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Background: Professional autonomy is a crucial component of the nursing profession. It enables nurses to make timely decisions at the patient’s bedside. The competency of human resources, especially nurses, is essential in maintaining patient safety and ensuring high-quality services. This study investigates nurses’ professional autonomy and its association with patient safety competency. Methods: This descriptive-correlational study was conducted on 200 nurses in educational-therapeutic hospitals affiliated with Tabriz University of Medical Sciences, Tabriz City, Iran, in 2021. They were recruited utilizing stratified random sampling. Data collection tools comprised a demographic questionnaire, professional autonomy questionnaire, and patient safety competency self-evaluation questionnaire. The obtained data were analyzed using descriptive statistics (frequency, percentage, and median), the Mann-Whitney U test, the Kruskal-Wallis test, the Kendall Tau, and Spearman non-parametric correlation coefficients in SPSS software, version 26. P

ABSTRACT Background and Aims According to the World Health Organization (WHO), an Adverse Drug Reaction (ADR) is defined as “a response to a drug which is noxious and unintended, and which occurs at doses normally used in humans for the prophylaxis, diagnosis, or therapy of disease, or for the modification of physiological function.” The aim of this research was to evaluate the current practice and implement the best practices for detecting and reporting ADR in a tertiary hospital in Tabriz, Iran. Methods We used a mixed‐methods sequential explanatory design in the current study. The research was conceptually informed by the Joanna Briggs Institute model of Evidence‐Based Healthcare (JBI EBHC). A three‐phase implementation process, outlined by this model, was used in this study. The first and third phases comprised the quantitaive phase of the study, in which we evaluated the current practice and conducted a final evaluation to measure changes in compliance with the best practice. The qualitative phase, the second phase of the JBI EBHC model, was conducted to identify barriers and develop implementation strategies. There were seven evidence‐based audit criteria for evaluating the practice, with a sample size of 23 nurses for the quantitative phase and 10 participants for the qualitative phase. Results The quantitative findings revealed an improvement in compliance rates for all criteria following the follow‐up audit. From the qualitative analysis, four themes of barriers were identified: time and workload, lack of a proper reporting system for ADR, lack of belief and readiness for change among nurses, and lack of awareness about the importance of documenting ADR. Conclusion The results of this implementation study demonstrated enhanced ADR reporting. It can be inferred that implementing educational strategies, such as holding conferences, informal meetings, workshops, and educational pamphlets, can facilitate the implementation of evidence into practice. Implications for Nurses Findings will help nurses across sectors of primary, secondary, and tertiary care use the implemented strategies to improve the quality of care and reduce ADR.

The aim of this study was to determine the lysine requirement for tambaqui and estimate other essential amino acids (EAA) requirement based on the ideal protein concept. A total of 144 tambaqui juveniles (184.1 g ± 1.96) were randomly assigned into 18 500 L-aquaria connected to a water recirculation system. The experiment was performed in a completely randomized design with six treatments and three replicates. A basal control diet (52.5 g of protein kg−1 dry matter) was supplemented with six levels of synthetic lysine (9, 12, 15, 18, 21, and 24 g kg−1 diet). Then, a dose-response trial was conducted to determine the optimal level of lysine for enhancing fish growth and nutrient utilization. Additional analyses were carried out to understand and correlate the fish responses to the dietary lysine levels, including blood chemistry analysis, enzymatic activity, and muscle development patterns. Weight gain increased until reaching 2.27 g at 17.4 g kg−1 diet lysine. Protein (25.6 g) and lysine (55.6 g) retention plateaued at 18 g kg−1 lysine. The lipid concentration declined linearly (P < 0.001, R2 = 0.81) according to the increase in dietary lysine levels. Plasma ammonia and alanine aminotransferase activity decreased as lysine levels increased (P < 0.05, R2 = 0.95, 0.84, respectively). No differences were observed for muscle morphology. Regardless the dietary lysine levels, the predominance of muscle growth was via hypertrophy. In sum, the estimated lysine requirement based on weight gain for tambaqui was 17.4 g kg−1 diet or 54.37 g kg−1 of dietary protein.

