Search

In recent times, there has been a notable increase in economic activities in the world’s oceans. This growth in oceanic economic activity is attributed to various natural resources, such as fish, minerals, and energy reserves, which promise significant economic gains. In many cases, helicopters have proven valuable for efficient and flexible transportation due to their ability to navigate challenging terrain and reach remote locations. They are often used for various transportation tasks, including emergency medical services, search and rescue operations, offshore oil rig transportation, and corporate travel. Flying across the ocean poses a significant risk due to the absence of a landing platform throughout the journey. In an emergency, there may not be a safe place to land, potentially endangering the lives of those on board. Additionally, aircraft must be equipped with advanced technology and safety features to mitigate potential risks and ensure a successful journey across the vast expanse of the ocean. The aviation authority’s studies on using Emergency Floatation Systems (EFS) have highlighted the need for improvements to prevent fatalities resulting from helicopter ditching. Despite implementing the Emergency Floatation System (EFS) in helicopters, several reports indicate that fatalities still occur, often related to the helicopter’s stability during ditching. This suggests that while safety measures have been put in place, there may be a need for further improvements in helicopter design and safety protocols to minimize the risk of accidents and fatalities. This research utilizes simulation techniques to measure the stability performance of helicopters during water ditching quantitatively. This study aims to optimize the configuration of EFS to prevent capsizing, with a particular focus on the role of weather conditions in contributing to EFS failures. Through careful analysis and consideration of this crucial factor, the research aims to identify and implement strategies to enhance EFS operations’ safety and stability, ultimately improving overall performance and reducing the risk of catastrophic incidents.

The Bale beleq traditional house of Jerowaru Village and Wakan Village is a historical heritage. This house is different from ordinary traditional houses because Bale beleq is occupied by people who are respected. In addition, there are also historical relics such as keris, swords, and many more. This research aims to examine information about the meaning and philosophy of the Bale beleq traditional house. This research was conducted in Jerowaru Village and Wakan Village. Eight respondents were interviewed. The research method used was the qualitative method. Data collection was done by using observation, interview, and documentation methods. The data analysis techniques are data collection, data reduction, data presentation, and conclusion drawing or verification. The results of the study found the history of the emergence of the Bale beleq traditional house, the meaning and philosophy of Bale beleq, and the values within Bale beleq. Currently, Bale beleq is used as a center for socio-cultural religious activities. One way to maintain and preserve traditional houses is to make the house a cultural heritage so that it does not erode with the time, and to make Bale beleq an educational and cultural tour site.

Pengambilan minyak melati (Jasminum sambac) dengan metode enfleurasi telah dilakukan dengan memvariasikan waktu enfleurasi dan jenis adsorben. Metode enfleurasi dapat mencegah kerusakan minyak atsiri yang diperoleh karena dilakukan pada suhu rendah. Tujuan penelitian untuk melihat jenis adsorben dan berat bunga yang tepat untuk mendapatkan minyak melati optimum. Penelitian dilakukan dengan memvariasikan jenis adsorben (mentega putih dan mentega kuning) dan waktu enfleurasi (6, 10, 12, 16, dan 20 hari). Parameter yang diamati adalah rendemen, komponen minyak, densitas, aroma dan warna minyak yang diperoleh. Hasil penelitian menunjukkan adsorben mentega putih lebih efektif dibandingkan mentega kuning dengan perolehan minyak atsiri tertinggi pada waktu enfleurasi 20 hari dan jumlah bunga 230 gram dengan rendemen 8,69%. Perolehan minyak terendah dengan rendemen 5,21% menggunakan adsorben mentega kuning pada waktu enfleurasi 10 hari dengan berat bunga 115 gram. Komponen-komponen dominan yang terdeteksi dalam minyak diantaranya adalah linalool (8,82%), benzyl acetat (4,58%), hexyl salicylate (4,90%), 1-Phenanthrenecarboxylic acid (5,99%), versalide (3,14%), dan 3-phenyl-propenal (3,29%). Minyak melati yang dihasilkan berwarna kuning muda jernih dengan densitas berkisar antara 0,8821-0,8845 g/mL pada penggunaan adsorben mentega putih dan 0,8175-0,8675 g/mL dengan adsorben mentega kuning. Hasil uji organoleptik menunjukkan rata-rata panelis menyukai aroma dan warna pada minyak melati pada perlakuan waktu enfleurasi 6, 10, dan 12 hari dengan tingkat kesukaan panelis 100% suka

