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Objectives COVIDTrach is a UK multicentre prospective cohort study project that aims to evaluate the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation and record the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure.Design Data on patient demographic, clinical history and outcomes were entered prospectively and updated over time via an online database (REDCap). Clinical variables were compared with outcomes, with logistic regression used to develop a model for mortality. Participants recorded whether any operators tested positive for SARS-CoV-2 within 2 weeks of the procedure.Setting UK National Health Service departments involved in treating patients with COVID-19 receiving mechanical ventilation.Participants The cohort comprised 1605 tracheostomy cases from 126 UK hospitals collected between 6 April and 26 August 2020.Main outcome measures Mortality following tracheostomy, successful wean from mechanical ventilation and length of time from tracheostomy to wean, discharge from hospital, complications from tracheostomy, reported SARS-CoV-2 infection among operators.Results The median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration, positive end-expiratory pressure setting, fever, number of days of ventilation before tracheostomy, C reactive protein and the use of anticoagulation and inotropic support independently predicted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within 2 weeks of the procedure.Conclusions Tracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical parameters that are predictive of mortality.Trial registration number The study is registered with ClinicalTrials.Gov (NCT04572438).

Two radioisotopes of 18F (T1/2=109.7 min, Iβ+= 97%, Eβ+= 0.63 MeV), and 13N (T1/2=10min, Iβ+=100%, Eβ+=0.96 MeV) decay almost completely via positron emission. Due to this characteristic, these radioisotopes are used in PET (positron emission tomography) camera for detection of cancer cells. In this article, after calculating the excitation function for nuclear reactions leading to the 18F, 18O (p, n) 18F, and 13N, 16O (p, α) 13N formation using the ALICE-91 nuclear code and by a comparison of the results with the experimental data, the best range of energy to produce with a cyclotron accelerator and the amount of heat deposited to the target material, was determined. For the waste heat removal, a miniature heat exchanger was designed and manufactured. A thermal design of the heat exchanger by the Aspen HTFS+ software was created, and its mechanical plan sheet was drawn using the SolidWorks software. After the fabrication of the heat exchanger and recirculation liquid target located at the liquid target room, 13N was produced via pure water proton bombardment with 17.5 MeV energies verifying the theoretical calculations.

Introduction: Sulfur mustard(SM) is a strong alkylating agent that increases the formation of free radicals. Therefore, this study aimed to evaluate the protective and therapeutic roles of hexamethylenetetramine (HMT) and N-acetyl-cysteine(NAC) in reduction of SM-induced oxidative stress in rat serum. Methods: In the present experimental study, male Wistar rats were randomly divided into eight groups including: control group, SM group (an endotracheal injection of SM 0.5%/kg only once), HMT group (7.5mg/kg), NAC group (0.5mg/kg), HMT-SM group, NAC-SM group, SM-HMT group and SM-NAC group. HMT and NAC were received daily an hour before and after receiving SM by intraperitoneal injection for 14 days. After 14 days, the rats were anesthetized by ether, their blood was collected by cardiac puncture and the serum was obtained. Then, superoxide dismutase(SOD), catalase(CAT) and glutathione S-transferase(GST) activities, as well as glutathione(GSH) and malondialdehyde(MDA) levels were determined by biochemical methods. Results: SM decreased serum SOD (p

SUMMARY: The aim of this study was to investigate the effects of early dextrose (Dex) feeding on subsequent growth performance of broilers. A total of 700 male day-old broiler chicks were randomly allocated into 50 floor pens (in a balanced completely randomized design with 2 treatments) receiving either a control corn–soybean meal-based diet (control treatment) or a diet in which corn was partially (5%) replaced by Dex Monohydrate (Dex treatment). The performance data were recorded at 7, 20, 30, 40 d. Samples of the birds were slaughtered at 7, and 40 d of age, and their carcass, serum, and intestinal morphology traits were analyzed. The results showed that early feeding of the Dex resulted in significant improvement in weight gain (WG) during d 1 to 7 (P < 0.01), 21-30 (P < 0.05), and 1-40 (P < 0.01), as well as the carcass traits at d 40 (P < 0.05). Feeding Dex increased serum glucose, total protein, globulin, triiodothyronine (T3), and T3/T4 ratio (P < 0.05). Duodenal villi height, crypt depth, and villus to crypt ratio (V/C) were affected (P < 0.05) by early Dex feeding. In conclusion, early feeding of a highly available carbohydrate source (Dex) improves subsequent growth performance and carcass traits of broilers.

