Response to the Article “Comparison of the Cost-Utility Analysis of Electroacupuncture and Nonsteroidal Antiinflammatory Drugs in the Treatment of Chronic Low Back Pain”

Hossein Ayati 사단법인약침학회 2019 Journal of Acupuncture & Meridian Studies Vol.12 No.1

Dear Editor in Chief,We compared the cost-utility of electroacupuncture and NSAIDs in the treatment of chronic low back pain, and the results were published in JAMS on April 2018. Recently, we received a response to that article, making some questions and raising some great points. With many thanks to the commenting author(s) for the time and consideration, our response is as follows. 1. It is important to explain why NSAIDs were chosen as the comparator and what types and dosing schedules of NSAIDs were studied. According to the international guidelines, NSAIDs are used to treat chronic low back pain, and patients often use these drugs to relieve the pain [1], so these drugs are an appropriate choice to be the standard comparator. Types and dosing of NSAIDs, which was studied, are listed in Table 1 [2]. In this study, the average consumption of these drugs (alone or combined with other NSAIDs) was multiplied with the drug price to obtain the cost of these medications. 2. The costs presented in the study are not transparent. It is challenging to analyze the specific costs, especially the direct nonmedical costs, because they are not specified. In the materials and methods section of the article, a variety of costs and the way they were measured are clearly explained. The direct nonmedical costs include travel, meals, and hoteling costs when patients are receiving medical services. However, in this study, we considered only the travel costs because all participants were residents of Tehran. 3. The study failed to present the results in the appropriate format; cost-utility analyses require results in terms of quality-adjusted life years and incremental cost-utility ratios (ICER). However, only utilities and average costeffectiveness ratios (ACER) were reported in the study. The ACER is the ratio of the cost to benefit of an intervention without any comparisons to alternatives, and ICER is always used when comparing different treatment options Owing to the 1-year study period, cost-utility analysis does not require quality-adjusted life year calculation [3]. According to our results, the cost of the electroacupuncture method was less than NSAID therapy method and the electroacupuncture method was more effective, so the electroacupuncture method is the dominant option, and the NSAID therapy method is a dominated option, and in this situation, it is not necessary to calculate the ICER [4]. The ACER is also reported as an additional calculation in this study. 4. The study did not conduct any sensitivity analysis, thus not allowing for any uncertainty in the estimates of costs and consequences, which were already vague and difficult to decipher. Regarding the sensitivity analysis, when applying the one-way sensitivity analysis, (the variation range was 20% for costs and effectiveness), the results did not change, so the sensitivity analysis results were not presented in the article. However, the results of the one-sided sensitivity analysis are reported here (Fig. 1). We appreciate the commenting authors and hope that the aforementioned explanations are satisfying. Best regards. On behalf of co-authors. M. Hossein Ayati, MD, PhD.

MUNICIPAL SOLID WASTE MANAGEMENT IN THE GREAT CITY OF TEHRAN, I.R.IRAN

( Bita Ayati ),( Hossein Ganjidoust ),( Nader Mokhtarani ) 한국폐기물자원순환학회 2002 APLAS Vol.2002 No.1

Large amount of different solid wastes are produced in the capital city, Tehran every day. Many rules are set by the Department of Environment (DOE), which must be implemented by hospitals, trade centers, industries and other sectors, which are located in the cities. Amongst these rules, are the ones for municipal solid waste generation, collection, transporting, separation, treatment and final disposal? In almost all cities, municipal solid wastes along with hospital and industrial ones (including hazardous wastes) are disposed in landfill. Although some of the delivered wastes to landfill sides are known in quantities, but not known in qualities. It is therefore, very difficult to identify the composition of the waste, because in some parts different waste are disposed with each other. Even the landfill leachate are not collected and treated in most of the cases. There are several composting centers in and near the city of Tehran. There are also many private reuse centers for papers, glasses and plastics. Unfortunately, some poor people collect these materials in unhealthy conditions. In recent years, municipality has noticed to this problem especially for those papers, which are used in confectionaries. The purpose of this study is to investigate the current situation and major problems in different steps of generation, collection, transportation, treatment processes and disposal of municipal solid wastes in the city of Tehran. The discussion of solid waste minimization programs as one of the important task of the municipality is another purpose of this paper.