Background: Drugs containing the 4-anilinoquinazolines scaffold play a critical role in cancer treatment by inhibiting protein kinases, especially tyrosine kinases. In this study, a novel series of 4-anilinoquinazoline derivatives were synthesized and evaluated as cytotoxic agents. Methods: All final compounds were synthesized using two methods, including a conventional approach using potassium iodide and dimethylformamide as well as a green method using a deep eutectic solvent (DES) comprising choline chloride: urea. The cytotoxicity was tested on the A431, HUVEC, and HU02 cell lines. To evaluate the binding pattern of the compounds with EGFR and VEGFR-2, a molecular docking investigation was performed. Finally, the wound healing assay was carried out to assess the potency of compounds in inhibiting cell migration. Results: The final reaction time was approximately 15-20 min with yields of 60-72% using DES, while the conventional method took 3 to 4 h to complete, with yields between 30% and 42%. Compounds 8k and 8l showed better cytotoxicity against both cell lines compared to vandetanib (IC50=0.11 µM and 0.26 µM on A431 and IC50=5.01 µM and 5.24 µM on HUVEC, respectively). Molecular docking studies revealed that compound 8k, which contained 3-methylaniline at the 4-position of the quinazoline core, showed efficient binding affinity to both EGFR and VEGFR-2. An essential hydrogen bond was formed between quinazoline N1 of 8k and the Met796 residue of EGFR with a docking score of -8.76 kcal/mol. The imidazole N3 of 8k interacted with the Cyc919 residue of VEGFR-2, forming a hydrogen bond with a docking score of -9.03 kcal/mol. Moreover, compound 8k exhibited the best inhibitory activity on cell migration and wound healing. Conclusion: DES significantly improved the time and yield of the final reactions. Compound 8k, which showed the best cytotoxicity and inhibitory activity on cell migration, could be a suitable candidate for further structural optimization.

Aiming to contribute to the energy transition, this study provides an integrated picture of the geothermal system hosted in the West Netherlands Basin and shows how the reconstruction of the basin's geological history can contribute to the correct exploration and exploitation of its geothermal resources. In the West Netherlands Basin, the main geothermal targets are found in the Cretaceous and Jurassic strata that were deposited during the rifting and post-rifting stages and were deformed during the subsequent basin inversion. Despite multiple studies on the tectonic setting, the timing and tectono-stratigraphic architecture of the rift system and its overall control on the development and evolution of geothermal systems are still to be fully deciphered. In this study, a detailed seismo-stratigraphic interpretation of the syn- and post-rift intervals in the West Netherlands Basin will be given within the framework of geothermal exploration. A recently released and reprocessed 3D seismic cube is used, covering a large portion of the onshore section of the basin. We identified two major Jurassic rifting episodes and a Late Cretaceous inversion event. During the Jurassic rifting phases, the compartmentalization of the basin and the creation of accommodation space led to the deposition of the Late Jurassic Nieuwerkerk Formation, which is the main regional geothermal producing target. Within this formation, we individuate growth synclines located in the central portions of the Jurassic half-grabens as sites that show good potential for geothermal exploration.

Abstract Background Accreditation is a prerequisite for scientific management of the health system, owing to its numerous benefits on health centres’ performance. The current study examined Iran’s primary healthcare accreditation program to ascertain the challenges to its successful implementation. Methods This qualitative study examined the perspectives of 32 managers and staff members in the pilot accreditation program (from the Ministry of Health and Medical Education, Semnan University of Medical Sciences, and Aradan District Health Network). Three in-depth group interviews were conducted using a semi-structured questionnaire, and the data obtained were assessed using thematic analysis. As a result of this investigation identified six themes, 29 sub-themes, and 218 codes as challenges to the successful accreditation of primary health care in Iran. Results Six main themes, including “organisational culture”, “motivational mechanisms”, “staff workload”, “training system”, “information systems”, and “macro-executive infrastructure”, were identified as the main domain of challenges, with seven, five, two, four, three, and eight sub-themes respectively. Conclusion Accreditation of PHC in Iran faces significant challenges and obstacles that, if ignored, can jeopardise the program’s success and effectiveness. By identifying challenges and obstacles and making practical suggestions for overcoming them, the findings of this study can aid in the program’s successful implementation and achievement of desired outcomes.

