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Commercial volume trees are an important variable that contributes to economic decision-making and analysis in forest management. In this regard, Commercial Volume modeling in Hyrcanian forests is the key to implementing sustainable forest management plans. Due to time and cost constraints and the lack of local or public volumetric measurements in the equations, most forest managers still use traditional expansion factors to estimate volume. Therefore, using independent variables in volumetric modeling is an essential step in fitting models to representation. Therefore, the present study aims to model and predict business volume with minimal error using two ANN and CART algorithms. The study area was parcels 14, 16 and 24 of the educational-research forest of Sari Faculty of Natural Resources located in Darabkola, one of the functions of Sari city. After rotating the forest, masses with different forest types were studied according to the purpose of the study: Trees of pure beech, pure hornbeam and beech-hornbeam. For this purpose, at least 20 trees fell in each type and all standing trees in each sample parcel were measured. In each plot, quantitative characteristics of all trees including total tree height, trunk height (length), diameter per chest and qualitative characteristics including the degree of tree rot were measured. After measuring all the required characteristics of fallen trees at the level of Study forest types by species, to accurately estimate the volume was measured. Then the actual volume of the tree was calculated in the form of different trunk parts based on the ESmalian relationship. Finally, ANN and CART algorithms were used for modeling in STATISTICA12.0 software environment. The results of modeling the commercial volume of three masses of pure beech, pure hornbeam and beech-hornbeam with two ANN and CART algorithms showed the values of R² explanation coefficient (0.82; 0.77), (0.44; 0.72) respectively and (0.91; 0.84). The results of modeling the commercial volume of three masses of pure beech, pure hornbeam and beech-hornbeam with two algorithms ANN and CART showed that the ANN algorithm with a R²=0.91and the percentage of RMSE%= 10.51 is more precision. Finally, the findings showed that the ANN algorithm leads to better prediction than the CART algorithm. Also, the performance of this algorithm for beechborder mixed mass is higher than any of the pure beech and hornbeam masses. [ABSTRACT FROM AUTHOR]

This study investigated the effects of diet supplementation with poly-β-hydroxybutyrate ( PHB) on growth performance, digestive enzyme activity, lipid metabolism, mineral uptake and bacterial challenge of the rainbow trout fry (initial weight: 111.3 ± 13.7 mg) during a 6-week experimental period. In the experimental set-up, the commercial diet of rainbow trout fry was replaced with 0.5%, 1% and 2% PHB. The results of our work showed that the replacing of diets with PHB in experimental treatments decreases the weight of rainbow trout fry during the first 2 weeks before significantly increasing final weight at the end of the 6-week period. PHB also improved digestive enzyme activity in experimental treatments. The highest total protease, pepsin activity and pancreatic enzyme secretion were observed with the 0.5% PHB treatment. A higher concentration of Na and K was observed in the whole body of the fry fed on 1% and 2% PHB-supplemented diets. Enhanced survival rates occurred in all groups of fry after bath exposure to Yersinia ruckeri compared to rates in those fed the control diet. Our results suggest that the diet supplemented with PHB may improve growth performance, digestive enzyme activity and the functioning of the immune system. These positive effects could be considered for new applications in aquaculture. [ABSTRACT FROM AUTHOR]

Introduction: Aging is a physiological process, and it seems that Iranian population progresses to old aging more rapidly. Hearing loss is the most common otolaryngologic manifestation of aging, with direct and indirect expenditure for both the individuals and systems, that remains far from attention in many cases. Objective: Evaluation of audiologic disorders in geriatric population of rural areas of Rasht city, Guilan province in north of Iran, given the importance of the issue. Materials and Methods: In this descriptive cross-sectional study performed in 2013, we randomly selected 35 rural areas and then, elderly population of those areas were selected randomly, with informed consent obtained from them and then they were examined by general practitioners, ENT specialists, and an audiologist. Data were recorded and analyzed. Results: Of the 421 geriatric cases (52.8% male and 47.2% female), 324 underwent audiological testing. Sensorineural hearing loss in the right or left ear of 290 cases (89.5%), conductive hearing loss in 13 ears (4.01%), normal hearing in 20 (6.17%), and mixed hearing loss in one ear (0.3%) were detected. As revealed, 263 (90 68%) were with mild to moderate hearing loss, and 27 (9.31%) had severe hearing impairment. The pattern of hearing loss was in higher frequencies (247 cases: 76.23%), flat hearing loss in 53 patients (16.35%), and in the low frequencies in 4 cases (1.23%), as observed. Conclusions: In the elderly population living in rural areas in Rasht city, hearing disorders are relatively common and noticeable. Conflict of interest: non declared [ABSTRACT FROM AUTHOR]