Intracranial pressure (ICP) is a physiological parameter that conventionally requires invasive monitoring for accurate measurement. Utilising multivariate predictive models, we sought to evaluate the utility of non-invasive, widely accessible MRI biomarkers in predicting ICP and their reversibility following cerebrospinal fluid (CSF) diversion. The retrospective study included 325 adult patients with suspected CSF dynamic disorders who underwent brain MRI scans within three months of elective 24-h ICP monitoring. Five MRI biomarkers were assessed: Yuh sella grade, optic nerve vertical tortuosity (VT), optic nerve sheath distension, posterior globe flattening and optic disc protrusion (ODP). The association between individual biomarkers and 24-h ICP was examined and reversibility of each following CSF diversion was assessed. Multivariate models incorporating these radiological biomarkers were utilised to predict 24-h median intracranial pressure. All five biomarkers were significantly associated with median 24-h ICP (p < 0.0001). Using a pair-wise approach, the presence of each abnormal biomarker was significantly associated with higher median 24-h ICP (p < 0.0001). On multivariate analysis, ICP was significantly and positively associated with Yuh sella grade (p < 0.0001), VT (p < 0.0001) and ODP (p = 0.003), after accounting for age and suspected diagnosis. The Bayesian multiple linear regression model predicted 24-h median ICP with a mean absolute error of 2.71 mmHg. Following CSF diversion, we found pituitary sella grade to show significant pairwise reversibility (p < 0.001). ICP was predicted with clinically useful precision utilising a compact Bayesian model, offering an easily interpretable tool using non-invasive MRI data. Brain MRI biomarkers are anticipated to play a more significant role in the screening, triaging, and referral of patients with suspected CSF dynamic disorders., (© 2024. The Author(s).)

In this study, a bovine serum albumin-decorated zeolitic imidazolate framework (ZIF-8@BSA) was used to enhance the anticancer and antimetastatic properties of methotrexate. SEM, DLS, FT-IR, and XRD confirmed the physicochemical suitability of the developed nanoparticles. According to the SEM analysis, the mean size of ZIF-8 nanoparticles was 68.5 ± 13.31 nm. The loading capacity and encapsulation efficiency of MTX@ZIF-8@BSA were 28.77 ± 2.54% and 96.3 ± 0.67%, respectively. According to the in vitro hemolysis test, MTX@ZIF-8@BSA showed excellent blood compatibility. MTX@ZIF-8@BSA exhibited pH sensitivity, releasing more MTX at pH 5.4 (1.73 times) than at pH 7.4. The IC 50 value of MTX@ZIF-8@BSA on 4T1 cells was 32.7 ± 7.3 µg/mL after 48 h of treatment, outperforming compared to free MTX with an IC 50 value of 53.3 ± 3.7 µg/mL. Treatment with MTX@ZIF-8@BSA resulted in superior tumor growth suppression in tumor-bearing mice than free MTX. Furthermore, based on histopathology tests, MTX@ZIF-8@BSA reduced the metastasis in lung and liver tissues. While there was not any noticeable toxicity in the vital organs of MTX@ZIF-8@BSA-receiving mice, free methotrexate resulted in severe toxicity in the kidneys and liver. According to the preliminary in vitro and in vivo findings, MTX@ZIF-8@BSA presents an attractive drug delivery system candidate for breast cancer due to its enhanced antitumor efficacy and lower toxicity.

Polycyclic aromatic hydrocarbons (PAHs), toxic persistent pollutants, result in adverse impacts to human being health. Among the variety contaminant remediation approaches, nanotechnology was found promising in terms of its efficiency and exceptional size-dependent properties. Nanomaterials also possess high particular surface area, rapid dissolution characteristics, high sorption, magnetic -properties and quantum confinement. Nanoparticles (NPs) have been employed as sorbents in the assessment of PAHs, including carbon NPs, mesoporous silica NPs, metallic species, metal oxides, as well as magnetic and magnetized NPs. Magnetic nanocomposites have demonstrated high efficiency (>99 %) in removing PAHs from food products. Similarly, a magnetic chitosan/molybdenum disulfide nanocomposite exhibited excellent adsorption capacities for PAHs in milk samples. Present research was conducted on multiple academic platforms, including Google Scholar, Science Direct, Elsevier, Springer, Scopus, and PubMed from 2017 to 2024. Various combinations of keywords, such as "PAHs," "extraction," "removal," and "nanomaterials," were used in the search. The aim of this manuscript is to reviews the application of nanotechnologies for the elimination and extraction of PAHs from contaminated food products. The findings of this study offer novel insights into efficient and cost-saving approach and suggest the potential of NPs as promising agents for preconcentration and remediation of PAHs from variety food samples. Also, the obtained results will pave the way for future explorations that will lead to the achievement of maximum efficiency for the analysis and extraction of materials in more diverse matrices. Therefore, it is suggested to investigate the potential of various nanomaterials regarding various matrices in future., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Quercetin (Qc) possesses anti-cancer properties, such as cell signaling, growth suppression, pro-apoptotic, anti-proliferative, and antioxidant effects. In this study, we developed an alginate-modified ZIF-8 (Alg@ZIF-8) to enhance the anti-tumor efficacy of Qc. The developed alginate-modified quercetin-loaded ZIF-8 (Alg@Qc@ZIF-8) was characterized using scanning electron microscope (SEM), dynamic light scattering (DLS), fourier transform infrared spectroscopy Thermogravimetric analysis, Brunauer-Emmett-Teller, and x-ray diffraction. The drug release pattern was evaluated at pH 5.4 and 7.4. The cytotoxicity of nanoparticles was assessed on the 4T1 cell line. Finally, the anti-tumor activity of Alg@Qc@ZIF-8 was evaluated in 4T1 tumor-bearing mice. SEM showed that the nanoparticles were spherical with a diameter of mainly below 50 nm. The DLS showed that the developed nanoparticles' hydrodynamic diameter, zeta potential, and polydispersity index were 154.9 ± 7.25 nm, -23.8 ± 5.33 mV, and 0.381 ± 0.09, respectively. The drug loading capacity was 10.40 ± 0.02%. Alg@Qc@ZIF-8 exhibited pH sensitivity, releasing more Qc at pH 5.4 (about 3.62 times) than at pH 7.4 after 24 h. Furthermore, the IC 50 value of Alg@Qc@ZIF-8 on the 4T1 cell line was 2.16 times lower than net Qc. Importantly, in tumor-bearing mice, Alg@Qc@ZIF-8 demonstrated enhanced inhibitory effects on tumor growth and lung metastasis compared to net Qc. Considering the in vitro and in vivo outcomes, Alg@Qc@ZIF-8 might hold great potential for effective breast cancer management., (© 2024 IOP Publishing Ltd. All rights, including for text and data mining, AI training, and similar technologies, are reserved.)

