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The efficient scheduling of tasks in distributed server systems is of great importance to minimise the response time and thus improve the performance of such systems. This paper presents an integrated fuzzy simulation approach to improve the performance of distributed server systems. Performance is defined in terms of time-varying distributions of job arrival, job parallelism and task service demand with fuzzy parameters. In order to achieve the most efficient policies for job scheduling in this fuzzy system, an integrated fuzzy simulation approach is used. This is the first study that uses fuzzy simulation for performance improvement of uncertain distributed server systems. [ABSTRACT FROM PUBLISHER]

One of the most common objectives in single-machine scheduling problems is the minimisation of total tardiness. Due to the non-deterministic polynomial-time hard nature of this problem, different heuristic and metaheuristic algorithms have been employed to solve it. In this article, an integer programming model with non-monotonic time-dependent job processing times is developed in which deterioration and learning considerations are incorporated simultaneously. A hybrid genetic algorithm-tabu search (GA-TS) approach is employed to solve the problem. Also, to improve the performance of the GA, Taguchi method is used for parameter tuning. Lastly, in an attempt to validate the proposed model, different test problems are generated randomly and solved by both the hybrid GA-TS and an optimisation software, and thereafter a comparison is performed between the results obtained by them. According to the results, the developed approach has potential to yield near-optimum solutions in large-sized problems. To the best of our knowledge, this is the first study that considers non-monotonic time-dependent processing times, deterioration and learning effect simultaneously in a single-machine scheduling problem with the objective of total tardiness minimisation. [ABSTRACT FROM AUTHOR]

Background: Justice in health is one of the main concerns of health organizations, and discrimination in health care is one of the negative outcomes to achieving this goal. Hence, a full understanding of the phenomenon of discrimination in health care and adopting strategies to eliminate it is necessary. The present study was conducted to explore and describe the experiences of nurses of discrimination in health care., Materials and Methods: The present qualitative content analysis study was conducted between 2019 and 2020. Data were collected through semi-structured interviews with 18 participants (two physicians, three nursing supervisors, two head nurses, four clinical nurses, two nursing assistants, and three hospitalized patients) in one public and one private hospital in the city of Tehran. The participants were selected by purposive sampling, which continued until saturation of data. Data obtained were analyzed using the Graneheim and Lundman method., Results: Four main categories and 14 subcategories were extracted from data analysis: 1) habitual discrimination (everyday discrimination in health centers, ignoring patient rights, low levels of trust in medical staff); 2) interpersonal relationships (expectations of associates, respect for colleagues and friends, the possibility of the occurrence of similar situations, reciprocating people's favors); 3) shortage of health-care resources (shortage of medical equipment, heavy workload, infrastructure of medical centers, lack of access to physicians); and 4) favoritism (ethnicity, favoritism as a common method, and favoritism as the ultimate solution to treatment problems)., Conclusion: The present study revealed certain dimensions of discrimination in health care that remain hidden in many quantitative studies. It appears that health system managers will be able to move toward eliminating discrimination in health care. Thus, designing effective models to reduce discrimination in health care based on the underlying concepts of this study is recommended., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Education and Health Promotion.)

Background: Discrimination in health care is an international challenge and a serious obstacle to justice and equality in health., Research Objective: The purpose of this study was to design a grounded theory of discrimination in health care based on the experiences and perceptions of Iranian healthcare providers and patients., Research Design: This qualitative study was conducted using by the grounded theory method., Participants and Research Context: Data were collected through semi-structured interviews with 18 healthcare providers including 11 nurses, two physicians, two nurse's assistants, and three patients in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling and analyzed simultaneously using the Corbin and Strauss (2015) approach., Ethical Considerations: The study was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethics code: IR.USWR.REC.1398.023). Also, after explaining the objectives of the study, all the participants completed and signed the written consent form ., Findings: The "culture of discrimination" was the study's core category, reflecting the nature of discrimination in health care. The theory of "culture of discrimination in health care" is the result of five main categories: "individual social stimuli," "culture of discrimination," "unintentional discrimination," "conflict with discrimination," and "dissatisfaction with discriminatory behavior." These categories cover the underlying factors, strategies, and outcomes of the discrimination process in health care., Discussion: The results of the study showed that nurses and other health care providers experience unintentional discrimination. Unintentional discrimination refers to discriminatory behaviors and practices of health care providers ., Conclusion: The theory of culture of discrimination in health care can be used as a practical guide to describe and understand the role of health care providers, especially nurses. Further studies with a quantitative approach to applying this theory in medical settings are recommended.