Introduction: After elective surgery of head and neck region, one of the complaints of patients is unsteadiness and vertigo. This complaint was seen more in some surgeries in clinical experiences, one of which is rhinoplasty. Given the community's increasing trend to rhinoplasty, considering this complaint of patients is important for appropriate prevention or treatment Objective: To evaluate vertigo occurrence inpatients undergoing rhinoplasty, Amiralmomenin Hospital of Rasht Materials and Methods: In this case-control study, 63 patients in case group (Rhinoplasty) and 50 patients in control group (Functional Endoscopic Sinus Surgery), were evaluated for vertigo. The two groups were matched for possible confounding factors. All the patients were evaluated for vertigo l week, land 3 months after surgery. Also, in rhinoplastic patients, lateral osteotomy approach was considered as a possible factor. Using SPSS 19, data were analyzed with t and /2 tests and P<0.05 was considered significant. Results: Fifty patients of case group and 45 patients of control group were followed for 3 months. Female patients comprised 80 and 44.4% of case and control groups, respectively. The frequency of vertigo in patients of case group was 17, 3 and 2, respectively. Only one case was due to benign paroxysmal positional vertigo and others were due to orthostatic hypotension. In control group, frequency of vertigo was 11,1 and 1, respectively. The cause of all cases was orthostatic hypotension. The rhinoplastic patients with external and internal lateral osteotomy approach complained of vertigo in 58.6 and 11.5%, respectively. This difference was significant statistically (P<0.0001). Conclusion: This study showed that the most frequent cause of vertigo in both groups is pseudo vertigo and due to orthostatic hypotension. It seems that true vertigo is not associated with operation types (including rhinoplastic and nasal endoscopy). We advised more detailed investigations with larger sample size in this area. [ABSTRACT FROM AUTHOR]

Introduction: Specialty choices among medical students is an important Issue. Economic, social and cultural factors are influential in this respect. Objective: To determine the factors associated with Medical Students tendency Materials and Methods: This cross sectional study was conducted on all second semester, students, Extern and intern. We used census method for selecting case of study. Data were collected using a two part questionnaire consisting of demographic features and a questionnaire that was adapted from AHP and translated into Persian with validity and reliability confirmed through content validity. The data were analized by descriptive and analytical tests using SPSS 17 software. Results: In total, 191 medical students participated in this study. average student age was 23.07±2.81, 66.5% were women and 85.3 percent were single, 25.1%, second semester, 29.3%, Student, 20.9%, Extern and 24.6% were intern. The priorities in female participants were Dermatology, Radiology and Cardiology and in male were orthopedy, ophtalmology and cardiology. The preference in the selection of specialization courses was for education, including the Cardiology and Neurosergury in second semesters and in Student, Extern and intern were Dermatology. Overall, dermatology (41.4%) Radiology (9.4%) and Ophthalmology (7.9%) were the most favored specialty choices. According chi-square test, of the variables, studied military service related problems P <0/005)) and gender (P<0/002) were significantly associated with specialty choice. The most important factors in student specialty choice, were individual and economic factors. From economic factors, labor market (2.91 ± 1.04) and between individual factors, personal interest (3.39 ± 0.86) were the most associated factors with specialty choice (P<0/0001). Followed by other factors, including future revenues from economic factors and occupational factors, was private job after graduation from college. Among all of the relevant factors, economic factors, (p<0/0001), were the most important ones. Conclusion: Personal interest and future earning were the most important factors and dermatology,radiology and opthalmology were the most favored specialty Choices among Guilan University of Medical Sciences students Therefore, these factors should be considered by the respective authorities when choosing the field and plan to develop programs for the graduates. Conflict of interest: non declared [ABSTRACT FROM AUTHOR]

Background Bone mineral density (BMD) may be occurred following treatment of Acute lymphoblastic Leukemia (ALL). 25-hydroxyvitamin D insufficiency has been described in these patients. In this Randomized Control Trial (RCT) we assessed the effectiveness of oral vitamin D administration after one year of treatment to protect bone density. Materials and Methods Twenty-four survivors of ALL (17 males and 7 females), who had completed their treatment with oral vitamin D supplement, at least 1 yr previously, and Twenty-five (20 males and 5 females) control group were examined with dual energy x-ray absorptiometry of the total body and L2-L4 vertebrae and neck of femur. Result Average of BMD (g/cm2) was significantly increased in oral vitamin D supplemented children (p=0.038) but average of Z-score decrease (p=0.006). Osteoporosis in this group was 4.2% and in lortnoc group, 40.9%. Conclusion Oral vitamin D supplementation to ALL children during 1 year did not show impact on Z-score and BMD (g/cm2). In the other hand osteoporosis decreased in this group. [ABSTRACT FROM AUTHOR]

Hydroxyapatite was synthesized by the wet chemical technique. Diammonium hydrogen phosphate and calcium nitrate 4-hydrate were used as starting materials and sodium hydroxide solution was used as the agent for pH adjustment. The powder sample was characterized by the commonly used bulk techniques of scanning electron microscopy (SEM), transmission electron microscopy, Fourier transform infra-red spectroscopy, differential thermal analysis, thermal gravimetric analysis, X-ray diffraction, atomic absorption spectroscopy and EDTA titration analyses. With respect to the results achieved from the above analyses, it was found that nanocrystalline hydroxyapatite can successfully be produced through the wet precipitation method. The bulk Ca/P molar ratio of synthesized hydroxyapatite was determined as 1.71, which was higher than the stoichiometric ratio (1.667) that is expected for a pure HA phase. SEM investigations revealed that, there is a distribution of small particles and large agglomerates consisting of fine particles cold welded together. Lastly, the TEM technique demonstrated that the crystallites of the prepared powder were nanosized and had a needle-like morphology. The aspect ratio of the crystallites was about 8. [ABSTRACT FROM AUTHOR]

