Search

BACKGROUND: Improving shared decision-making using a treat-to-target approach, including the use of clinical outcome measures, is important to providing high quality care for rheumatoid arthritis (RA). We developed an Electronic Health Record (EHR) integrated, patient-facing sidecar dashboard application that displays RA outcomes, medications, and lab results for use during clinical visits (RA PRO dashboard). The purpose of this study was to assess clinician perceptions and experiences using the dashboard in a university rheumatology clinic. METHODS: We conducted focus group (FG) discussions with clinicians who had access to the dashboard as part of a randomized, stepped-wedge pragmatic trial. FGs explored clinician perceptions towards the usability, acceptability, and usefulness of the dashboard. FG data were analyzed thematically using deductive and inductive techniques; generated themes were categorized into the domains of the Technology Acceptance Model (TAM). RESULTS: 3 FG discussions were conducted with a total of 13 clinicians. Overall, clinicians were enthusiastic about the dashboard and expressed the usefulness of visualizing RA outcome trajectories in a graphical format for motivating patients, enhancing patient understanding of their RA outcomes, and improving communication about medications. Major themes that emerged from the FG analysis as barriers to using the dashboard included inconsistent collection of RA outcomes leading to sparse data in the dashboard and concerns about explaining RA outcomes, especially to patients with fibromyalgia. Other challenges included time constraints and technical difficulties refreshing the dashboard to display real-time data. Methods for integrating the dashboard into the visit varied: some clinicians used the dashboard at the beginning of the visit as they documented RA outcomes; others used it at the end to justify changes to therapy; and a few shared it only with stable patients. CONCLUSIONS: The study provides valuable insights into clinicians perceptions and experiences with the RA PRO dashboard. The dashboard showed promise in enhancing patient-clinician communication, shared decision-making, and overall acceptance among clinicians. Addressing challenges related to data collection, education, and tailoring dashboard use to specific patient populations will be crucial for maximizing its potential impact on RA care. Further research and ongoing improvements in dashboard design and implementation are warranted to ensure its successful integration into routine clinical practice.

Abstract Background Despite the numerous advantages of the nursing process, nursing students often struggle with utilizing this model. Therefore, studies suggest innovative teaching methods to address this issue. Teaching based on real clinical cases is considered a collaborative learning method that enhances students’ active learning for the development of critical thinking and problem-solving skills. In this method, students can acquire sufficient knowledge about patient care by accessing authentic information. Objective The aim of the present study was to investigate the experiences of nursing students and faculty members regarding the implementation of nursing process educational workshops, based on real case studies. Design A qualitative descriptive study. Participants 9 Nursing students and 7 faculty members from the Isfahan School of Nursing and Midwifery who attended the workshops. Methods This qualitative descriptive study was conducted from 2021 to 2023. Data was collected through semi-structured individual and focus group interviews using a qualitative content analysis approach for data analysis. Results After analyzing the data, a theme titled “Breaking Taboos in the Nursing Process” was identified. This theme consists of four categories: “Strengthening the Cognitive Infrastructure for Accepting the Nursing Process,” “Enhancing the Applicability of the Nursing Process,” “Assisting in Positive Professional Identity,” and “Facilitating a Self-Directed Learning Platform.” Additionally, thirteen subcategories were obtained. Conclusion The data obtained from the present study showed that conducting nursing process educational workshops, where real clinical cases are discussed, analyzed, and criticized, increases critical thinking, learning motivation, and understanding of the necessity and importance of implementing the nursing process. Therefore, it is recommended that instructors utilize this innovative and effective teaching method for instructing the nursing process.

Abstract Considering the toxicological effects of some heavy metals (HMs) in which directly related to mortality and carcinogenicity in the population by their entrance from plants through livestock grazing, and medical skin cream, the rehabilitation of contaminated sites through phytoremediation by native plants might be quite challenging. Diplotaenia damavandica Mozaff. ex-Hedge & Lamond, is used as medical skin creams due to the existence of specific ingredients, which can be effective in treating skin disease. In the present study, the plant and associated soil sampling were performed around the boundary of D. damavandica. The concentration was measured using the Inductively coupled plasma mass spectrometry (ICP-MS). The results revealed the effect of existing endemic plants on reducing the average concentration of lead and zinc in soil by 40 and 60%, respectively, due to phytoremediation. EDX confirmed the presence of Pb and Zn in root and shoot tissues. Based on the results of this study, D. damavandica is an endemic perennial herbaceous plant with 60% biomass and prosperous root systems, which can grow in low contaminated areas of Pb in the southeast of Damavand Mt. Hence, the HMs pattern indicated less often in the aerial parts except for lead, which should be examined more carefully for skin cream uses.