Objective: This study aims to evaluate the roles and tasks of school nurses in the UAE, quantify the time spent on each, and identify areas for improvement in school health services. This aligns with the UAE government's initiative to enhance primary healthcare, focusing on illness prevention and health promotion for children and adolescents., Methods: The research adopts an observational study design, utilizing self-observation through diary recordings by school nurses to collect data on their daily tasks and time allocation. A sample of total of 2024 school nurse activities were recorded and analyzed over 126 days and 1084 h of observation by eight school nurses using self-report diaries. This method allowed for the collection of detailed information on how nursing time is allocated between core and noncore tasks., Results: In this study a total of 2024 tasks were observed over 1084 h. The findings reveal that core nursing tasks accounted for 78% of activities but only 53% of the total 1084 h observed, while non-nursing tasks, making up 22% of activities, disproportionately consumed 47% of the hours. This discrepancy highlights the inefficiency of time allocation, with non-nursing tasks such as administrative duties taking significantly longer than core patient care tasks., Conclusions: The study highlights a significant opportunity to enhance school health services in the UAE by optimizing the allocation of nursing time towards more illness prevention and health promotion interventions. By addressing the identified challenges, including the gaps in nurse competencies and the lack of structured practice frameworks, school health services can be improved., (© 2024 Wiley Periodicals LLC.)

Introduction:  Surgical education has seen a transition in the delivery of training, with increased use of online platforms to facilitate remote learning. Simulation training can increase access to education and reduce cost implications, while reducing patient risk. This study aims to compare commercially available digital microscopes, alongside a standard binocular surgical microscope, and determine whether they can be used as an alternative tool for remote microsurgery simulation., Methods:  Data were collected for a total of four microscopes, including three commercially available digital microscopes, smartphone, and a binocular table microscope. Product characteristics were collated, and a subjective assessment was conducted using an 11-criteria questionnaire, graded with a 5-point scale. Results of digital microscopes were compared with the table binocular microscope.The Kruskal-Wallis test was used to compare the performance of digital microscopes to the standard binocular microscope RESULTS:  The questionnaire was completed by 31 participants: two consultants, nine surgical registrars, fourteen junior trainees, and six medical students. Digital microscopes were found to be significantly more affordable and convenient for trainees; however, the cost of the smartphone was significant. Overall, the Pancellant Digital Microscope performed the poorest, with trainees commenting on its unsuitability for surgical practice; the Plugable USB Digital Microscope (PLDM) was rated overall most like the binocular table microscope. The Depth of field was shallow in all digital microscopes., Conclusion:  With the increasing role of remote learning and simulation training in surgical education, the PLDM can provide a cheaper, more accessible alternative for junior trainees, in their pursuit of microsurgical skill acquisition., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

Background: Patients can play a key role in delivering safe care by becoming actively involved in their health care. This study aimed at reviewing the literature for evidence of patients' and families' engagement in patient safety in the Eastern Mediterranean Region (EMR)., Methods: We conducted a scoping review of the literature published in English using PubMed, Medline, CINAHL, Scopus, ISI Web of Science, and PsycINFO until June 2023., Results: A total of 9019 studies were screened, with 22 meeting the inclusion criteria. Our review found few published studies of patient and family engagement in patient safety research in the EMR. Thirteen studies explored the attitudes, perceptions, and/or experiences / preferences of patients, families, and healthcare providers (HCPs) regarding patient engagement in patient safety. Nine publications reported patient involvement in patient safety activities at varying levels. Three categories of factors were identified that may affect patient involvement: patient-related (e.g., lack of awareness on their role in preventing harms, unwillingness to challenge HCPs' authority, and cultural barriers); HCP-related (e.g., negative attitudes towards patient engagement, poor patient-provider communication, and high workload); and healthcare setting-related (e.g., lack of relevant policies and guidelines, lack of training for patients, and HCPs, and lack of patient-centered approach)., Conclusion: This review highlighted limitations in the current literature on patient and family engagement in patient safety in the EMR, including both the depth of evidence and clarity of concepts. Further research is needed to explore how to actively involve patients and their families, as well as to determine whether such involvement translates into improved safety in practice., (© 2024. The Author(s).)