Background: This study was conducted to describe and explain the culture of patient care in international nursing students., Methods: This qualitative study was conducted using focused ethnography. Participants (n = 21) were purposefully selected from non-Iranian international students and their nursing instructors. Data collection included semi-structured interviews, and field-note taking. Data were analyzed with the Roper and Shapira inductive approach of ethnographic content analysis., Results: The cultural model of the study included the acquisition of cultural competence through acceptance of differences and finding commonalities. Subcategories were: "avoiding cultural bias", "trying to be on the path of adaptation", "appealing to the support and companionship of colleagues", "coping with culture shock", "acculturation", "getting help from cultural intelligence", "cultural empathy", and "language and communication enhancement"., Conclusion: Cultural competence is teachable. The pattern of formation is through accepting differences and searching for commonalities. Suggestions for promoting the culture of care among international students include effective use of peer groups and teaching different national ethnicities and cultures., (© 2024. The Author(s).)

Background: Pre-hospital trauma life support (PHTLS) training courses have been developed and widely adopted to enhance the proficiency of pre-hospital personnel in handling trauma patients. The objective of this study was to assess the effectiveness of the educational program for managing trauma patients in the pre-hospital emergency setting, utilizing Kirkpatrick's educational evaluation model., Methods: This is an observational approach, consisting of four sub-studies. The PHTLS course was conducted over a 2-day period, encompassing both theoretical and practical components. For this study, we selected pre-hospital personnel from three emergency aid stations using a convenient sampling method. These personnel underwent their first-ever PHTLS course training, and we subsequently analyzed the effectiveness of the training program using Kirkpatrick's four levels of evaluation: satisfaction, learning, behavior, and results., Results: The study conducted on Kirkpatrick's first-level analysis revealed that participants expressed a high level of satisfaction with the quality of all aspects of the course. Moving on to the second and third levels, namely learning and behavior, significant improvements were observed in the average scores of various skills that were examined both immediately after the course and 2 months later (P < 0.05). However, when it comes to the fourth level and the impact of the course on indicators such as mortality rate and permanent disability, no significant changes were observed even after an average of 3 months since the course was introduced., Conclusion: The implementation of PHTLS has been linked to the enhancement of participants' skills in treating trauma patients, leading to the application of acquired knowledge in real-life scenarios and a positive change in participants' behavior. The evaluation of PHTLS courses in Iran, as in other countries, highlights the need for specialized training in pre-hospital trauma care. To ensure the continued effectiveness of the PHTLS course, it is advisable for managers and policymakers to encourage regular participation of PHTLS employees in the program., (© 2024. The Author(s).)

Background and Objective: The emergence and widespread dissemination of antibiotic resistance in A. baumannii, has become a globally challenge. The increasing hospital outbreaks by multi-drug resistant (MDR) A. baumannii strains, shows the necessity of continuous monitoring to find sources of resistant strains in hospitals. This study aimed to identify the presence of class 1 integrons and metallo-β-lactamase (MBL) related genes in A. baumannii isolates from hospital environment., Methods: In order to identify A. baumannii isolates, a total of 297 environmental samples were collected from burn wards and intensive care units (ICUs) of two university hospitals. Resistance to common antibiotics was studied by disk diffusion method and microbroth dilution assay was used to determine the minimum inhibitory concentrations (MICs) of imipenem, colistin and tigecycline. The A. baumannii isolates were studied by polymerase chain reaction (PCR) for the presence of class 1 integrons (intI1, intl CS) and metallo-β-lactamases (MBLs) (bla IMP , bla VIM , bla NDM ) genes., Results: A. baumannii was identified in 68/297 (22.9%) of hospital environment. All A. baumannii strains were multidrug-resistant (MDR), but none of them were resistant to colistin, tigecycline and ampicillin-sulbactam. All (100%) and 38 (95.0%) of A. baumannii isolates from ICUs and burn wards were imipenem resistant respectively. Class 1 integrons was identified in 30/40 (75.0%) and 23/28 (82.1%) isolates from burn wards and ICUs respectively. Two different types of gene cassettes were identified, which included: arr-2, ereC, aadA1, cmlA5 and arr2, cmlA5. MBL genes including bla VIM and bla IMP were detected in 26/28 (92.8%), 27/28(96.4%) and 39/40 (97.5%) and 31/40 (77.5%) of the isolates from the ICUs and the burn wards respectively. None of the isolates contained the bla NDM-1 gene., Conclusion: The findings of the present study showed that the isolation rate of MBL producing carbapenem-resistant A. baumannii (CRAB) was relatively high in the environmental surface of burn wards and ICUs, which can be considered as a potential source of outbreaks in hospitalized patients., (© 2023. The Author(s).)

Background and Objectives: Group A Rotavirus (RVA) is the most important causative agent of acute diarrheal disease in pediatrics 5 years and below. This study aimed to determine the distribution of circulating RVA in Mashhad, Iran to develop health improvement strategies and vaccine decision making., Materials and Methods: A total of 106 fecal specimens were collected from children admitted to Akbar and Dr. Sheikh referral pediatric hospitals of Mashhad City during the December 2020 to March 2021 and December 2021 to March 2022. All specimens were tested for specific bacterial, parasitic, and amoebic infections. Negative samples were analyzed for RVA infections using the RT-PCR method., Results: RVA was detected in 31.3% of the specimens, indicating no statistical significance in gender distribution or between fall and winter positivity rates. The number of RVA-positive specimens increased following age increasing in the range of 1 to 60 months., Conclusion: Today, acute diarrheal disease (ADD) is still caused mostly by Rotavirus infections in pediatrics in Mashhad. Comprehensive studies are needed to determine the genetic diversity of circulating Rotavirus strains in this era., (Copyright © 2023 The Authors. Published by Tehran University of Medical Sciences.)