이란 테헤란 시에서의 도시고형 폐기물 관리

( Bita Ayati ),( Hossein Ganjidoust ),( Nader Mokhtarani ) 한국폐기물자원순환학회 2002 APLAS Vol.2002 No.2

테헤란시에서는 많은 양의 다양한 고형 폐기물이 발생한다. 이란 환경부 (DOM) 는 많은 환경 법규를 제정하여 도시에 위치한 병원, 무역 센타, 산업시설 및 다른 산업분야에서 준수하도록 하고 있다. 이러한 법규에는 도시고형폐기물의 발생, 수거, 운반, 분별, 처리, 최종처분에 관한 것도 마련되어 있다. 거의 모든 도시에서, 감염성 폐기물과 위해성 폐기물을 포함한 산업폐기물이 도시고형폐기물과 함께 매립 처분되고 있다. 비록 매립지에 인도된 폐기물의 양을 알지라도, 폐기물 조성은 알지 못하며, 결국, 각각 다른 폐기물과 함께 매립이 이루어지기 때문에, 폐기물의 구성을 확인 하는 것은 매우 어렵다. 심지어 대부분 매립지 침출수의 수집 처리도 이루어 지지 않았다. 테헤란의 도시 혹은 주변에는 퇴비화 시설이 여러 개 있으며, 종이·유리·플라스틱에 대한 사기업의 재이용시설이 있다. 불행하게도, 인부들은 이런 재활용 가능한 물질들을 비위생적인 상태에서 수집한다. 본 연구의 목적은 이란 테헤란 시에서의 고형폐기물의 발생, 수거, 운반, 처리 과정과 처분 시 발생하는 주된 문제와 현황을 살펴보는 것이며, 시당국에서 가장 중요한 업무 중의 하나인 도시고형폐기물 최소화 프로그램을 논의하고자 하였다. Large amount of different solid wastes are produced in the capital city, Tehran every day. Many rules are set by the Department of Environment (DOE), which must be implemented by hospitals, trade centers, industries and other sectors, which are located in the cities. Amongst these rules, are the ones for municipal solid waste generation, collection, transporting, separation, treatment and final disposal? In almost all cities, municipal solid wastes along with hospital and industrial ones (including hazardous wastes) are disposed in landfill. Although some of the delivered wastes to landfill sides are known in quantities, but not known in qualities. It is therefore, very difficult to identify the composition of the waste, because in some parts different waste are disposed with each other. Even the landfill leachate are not collected and treated in most of the cases. There are several composting centers in and near the city of Tehran. There are also many private reuse centers for papers, glasses and plastics. Unfortunately, some poor people collect these materials in unhealthy conditions. In recent years, municipality has noticed to this problem especially for those papers, which are used in confectionaries. The purpose of this study is to investigate the current situation and major problems in different steps of generation, collection, transportation, treatment processes and disposal of municipal solid wastes in the city of Tehran. The discussion of solid waste minimization programs as one of the important task of the municipality is another purpose of this paper.

OPTIMIZATION OF THE EXPERIMENTAL CONDITIONS IN SYNTHESIS OF Au NPs USING PREYSSLER HETEROPOLYACID BASED ON THE TAGUCHI ROBUST DESIGN

ALI AYATI,ALI AHMADPOUR,FATEMEH F. BAMOHARRAM,MAJID M. HERAVI,HAMED RASHIDI 성균관대학교(자연과학캠퍼스) 성균나노과학기술원 2012 NANO Vol.7 No.1