Transgenic Bt cotton developed against lepidopteran pests may not be compatible with parasitoid of secondary pests such as Bemisia tabaci which attack many plants such as cotton. In this study, the effects of Bt cotton on the demographic parameters of Encarsia formosa, parasitoid of B. tabaci were assessed. The data were analysed using the age specific, two-sex life table parameters. The results indicated that pre-adult developmental time, the total preoviposition period (TPOP) and the adult preoviposition period (APOP) in the Bt cotton were significantly longer than in the non-Bt cotton. Also, fecundity and body size in both lines were significantly different. The fecundity was 23.64±0.73 and 43.75±0.89 eggs/females in the Bt and non-Bt cotton, respectively. All the population parameters were affected by the Bt cotton. The intrinsic rate of increase (r) was 0.15 day-1 in the non-Bt cotton but it was 0.10 day-1 in the Bt cotton. The finite rate of increase (λ) was 1.11 day-1 in the non-Bt cotton whilst it was 1.08 in the Bt cotton. The net reproductive rate (R0) in the non-Bt cotton was 36.75 but in the Bt cotton these parameters showed 19.62 offspring/individual. Also, the mean generation time (T ) in the non-Bt and Bt cotton was 22.69 and 27.79 days, respectively. The results illustrated, that although transgenic crops are effective tools for management of the target pests, they can adversely affect, either directly or indirectly, the natural enemies dependent on these plants.

Abstract Background Premenstrual dysphoric disorder (PMDD) is a debilitating condition, affecting women of reproductive age. It is characterized by severe periodic physical and psychological symptoms, which end after the onset of menstruation. This study aimed to evaluate the effectiveness of emotion-focused therapy (EFT) for PMDD patients. Methods A total of 48 PMDD women, in the age range of 18–44 years, were randomly assigned to two intervention and control groups. The intervention group participated in 16 weeks of EFT treatment, while the control group was selected based on the waiting list (waitlist control group) and followed-up after three months. Forty-four patients finally completed this study. The participants completed the Premenstrual Syndrome Screening Tool (PSST), Difficulties in Emotion Regulation Scale (DERS), and Depression Anxiety Stress Scale-21 (DASS-21) in the first premenstrual period before treatment, the first premenstrual period after treatment, and the premenstrual period three months after treatment. Results Based on the repeated measure analysis of variances, the total score of DERS and the total score of PSST decreased significantly (P 0.05). Conclusion Based on the present results, EFT can be an effective treatment for alleviating the symptoms of PMDD. This treatment can reduce the emotion regulation difficulties of women with PMDD and alleviate the symptoms of depression and stress. Trial registration Iranian Registry of Clinical Trials, IRCT ID: IRCT20220920055998N1, Registered on: 12/2/2023.

Abstract Background Polycystic ovary syndrome (PCOS) is the most common endocrine disorder in reproductive age and the most common cause of infertility due to anovulation. PCOS in adolescents is concerning. Nigella sativa is effective in improving gonadotropins and sex hormones. The current study was designed to investigate the effect of Nigella sativa supplementation on PCOS symptoms and their severity in adolescents. Methods The current randomized clinical trial was conducted on 114 adolescents with PCOS who were referred to gynecologist offices and clinics in Gonabad, Iran from March 2022 to March 2023. Participants were randomly allocated to the intervention (Nigella sativa 1000 mg/day) and control (10 mg/day medroxyprogesterone from the 14th day of the cycle for 10 nights) groups. The study duration was 16 weeks. Ovarian volume (measured by ultrasound), anthropometric and blood pressure; serum testosterone, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEA-S), luteinizing hormone (LH), hirsutism severity (Ferriman–Gallwey score) levels were evaluated before and after the study. Results Data from 103 participants (control group = 53, intervention group = 50) were analyzed. The mean age of participants was 17.0 (Interquartile range [IQR]:2.0). The mean difference in hirsutism score changes (p