Background: Breast cancer (BC), as a significant global health problem, is the most common cancer in women. Despite the importance of clinical cancer registries in improving the quality of cancer care and cancer research, there are few reports on them from low- and middle-income countries. We established a multicenter clinical breast cancer registry in Iran (CBCR-IR) to collect data on BC cases, the pattern of care, and the quality-of-care indicators in different hospitals across the country., Methods: We established a clinical cancer registry in 12 provinces of Iran. We defined the organizational structure, developed minimal data sets and data dictionaries, verified data sources and registration processes, and developed the necessary registry software. During this registry, we studied the clinical characteristics and outcomes of patients with cancer who were admitted from 2014 onwards., Results: We registered 13086 BC cases (7874 eligible cases) between 1.1.2014 and 1.1.2022. Core needle biopsy from the tumor (61.25%) and diagnostic mammography (68.78%) were the two most commonly used diagnostic methods. Stage distribution was 2.03% carcinoma in situ, 12% stage I, 44.65% stage II, 21.32% stage III, and 4.61% stage IV; stage information was missing in 1532 patients (19.46%). Surgery (95.01%) and chemotherapy (79.65%) were the most common treatments for all patients., Conclusion: The information provided by this registry can be used to evaluate and improve the quality of care for BC patients. It will be scaled up to the national level as an important resource for measuring quality of care and conducting clinical cancer research in Iran., (© 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Regarding the dynamic and increasing needs of communities, changes in the education system are essential to train competent healthcare professionals. The study aimed to explore the experience of educational directors, teachers, and students to gain insight into the implementation of educational transformative programs., Method: A qualitative approach with the grounded theory method was applied in this study. Twenty-four participants were selected by using a purposive and theoretical sampling method. The data were collected from April 2019 to May 2020 in nursing schools of Tehran, through in-depth semi-structured individual face-to-face interviews and field notes. Collected data were analyzed by Corbin and Strauss's (2015) approach., Results: In this study, transformational leadership was extracted as the core concept. The core concept emerged from four sub-concepts including transformative management; educational policy requirements; providing a platform and community-centered education., Conclusions: Nurse educational directors need to achieve some competencies and capabilities for implementing transformative education in nursing schools. Also, achieving a transformative perspective by educational directors is essential., (© 2023. The Author(s).)

Multidrug-resistant (MDR) Acinetobacter baumannii is a serious global health threat. Burn patients are at high risk to acquire A. baumannii infections from endogenous sources. This study evaluated carbapenem resistance and clonal relatedness of A. baumannii isolated from burn patients and healthcare workers (HCWs).The study was performed in 100 non-duplicated A. baumannii isolates from nasal and hand samples of hospitalized burn patients and HCWs in two hospitals of Iran from June 2020 to August 2021. Antimicrobial susceptibility testing was performed and carbapenemase genes were detected by PCR. Clonal relatedness of A. baumannii isolates was determined by two single-locus sequence-based typing of blaOXA-51-like and ampC and by multilocus sequence typing (MLST).All A. baumannii isolates were found to be MDR while susceptible to colistin. The intI1, conserved segments of class 1 integron (intI1 CS), blaIMP, blaVIM, blaOXA-51-like, and blaOXA-23-like, genes were detected in 32.5%, 29.1%, 36%, 95.3%, 100%, 100%; and 14.3%, 14.3%, 21.4%, 92.9%, 100%, and 85.7% of isolates from patients and from healthcare workers, respectively. The blaOXA-58, and blaOXA-143 were not detected among the isolates. Using dual-locus blaOXA-51-like and ampC sequence-based typing (SBT), the isolates obtained from nasal samples of burn patients were grouped into 3 clusters including blaOXA-317, blaADC-88 (72.1%); blaOXA-64, ampC-25 (18.6%); and blaOXA-69, ampC-1 (9.3%). While only allele type blaOXA-317, blaADC-88 was determined among isolates from HCWs. MLST results showed A. baumannii ST136, ST25, and ST1 from burn patients. However, A. baumannii strains from HCWs belonged to ST136. Our findings indicate high prevalence of globally spreading of MDR A. baumannii ST136 carrying blaOXA-23-like from nasal and hand samples of burn patients and HCWs.

Objectives: In the nursing education system, evolution is required to train qualified and professionally competent nurses who can face workplace challenges and evolving needs of societies. This study aimed to explore effective factors and challenges of the formation of transformational education in the nursing education system., Methods: This was a qualitative study with a grounded theory approach. Twenty-four individuals participated through purposive and theoretical sampling. The authors collected data using semi-structured interviews and analyzed them by Corbin, J., & Strauss, A. (2015). Basics of qualitative research: Techniques and procedures for developing grounded theory (4th ed.). Los Angeles: Sage Publication grounded-theory method., Results: Findings showed the process of formation of transformational education which encompasses four concepts including, "transformational leadership", "effective learning", "necessity of foresight in education", and "inhibitors of educational transformation". Transformational education is a complex and multidimensional education., Conclusions: Implementation of this education requires preparing transformational leaders, planning to empower faculty members and students, and preparing for the challenges facing the education system., (© 2022 Walter de Gruyter GmbH, Berlin/Boston.)

