the biofeedback therapy, the IBS symptoms have been decreased significantly (the median of 2 before and 1 after therapy, P < 0.01). The biofeedback therapy significantly decreased the anismus index in IBS group by the mean of 0.75 ± 0.31, 0.28 ± 0.07 and 0.28 ± 0.06 in three phases, respectively. Similar results were found in non-IBS patients (the mean of 0.74 ± 0.32, 0.28 ± 0.08, 0.27 ± 0.08 in three phases, respectively). The symptoms of constipation (sensation of incomplete evacuation, difficult and painful defecation), defecation facilitative manual maneuver frequency, pelvic floor muscles resting amplitude and strain amplitude decreased and squeezing amplitude improved significantly after biofeedback therapy in both groups with and without IBS (P < 0.001). There were not significant differences between patients with and without IBS (P > 0.05) with respect to outcome. No complication was observed in treatment groups. Conclusion: Dyssynergic constipation patients with and without IBS will likely benefit from biofeedback therapy.