ObjectivesClinical notes are a veritable treasure trove of information on a patient's disease progression, medical history, and treatment plans, yet are locked in secured databases accessible for research only after extensive ethics review. Removing personally identifying and protected health information (PII/PHI) from the records can reduce the need for additional Institutional Review Boards (IRB) reviews. In this project, our goals were to: (1) develop a robust and scalable clinical text de-identification pipeline that is compliant with the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule for de-identification standards and (2) share routinely updated de-identified clinical notes with researchers.Materials and methodsBuilding on our open-source de-identification software called Philter, we added features to: (1) make the algorithm and the de-identified data HIPAA compliant, which also implies type 2 error-free redaction, as certified via external audit; (2) reduce over-redaction errors; and (3) normalize and shift date PHI. We also established a streamlined de-identification pipeline using MongoDB to automatically extract clinical notes and provide truly de-identified notes to researchers with periodic monthly refreshes at our institution.ResultsTo the best of our knowledge, the Philter V1.0 pipeline is currently the first and only certified, de-identified redaction pipeline that makes clinical notes available to researchers for nonhuman subjects' research, without further IRB approval needed. To date, we have made over 130 million certified de-identified clinical notes available to over 600 UCSF researchers. These notes were collected over the past 40 years, and represent data from 2757016 UCSF patients.

Creatinine (Cr) is often used as a standalone gold standard marker of kidney function. Cystatin C (Cys C) is a less physiologically labile marker of renal function, particularly in certain subgroups. Herein, we analyze trends in cystatin C as compared to creatinine in men on testosterone replacement therapy with varying body mass indices and percent body fat (PBF). This retrospective analysis observes 227 men with testosterone-induced muscle hypertrophy who visited a men’s health tertiary care clinic. All participants were characterized as competitive or recreational athletes. In patients with a normal body mass index (BMI), there was no clinically significant correlation between Cr and Cys C. Slight correlation was seen with overweight ( R 2 = .27) patients ( p < .0001) and obese ( R 2 = .29) patients ( p < .0001). Patients with PBF of 0%–10% ( n = 22) exhibited minimal ( R 2 = .23) positive correlation between Cys C and Cr ( p = .03). Positive correlation between Cys C and Cr in patients with PBF of 10%–20% was clinically negligible ( R 2 = .17, n = 87), modest ( R 2 = .49) in patients with PBF of 20%–30% ( n = 42), and evident ( R 2 = 1.00) in patients >30% ( n = 3) ( p < .0001, respectively). Cystatin C measurements display less variance compared with creatinine at differing BMI distinctions. At the upper limit of BMI or PBF in our patient population, cystatin C exhibits minimal to moderate variability compared with creatinine.

Thrombosis occurs through the accumulation of platelets and the formation of a blood clot in the blood vessels, which is a life-threatening condition. Thrombolytic therapy based on nanomaterials is a life-saving developing approach that lyses and dissolves thrombus by different mechanisms. Bioengineering of nanosized metallic particles is an innovative approach to preparing metallic nanoparticles (NPs) employing biological resources, such as plant extracts, bacteria, fungi, and algae, as reducing and capping agents. Biogenic synthesis of metallic NPs is an environmentally sound and safe route for engineering NPs. The biosynthesis of silver nanoparticles (SNPs) and gold nanoparticles (GNPs) is of great interest due to their unique physicochemical and biological performance. Further, among different applications of nanobiotechnology, the ability of biogenic metallic NPs, especially SNPs, and GNPs, to lyse blood clots has attracted enormous attention recently. However, the probable toxicity of NPs to red blood cells (RBCs) should be considered and addressed in medical usage. In this review, multiple studies are thoroughly discussed in which SNPs and/or GNPs were fabricated with various morphologies and sizes through green routes, and their thrombolytic and/or hemolytic activities were reviewed. Most of the studies indicated the significant thrombolytic performance of biosynthesized silver and gold particles. Furthermore, most of the studies reported dose-dependent hemolysis of these NPs. Further studies are required to validate the efficacy of SNPs and/or GNPs in clinics, and the other drawbacks of these NPs in the body should be addressed.