Objectives: Edication management is a process in which medications are selected, procured, delivered, prescribed, reviewed, administered and monitored to assure high-quality patient care and safety. This paper explores clinicians' attitudes towards medication management which is both open to influence and strongly linked to successful changes in mediation behaviour. We aimed to investigate effects of engaging in participatory action research to improve emergency medicine clinicians' attitudes to safety in medication management., Setting: Emergency department of one university affiliated hospital., Participants: A total of 85 clinicians including nurses and physicians partook as participants. Eight managers and clinicians participated as representatives., Design: Data are drawn from two-cycle participatory action research. Initially, a situation analysis on the current medication management and clinician views regarding medication management was conducted using three focus groups. Evaluation and reflection data were obtained through qualitative interviews. All qualitative data were analysed using content analysis., Results: Clinicians initially expressed negative attitudes towards existing and new plans for medication management, in that they were critical of current medication-related policy and procedures, as well as wary of the potential relevance and utility of potential changes to medication management. Through the action research, improvement actions were implemented including interprofessional courses, pharmacist-led interventions and the development of new guidelines regarding medication management. Participants and their representatives were engaged in all participatory action research stages with different levels of involvement. Extracted results from evaluation and reflection stages revealed that by engaging in the action research and practice new interventions, clinicians' attitude towards medication management was improved., Conclusions: The results support the impact of participatory action research on enhancing clinicians' positive attitudes through their involvement in planning and implementing safety enhancing aspects of medication management., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Improving the competencies of nurses requires improving educational methods through the use of novel methods in teaching and learning. We aim to explore the perceptions of stakeholders (including nursing education directors, faculty members and nursing students) of the requirements of implementing innovative educational approaches in nursing., Methods: In this qualitative descriptive study, 19 participants, including educational directors, faculty members, and undergraduate and graduate nursing students, were selected through the purposeful sampling method. Achieving the theoretical saturation in extracted categories was considered as a criterion for determining the sample size and the completion of sampling. The data were collected from December 2019 to May 2020 in nursing schools of Tehran, Iran, through in-depth semi-structured individual face-to-face interviews and were then analyzed based on the Graneheim and Lundman method., Results: Using qualitative content analysis, eight sub-themes and three themes were extracted. The extracted themes were 'novel educational policymaking', 'Innovative education-oriented platform', and 'managing barriers of innovative educational approaches'., Conclusions: Developing and implementing innovative educational approaches entail providing appropriate context, structure, and required facilities by the policymaking system and educational authorities. In addition, developing capacity and related competencies of faculty members and students as the major stakeholders in employing these approaches is crucial., (© 2021. The Author(s).)

The association of human papillomavirus (HPV) in laryngeal malignancies is largely known. This study evaluated the association between HPV and benign laryngeal lesions and also the role of smoking and alcohol consumption in increasing the prevalence of HPV in such benign lesions. Seventy-eight specimens of benign laryngeal lesions including 26 polyps, 26 dysplasia, and 26 other lesions such as nodules and cysts were enrolled in this study. Polymerase chain reaction (PCR) technique was used to detect HPV DNA in the tissues. The role of smoking and alcohol consumption in the prevalence of HPV was also evaluated through appropriate statistical tests. This study showed that the prevalence of HPV in benign laryngeal lesions was not statistically significant. The Cohen's effect size for comparing polyps vs. other lesions was nearly 0.7, indicating that HPV prevalence in laryngeal polyps may be clinically meaningful. Another finding in our study is the role of smoking in increasing the HPV prevalence in laryngeal polyps ( P  = 0.034). In benign laryngeal polyps, HPV prevalence may be clinically important. Smoking acts as a co-factor to induce HPV infection in laryngeal polyps in our study., Competing Interests: Conflict of interestAuthors declared that they do not have any conflict of interest., (© Indian Virological Society 2021.)

Aim: To explore the extent to which action research assists developing medication safety behaviours among emergency medicine staff., Background: Health care staff involved in medication therapy are frequently required to implement progressive changes. To permanently improve medication safety, we must consider staff behaviour. This study utilizes action research to engage health care workers and engender behavioural changes., Method: Two cycles of action research were implemented. Data were collected through pre- and post-medication safety surveys, unstructured interviews and field notes. Staff in the emergency department worked together to progress the study cycles., Results: The pre-evaluation phase revealed deficiencies in staff medication safety behaviour. Subsequent to the implementation of safety initiatives, pre- to post-evaluation comparison indicated significant improvement in medication safety behaviours. In response to qualitative reflection phase data in reflection, ward pharmacists were placed in the emergency department and anew policy on responding to medication error was developed. Analysed field notes revealed improved safe patient care, enhanced pharmaceutical knowledge and changes in the emergency department climate., Conclusions: Through action research, this study introduced actions to improve medication safety behaviours in the emergency department. Staff involvement led to changed safety behaviours., Implication for Nursing Management: This study advises nurse managers of the benefit of pharmacist-led medication therapy, interprofessional medication safety courses and active communication between front-line staff and managers regarding medication safety., (© 2020 John Wiley & Sons Ltd.)