Singkong karet (Manihot glaziovii Muell) adalah salah satu sumber bahan baku bioetanol yang mempunyai kandungan pati yang cukup tinggi (98,5%). Penelitian ini bertujuan mempelajari kinerja katalis H2SO4, HCl, dan zeolit pada proses hidrolisis pati umbi singkong karet untuk menghasilkan glukosa. Proses hidrolisis untuk katalis homogen dilakukan pada temperatur 120oC dan volume asam 250 ml, sedangkan untuk katalis heterogen dengan rasio massa pati dan aquades (1:25), waktu 60 menit, dan temperatur 120oC. Perolehan glukosa untuk katalis homogen diamati melalui variasi konsentrasi HCl dan H2SO4 masing-masing (0,1; 0,15; 0,2; 0,25; dan 0,3 N) dan waktu hidrolisis (45; 60; dan 75 menit). Untuk katalis heterogen, perolehan glukosa diamati melalui variasi massa zeolit (1; 3; dan 6 g), jenis asam pengaktif HCl dan H2SO4 dengan konsentrasi0,15 N, dengan metode perendaman dan pemanasan pada temperature 50oC. Hasil penelitian memperlihatkan konsentrasi dan waktu hidrolisis pati singkong karet berpengaruh terhadap perolehan glukosa pada penggunaan jenis katalis homogen (H2SO4 dan HCl). Glukosa tertinggi (27,25%) diperoleh pada katalis homogen dengan konsentrasi H2SO4 0,15 N dan waktu 60 menit. Zeolit yang diaktivasi dengan HCl dengan metode perendaman menghasilkan kadar glukosa lebih tinggi (14,13%) daripada zeolit yang diaktifkan dengan H2SO4 (12,58%).AbstractRubber cassava (Manihot glaziovii Muell) is one source of bioethanol raw material which has high starch content (98.5%). The manufacture of bioethanol is carried out through the process of hydrolysis and fermentation. This research was aimed to study the performance of the homogeneous and heterogeneous catalysts in the hydrolysis process of starch from rubber cassava tubers to produce glucose. The hydrolysis process for homogeneous catalyst was carried out at a temperature 120oC and 250 ml acid volume, while for heterogeneous catalyst was the ratio of starch mass and distilled water (1:25), 60 minutes time, and 120oC temperature. The glucose obtained for heterogeneous catalyst was observed through variations of HCl and H2SO4 concentrations (0.1; 0.15; 0.2; 0.25; and 0.3 N) and hydrolysis time (45; 60; and 75 minutes). For heterogeneous catalyst, the glucose obtained was observed through zeolite mass variations (1; 3; and 6 g), type of activating acid HCl and H2SO4 with 0.15 N concentration by immersion and heating method at 50oC. The results showed that the concentration and hydrolysis time of rubber cassava starch affected the glucose obtained in the use of homogeneous catalyst types (H2SO4 and HCl). The highest glucose was obtained at 0.15 N acid concentrations and 60 minutes time. Zeolite which was activated with HCl with soaking method resulted in higher glucose levels (14.13%) than activated with H2SO4 (12.58%).

Isolation of inulin from starch generally is done by extraction method. The size of the material to be extracted will affect the extraction process performance. In laboratory scale, the size reduction was done with a knife and the separation of starch from tubers was done by juicer. Temperature fluctuations during the extraction process would affect the yield of inulin, hence juicers and waterbath were found ineffective for larger scale. This research was aimed to design an extractor equipped with agitator blades for size reduction and a temperature controller. Extractor performance was investigated by evaluating agitation time (60-150 minutes), distance between agitator blades on the shaft (5 and 7 cm), number of the agitators, (1, 2, and 3 blades) against the fineness of cut material, starch and inulin content. The results showed that the highest fineness of the samples was achieved at a distance of agitator blade of 7 cm, with 3 agitator blades and agitating time of 150 minutes. The highest yield of starch was 11.7% at size reduction time of 120 and 150 minutes using 3-blades agitator and the distance of 7 cm. The content of crude inulin obtained were by using the extractor was 2.206% and 2.213% by using the water bath. The difference of inulin content was 0.007% so it suggests that the extractor designed in this study can be used on inulin production in larger scale. The efficiency of the extractor was 85%.