To eliminate contaminated organic matter from water and wastewater, a stable, recyclable, and environmentally friendly nano-biocomposite was designed. The magnetic Fe3O4 nanoparticles were functionalized by SiO2/N-2-(aminoethyl)-3-aminopropyl/glutaraldehyde/chitosan/Cobalt to fabricate nano-biocomposite (FS-(Am/g/Cs)@CoNPs). The morphological/structural identification of nano-biocomposite was carried out by ICP-OES, DR-UV, XRD, FE-SEM, TEM, HR-TEM, BET, EDX, FT-IR, TGA, and VSM techniques. The catalytic performance of this heterogeneous catalyst was studied in the degradation of organic dyes including methylene blue, methyl orange, methylene violet, and Bisphenol A, and efficiency was achieved at 99.3 % (kobs = 0.3703 min−1), 97.4 % (kobs = 0.3627 min−1), 93.6 % (kobs = 0.228 min−1) and 98.8 % (kobs = 0.459 min−1) after 12–14 min at room temperature in pH = 7.0, respectively. The reaction proceeded through the activation of Co2+/Co3+ which occurs on the surface of the FS-(Am/g/Cs)@CoNP by the PMS/O2 system through recombination of SO4•- and OH•. Furthermore, selective allylic oxidations of cyclohexene to cyclohexenone (TOF = 4583.7 h−1, 100 % selectivity, 98 % conversion) were done by this nano-biocomposite.

Abstract Aim The present study aimed to assess professional autonomy among clinical nurses and identify its predictors using a native and contemporary tool, which is in line with the recent advancement in nursing professionalism in Iran. Design The study used an analytical cross‐sectional design. Methods A total of 1601 nurses working in medical centres nationwide under the Ministry of Health participated in the study. The research instrument consisted of two parts, including individual and organizational characteristics and a questionnaire on clinical nurses' professional autonomy. Data analysis involved descriptive and inferential statistics as well as multiple logistic regression analysis using SPSS software. Results The results indicated that the total professional autonomy score among clinical nurses was 75.86 ± 12.03, with the majority (n = 1262, 78.9%) reporting high professional autonomy. Multiple logistic regression analysis revealed that nurses with 5–15 years of experience had 1.82 times higher odds (95% confidence interval: 2.47–1.35) of having high professional autonomy compared to those with less than 5 years of experience. Similarly, nurses with over 15 years of experience had 2.25 times higher odds (95% confidence interval: 1.56–3.26). Head nurses had 4.56 times higher odds (95% confidence interval: 2.60–7.99) of having high professional autonomy compared to clinical nurses. Conclusion Educational interventions to enhance the professional autonomy of less experienced nurses, with more experienced nurses serving as role models, are recommended. Additionally, measures such as supporting nurses, providing effective communication training and empowering nurses are essential to promote professional mutual respect among nurses. No Patient or Public Contribution This study explored professional autonomy in clinical nurses in Iran. No patient or public contribution was investigated.

Abundant, diversified algal assemblages comprising more than 25 species of Dasycladales are described from Barremian-Aptian limestone deposits of the Tirgan Formation in NE Iran. New species are described: one of them possibly belongs to a new endosporate genus, tentatively assigned the Triploporellaceae; two others, Clypeina ? sp. 1 and Rajkaella ? sp. 1, are left in open nomenclature. The widely distributed, locally abundant Montiella ? elitzae is revisited, because of the presence of a complete, exceptionally well preserved specimen. Yet to be demonstrated, the species is a junior synonym of Turkmenaria adducta Maslov, also originally described from the Kopet Dagh. Other species found in the Arkan section have already been reported from remote locations, primarily in Europe, in areas corresponding to the Northern and/or Southern Tethyan domains. Some of them are known only from the Hauterivian and/or the Barremian, excluding the Aptian, thus dating the lower part of the Arkan section as Barremian, but not excluding the Late Hauterivian.