Preparation of gold nanoparticles by chemical reduction method using Preyssler heteropolyacid was investigated. The experimental conditions have been optimized using Taguchi robust design method with L9 orthogonal array. Particle size of the gold nanoparticles was considered as the property in the optimization. Amounts of Preyssler heteropolyacid, pH and irradiation time were selected as the main parameters. The result of Taguchi analysis has shown that in this process, the preyssler acid amount is the most influencing parameter on the size of gold nanoparticle. Also, the effects of different parameters are in order to: Preyssler acid amount > pH > irradiation time (negligible). This method showed that decreasing Preyssler amount and increasing pH of solution lead to formation of smaller nanoparticles. Finally, the prepared nanoparticles at optimum condition with a size of about 6.42 were characterized by using Dynamic Light Scattering (DLS) method, transmission electron microscopy (TEM), and UV-Vis spectroscopy.

3D-QSAR Studies of 2-Arylbenzoxazoles as Novel Cholesteryl Ester Transfer Protein Inhibitors

Jahan B. Ghasemi,Mahnaz Ayati,Somayeh Pirhadi 대한화학회 2011 Bulletin of the Korean Chemical Society Vol.32 No.2

The 3D-QSAR study of 2-arylbenzoxazoles as novel cholesteryl ester transfer protein inhibitors was performed by comparative molecular field analysis (CoMFA), CoMFA region focusing (CoMFA-RF) for optimizing the region for the final PLS analysis, and comparative molecular similarity indices analysis (CoMSIA) methods to determine the factors required for the activity of these compounds. The best orientation was searched by all-orientation search strategy using AOS, to minimize the effect of the initial orientation of the structures. The predictive ability of CoMFARF and CoMSIA were determined using a test set of twelve compounds giving predictive correlation coefficients of 0.886, and 0.754 respectively indicating good predictive power. Further, the robustness and sensitivity to chance correlation of the models were verified by bootstrapping and progressive scrambling analyses respectively. Based upon the information derived from CoMFA(RF) and CoMSIA, identified some key features that may be used to design new inhibitors for cholesteryl ester transfer protein.

HAZARDOUS WASTE MANAGEMENT IN ISLAMIC REPUBLIC OF IRAN

( Hossein Ganjidoust ),( Bita Ayati ) 한국폐기물자원순환학회 2002 APLAS Vol.2002 No.1

Lots of industrial wastewater is produced every day in all countries. Large amount of money is spent for treatment of this wastewater. The industries do not like seriously to spend the money because they will not get any profit from that. In another words, industries do not get back any money that they expect on treating their own wastewater. But it is a real requirement from the environmental protection agencies that the wastewater discharges have to obey certain constituent's level. Large amount of hazardous waste materials is produced in the country. It is important to control them for securing the human beings life. Many rules are set by the Department of Environment, which must be implemented by industries and other sectors. Amongst these rules, are special one for the hazardous waste materials handling, storage, collection, disposal, and so on. It is the purpose of this study to investigate the current situation and major problems in I.R. Iran in the generation, collection, transportation, storage, handling, processing and disposal of hazardous substances and wastes. The hazardous waste minimization case studies in one or two companies were also another purpose of this study.

이란 산업시설에서의 폐기물 최소화 실행

( M. Shafikhani ),( B. Ayati ),( H. Ganjidoust ) 한국폐기물자원순환학회 2002 APLAS Vol.2002 No.2