Groups have cognitive existence through the prototype of the group (Haslam et al., 1995; https://doi.org/10.1002/ejsp.2420250504). Past group prototypes then refer to the most representative characteristics that define the group in these previous states. We suppose, as collective events might have different versions associated with different valences (Zaromb et al., 2014; https://doi.org/10.3758/s13421-013-0369-7), this might also be the case for prototypes also held in the collective memory (Halbwachs, 1950; http://dx.doi.org/doi:10.1522/cla.ham.mem1). After highlighting different facets of the past (Study 1) or not (Study 2), we used the “free association method” (Lo Monaco et al., 2017; https://doi.org/10.1111/jtsb.12124; Vergès, [1992], L’évocation de l’argent. Bulletin de Psychologie, 45(4–7), 203–209). Yet, this research explored the content of past prototypes associated with different elements of French collective memory: the French during the Second World War (Study 1, N = 301), and French people in 18th century (Study 2, N = 354). Results suggest the existence for each of these periods of a “two-sided” prototype, i.e., a positive vs. negative-valence prototype. The implications of the existence of these “two-sided” prototypes, the implication of collective continuity perceived for each of them and avenues for future research will be discussed.

Background: Multiple sclerosis (MS) is one of the critical diseases due to its adverse clinical, social, and economic consequences for affected people. This study aims to assess the quality of life (QoL) of patients with MS in East Azerbaijan, Iran. Methods: This cross-sectional study was conducted using the multiple sclerosis quality of life-54 (MSQoL-54) questionnaires to interview 300 randomly selected MS patients in East Azarbaijan Province, Iran. The independent t-test, analysis of variance (ANOVA), and Tukey post hoc test were used to examine the relationship between demographic variables, and QoL, and all analyses were performed using SPSS software, version 19. Results: The QoL score in MS patients is 48.22±22.48. The “life satisfaction” is the best and “physical role limitation” is the worst QoL aspect. Significant relationships were observed between marital status, education level, employment status, age of symptoms onset, and years of illness with QoL (P

Background: Prior guidelines recommended maintaining normothermia following traumatic brain injury (TBI), but recent studies suggest therapeutic hypothermia as a viable option in pediatric cases. However, some others demonstrated a higher mortality rate. Hence, the impact of hypothermia on neurological symptoms and overall survival remains contentious. Methods: We conducted a systematic review and meta-analysis to evaluate the effects of hypothermia on neurological outcomes in pediatric TBI patients. The PubMed/Medline, Scopus, and Web of Science databases were searched until 1 January 2024 and data were analyzed using appropriate statistical methods. Results: A total of eight studies, comprising nine reports, were included in this analysis. Our meta-analysis did not reveal significant differences in mortality (RR = 1.58; 95% CI = 0.89–2.82, p = 0.055), infection (RR = 0.95: 95% CI = 0.79–1.1, p = 0.6), arrhythmia (RR = 2.85: 95% CI = 0.88–9.2, p = 0.08), hypotension (RR = 1.54: 95% CI = 0.91–2.6, p = 0.10), intracranial pressure (SMD = 5.07: 95% CI = −4.6–14.8, p = 0.30), hospital length of stay (SMD = 0.10; 95% CI = −0.13–0.3, p = 0.39), pediatric intensive care unit length of stay (SMD = 0.04; 95% CI = −0.19–0.28, p = 0.71), hemorrhage (RR = 0.86; 95% CI = 0.34–2.13, p = 0.75), cerebral perfusion pressure (SMD = 0.158: 95% CI = 0.11–0.13, p = 0.172), prothrombin time (SMD = 0.425; 95% CI = −0.037–0.886, p = 0.07), and partial thromboplastin time (SMD = 0.386; 95% CI = −0.074–0.847, p = 0.10) between the hypothermic and non-hypothermic groups. However, the heart rate was significantly lower in the hypothermic group (−1.523 SMD = −1.523: 95% CI = −1.81–−1.22 p < 0.001). Conclusions: Our findings challenge the effectiveness of therapeutic hypothermia in pediatric TBI cases. Despite expectations, it did not significantly improve key clinical outcomes. This prompts a critical re-evaluation of hypothermia’s role as a standard intervention in pediatric TBI treatment.