Abstract Background Improving shared decision-making using a treat-to-target approach, including the use of clinical outcome measures, is important to providing high quality care for rheumatoid arthritis (RA). We developed an Electronic Health Record (EHR) integrated, patient-facing sidecar dashboard application that displays RA outcomes, medications, and lab results for use during clinical visits (“RA PRO dashboard”). The purpose of this study was to assess clinician perceptions and experiences using the dashboard in a university rheumatology clinic. Methods We conducted focus group (FG) discussions with clinicians who had access to the dashboard as part of a randomized, stepped-wedge pragmatic trial. FGs explored clinician perceptions towards the usability, acceptability, and usefulness of the dashboard. FG data were analyzed thematically using deductive and inductive techniques; generated themes were categorized into the domains of the Technology Acceptance Model (TAM). Results 3 FG discussions were conducted with a total of 13 clinicians. Overall, clinicians were enthusiastic about the dashboard and expressed the usefulness of visualizing RA outcome trajectories in a graphical format for motivating patients, enhancing patient understanding of their RA outcomes, and improving communication about medications. Major themes that emerged from the FG analysis as barriers to using the dashboard included inconsistent collection of RA outcomes leading to sparse data in the dashboard and concerns about explaining RA outcomes, especially to patients with fibromyalgia. Other challenges included time constraints and technical difficulties refreshing the dashboard to display real-time data. Methods for integrating the dashboard into the visit varied: some clinicians used the dashboard at the beginning of the visit as they documented RA outcomes; others used it at the end to justify changes to therapy; and a few shared it only with stable patients. Conclusions The study provides valuable insights into clinicians’ perceptions and experiences with the RA PRO dashboard. The dashboard showed promise in enhancing patient-clinician communication, shared decision-making, and overall acceptance among clinicians. Addressing challenges related to data collection, education, and tailoring dashboard use to specific patient populations will be crucial for maximizing its potential impact on RA care. Further research and ongoing improvements in dashboard design and implementation are warranted to ensure its successful integration into routine clinical practice.

Abstract Background Impaired immune response in multiple myeloma renders the patients vulnerable to infections, such as COVID-19, and may cause worse response to vaccines. Researchers should analyze this issue to enable the planning for special preventive measures, such as increased booster doses. Therefore, this meta-analysis aimed to evaluate the response and efficacy of COVID-19 vaccines in patients with multiple myeloma. Methods This meta-analysis followed PRISMA 2020 guidelines, conducting a comprehensive database search using specified keywords. Study selection involved a two-phase title/abstract and full-text screening process. Data extraction was performed by two researchers, and statistical analysis involved meta-analysis, subgroup analysis based on vaccine dosage and study time, random effects meta-regression, and heterogeneity testing using the Q test. Results The meta-analysis revealed that patients with multiple myeloma (MM) had a lower likelihood of developing detectable antibodies after COVID-19 vaccination compared to healthy controls (Log odds ratio with 95% CI: -3.34 [-4.08, -2.60]). The analysis of antibody response after different doses showed consistent lower seropositivity in MM patients (after first dose: -2.09, [-3.49, -0.69], second: -3.80, 95%CI [-4.71, -3.01], a booster dose: -3.03, [-5.91, -0.15]). However, there was no significant difference in the mean level of anti-S antibodies between MM patients and controls (Cohen’s d -0.72, [-1.86, 0.43]). Evaluation of T-cell responses indicated diminished T-cell-mediated immunity in MM patients compared to controls. Seven studies reported clinical response, with breakthrough infections observed in vaccinated MM patients. Conclusions These findings highlight the impaired humoral and cellular immune responses in MM patients after COVID-19 vaccination, suggesting the need for further investigation and potential interventions.

Objective Insurance deductions are among the most important causes of hospital resource waste. Insurance deductions cause financial problems for hospitals and create tension between insurance organizations and hospitals. This study, done by the University of Social Welfare and Rehabilitation Sciences, investigates the reasons for deductions of inpatient bills covered by Social Security Insurance in Rofeideh Rehabilitation Hospital Materials & Methods The study was conducted cross-sectionally on 776 cases admitted to Rofeidah Rehabilitation Hospital in 2021. All invoices for inpatient services sent to Social Security Insurance were reviewed using the census method. To collect data, invoices sent to Social Security, inpatient records and checklists, and a 31-question questionnaire of Mohammadkhani et al. were used. The collected data were analyzed by descriptive (frequency and percentage) and analytical statistics (the Spearman correlation coefficient) in SPSS software, version 23. Results According to the findings, the highest frequency of inpatient prescriptions was related to November 2021 (7.48%). The most frequent deductions of inpatients’ bills were related to medicine and consumables to the amount of 310815448 Rails and surgeon’s fees in 187728448 Rails. Also, the most common reasons were requesting a surcharge and wrong coding. In this study, there was a significant relationship between the documentation of nurses and doctors and the amount of deductions (P