Background: A comprehensive guideline named "Diagnostic Therapeutic Flow Chart for Covid-19″ (DTFC) was released by the Scientific Committee of Covid-19 of Iran's Ministry of Health and Medical Education and regularly was updated. The aim of this study was to compare the prescription pattern of drug treatment in outpatient Covid-19 patients with the DTFC., Methods: A cross-sectional study was conducted on the prescription pattern of drugs given to outpatients with a diagnosis of Covid-19, in Isfahan City from June to September 2021 (concurrent with the fifth peak of Covid-19 in Iran) taking into account the recommendations of the 9th version of DTFC (December 2020). A total of 8250 prescriptions were retrieved from the Public Health Department of Isfahan City., Results: Famotidine 20, 40 mg tablets (N = 936 patients) was the most prescribed drug followed by dexamethasone ampule (N = 588), prednisolone 5, 50 mg tablets (N = 478), azithromycin 250, 500 mg capsules (N = 452), diphenhydramine syrup (N = 362), vitamin D3 soft gel 50,000 Iu (N = 526), naproxen 250, 500 mg tablets (N = 266) and favipiravir 200 mg tablet (N = 191). The following drugs were administered against the recommendation of the DTFC-9: azithromycin, favipiravir, remdesivir, cetirizine, corticosteroids, vitamin C, vitamin B12, multivitamins, proton pump inhibitors (e.g., omperazole, anticoagulants (rivaroxaban,….), aspirin and ivermectin. Administration of analgesics, famotidine, hydroxychloroquine, vitamin D3, diphenhydramine and statins were in concordance with the DTFC-9., Conclusion: In this study, we showed frequent use of drugs with unproven efficacy in outpatient cases of Covid-19 mostly attributed to corticosteroids and antibiotics use. Our research highlights the discrepancy between recommendations for care and clinical practice and the need for strategy to bridge gaps in evidence-based informed decision-making., (© 2023. The Author(s).)