Agitation, a common dementia symptom often arising from untreated pain, lacks comprehensive research on its connection with opioids prescribed for long-term pain. This study investigated the relationship between opioid use and agitation in dementia patients. Participants ( n  = 188) were categorized into opioid, acetaminophen PRN, or no-pain medication groups. Despite higher reported pain levels in the opioid group, no significant differences in agitation were observed among the groups. In conclusion, opioid use for pain management in older adults with dementia did not significantly impact agitation, emphasizing the ongoing importance of proper pain management in improving dementia care and addressing agitation in this population., Competing Interests: The authors have no conflict of interest to report., (© 2024 – The authors. Published by IOS Press.)

Background: Quality of life (QoL) is an important outcome to capture in clinical trials evaluating deprescribing interventions., Objective: We aimed to conduct a scoping review to examine how QoL has been measured in deprescribing trials among older people and identify potentially relevant QoL scales, to better inform QoL measurement in future deprescribing trials., Methods: We searched MEDLINE, Embase, PsycINFO, the Cochrane Central Register of Controlled Trials, Google Scholar, Epistemonikos, ClinicalTrials.gov, and reference lists of eligible studies (from inception to October 2023). We included randomized and non-randomized comparative studies with a control group that evaluated deprescribing and polypharmacy reduction interventions in people ≥ 65 years of age and measured QoL as an outcome. We also included studies describing the development and validation of QoL scales related to deprescribing, polypharmacy, or medication burden in adults ≥ 18 years of age. Two independent reviewers screened titles and abstracts, then full texts. Two independent reviewers extracted data from 25% of eligible studies in order to verify agreement, then a single reviewer extracted data from the remaining studies, which a second reviewer cross-checked. We critically appraised scales based on the COSMIN checklist., Results: We retrieved 7290 articles, of which 52 were eligible for inclusion, including 44 deprescribing trials and eight scale development studies. From these studies, we found 21 scales that have been used in the context of deprescribing/polypharmacy (12 generic scales used in clinical trials and nine medication-specific scales). Variations of the generic EQ-5D were the most used scales. The measurement properties of scales for capturing changes in QoL from deprescribing were uncertain. Medication-specific QoL scales have not been employed in deprescribing clinical trials and thus, their performance in this context is also not clear., Conclusions: Several existing QoL scales have been applied to the context of deprescribing/polypharmacy clinical trials, and new scales specific to the problem have been proposed. If deprescribing does impact QoL, our findings suggest it is uncertain whether existing QoL scales can practically and reliably capture such a change or whether any scale is best. However, this review compares various aspects of the scales that researchers and clinicians can consider in decisions about measuring QoL in deprescribing trials, and in planning future research., Protocol Registration: Open Science Framework: osf.io/aez6w., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Auricular reconstruction remains a challenging procedure, requiring a high degree of manual dexterity and attention to detail in order to reconstruct the complex three-dimensional geometry of the ear successfully. Most techniques will rely on autologous cartilage for auricular framework fabrication, carrying a risk of donor and recipient site morbidity. The aim of this report is to investigate the complications and aesthetic outcomes associated with autologous cartilage harvest in auricular reconstruction. A systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies for four databases were developed. Studies were screened according to the inclusion and exclusion criteria by two independent reviewers. The literature search identified 7171 articles. Filtering for relevance and duplication reduced the number of articles to 52. A total of 12,215 patients underwent auricular reconstruction utilising autologous cartilage. Indications included 11,696 patients due to microtia, 334 patients due to burns or trauma, 70 patients due to constricted ears, and 115 patients due to prominent ears. The most commonly reported donor site complications included chest wall deformities (n = 159). The most commonly reported recipient site complications included hypertrophic or keloid scars (n = 279), haematoma (n = 155), tissue expander exposure (n = 111), cartilage or framework exposure (n = 122), and cartilage framework deformation or resorption (n = 50). Although a challenging procedure, auricular reconstruction utilising autologous cartilage is possible. Exceptional aesthetic results can be achieved when performed by a skilled surgeon on appropriately selected individuals. However, the potential risks and complications associated with the procedure should be discussed with the patient and family beforehand., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Abukhder et al.)