This study investigates pressure gradient dynamics within a porous medium in the context of two-phase fluid flow, specifically water and sand particle interactions. Using experimental data, we refine pressure correction coefficients within a numerical solution framework, employing the Semi-Implicit Method for the Pressure-linked Equations algorithm. Our findings highlight the relative nature of pressure gradient phenomena, with particle size and volume fraction emerging as crucial determinants. Graphical representations reveal a clear trend: an increase in volume fraction, up to 40%, across varying Reynolds Numbers, leads to a transition towards non-Newtonian behavior in the two-phase fluid system. Unlike the linear pressure gradient seen in single-phase fluid flow, the interplay between liquid and solid phases, along with drag forces, imparts a distinctly nonlinear trajectory to the pressure gradient in two-phase fluid flow scenarios. As the two-phase flow enters a porous medium, numerous factors come into play, resulting in a pressure drop. These factors include changes in cross-sectional geometry, alterations in boundary layer dynamics, and ensuing momentum fluctuations. Interestingly, an increase in porosity percentage inversely correlates with pressure gradient, resulting in reduced pressure gradient with higher porosity levels.

Abstract A mammutid is described here for the first time from the Late Miocene (MN12 equivalent) deposits of Abkhareh village, Varzeghan region, in the North-Western part of Iran. It is identified as “Mammut” cf. obliquelophus and is represented by an isolated and moderately worn upper third molar with a zygodont crown pattern typical of mammutids. In addition, two upper incisors found associated with the molar and probably belonging to the same individual are assigned as Mammut. The studied material expands the geographic distribution of “Mammut” obliquelophus into Western Asia.

In this study, the aqueous seed extract of Trachyspermum copticum was employed to fabricate silver nanoparticles (AgNPs) for their antibacterial performance. The structural characteristics of the phytofabricated AgNPs were investigated using ultraviolet–visible, energy dispersive X-ray, dynamic light scattering, zeta potential, field emission scanning electron microscope, and Fourier transform infrared spectroscopy. Further, the antibacterial effects of AgNPs were evaluated against two standard gram-positive strains of Staphylococcus aureus and Streptococcus pyogenes and two standard gram-negative strains of Escherichia coli and Klebsiella pneumoniae. The findings showed the phytofabrication of spherical-shaped AgNPs with a Z-average diameter of 119.7 nm and the polydispersity index of 0.56. The minimum inhibitory concentration of AgNPs against S. aureus, S. pyogenes, E. coli, and K. pneumoniae strains was 0.25, 1, 0.5, and 0.5 μg·mL−1, respectively. In addition, the minimum bactericidal concentration of these nanoparticles (NPs) against the mentioned strains was 8, 16, 4, and 4 μg·mL−1, respectively. Furthermore, the AgNPs enhanced the generation of reactive oxygen species significantly in all studied bacteria compared to the control (P < 0.05) suggesting an oxidative-associated antibacterial mechanism of AgNPs. Moreover, a dose-dependent cell death was found in all bacterial samples based on flow cytometry analysis. Overall, this study showed a biological approach for the biosynthesis of AgNPs with significant antibacterial effects.

Introduction: Feelings of shame and guilt are seen in a wide range of psychological disorders, and these feelings are of high importance in disorders related to eating and obesity. Aim: The present study was conducted with the aim of investigating the psychometric properties of the Persian version of the Guilt and Shame Questionnaire. Method: This study was applied in terms of aim and in terms of methodology in the field of descriptive-correlation researches of psychometric type, respectively. The statistical population included all individuals with high Body Mass Indexes (BMI > 25) who referred to nutrition clinics affiliated to Iran University of Medical Sciences in 2022, 573 of whom were selected using convenience sampling. Data were collected using External Shame Scales (1994) and Body Image Flexibility Questionnaire (2013) and Guilt and Shame Questionnaire (2022). In order to analyze the findings, the internal consistency method with Cronbach's alpha was performed, and to check the construct validity with confirmatory factor analysis, SPSS version 25 and Lisrel version 8.8 were employed. Results: The results showed that this scale has desirable psychometric properties. There is a significant positive correlation (r=0.66) between the current Questionnaire and the Scale of External Shame, and a significant negative correlation (r=-0.63) with the Scale of Flexibility Body Image. Also, Cronbach's alpha coefficient for the total scale was 0.87. Conclusion: Considering the desirable psychometric features of the Shame and Guilt Scale and the short form of the questionnaire (8 questions), this questionnaire can be used in people with high body mass indexes and people with eating disorders.