Essential oils (EOs) are natural products called volatile oils or aromatic and ethereal oils derived from various parts of plants. They possess antioxidant and antimicrobial properties, which offer natural protection against a variety of pathogens and spoilage microorganisms. Studies conducted in the last decade have demonstrated the unique applications of these compounds in the fields of the food industry, agriculture, and skin health. This systematic article provides a summary of recent data pertaining to the effectiveness of EOs and their constituents in combating fungal pathogens through diverse mechanisms. Antifungal investigations involving EOs were conducted on multiple academic platforms, including Google Scholar, Science Direct, Elsevier, Springer, Scopus, and PubMed, spanning from April 2000 to October 2023. Various combinations of keywords, such as "essential oil," "volatile oils," "antifungal," and " Aspergillus species," were used in the search. Numerous essential oils have demonstrated both in vitro and in vivo antifungal activity against different species of Aspergillus , including A. niger , A. flavus , A. parasiticus , A. fumigatus , and A. ochraceus. They have also exhibited efficacy against other fungal species, such as Penicillium species, Cladosporium , and Alternaria. The findings of this study offer novel insights into inhibitory pathways and suggest the potential of essential oils as promising agents with antifungal and anti-mycotoxigenic properties. These properties could make them viable alternatives to conventional preservatives, thereby enhancing the shelf life of various food products., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Background: The aim of this study was to examine the quality of care by age and gender in oesophageal cancer using Global Burden of Disease (GBD) database., Methods: Patients aged 20 and over with oesophageal cancer were included in this longitudinal study using GBD 1990-2019 data. We used the Socio-Demographic Index (SDI) to classify the regions. We used Principal Component Analysis (PCA) method to calculate the Quality of Care Index (QCI). The QCI was rescaled into a 0-100 single index, demonstrating that the higher the score, the better the QC., Results: The age-standardized QCI for oesophageal cancer dramatically increased from 23.5 in 1990 to 41.1 in 2019 for both sexes, globally. The high SDI regions showed higher QCI than the rest of the regions (45.1 in 1990 and 65.7 in 2019) whereas the low SDI regions had the lowest QCI, which showed a 4.5% decrease through the years (from 13.3 in 1990 to 12.7 in 2019). Globally, in 2019, the QCI showed the highest scores for patients aged 80-84, reported 48.2, and the lowest score for patients aged 25-29 reported 31.5, for both sexes. Globally, in 2019, age-standardized Gender Disparity Ratio (GDR) was 1.2, showing higher QCI in females than males., Conclusion: There were fundamental differences in the QCI both globally and regionally between different age groups as well as between males and females. To achieve the goal of providing high-quality services equally to people in need in all over the world, health systems need to invest in effective diagnostic services, treatments, facilities, and equipment and to plan for screening and surveillance of high-risk individuals., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Iezadi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The food industry has always sought to produce products enriched with vitamins, probiotics, polyphenols, and other bioactive compounds to improve physiological function, enhance nutritional value, and provide health. These compounds are essential for human health, and their deficiency can lead to adverse effects. Therefore, food enrichment is an important strategy to improve the nutritional value and, in some cases, improve the quality of food. Recently, functional foods have been very popular around the world. Among food products, dairy products constitute a major part of people's diet, and due to the high consumption of dairy products, including yogurt, the enrichment of this product effectively reduces or prevents diseases associated with nutritional deficiencies. Most consumers generally accept yogurt due to its high nutritional value and low price. So, it can be considered a good candidate for enrichment with micronutrients and probiotics. In recent years, using functional foods to prevent various diseases has become a popular topic for research. In this study, the effect of fortified yogurt in preventing diseases and improving deficiencies has been investigated, and it has been proven that super healthy yogurt has a positive effect on human health., Competing Interests: Declaration of competing interest The authors declare that they have no conflicts of interest., (Copyright © 2023 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Introduction: Core Surgical Training has become increasingly competitive over the last 5 years with the competition ratio reaching 4.16 in 2021 compared to 2.31 in 2015. This is thought to be due to two key factors: a large yearly increase in the number of applicants and an unchanging number of jobs. Steps are taken by HEE to ensure the process is as standardised and fair as possible. Interview date and time selection remains the only aspect of the process that candidates currently control. We aim to explore whether time and date of an interview has any impact on interview scores within CST., Methods: This study is a national, retrospective cohort study. A freedom of information act request was submitted to HEE to acquire anonymised interview scores and date/time of interview for all CST interviews conducted for the 2022-2023 cohort., Results: Across the two-week period whereby interviews were held 1264 interviews were undertaken. Candidates with morning interviews had a mean score of 111 (±16) and candidates in the afternoon had a mean score of 108 (±18.5) (p = 0.023). Candidates interviewing in week 1 had a mean score of 107 (±18) and candidates interviewing in week 2 had a mean score of 112 (±16.4) (p < 0.001)., Discussion: A small difference in score has a significant impact for candidates with their geographical location, specialty choice or event enrolment in the core training programme potentially impacted. It is therefore imperative that these findings receive further evaluation going forward to ensure the process is fair and robust for all participants., Competing Interests: Declaration of Competing Interest 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 © 2022 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Introduction: Iran launched a series of health reforms called Health Transformation Plan (HTP) in order to improve financial protection and access to health care in 2014. This study aimed to investigate the extent of impoverishment due to out of pocket (OOP) payments during 2011-2016 and to assess the implications of health expenditures to overall national poverty rate before and after the HTP implementation, with a focus on monitoring the first Sustainable Development Goals (SDGs)., Methods: The study relied on data from a nationally representative household income and expenditure survey. Two measures of poverty were estimated in this study: the prevalence (poverty headcount) and the intensity of poverty before and after OOP health payments (poverty gap). Proportion of the population fell into poverty due to OOP spending for health care from total poor population calculated for 2 years before and after the HTP implementation using three poverty lines suggested by the World Bank for global poverty comparison ($1.90, $3.2 and $5.5 per day in 2011 purchasing power parity (PPP) $)., Results: Our results indicate that the incidence of impoverishing health expenditures has remained relatively low during 2011-2016. At the 2011 PPP $5.5 daily poverty line, the average incidence rate at the national level was 1.36% during the period. The percentage of population impoverished due to OOP health expenditures increased after HTP implementation, irrespective of the poverty line used. However, the proportion of individuals that pushed further into poverty decreased after HTP implementation. It was estimated that around 12.5% of total poor population fell below poverty line due to paying OOP payments in 2016., Conclusion: Although health care costs are not major causes of impoverishment in Iran, the relative impact of OOP spending for health is not negligible. To attain SDG 1, pro-poor interventions that aim to reduce the burden of OOP payments should be advocated and implemented with an inter-sectoral approach., (© 2023 John Wiley & Sons Ltd.)