Background: Diffuse sclerosing osteomyelitis (DSO) affecting the mandible is an uncommon condition characterised by recurrent pain and functional disturbances. Traditional treatments involving antibiotics, steroids, and analgesics have generally yielded unsatisfactory results. Numerous articles have proposed the utilisation of bisphosphonate therapy as an alternative approach to achieve sustained symptom relief. This study aims to consolidate the available evidence on the effectiveness of bisphosphonate therapy in managing DSO., Methods: A systematic review protocol was registered with PROSPERO and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. Comprehensive electronic search strategies were devised, and studies were screened based on predefined inclusion and exclusion criteria., Results: Ten articles met the eligibility criteria, encompassing a total of 135 patients diagnosed with DSO who received bisphosphonate treatment. All included studies consistently reported a reduction in pain levels and swelling, along with a decrease in the cumulative use of analgesics. The majority of patients reported long-lasting symptom improvement with bisphosphonate therapy. Notably, four studies documented improvements in maximal mouth opening, with one study reporting a mean increase of 9.6mm. Furthermore, six studies observed improvements in panoramic radiographs and cone beam computed tomography scans, with one publication describing two patients exhibiting near-normal bone architecture. Importantly, all studies reported the absence of long-term complications., Conclusions: Bisphosphonate therapy emerges as a promising treatment modality for DSO, exhibiting efficacy in symptom alleviation and radiological enhancement while conferring lasting benefits. Nevertheless, further prospective studies are warranted to refine treatment protocols and substantiate these findings., Competing Interests: None.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose: Patients and physicians in low- and middle-income countries (LMICs) face challenges owing to limited expertise and suboptimal access to appropriate diagnostic and treatment modalities. We report our experience in treating posterior fossa ependymoma (PFE) at MAHAK, a charity organization in Iran whose radiation oncology department is the only one exclusively dedicated to childhood cancer in the whole country., Methods and Materials: Pediatric patients with PFE referred to MAHAK between November 2008 and January 2016 were identified. Details on investigations and management done before referral were collected. Management at MAHAK and patient outcomes were analyzed., Results: Of 80 patients diagnosed as having ependymoma, 54 with PFE were identified. Forty-three patients received adjuvant radiation therapy, and 11 were irradiated initially after recurrence. At a median follow-up of 5.1 years (range, 0.3-9.7 years), the latter group had the worst outcome, with a 5-year overall survival (OS) rate of 27% (95% CI, 7%-54%). Patients who started radiation therapy within 77 days after initial surgery had a better outcome compared with those who started later (5-year OS: 74% vs 32%; P = .05). Compliance with follow-up recommendations was poor. Only 22% of the patients had at least 2 IQ test assessments, and 50% showed some decline over time. Three cases of growth hormone deficiency were detected, but none of the patients received replacement therapy., Conclusions: Access to pediatric neurosurgery, anesthesia, and timely radiation therapy are among the most challenging obstacles to be overcome in LMICs. Our series confirmed that chemotherapy is not an appropriate option for delaying radiation therapy, especially in young children. The importance of long-term follow-up should be acknowledged by the parents and medical team., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The limitations of current cancer therapies, including the increasing prevalence of multidrug resistance, underscore the urgency for more effective treatments. One promising avenue lies in the repurposing of existing drugs. This review explores the impact of phenothiazines, primarily used as antipsychotic agents, on key mechanisms driving tumor growth and metastasis. The cationic and amphiphilic nature of phenothiazines allows interaction with the lipid bilayer of cellular membranes, resulting in alterations in lipid composition, modulation of calcium channels, fluidity, thinning, and integrity of the plasma membrane. This is especially significant in the setting of increased metabolic activity, a higher proliferative rate, and the invasiveness of cancer cells, which often rely on plasma membrane repair. Therefore, properties of phenothiazines such as compromising plasma membrane integrity and repair, disturbing calcium regulation, inducing cytosolic K-RAS accumulation, and sphingomyelin accumulation in the plasma membrane might counteract multidrug resistance by sensitizing cancer cells to membrane damage and chemotherapy. This review outlines a comprehensive overview of the mechanisms driving the anticancer activities of phenothiazines derivates such as trifluoperazine, prochlorperazine, chlorpromazine, promethazine, thioridazine, and fluphenazine. The repurposing potential of phenothiazines paves the way for novel approaches to improve future cancer treatment., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Mehrabi, Elmi and Nylandsted.)