A 32-year-old female with no cardiac risk factors was admitted for treatment of a perianal abscess. During her hospital stay, she had a pulseless electrical activity arrest with a return of spontaneous circulation after one round of cardiopulmonary resuscitation (CPR). After transfer to the Intensive Care Unit (ICU), the patient had polymorphic ventricular tachycardia (PVT) requiring defibrillation shock. Her PVT was resistant to medical interventions. She was shocked a total of 33 times before her arrhythmia was terminated by passing a temporary transvenous pacemaker with overdrive pacing. After an extensive review of her history and presentation, no clear cause of her resistant arrhythmia was identified, however, she was found to have recently started taking over-the-counter weight loss supplements containing raspberry ketones which is a potentially cardiotoxic ingredient.

Substances like asbestos and other air pollutants, such as BTEX (benzene, toluene, ethylbenzene, and xylene), are hazardous compounds due to their adverse effects on human health. This study aims to investigate the levels, seasonal variations, spatial distribution, potential sources, and associated health risks associated with BTEX compounds and asbestos fibers in the ambient air of Tabriz. Air samples were taken at 16 different locations during the 2020–2021 period. Glass containers with charcoal were used for sample collection, and the BTEX content was determined using the GC-FID method. Phase-contrast microscopy (PCM) analysis was conducted with a low-volume peripheral pump for asbestos fiber sampling. The results showed that the average concentration of ∑BTEX was 37.94 and 27.98 μg/m3 in autumn and spring, respectively. The same parameter was 2.26 and 1.68 f/L for asbestos in the autumn and winter, respectively. The contribution of BTEX to ozone formation potential (OFP) in the research area showed that xylene and toluene were the major contributors to ozone production in different seasons. The risk of exposure to benzene compounds was 24 × 10−4 in children and 55.9 × 10−4 in adults, while the risk of exposure to ethylbenzene was 3.78 × 10−4 in children and 3.25 × 10−4 in adults. The estimated lifetime cancer risk was found to be the highest for benzene, followed by ethylbenzene. The estimated cancer risk for benzene and ethylbenzene exceeded the threshold values set by EPA, which signals a significant carcinogenic risk due to exposure to these substances in the ambient air of Tabriz. According to the EPA guidelines, the low carcinogenicity risk levels are between 10−4 and 10−6. According to the findings for the exposure to asbestos fibers, the maximum values of excess cancer risk (ECR) and estimated lifetime cancer risk (ELCR) were observed in the 16–30 age range across all locations, suggesting increased exposure to asbestos fibers compared to other age groups.

Killer-cell immunoglobulin-like receptors (KIR) are essential for acquiring natural killer (NK) cell effector function, which is modulated by a balance between the net input of signals derived from inhibitory and activating receptors through engagement by human leukocyte antigen (HLA) class I ligands. KIR and HLA loci are polygenic and polymorphic and exhibit substantial variation between individuals and populations. We attempted to investigate the contribution of KIR complex and HLA class I ligands to the genetic predisposition to lung cancer in the native population of southern Iran. We genotyped 16 KIR genes for a total of 232 patients with lung cancer and 448 healthy controls (HC), among which 85 patients and 178 HCs were taken into account for evaluating combined KIR-HLA associations. KIR2DL2 and 2DS2 were increased significantly in patients than in controls, individually (OR 1.63, and OR 1.42, respectively) and in combination with HLA-C1 ligands (OR 1.99, and OR 1.93, respectively). KIR3DS1 (OR 0.67) and 2DS1 (OR 0.69) were more likely presented in controls in the absence of their relative ligands. The incidence of CxTx subset was increased in lung cancer patients (OR 1.83), and disease risk strikingly increased by more than fivefold among genotype ID19 carriers (a CxTx genotype that carries 2DL2 in the absence of 2DS2, OR 5.92). We found that genotypes with iKIRs > aKIRs (OR 1.67) were more frequently presented in lung cancer patients. Additionally, patients with lung cancer were more likely to carry the combination of CxTx/2DS2 compared to controls (OR 2.04), and iKIRs > aKIRs genotypes in the presence of 2DL2 (OR 2.05) increased the likelihood of lung cancer development. Here we report new susceptibility factors and the contribution of KIR and HLA-I encoding genes to lung cancer risk, highlighting an array of genetic effects and disease setting which regulates NK cell responsiveness. Our results suggest that inherited KIR genes and HLA-I ligands specifying the educational state of NK cells can modify lung cancer risk.