Background: Nursing students' perceptions of their professional preparedness help them perform their independent nursing role with self-confidence., Objectives: To develop and psychometric testing of an instrument, the "Perceived Professional Preparedness of senior Nursing Students" questionnaire., Design: Mixed-method exploratory study., Methods: We conducted this study in two phases: (1) development of initial questionnaire through interview and literature review; (2) evaluation of psychometric properties of the instrument to introduce a reliable, valid tool., Settings and Participants: We assessed qualitative and quantitative face validity of initial questionnaire by administering it to 10 nursing students. Then, a panel of 10 nursing specialists determined the Content Validity Index. After modifying items, we assessed the construct validity of the 45-item questionnaire. A sample of 159 senior nursing students completed the questionnaire, and we conducted exploratory and confirmatory factor analysis using this data. To assess the test-retest reliability, 30 students completed the instrument twice with a two-week time interval., Results: The Content Validity Index with the modified Kappa coefficient was calculated as ≥0.72, which is considered satisfactory. In exploratory factor analysis using the maximum likelihood method and varimax rotation, we extracted 19 items in four factors. This structure included 61.91% of the total variance. The factors were clinical competency, evidence-based practice, framework-oriented performance, and patient-centered care. Cronbach's alpha coefficient and McDonald's omega values higher than 0.70 and inter-class correlation coefficient above 0.90 for all factors confirmed reliability. Confirmatory factor analysis indicated a suitable fitting of the final developed model., Conclusion: The developed questionnaire is a valid, reliable tool to assess the perceived preparedness of senior nursing students for transition to the clinical setting. Further psychometric testing for this questionnaire on larger populations and in different contexts is suggested., Competing Interests: Declaration of competing interest The author(s) declares that they have no conflict of interests., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background and Aims: Upper limb amputations cause numerous physical and psychosocial challenges including disruptions to quality of life as well as limitations in participation in society. While there is a great deal of literature on patients undergoing lower limb amputation, information on upper limb amputation is limited. This study aimed, therefore, to explore care needs in patients undergoing upper limb amputation., Materials and Methods: An integrative review was conducted. The five-stage framework introduced by Whittemore and Knafl was used: problem identification, literature search, data evaluation, data analysis and presentation of results. Searches were performed based on predefined inclusion and exclusion criteria for online and unpublished research between 2008 to 2018. Data was extracted using CASP and STROBE checklists and analyzed using conventional inductive content analysis., Results: Conventional content analysis method, applied to the full texts of the final articles, included 21 articles (4 qualitative articles and 17 quantitative articles). The care needs identified included 33 care needs in 6 domains: social needs, health care system, rehabilitation program, necessity of self-care, assisting in timely and correct decision-making and patient and family education., Conclusion: Rehabilitation plans should be made for all patients, with special attention to male workers. This should begin at the time of admission and continue after their discharge. Routine follow up after discharge is essential. Care must be provided by a multidisciplinary team with timely and accurate referral and with consideration of culture and individual factors., Competing Interests: Declaration of competing interest There was no conflict of interest., (Copyright © 2020. Published by Elsevier Ltd.)

Background: Epidemiological studies have shown different association between migraine and Meniere's disease (MD). Few studies investigated the frequency of phonophobia in MD. Objectives: This study aimed to determine the frequency of phonophobia and other features of migraine in definite MD. Material and Methods: Patients with definite MD and a group of healthy (non-MD, non-vertiginous) control subjects participated. Demographic data and other clinical features of the two diseases recorded. Data analyzed in SPSS software version 20, by qi square and independent T test and logistic regression model. Results: 69 MD patients (average age: 48.87 ± 12.15 years) and 60 control subjects (average age: 47.58 ± 12.05 years) enrolled. The frequency of migraine headache in MD cases was 16% (45% with aura) compared with 5% in control group (three cases; 2 without and 1 with aura) ( p  < .001). Family history of migraine was the only determinant of the presence of migraine in MD ( p  = .001, OR = 15.625, 95%CI: 2.94-88.33). The frequency of phonophobia in MD was very high (88.4%: 54.5% in migraine subgroup and 89.6% in non-migraine cases) and without significant relation to existence of migraine, in contrast to photophobia and osmophobia ( p  = .064). Conclusions: The frequency of migraine in MD is higher than normal subjects. Phonophobia may be an independent symptom in MD.

Background: Professional identity (PI) is a key factor behind nurses' ability to provide quality care. PI assessment requires valid and reliable tools., Aim: This study aimed to translate into Persian the 9-item Macleod Clark Professional Identity Scale (MCPIS) and evaluate its psychometric properties among Iranian nursing students., Methods: In this methodological study, SMCPIS was translated into Persian through forward-backward translation. The face and content validity of the translated scale were respectively assessed by 10 nursing students and a panel of 10 experts. Then, 171 nursing students completed MCPIS and Nurse Self-Concept Questionnaire. Collected data were used for construct validity assessment through confirmatory factor analysis and criterion validity assessment through correlation analysis. Reliability assessment was also performed through the internal consistency and the test-retest methods., Findings: Confirmatory factor analysis revealed good fit model for the scale. Criterion validity, measuring convergent validity, assessment also showed a significant correlation between the scores of MCPIS and Nurse Self-Concept Questionnaire ( r = -0.2, P = .07). Cronbach's alpha and test-retest correlation coefficient were .87 and .72, respectively. Students' MCPIS scores ranged from 15 to 54 with a median of 44 (in the possible range of 9-54)., Conclusion: The Persian MCPIS is a valid and reliable tool for PI assessment. Further studies are recommended to produce evidence supporting the validity and reliability of the scale., (© Copyright 2020 Springer Publishing Company, LLC.)