Introduction: Subacute thyroiditis (SAT), also known as de Quatrain's thyroiditis or granulomatous thyroiditis, is an inflammatory disease of the thyroid. Most of the time, it manifests in the thirties to fifties and is more common in women. SAT can have either viral or post-viral origin. Some viruses, like influenza, COVID-19, Epstein-Barr virus, cytomegalovirus, hepatitis, coxsackievirus 16, and mumps virus, have been linked to SAT development. The COVID-19 pandemic has affected people's lives all around the world and has changed our attitude toward the treatment of many diseases. It has also made us look deeper into the subject in a way that we would be able to treat this sort of disease with a newer insight., Objective: Regarding the importance of this issue, we decided to summarize our extensive searches from online databases, including PubMed, Google Scholar, Medline, Web of Science, and Scopus until February 2023, which we found effective in elucidating the association of subacute thyroiditis and viral diseases., Method: Different online databases were searched for narrative review articles, systemic review articles, and original articles, which were published until February 2023., Result: According to the included studies, we found that there is a correlation between SAT and several viruses such as Epstein-Barr virus, influenza virus, human immunodeficiency virus, cytomegalovirus, oral and cervical virus, hepatitis, dengue virus, and SARS-COV-2. The effect of each of the viral diseases mentioned in the SAT is given in the text., Conclusions: According to the results mentioned in the text, because SAT may be challenging for early diagnosis, due to the potential of classic symptoms as well as the interference of similar clinical symptoms between thyrotoxicosis and viral reactions, the correlation between SAT and viral diseases should be considered so that we can avoid misdiagnosis and lateness., Competing Interests: Authors declare no conflict of interest., (National Institute of Public Health NIH – National Research Institute.)

Telephone practice is an essential component of ambulatory nursing practice to address patient concerns between their clinic visits. Proactive telephone practice has been part of oncology nursing at a large regional cancer centre for six years and involves taking the initiative of calling patients and families before they are in distress. A review of nursing practice regarding proactive calls in the centre revealed a lack of standardization across cancer disease sites in identifying and assessing patients who would benefit from proactive calls, and variability in how nurses documented telephone interactions. To create a standardized approach for proactive telephone practice, we began by identifying when patients require a proactive call based on key transition points across their cancer care trajectory. Based on the practice review of proactive calls, the needs assessment with patients, and a literature review, a Proactive Telephone Nursing Assessment Guideline was developed. The guideline provided guidance for conducting a proactive telephone call and identifying patient needs, intervening as required, and documenting the exchange. The guideline was piloted with newly diagnosed patients to determine if the call helped in meeting their needs. Informational and practical needs were most common. The pilot revealed both patients and families were satisfied with the proactive call. Nurses felt the guideline was useful, but could be burdensome, especially when it was first used. Through the pilot, it was identified that proactive telephone calls can be utilized to focus on patient and family supportive care needs., (© 2023 Canadian Association of Nurses in Oncology (CANO).)

Telepractice in oncology is an evolving practice for nurses and cancer patients. Understanding the needs of our patients led the nursing leaders of a large academic teaching centre to undertake the challenge of creating a measurable and sustainable Telephone Readiness Assessment and Orientation Program. The experiences of patients and families regarding telephone interactions triggered the launch of Live Voice Answer, a centre-wide telepractice change. To support the transition from clinic practice to telepractice with the introduction of Live Voice Answer, an orientation program was created to lay the foundation for nurses to provide excellent standardized telepractice care. A Practice Training Process map was designed to depict three stages required to successfully complete the orientation: Telephone Readiness Assessment, Telephone Practice Training session, and Practical Application. The frameworks used to support the Practice Training Process includes COSTaRS, College of Nurses of Ontario Practice Guideline: Telepractice, Cancer Care Ontario: Oncology Nursing Telepractice Standard, Cancer Care Ontario - Symptom Management Guides as well as our organizational policies. Benner's Novice to Expert Theory is also embedded to guide the skill/competency development. The purpose of this manuscript is to describe the telephone practice orientation program and share lessons learned that have contributed to its current evolution., (© 2022 Canadian Association of Nurses in Oncology (CANO).)

In 2016, a Live Voice Answer symptom management and distress telephone line was developed at a large regional cancer centre in Toronto. Prior to the initiation of Live Voice Answer, the previous telephone practice involved patients leaving a voicemail message for a nurse without a definitive return call time. An interprofessional team, including patient partners, sought to address this drawback and ensure all patients living with cancer have access to a nurse in real time (live voice) when they called the centre. After piloting the feasibility of real time telephone access, the Live Voice Answer initiative expanded beyond the pilot to meet the needs of all patients and families. Overall, the Live Voice Answer initiative has led to marked improvements in patient satisfaction compared to the pre-pilot state and timeliness of telephone access for patients and their families. This article describes the Live Voice Answer initiative, process improvements, and evaluation results., (© 2022 Canadian Association of Nurses in Oncology (CANO).)