청정 생산은 원료와 에너지 보전을 가져올뿐만 아니라 또한 제품의 생산과정에서 발생하는 오염물질의 양과 독성을 감소시켜준다. UNEP로 정의 되는 청정생산 프로그램의 목적은 전략적 환경적인 생산의 인식증가는 정부와 산업의 도움으로부터 이루어진다. 청정기술 노후된 시설을 재활용 하여 변경 및 개선한 시설로 대신 작동한다. 청정생산은 재설계, 변형과정 그리고 유해물질 감소에 사용되는 화학적 변경을 이끌어낸다. 이 논문은 전략적 오염예방 예를들면 폐기물의 최소발생 및 청정기술로 환경관리에 유용함을 목적으로 한다. 더좋은 주거시설 및 산업시설의 유지관리는 목재 및 제지 회사의 폐기물 발생의 30% 이상 줄일 수 있다. 모든 그리스 물질(총폐수의 20%는 시설에서 발생된다.)은 재활용에 의해 제거되고 또한 이란의 목재 및 섬유회사의 화학적으로 사용된 폐수를 감소시킨다. 이는 또한 폐수의 COD30%와 폐수발생 20%를 감소시킨다. 몇번의 염색과정에서 사용된 물의 재이용은 Famakh &Mahnakh Textile사의 폐수발생의 감소로 나타났다. 전기도금회사에서 DRCS법에 의한 크롬회수는 총 폐수처리 비용을 절감할수 있었다. 폴리머의 이용은 폐수 30% COD를 줄일수 있었다. 새로운 청정생산은 석유화학사에 40%이상 폐기물을 절감하였다. Cleaner production resulted in the conservation of raw materials and energy. It ensures the elimination of toxic materials, and the reduction of quantity and toxicity of all emissions and wastes from the product materials. The objectives of cleaner production programs which was defined by UNEP, are worldwide awareness of the preventive environmental production strategy should be increased and insuring development of cleaner production programs and activities for the cleaner production expansion by helping government and industry. The clean technologies have been practiced in process plant, recycling, process modification, and improved plant operation and input substitution. The clean products have been obtained by many ways such as redesigning, and modification of the process and changing chemicals used to less hazardous ones. The purpose of this paper is to look at the benefits of environmental management strategies in pollution prevention such as waste minimization and clean technologies. Better house keeping and in plant maintenance resulted in up to 30 percent reduction (both quantitatively and qualitatively) of the waste generation in wood and paper company. All grease materials (20 percent of the total wastewater generated from the plant) were eliminated by recycling which also reduced the water and chemical used in the process of Iran Wood Fiber Company. This also resulted in 20 percent reduction of the wastewater generated and 30 percent COD reduction from the wastewater. Reuse of the colored water for several times in the dying and printing processes resulted in reduction of wastewater generated in Farnakh & Mahnakh Textile Company. Recovery of chromium from electroplating company was treated by DRCS method resulted in reduction of the total wastewater treatment cost. Use of polymers resulted in reduction of the whey wastewater COD by 30 percent. New clean production advice has been given to the Petrochemical Company and over 40 percent waste has been reduced.

Degradation of oxytetracycline by nano zero valent iron under UV-A irradiation: Chemical mechanism and kinetic

Hassanzadeh, Parisa,Ganjidoust, Hossein,Ayati, Bita Techno-Press 2014 Advances in environmental research Vol.3 No.1

Pharmaceutical wastewater effluents are well known for their difficult elimination by traditional biotreatment methods and their important contribution to environmental pollution due to its fluctuating and recalcitrant nature. OTC is one of the nonbiodegradable antibiotics that makes antibiotic-resistant, so it can make be high risk for environment. NZVI can be a good choice for removal of OTC in aqueous solution. Response surface methodology (RSM) was used to optimize the amounts of NZVI and OTC to be used at pH 3 and under 200 W, UV-A irradiation. The responses were removal percent of absorption at 290 and 348 nm, TOC and COD of OTC. In the optimum condition, Linear model was performed 155 ppm of OTC were removed by 1000 ppm NZVI after 6.5 hours and the removal efficiency of absorption at 290 and 348 nm, TOC and COD were 87, 95, 85 and 89 percent, respectively. In the similar process, there is no organic compound after 14 hours. The parameters ORP, DO and pH were investigated for 6:30 hours to study the type of NZVI reaction in process. In the beginning of reaction, oxidation was the dominant reaction after 3 hours, photocatalytic reaction was remarkable. The mechanism of OTC degradation is proposed by HPLC/ESI-MS and four by products were found. Also the rate constants (first order kinetic chain reaction model) were 0.0099, 0.0021, 0.0010, 0.0049 and $0.0074min^{-1}$, respectively.