Aim: This study aimed to explore the experiences of nurses in providing care to COVID-19 patients., Method: This qualitative study was conducted with the content analysis approach between June and Agust 2020 in Iran. Fourteen nurses working in COVID-19 wards were selected via purposive sampling. The data were collected via semi-structured interviews and the Graneheim and Lundman content analysis method was adopted for the data analysis., Results: The experiences of nurses in providing care to COVID-19 patients were divided into four categories "a scarcity of knowledge about COVID-19 patient care," "changes in daily life," "patient care challenges," and "occupational burnout.", Conclusion: The results of this study can be used by managers when facing crises similar to COVID-19 so that by paying attention to the challenges of caring for patients identified in this study, they can make the necessary preparations for caring for patients during other pandemic crises and plan the necessary measures accordingly. Also, to maintain and promote the quality of nursing care, it is crucial to ensure the adequate provision of resources for patient care, such as utilizing personal protective equipment and mechanisms that offer financial and emotional support to nurses.

Introduction: Along with the challenges of COVID-19 vaccine supply in low-income countries, vaccine hesitancy was another problem for the health system. The aim of this study was to deeply understand the challenges of vaccine acceptance, the vaccination process, and to compare the affecting vaccine acceptance in the high and low points of the epidemic in Iran., Methods: In the qualitative part of this mixed-methods study, content analysis was used to investigate experiences and perceptions about COVID-19 vaccination in four groups. In the quantitative study, in March 2021 (low point), and on August 1, 2021 (high point), two population-based cross-sectional studies were performed in Tehran and its rural, with sample sizes of 1,200 and 1,872 people aged over 18 years, respectively. Multinomial (polytomous) logistic regression was used to determine the factors affecting hesitation and unwillingness to receive the vaccine., Results: Disbelief in vaccine safety, vaccine distrust, ignorance and confusion, and inadequate facilities were the common reasons extracted in the two qualitative studies. At the low and high points of the epidemic, vaccine acceptance was 83.6% (95% CI: 81.3-85.9) and 65.8% (95% CI: 65.8-71.0), respectively. Residence in rural areas, (Odds Ratio: 0.44, p = 0.001), being a student (Odds Ratio: 0.41, p = 0.011), housewives (Odds Ratio: 0.63, p = 0.033), illiteracy (Odds Ratio: 4.44, p = 0.001), and having an underlying disease (Odds Ratio: 4.44, p = 0.001) were factors affecting on vaccine acceptance., Discussion: Counter-intuitively, acceptance did not increase at the peak of epidemic. The presence of obstacles, such as increased distrust in the effectiveness of vaccines due to the occurrence of multiple peaks in different vaccinated countries, as well as the influence of the media, anti-vaccine campaigns, and lack of proper communication about risks caused more hesitation. More investigation to understand how people accept or reject vaccine and its long term consequences is recommended., 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 Khankeh, Pourebrahimi, Hosseinabadi-Farahani, Farrokhi, Khanjani, Shojafard, Hamedanchi, Ranjbar, Jenabi Ghods, Ahmadi, Ghanaatpisheh and Saatchi.)

Background: Discrimination in health care is a common phenomenon whose complete understanding has always been a major concern of health-care systems to control and reduce it. This study aimed to explore the experiences of unintentional discrimination and related factors in health-care providers., Materials and Methods: This qualitative study was conducted with a content analysis approach in 2019. Data were collected through semi-structured interviews with 13 health-care providers including two physicians, three nursing supervisors, two head nurses, four staff nurses, and two nurse aides in two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling. The obtained data were analyzed by Graneheim and Lundman method., Results: Three main categories and eight subcategories were obtained from the data analysis: (1) forced discrimination (superiors' pressures and executive orders, occupational concerns, and fear of the superiors); (2) guided discrimination (professional challenges, managers' policymaking, and lack of medical ethics knowledge); and (3) lack of resources (workforce shortage and lack of medical equipment)., Conclusion: The results of this study suggest that health-care providers such as doctors and nurses are unintentionally forced to provide discriminatory care on some occasions. Knowing and managing these unwanted factors can partly counteract unintentional discrimination. Thus, preventing the factors that lead to superiors' pressures and occupational forces and improving the medical ethics knowledge should be considered by health-care managers., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)