The extraordinary gamma-ray burst GRB 221009A provides a great opportunity to investigate the enigmatic origin and evolution of gamma-ray bursts (GRBs). However, the complexity of the observations associated with this GRB provides significant challenges to developing a theoretical modeling in a coherent framework. In this paper, we present a theoretical interpretation of the GRB 221009A afterglow within the relativistic fireball scenario, aiming to describe the broadband data set with a consistent model evolution. We find that the adiabatic fireball evolution in the slow-cooling regime provides a viable scenario in good agreement with observations. Crucial to our analysis is the set of simultaneous GeV and TeV gamma-ray data obtained by AGILE and LHAASO during the early afterglow phases. Having successfully modeled as inverse Compton emission the high-energy spectral and lightcurve properties of the afterglow up to 10 ^4 s, we extend our model to later times when also optical and X-ray data are available. This approach results in a coherent physical framework that successfully describes all observed properties of the afterglow up to very late times, approximately 10 ^6 s. Our model requires time-variable microphysical parameters, with a moderately increasing efficiency ε _e of a few percent for transferring the shock energy to radiating particles and a decreasing efficiency for magnetic field generation ε _B in the range 10 ^−5 –10 ^−7 . Fitting the detailed multifrequency spectral data across the afterglow provides a unique test of our model.

ABSTRACTLittle is known about adolescents’ own beliefs regarding their level of risk taking or regarding peer influence on the latter. This is an important matter given that beliefs influence judgements and decisions. With the present study, we aimed to study adolescents’ and adults’ beliefs about adolescents’ risk taking compared to adults’ risk taking, and beliefs about peer influence on risk taking. To this end, an experimental design was used. A cross-sectional study included 56 adolescents and 43 adults, who completed a questionnaire asking about adolescents’ and adults’ risk-taking propensity and a syllogistic reasoning task designed to indirectly study these beliefs. Both direct and indirect measures indicated that adolescents perceived adolescence as a period of higher risk taking compared to adulthood, and believed peer presence to promote this effect. Adults perceived this detrimental effect of peers to be present irrespective of age. We discuss the implications of these results in terms of social representation.

Background: Financial protection of populations against healthcare costs is one of the fundamental responsibilities of governments. This study aimed to investigate the incidence of catastrophic health expenditures (CHE) and it’s affecting factors in hospitalized patients with delta variant of COVID-19. Methods: In this cross-sectional study, we included 400 hospitalized COVID-19 patients at Kosar Hospital of Semnan in 2022, using a researcher-made checklist. Based on qualitative nature of the variables, chi-square test was used to investigate the statistical associations between the demographic/background characteristics and the incidence of CHE. Results: On average, COVID-19 imposed 1833.43 USD direct medical costs per one hospitalized patient. The ratio of direct-medical costs to household’s non-food expenses was 2.35, and 61% (CI:±4.78%) of the patients were subject to CHE. Besides, residence place, basic insurance type, benefitting from supplementary insurance, suffering from underlying diseases, hospitalization in ICU, falling into a coma, facing pulmonary failure, and performing hemoperfusion had significant associations with CHE (P