Objectives: Neuropsychiatric symptoms (NPSs) in those with major neurocognitive disorder (MNCD) include the responsive behaviors of agitation and aggression. Electroconvulsive therapy (ECT) has shown some effectiveness based on retrospective studies and one open label prospective study. We hypothesized that ECT will reduce NPSs between baseline and after treatment in those with medication-refractory behaviors., Method/design: This Canadian prospective multicenter study included MNCD patients admitted to geriatric psychiatry units for the management of refractory NPSs. All treatment-refractory participants suffered from advanced MNCD. We conducted the Neuropsychiatric Inventory-Clinician version and the Pittsburgh Agitation Scale at baseline, and during and after the ECT course. A bitemporal or bifrontal ECT series based on dose titration to 1.5 to 2.5 times seizure threshold was administered., Results: Data were collected for 33 patients with a mean age of 73 and categorized with severe MNCD using the Functional Assessment Staging of Alzheimer's Disease scale (stages 6 and 7). The data showed a drop in mean Neuropsychiatric Inventory-Clinician version from 58.36 to 24.58 (P < 0.0001). Mean Neuropsychiatric Inventory agitation subscale dropped from 7.12 to 3.09 (P = 0.007). Mean Neuropsychiatric Inventory aggression subscale dropped from 6.94 to 0.97 (P < 0.0001). There was a concomitant significant decline in Pittsburgh Agitation Scale scores. No participants dropped out because of intolerance of ECT. One participant died from pneumonia, which did not appear related to ECT., Conclusions: In this naturalistic study, ECT was found to be a safe and effective treatment for certain NPSs in people with MNCD. This can translate into improving quality of life., Competing Interests: P.C. is a coowner of Brainstim (rTMS) Healthcare, advisory board for Janssen-Ortho. The remaining authors have no conflicts of interest or financial disclosures to report., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Nurses play a key role in increasing the efficiency of healthcare systems. Given the 24-hour performance of hospitals and the small number of nurses in the field of treatment, it is quintessential to re-shift them in the hospital. This study set out to achieve coherence in nursing shift planning and justice in the order of shifts in hospital., Methods: This applied and a developmental study was performed from 2019 to 2020. We used genetic algorithm to provide operational solutions and define flexible shifts and plan nurses' working hours in Yas Hospital, Tehran University of Medical Sciences Hospital, Tehran, Iran., Results: Based on the selection of each nurse and determining the approved shifts of each ward, the possibility of appropriate planning was provided to determine the required shifts per month and to estimate the needs of each department., Conclusion: Using genetic algorithm and nursing shift in office automation console provides useful tools for managers at all organizational levels, according to which a good balance between the hospital's need for nurse and nurses' demands in different time periods., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright © 2022 Torabi et al. Published by Tehran University of Medical Sciences.)

Background: Agitation and aggression are common in patients with Alzheimer's disease and related dementias and pose a significant burden on patients, caregivers, and the healthcare systems. Guidelines recommend personalized behavioral interventions as the first-line treatment; however, these interventions are often underutilized. The Standardizing Care for Neuropsychiatric Symptoms and Quality of Life in Dementia (StaN) study (ClinicalTrials.gov Identifier # NCT0367220) is a multisite randomized controlled trial comparing an Integrated Care Pathway, that includes a sequential pharmacological algorithm and structured behavioral interventions, with treatment-as-usual to treat agitation in dementia in long-term care and inpatient settings., Objective: To describe the rationale and design of structured behavioral interventions in the StaN study., Methods: Structured behavioral interventions are designed and implemented based on the following considerations: 1) personalization, 2) evidence base, 3) dose and duration, 4) measurement-based care, and 5) environmental factors and feasibility., Results: The process to design behavioral interventions for each individual starts with a comprehensive assessment, followed by personalized, evidence-based interventions delivered in a standardized manner with ongoing monitoring of global clinical status. Measurement-based care is used to tailor the interventions and integrate them with pharmacotherapy., Conclusion: Individualized behavioral interventions in patients with dementia may be challenging to design and implement. Here we describe a process to design and implement individualized and structured behavioral interventions in the context of a multisite trial in long-term care and inpatient settings. This process can inform the design of behavioral interventions in future trials and in clinical settings for the treatment of agitation in dementia.