이란에서의 유해폐기물 관리

( Hossein Ganjidoust ),( Bita Ayati ) 한국폐기물자원순환학회 2002 APLAS Vol.2002 No.2

많은 양의 산업폐수는 모든 국가에서 매일 발생하며, 이런 산업 폐수 처리를 위해 많은 돈이 소요된다. 산업체들은 산업폐수 처리로부터 이익을 얻을 수 없기 때문에, 돈 소비하는 것을 싫어한다. 즉, 산업체에서 발생한 폐수를 적절하게 처리할 경우 산업체에서는 어떤 돈도 되돌려 받지 못한다. 그러나 폐수의 배출은 어떤 배출기준에 준수하도록 환경부로부터 요구 받는다. 많은 양의 유해폐기물은 발생되며, 인간의 삶의 보호를 위해서는 유해폐기물을 통제하는 것이 중요하다. 많은 규정들은 환경부에서 제정되었으며, 이런 규정들은 산업체들과 다른 분야에 의해서 이행되어진다. 이런 규정 중에, 유해폐기물의 취급, 저장, 수집 및 처분등에 대해서는 매우 특별한 것이다. 본 연구의 목적은 이란에서의 유해폐기물 발생, 수집, 운송, 저장, 취급, 처리, 처분등에서의 현황과 주된 문제점을 조사하는 것이다. 한 두개 기업의 실례 연구 통해서 유해폐기물 최소화는 본 연구의 또 다른 목적이다. Lots of industrial wastewater is produced every day in all countries. Large amount of money is spent for treatment of this wastewater. The industries do not like seriously to spend the money because they will not get any profit from that. In another words, industries do not get back any money that they expect on treating their own wastewater. But it is a real requirement from the environmental protection agencies that the wastewater discharges have to obey certain constituent's level. Large amount of hazardous waste materials is produced in the country. It is important to control them for securing the human beings life. Many rules are set by the Department of Environment, which must be implemented by industries and other sectors. Amongst these rules, are special one for the hazardous waste materials handling, storage, collection, disposal, and so on. It is the purpose of this study to investigate the current situation and major problems in I.R. Iran in the generation, collection, transportation, storage, handling, processing and disposal of hazardous substances and wastes. The hazardous waste minimization case studies in one or two companies were also another purpose of this study.

WASTE MINIMIZATION IMPLEMENTATION IN IRANIAN INDUSTRIES

( M. Shafikhani ),( B. Ayati ),( H. Ganjidoust ) 한국폐기물자원순환학회 2002 APLAS Vol.2002 No.1

Cleaner production resulted in the conservation of raw materials and energy. It ensures the elimination of toxic materials, and the reduction of quantity and toxicity of all emissions and wastes from the product materials. The objectives of cleaner production programs which was defined by UNEP, are worldwide awareness of the preventive environmental production strategy should be increased and insuring development of cleaner production programs and activities for the cleaner production expansion by helping government and industry. The clean technologies have been practiced in process plant, recycling, process modification, and improved plant operation and input substitution. The clean products have been obtained by many ways such as redesigning, and modification of the process and changing chemicals used to less hazardous ones. The purpose of this paper is to look at the benefits of environmental management strategies in pollution prevention such as waste minimization and clean technologies. Better house keeping and in plant maintenance resulted in up to 30 percent reduction (both quantitatively and qualitatively) of the waste generation in wood and paper company. All grease materials (20 percent of the total wastewater generated from the plant) were eliminated by recycling which also reduced the water and chemical used in the process of Iran Wood Fiber Company. This also resulted in 20 percent reduction of the wastewater generated and 30 percent COD reduction from the wastewater. Reuse of the colored water for several times in the dying and printing processes resulted in reduction of wastewater generated in Farnakh & Mahnakh Textile Company. Recovery of chromium from electroplating company was treated by DRCS method resulted in reduction of the total wastewater treatment cost. Use of polymers resulted in reduction of the whey wastewater COD by 30 percent. New clean production advice has been given to the Petrochemical Company and over 40 percent waste has been reduced.