Background: Breast cancer disease and its classic treatment lead to decrease in patients' quality of life (QOL). This systematic review aimed to compare the effectiveness of complementary and alternative medicines (CAMs) categories on the QOL of women with breast cancer., Methods: English clinical trials from PubMed, Emabase, Scupos, and Google Scholar databases were searched electronically by the end of 2018 with the Cochrane Collaboration protocol. Two researchers independently extracted data such as participants' characteristics, CAM methods, QOL assessment tools. CAMs were classified into three categories of dietary supplements, herbal medicine, and mind-body techniques., Results: During the initial search, 1186 articles were found. After reviewing titles, abstracts, and full texts based on inclusion and exclusion criteria, 28 clinical trials were included in the systematic review, 18 of which was randomized controlled trial (RCT). Participants included women with breast cancer who were undergoing the first three phases of breast cancer or postcancer rehabilitation. Among CAM interventions, one article used a dietary supplement, and the other 27 articles included a variety of mind-body techniques. Twenty-seven studies showed improved QOL ( P > 0.05)., Conclusion: The findings may indicate the potential benefits of CAMs, especially mind-body techniques on QOL in breast cancer patients. Further RCTs or long-term follow-up studies are recommended. Moreover, the use of similar QOL assessment tools allows for more meta-analysis and generalizability of results, especially for the development of clinical guidelines., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Indian Journal of Palliative Care.)

Objective: Silibinin is an antioxidant agent and is shown to have anticancer effects in different cancers including lung, breast, colorectal, liver, prostate, and kidney. There are challenges in the clinical use of silibinin. The main limitation is low solubility, poor oral absorption, and extensive hepatic metabolism. We aim to develop a High-Performance Liquid Chromatography (HPLC) sensitive method for quantification of silibinin in aqueous samples to quantify its concentration in new formulations. A reverse-phase high-performance liquid chromatography (RP-HPLC) composed of C18 column as stationary phase and the mixture of methanol (90%) and water (10%) as mobile phase. The developed method was validated based on the established guidelines., Results: The retention time for silibinin was seen in 2.97 min after injection. The calibration curve was drawn and the established method demonstrated a linear ranged from 10 to 100 µg/ml, with a correlation coefficient of 0.996. The sensitivity of the developed method was 10 µg/ml. The accuracy calculated in the range of 88-105.9% and the precision (as relative standard deviation) was between 2.7 and 10.9%. These results demonstrate that the developed method can be a fast and accurate method for quantification of silibinin in aqueous samples.

Background: As the core of health promotion, proper assessment of empowerment is a base for planning for a process that increases people's control on their decisions, lifestyle, and effective activities for their health., Objective: To design and develop a special tool to assess the empowerment of NGO women in Iran., Methods: This successive exploratory study of combinational type was conducted in 2015 in two steps. In the first step, using comments of participants and the help of authentic texts related to this field, dimensions of psychological empowerment were developed. In the second step, psychometric properties of the scale or tool were determined using formal content, and structural validity and reliability were determined using internal consistency and stability via SPSS version 21., Results: In the first step, the initial tool including 58 items was developed in the form of eight domains. In the second step, based on exploratory factor analysis (EFA), the number of items was reduced to 37. Considering the eigenvalues of higher than one, items were classified into eight factors. KMO index was 0.896 in this study. Reliability of the tool was 0.81 using Cronbach's alpha. This tool is able to predict 66.1% of total changes in psychological empowerment., Conclusion: A questionnaire with relevant reliability and validity, including eight domains of participation, motivation, cognitive thinking, critical thinking, self-efficacy, intention, perceived control and social support was developed to measure psychological empowerment of NGO women in Iran., Competing Interests: Conflict of Interest: There is no conflict of interest to be declared.

Introduction: According to the health-promoting approach, people should be empowered such that they take responsibility for their health and follow a healthy lifestyle. Empowerment is a process in which people confront problems and tasks in their lives in order to better control them. This study was conducted to specify the relationship between individual empowerment and health-promoting lifestyle among women NGOs of northern Iran., Methods: In this cross-sectional study, 290 women NGOs of Guilan Province were selected randomly using multistage cluster sampling, and were examined using the questionnaire of health-promoting lifestyle profile II and individual empowerment inventory scale. Data were analyzed using STATA 11 software via one-way ANOVA, Pearson correlation coefficient and multivariate linear regression., Results: Both variables of individual empowerment and health-promoting lifestyle were of favorable status among the population under study. The highest score in individual empowerment belonged to the domain of social support and the highest score in lifestyle belonged to spiritual growth. A significant relationship was found between individual empowerment and health-promoting lifestyle (p<0.001). The highest correlation between individual empowerment and dimensions of health-promoting lifestyle was related to interpersonal relationships. In addition, it was specified that 21% of lifestyle variance could be explained by individual empowerment., Conclusion: There is a relation between individual empowerment and health-promoting lifestyle. Individual empowerment is a predictive variable to have a health-promoting lifestyle. Therefore, by increasing individuals' empowerment, their healthy lifestyle can be promoted., Competing Interests: Conflict of Interest: There is no conflict of interest to be declared.