The identification of biological markers for psychosis has an impact on its diagnosis, prognosis, and likelihood of treatment response. Tissue plasminogen activator (tPA) is involved in important functions such as synaptic plasticity, long-term potentiation and neurogenesis. Plasminogen activator inhibitor (PAI-1) is the most important inhibitor of tPA. Preliminary studies have shown that schizophrenia patients have lower tPA and higher PAI-1 levels than the general population. The association of tPA and PAI-1 abnormalities with psychotic spectrum disorders, however, remains elusive. Our primary objective was to assess the plasma levels of tPA and PAI-1 in patients experiencing acute psychotic episodes as compared to those in healthy controls. In this prospective case-control study, we collected peripheral blood samples from psychiatric inpatients and healthy age, gender and race-matched subjects and determined plasma levels of tPA and PAI-1 by enzyme-linked immune-absorbent assays. Plasma levels of PAI-1 in patients with schizoaffective disorder were significantly lower as compared to those in control subjects (P = 0.03). tPA was lower in cases as compared to controls although it did not reach statistical significance. Asian patients and controls had lower PAI-1 levels. Further, Asian patients with schizoaffective disorder had significantly lower PAI-1 level compared to Asian patients with schizophrenia. Our results indicate that patients with schizoaffective disorder have lower PAI-1 levels than those with schizophrenia, affective psychosis, and healthy controls. Further studies are warranted to explore the potential of PAI-1 as a biomarker for diagnosing schizoaffective disorder., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The practice environment pivotal role in patients and nurses better outcomes is evident. Practice Environment Scale of Nursing Work Index (PES-NWI) is widely utilized to assess nursing work environments. The present study was conducted to demonstrate the validity and reliability of the Persian version of PES-NWI., Materials and Methods: The instrument was translated and its psychometrics were investigated by content, construct validity (factor analysis), and homogeneity (internal consistency and intraclass correlation) on a sample of 350 nurses at educational hospitals in East Azerbaijan, Iran., Results: The 30 items loaded onto 4 factors explained 34.95-50.06% of the variance. The items across the factors differed slightly from those reported by the original author of the PES-NWI. Cronbach's alpha and Pearson coefficient for the entire instrument and also for extracted factors was 0.70-0.96., Conclusions: The Persian version of PES-NWI has an appropriate level of validity and reliability in the Iranian setting for nurses. The subscale of Nursing Foundations for quality care needs modification., Competing Interests: There are no conflicts of interest.

Objective: In chronically ill children who are hospitalized, many mood changes occur. For example, in children with cancer or renal failure, prolonged hospitalization and chemotherapy can lead to depression. With the improved survival of childhood malignancies, the effect of treatment on child's psychosocial well-being becomes increasingly relevant. In this study, we examined the prevalence of depression in hospitalized children with chronic and acute conditions in Dr Sheikh Pediatrics Hospital in Mashhad., Materials & Methods: After receiving the approval from the Ethics Committee of Mashhad University of Medical Sciences, we did this cross-sectional descriptive study, from April to June 2012 in Dr Sheikh Pediatric Hospital in Mashhad. Ninety children, between 8 to 16 years, were screened for depression. The sampling method was census. Children with a history of depressive or other mental disorders were excluded. Three groups of children (children with chronic renal disease, malignancy, and acute disease) were evaluated for depression using standard Children Depression Inventory Questionnaire (CDI). Two specifically trained nurses filled out the questionnaires at patients' bedside under the supervision of a psychiatrist. Depression scores were then analyzed by SPSS software., Results: Of 90 children, 43(47.7%) were male and 47(52.2%) were female. The Children's mean age was 11±2.3 years, and the mean length of hospitalization was 8±5.3 days. Depression was detected in various degrees in 63% of patients (N=57), and 36.6% of children (N=32) had no symptoms of depression. Severe depression was not seen in any of the patients with acute illness. More than half of patients with cancer and chronic kidney disease had moderate to severe depression. There was a significant statistical relationship between the duration of illness and severity of depression. There was also a significant correlation between severity of depression and frequency of hospitalization. Children who had been hospitalized more than 3 times in the previous year, experienced more severe levels of depression. We also found a significant correlation between pubertal age and severity of depression in patients with cancers and chronic renal failure., Conclusion: Children who are hospitalized due to chronic conditions are at a higher risk for mood disorders in comparison with the ones with acute conditions. It is therefore advisable to consider more practical plans to improve the care for hospitalized children's mental health.