Introduction: Glioblastoma multiforme (GBM) is an aggressive case of primary brain cancer which remains among the most fatal tumors worldwide. Although, some in vitro and in vivo models have been developed for a better understanding of GBM behavior; a natural model of GBM would improve the efficiency of experimental models of human GBM tumors. We aimed the present study to examine the survival and durability of U87 cells in the brain of wild-type rats., Methods: U87 cells were intracranially implanted in twenty-one wild-type rats. Tumor size and morphology as well as infiltration of immune cells were investigated at three-time points by H&E and immunohistochemistry (IHC)., Results: The results demonstrated that the inoculation of GBM cells led to the infiltration of host defense system cells which caused immunological regression of the tumor mass after six weeks. While the tumors successfully developed without any sign of host defense invasion in the second week of GBM inoculation. Also, a decrease in tumor size and infiltration of immune system cells were observed in the fourth week., Conclusion: These data remarkably suggest that time plays a crucial role in activating the immune system against human GBM tumors in rats; it shows that the regression of tumor mass depends on a time slope., Highlights: A noticeable proliferation of tumor cells was observed in the rat's brain by the second week.The distant metastatic masses of cancer infiltrated into the adjacent normal tissue by the second week.Tumor mass underwent a noticeable diminution in the size by the fourth week.Cancer cells completely regressed by the sixth week due to immunological reactions.In tumor rejection, the effective mechanism depends on immune system activity and the slope of time., Plain Language Summary: One of the most malignant tumors is the brain tumor in the world. Unfortunately, no effective treatment has yet been found for it. Of course, researchers need efficient animal models to find the appropriate treatment. The xenograft model is one of the tumor models in the laboratory. However, the main challenge is the interaction of the animal's immune system with induced-cancer cells so that the immune system finally rejects the tumor. In this study, we investigated how long the immune system needs to reject induced tumors in the xenograft model completely. For this purpose, we studied the animals in three periods (second week, fourth week, and sixth week). We concluded that the immune system does not recognize the induced cancer cells until the second week of the experiment. It results in the growth of cancer cells and the formation of tumors in the animal brain. However, the immune system begins to recognize the tumor mass after the fourth week which leads to a reduction in metastasis and tumor size. Eventually, the immune system completely rejects the formed tumor in the sixth week., Competing Interests: The authors declared no conflict of interest., (Copyright© 2023 Iranian Neuroscience Society.)

Background: Community health needs and assets assessment is a means of identifying and describing community health needs and resources, serving as a mechanism to gain the necessary information to make informed choices about community health. The current review of the literature was performed in order to shed more light on concepts, rationale, tools and uses of community health needs and assets assessment., Methods: We conducted a scoping review of the literature published in English using PubMed, Embase, Scopus, Web of Science, PDQ evidence, NIH database, Cochrane library, CDC library, Trip, and Global Health Library databases until March 2021., Results: A total of 169 articles including both empirical papers and theoretical and conceptual work were ultimately retained for analysis. Relevant concepts were examined guided by a conceptual framework. The empirical papers were dominantly conducted in the  United States. Qualitative, quantitative and mixed-method approaches were used to collect data on community health needs and assets, with an increasing trend of using mixed-method approaches. Almost half of the included empirical studies used participatory approaches to incorporate community inputs into the process., Conclusion: Our findings highlight the need for having holistic approaches to assess community's health needs focusing on physical, mental and social wellbeing, along with considering the broader systems factors and structural challenges to individual and population health. Furthermore, the findings emphasize assessing community health assets as an integral component of the process, beginning foremost with community capabilities and knowledge. There has been a trend toward using mixed-methods approaches to conduct the assessment in recent years that led to the inclusion of the voices of all community members, particularly vulnerable and disadvantaged groups. A notable gap in the existing literature is the lack of long-term or longitudinal-assessment of the community health needs assessment impacts., (© 2023. The Author(s).)

Purpose: The study of the radioactive role of natural and chemical substances on human and animal studies has been the subject of research by some researchers. Therefore, the review of some of the past and current studies conducted in this field, can provide helpful information to elucidate of the importance of radioprotective components in reducing radiation exposure side effects., Methods: The authors search for keywords including In vitro, In vivo, Radioprotective, Ionizing radiation, and Vitamin in ScienceDirect, Scopus, Pubmed, and Google Scholar databases to access previously published articles and search for more reference articles on the role of radioprotective materials from natural and chemical compounds., Results: Radiation exposure can produce reactive oxygen species (ROS) in the body, however most of which are eliminated by the body's natural mechanisms, but when the body's antioxidant systems do not have enough ability to neutralize free radicals, oxidative stress occurs, which causes damage to DNA and body tissues. Therefore, it is necessary use of alternative substances that reduce and inhibit free radicals., Conclusion: In general, recommended that antioxidant component(s) can be protect tissue damages in humans or animals, due to the their ability to scavenge free radicals generated by ionizing radiation.

Background: Patients can play an essential role in improving patient safety by becoming actively involved in their health care. The present study aimed to qualitatively explore healthcare providers' (HCPs) and managers' perceptions on patient participation in patient safety processes., Methods: This qualitative study carried out in three teaching hospitals in Tehran, Iran. The data were collected through semi-structured interviews with 31 HCPs and managers working at public teaching hospitals, medical universities and the Ministry of Health. The data were analyzed using thematic analysis., Results: Three main themes and 21 sub-themes emerged from the interviews. Participants believed that patients and their families can play an effective role in maintaining and improving patient safety through different roles. However, a variety of barriers were identified at patients, providers, and system levels hindering patient participation in delivering safe care., Conclusion: The participants identified facilitators and barriers to patient engagement in safety-orientated activities at multiple patients, providers, and system levels, indicating that complex, multifaceted initiatives must be designed to address the issue. This study encourages further research to enhance the understating of the problems and solutions to patient involvement in safety initiatives in the Iranian healthcare setting., (© 2022. The Author(s).)

Competing Interests: Competing interests: None declared.