Abstract Aim This descriptive‐analytical correlational study was carried out to examine moral awareness and its relationship with moral sensitivity among Iranian nursing students. Design A descriptive‐analytical correlational study. Methods The present descriptive‐analytical study was performed among 140 Iranian nursing students. The data collection tool was a three‐part questionnaire including (1) Demographic Information Questionnaire, (2) Nurses' Awareness about the Iranian Nursing Code of Ethics by Mohajjel Aghdam and (3) Moral Sensitivity Questionnaire (MSQ) by Kim Lutzen. The data collected from these questionnaires were analysed in SPSS‐26 using descriptive and inferential statistics. Results The mean moral awareness (29.42 ± 4.01) was good, and the mean moral sensitivity (135.05 ± 18.79) was moderate among the students. A significant positive correlation was observed between the total score of moral awareness and moral sensitivity (r = .22, p = .009) in the nursing students.

Nitrosoalkenes react with 8-methyl-1,6-dihydropyrrolo[3,2-c]carbazole to give both 2- and 3-alkylated products via hetero-Diels-Alder reaction followed by the cycloadduct ring-opening. Quantum chemical calculations, at DFT level of theory, were carried out to investigate the regioselectivity of the cycloaddition of ethyl nitrosoacrylate with 1,6-dihydropyrrolo[3,2-c]carbazoles as well as with pyrrole and indole, allowing a more comprehensive analysis of the reactivity pattern of nitrosoalkenes with five-membered heterocycles. Furthermore, theoretical calculations confirmed that ethyl nitrosoacrylate reacts with these heterocycles via a LUMOheterodiene-HOMOdienophile controlled cycloaddition. The reactivity of one of the oxime-functionalized 1,6-dihydropyrrolo[3,2-c]carbazole was explored and a new hexahydropyrido[4′,3':4,5]pyrrolo[3,2-c]carbazole system was obtained in high yield via a one-pot, two-step procedure.

The γ-ray sky above a few tens of megaelectronvolts (MeV) reveals some of the most powerful and energetic phenomena of our Universe. The Astrorivelatore Gamma ad Immagini LEggero (AGILE) Gamma-ray Mission was launched in 2007 with the aim of observing celestial sources by means of three instruments covering a wide range of energies, from hard X-rays up to 30 GeV. Thanks to its wide field of view, AGILE set to observe and detect emission from pulsars, pulsar wind nebulae, gamma-ray bursts, active galactic nuclei, fast radio bursts, terrestrial gamma-ray flashes, and the electromagnetic counterparts of neutrinos and gravitational waves. In particular, the fast on-ground processing and analysis chain allowed the AGILE team to promptly respond to transient events, and activate or participate in multiwavelength observing campaigns. Eventually, after 17 years of operations, the AGILE Italian scientific satellite re-entered the atmosphere on 14 February 2024, ending its intense activity as a hunter of some of the most energetic cosmic sources in the Universe that emit X and γ-rays. We will review the most relevant AGILE results to date and their impact on the advancements of theoretical models.

Abstract The effect of three reducing agents (sulphur dioxide, pyrite and carbon) on tungsten extraction from a scheelite-wolframite concentrate with chlorine gas was assessed. A low-grade ore (0.9% w/w WO3) was collected in the San Martín department, San Luis Province, Argentina, and subsequently enriched by physical means (65.73% w/w WO3). The minerals identified and their reactivities with chlorine were: scheelite (reactive), wolframite (reactive), pyrite (reactive), quartz (inert) and feldspars (inert). The metal recovered as WO2Cl2, with the different reagent combinations, was in increasing order: Cl2 + N2 < Cl2 + SO2 < pyrite + Cl2 + N2 < pyrite +Cl2 + SO2 < carbon + Cl2 + N2. It was proved that, according to its content, the pyrite initially present in the ore improves chlorination performance. At the same time, the non-volatile reaction products formed - CaCl2 and/or CaSO4 - and the manner of removing the nascent (desorbed) oxygen change depending on the reducing agent tested.