Clostridium perfringens beta toxin is only produced by types B and C and plays an important role in many human and animal diseases, causing fatal conditions that originate in the intestines. We compared the expression of C. perfringens type B vaccine strain recombinant beta toxin gene in the Escherichia coli strains Rosetta(DE3) and BL21(DE3). The beta toxin gene was extracted from pJETβ and ligated with pET22b(+). pET22β was transformed into E. coli strains BL21(DE3) and Rosetta(DE3). Recombinant protein was expressed as a soluble protein after isopropyl β-D-1-thiogalactopyranoside (IPTG) induction in strain Rosetta(DE3) but not in BL21(DE3). Expression was optimised by growing recombinant cells at 37 °C and at an induction of 0.5 mM, 1 mM, 1.5 mM IPTG. Expression was evaluated using sodium dodecyl sulfate Polyacrylamide gel electrophoresis (SDS-PAGE). The recombinant protein was purified via Ni-NTA and was analysed using western blot. We concluded that E. coli strain RosettaTM(DE3) can enhance the expression of C. perfringens recombinant beta toxin.

Biofloc technology is considered as a method that degrades organic waste by microorganisms and produces microbial flocs. A 30-day experiment was performed to investigate the effects of partial replacement of daily feeding intake with biofloc on the growth performances, digestive enzymes activity and liver histology of the common carp Cyprinus carpio L. fingerlings. Two hundred and eight healthy fingerlings (58.6 ± 0.2 g) were randomly distributed in 12 tanks (30 L) at a density of 25.4 kg m(-3) and fed experimental treatments (100 % daily feeding rate as a control, biofloc + 75% daily feeding rate, biofloc + 50% daily feeding rate, biofloc + 25% daily feeding rate). At the end of experiment, the results indicated that the highest weight gain was observed in the fish fed BFT 75% and control which differed significantly from those fed BFT 25 % (P < 0.05). Diet BFT 75% improved total protease and pepsin activity compared with BFT 25 and 50% (P > 0.05). No significant difference was observed in case of lipase, amylase and alkaline phosphatase activity between the treatments. In the liver, histological alterations were found in the treatments, and feeding the fish with BFT 75% significantly improved hepatocellular quantification and qualification than the other groups. The results obtained in this experiment suggest that the biofloc improves growth performances, digestive enzyme activity and liver condition of the common carp fingerlings when 25% of daily feeding rate (BFT 75%) was replaced with one carbohydrate such as molasses in zero-water exchange system.

Background: Restoring patient homeostasis after coronary angiography, the gold standard diagnostic test for coronary heart disease is usually achieved by manual compression of the puncture site using a sandbag and prolonged bed rest. However, this process frequently results in patient complaints of back pain and discomfort., Purpose: The aim of study was to assess the effect of positioning on patient outcomes after coronary angiography., Methods: This study used a single-blind randomized control trial approach. The sample consisted of 80 patients who had undergone a nonemergency coronary angiography via the femoral artery. Balanced block randomization was used to allocate participants into intervention and control groups. Routine care for the intervention group (n = 40) was adjusted to include the following: (1) intermittent changes to patient body and head position in bed during first 6 hours after catheterization, (2) reduction of sandbag compression time on the puncture site to 1 hour, and (3) regular examination for bleeding during the first 6 hours after catheterization. Intervention group participants were allowed to ambulate without restriction 6 hours after catheterization. Patients in the control group (n = 40) received routine care, consisting of (1) 6-24 hours of bed rest in the supine position with the affected leg fixed straight and immobilized and (2) sandbag compression on the puncture site for 6 hours. The main outcomes used in this study were level of back pain, discomfort, foot pain, bleeding, and hematoma., Results: Intervention group patients had significantly less back pain and foot pain and higher comfort than the control group at the second, third, and sixth hour after catheterization (p = .00). There was no significant difference between the two groups in terms of amount of bleeding and hematoma (p > .05)., Conclusions: Findings suggest that changes in patient position may be safer in the early period of postcatheterization bed rest than currently indicated in standard practice protocols. Furthermore, limiting sandbag compression to 1 hour has no measurable effect on the incidence and severity of vascular complications.

Background: Acute Lymphoblastic Leukemia (ALL) is the most common malignancy among children for whom radiotherapy and chemotherapy are used for treatment. When hypothalamus-pituitary axis is exposed to radiotherapy, children's hormone level and quality of life are influenced. The aim of this study is to determine late effects of radiotherapy on hormonal level in these patients., Materials and Methods: In this study 27 children with ALL, who have been referred to Shahid Ramezanzadeh Radiation Oncology Center in Yazd-Iran and received 18-24 Gy whole brain radiation with Cobalt 60 or 9 MV linear accelerator, were assessed. These patient's basic weight, height and hormonal levels were measured before radiotherapy and also after different periods of time., Results: GHD (growth hormone deficiency) after clonidine stimulation test was observed in 44% (n=12) and that in 50% of them (n=6), less than 1 year, had been passed from their radiation therapy. None of these patients demonstrated hormone deficiency in other axes., Conclusions: This study showed that even application of a 18-24 Gy radiation dose might influence growth hormone levels; therefore, we recommend reduction of radiotherapy dose in such patients whenever possible.