Background: The projection of levels and composition of financial resources for the healthcare expenditure (HCE) and relevant trends can provide a basis for future health financing reforms. This study aimed to project Iran's HCEs by the sources of funds until 2030., Methods: The structural macro-econometric modeling in the EViews 9 software was employed to simulate and project Iran's HCE by the sources of funds (government health expenditure [GHCE], social security organization health expenditure [SOHCE], out-of-pocket [OOP] payments, and prepaid private health expenditure [PPHCE]). The behavioral equations were estimated by autoregressive distributed lag (ARDL) approach., Results: If there is a 5%-increase in Iran's oil revenues, the mean growth rate of gross domestic product (GDP) is about 2% until 2030. By this scenario, the total HCE (THCE), GHCE, SOHCE, OOP, and PPHCE increases about 30.5%, 25.9%, 34.4%, 31.2%, and 33.9%, respectively. Therefore, the THCE as a percentage of the GDP will increase from 9.6% in 2016 to 10.7% in 2030. It is predicted that Iran's THCE will cover 22.2%, 23.3%, 40%, and 14.5% by the government, social security organization (SSO), households OOP, and other private sources, respectively, in 2030., Conclusion: Until 2030, Iran's health expenditures will grow faster than the GDP, government revenues, and non-health spending. Despite the increase in GHCE and total government expenditure, the share of the GHCE from THCE has a decreasing trend. OOP payments remain among the major sources of financing for Iran's HCE., (© 2022 The Author(s); Published by Kerman University of Medical Sciences This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Background: Tobacco use is an established preventable risk factor for many noncommunicable diseases and is considered as an important indicator for monitoring progress towards Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). This study aimed to determine the situation of tobacco use among Iranian adults using 2016 household survey., Methods: This is a secondary analysis of the data from 2016 nationally representative STEPwise approach to Surveillance (STEPs) survey with a sample size of 31,050. The data on tobacco consumption was gathered using questions incorporated in the survey questionnaire., Results: The prevalence of current tobacco use in Iran was 25.2 % (24.4-25.9) in men versus 4% (3.7-4.3) in women. The prevalence was higher in rural areas and among second wealth group. The prevalence of current daily cigarette smoking was 20.1% (19.4-20.7) in men versus 0.9% (0.8-1.1) in women). Average number of cigarettes per day among current cigarette smokers was 14.5% (14.1-14.9), mean age at start smoking among daily cigarette smokers was 21.6% (21.1-22), and 95.2% (94.4-96) of daily current daily cigarette smokers attempted for cessation during past 12 months. Prevalences of exposure to secondhand cigarette smoke among nonsmokers at homes and workplaces were 23.21% (22.65-23.76) and 18.04% (17.2-18.87), respectively., Conclusions: There was a large difference between the prevalence of tobacco use between men and women (25.2% vs. 4%). Higher prevalences of tobacco use in rural areas and among lower wealth quintiles require more equity-based approaches in tobacco combatting actions., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 International Journal of Preventive Medicine.)

Background: Diabetes as a leading cause of death imposes a heavy burden on health systems worldwide. This study investigated the trends in prevalence, awareness, treatment and control of diabetes among Iranian population aged 25 to 65 years over 12 years (2004-2016)., Methods: Secondary data analysis was performed using data from a national population-based survey, STEPwise approach to surveillance (STEPS) for non-communicable diseases (NCDs) in four rounds (2004, 2007, 2011, 2016). The sample sizes were 89,404, 29,991, 12,103 and 30,541 individuals, respectively across the country in both rural and urban areas. Data were analyzed using descriptive statistics and a logistic regression model with odds ratio at a significance level of less than 5% with no adjustment for age and sex. Logistic regression was used to identify socio-demographic factors associated with the levels of awareness, treatment and control of diabetes mellitus., Results: The prevalence of diabetes in four rounds was 8.4, 9, 11.1 and 13.2%, respectively. Among people with diabetes, 53.5, 65.6, 70.5 and 82.2% were aware of their condition and 35.9, 42, 46 and 39.6% were treated for this condition, respectively. In four rounds of study, 14.5, 20.8, 20.4 and 18.5% of all diabetic patients had adequate glycemic control, respectively. In the multivariable logistic regression analysis, there was a significant relationship between female gender, age over 40, living in the urban area, being in the third wealth quintile and having health insurance with diabetes prevalence. Female participants were more likely to be aware of the disease. Older participants were more likely to receive treatment and had adequate glycemic control., Conclusion: The prevalence of diabetes in Iran has been increasing and despite the great awareness of the disease, receiving treatment and effective control of the disease are suboptimal. While several national policies to improve diabetes screening and care have been passed in recent years, it seems large gaps remain in disease detection and treatment. It is suggested that more attention be paid to the treatment and control of diabetes by NCDs national policies to prevent the growing burden associated with the disease., (© 2022. The Author(s).)