BackgroundMultisystem inflammatory syndrome in children (MIS-C) is a novel disease that was identified during the COVID-19 pandemic and is characterised by systemic inflammation following SARS-CoV-2 infection. Early detection of MIS-C is a challenge given its clinical similarities to Kawasaki disease and other acute febrile childhood illnesses. We aimed to develop and validate an artificial intelligence algorithm that can distinguish among MIS-C, Kawasaki disease, and other similar febrile illnesses and aid in the diagnosis of patients in the emergency department and acute care setting.MethodsIn this retrospective model development and validation study, we developed a deep-learning algorithm called KIDMATCH (Kawasaki Disease vs Multisystem Inflammatory Syndrome in Children) using patient age, the five classic clinical Kawasaki disease signs, and 17 laboratory measurements. All features were prospectively collected at the time of initial evaluation from patients diagnosed with Kawasaki disease or other febrile illness between Jan 1, 2009, and Dec 31, 2019, at Rady Children's Hospital in San Diego (CA, USA). For patients with MIS-C, the same data were collected from patients between May 7, 2020, and July 20, 2021, at Rady Children's Hospital, Connecticut Children's Medical Center in Hartford (CT, USA), and Children's Hospital Los Angeles (CA, USA). We trained a two-stage model consisting of feedforward neural networks to distinguish between patients with MIS-C and those without and then those with Kawasaki disease and other febrile illnesses. After internally validating the algorithm using stratified tenfold cross-validation, we incorporated a conformal prediction framework to tag patients with erroneous data or distribution shifts. We finally externally validated KIDMATCH on patients with MIS-C enrolled between April 22, 2020, and July 21, 2021, from Boston Children's Hospital (MA, USA), Children's National Hospital (Washington, DC, USA), and the CHARMS Study Group consortium of 14 US hospitals.Findings1517 patients diagnosed at Rady Children's Hospital between Jan 1, 2009, and June 7, 2021, with MIS-C (n=69), Kawasaki disease (n=775), or other febrile illnesses (n=673) were identified for internal validation, with an additional 16 patients with MIS-C included from Connecticut Children's Medical Center and 50 from Children's Hospital Los Angeles between May 7, 2020, and July 20, 2021. KIDMATCH achieved a median area under the receiver operating characteristic curve during internal validation of 98·8% (IQR 98·0-99·3) in the first stage and 96·0% (95·6-97·2) in the second stage. We externally validated KIDMATCH on 175 patients with MIS-C from Boston Children's Hospital (n=50), Children's National Hospital (n=42), and the CHARMS Study Group consortium of 14 US hospitals (n=83). External validation of KIDMATCH on patients with MIS-C correctly classified 76 of 81 patients (94% accuracy, two rejected by conformal prediction) from 14 hospitals in the CHARMS Study Group consortium, 47 of 49 patients (96% accuracy, one rejected by conformal prediction) from Boston Children's Hospital, and 36 of 40 patients (90% accuracy, two rejected by conformal prediction) from Children's National Hospital.InterpretationKIDMATCH has the potential to aid front-line clinicians to distinguish between MIS-C, Kawasaki disease, and other similar febrile illnesses to allow prompt treatment and prevent severe complications.FundingUS Eunice Kennedy Shriver National Institute of Child Health and Human Development, US National Heart, Lung, and Blood Institute, US Patient-Centered Outcomes Research Institute, US National Library of Medicine, the McCance Foundation, and the Gordon and Marilyn Macklin Foundation.