Since the SARS-CoV-2 pandemic began, numerous studies have reported a concerning drop in the number of acute myocardial infarction (AMI) admissions. In the present systematic review and meta -analysis, we aimed to compare the rate of AMI admissions and major complication during the pandemic, in comparison with pre-pandemic periods. Three major databases (PubMed, Scopus, and Web of Science Core Collection) were searched. Out of 314 articles, 41 were entered into the study. Patients hospitalized for AMI were 35% less in the COVID-19 era compared with pre-pandemic periods, which was statistically significantly (OR = 0.65; 95% CI: 0.56-0.74; I 2  = 99%; p < 0.001; 28 studies). Patients hospitalized for STEMI and NSTEMI were 29% and 34% respectively less in the COVID-19 era compared with periods before COVID-19, which was statistically significantly (OR = 0.71; 95% CI: 0.65 -0.78; I 2  = 93%; p < 0.001; 22 studies, OR = 0.66; 95% CI: 0.58-0.73; I 2  = 95%; p < 0.001; 14 studies). The overall rate of in-hospital mortality in AMI patients increased by 26% in the COVID-19 era, which was not statistically significant (OR = 1.26; 95% CI: 1.0-1.59; I 2  = 22%; p < 0.001; six studies). The rate of in-hospital mortality in STEMI and NSTEMI patients increased by 15% and 26% respectively in the COVID-19 era, which was not statistically significant (OR = 1.15; 95% CI: 0.85-1.57; I 2  = 48%; p = 0.035; 11 studies, OR = 1.35; 95% CI: 0.64-2.86; I 2  = 45%; p = 0.157; 3 articles). These observations highlight the challenges in the adaptation of health-care systems with the impact of the COVID-19 pandemic., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 Published by Elsevier B.V.)

Background: Forecasting the future trend of health expenditures is an important step toward sustainable financing of health-care systems. This study aims to develop a conceptual framework for forecasting Iran health spending growth., Materials and Methods: At first, we concentrated on the general model and conceptual framework of health expenditure projection by reference to a broad literature review and smart classifications of the origins of health spending and indicators. At the second step, we developed a time series modeling for econometric estimation and forecasting national health expenditure without restrictive assumptions except for current laws and regulatory environment. In the third step, we tested the accuracy of model by forecasting Iran real per capita health expenditures (2017-2025)., Results: The results of the literature review represented a distinct classification of the origins of health spending and indicators, applicable to any health system and health spending projection model. Furthermore, the model of expenditure forecasting shows the power of certainty of no spurious estimation, assessment of the normal state of a health system, and test of the accuracy of forecasting results. The projection by the Iranian health system database showed that the real per capita health spending will grow 43 percent till 2025 in the absence of any unforeseen disturbance in the future., Conclusions: The presented model provides estimates that are compatible with actual trends of health spending and can be applied to forecast health expenditure in the near future. The forecasted image of Iran's health spending growth implies that health authorities need to concentrate more on the growth rate of the health budget and its fiscal space in the near future., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Education and Health Promotion.)

Hospitals all around the world play an essential role in response to the COVID-19 pandemic. During an epidemic event, hospital leaders frequently face new challenges requiring them to perform unaccustomed tasks, which might be well beyond the scope of their previous practice and experience. While no absolute set of characteristics is necessary in all leadership situations, certain traits, skills and competencies tend to be more critical than others in crisis management times. We will discuss some of the most important ones in this manuscript. To strengthen those managerial competencies needed to face outbreaks, healthcare leaders should be better supported by competency-based training courses as it is more and more clear that traditional training courses are not as effective as they were supposed to be. It seems we should look at the COVID-19 pandemic as a learning opportunity to re-frame what we expect from hospital leaders and to re-think the way we train, assess and evaluate them.

Background: The increasing prevalence of non-communicable diseases (NCDs) has some major implications on many countries to achieve universal health coverage. This study aimed to investigate the implementation of Global School-based Student Health Survey (GSHS), which is used to assess the risk factors of NCDs among children and adolescents in the eastern Mediterranean region (EMR)., Methods: This study was a meta-analysis and systematic literature review of 2001-2018 published studies, which were found by searching PubMed, Google Scholar, WHO, and CDC databases. In this study, the target group was students aged between 13 and 17 years old. GSHS implementation as well as risk factors of NCDs were compared across different countries. The random-effect model for meta-analysis was considered at 95% confidence interval., Result: In the EMR, 19 countries have implemented GSHS at least once following the survey manual (37 surveys). Overall, 201,795 students were included in our analysis. The overall estimation prevalence rateof the overweight was 24.5% (20.6-28.8), obesity was 7.3% (5.4-9.5), insufficient physical activity was 82.4% (80.7-84.1), tobacco usage was 14.3% (10.53-18.67), and smoking was 9.6% (8.1-11.3), respectively. Among those aged 13 to 17 years old, these rates were estimated as 19.8 (13.2-27.3), 9.7 (6.2-14.0), 86.1 (84.1-87.9), 17.8 (11.8-24.7), and 11.5 (9.4-13.8), respectively., Conclusion: GSHS has been widely implemented across EMR countries. Using nationally representative data, the results show that more efforts are needed to target the NCDs risk factors among adolescents in the region., (© 2022. The Author(s).)

Recently, the electroencephalogram (EEG) signal presents an excellent potential for a new person identification technique. Several studies defined the EEG with unique features, universality, and natural robustness to be used as a new track to prevent spoofing attacks. The EEG signals are a visual recording of the brain's electrical activities, measured by placing electrodes (channels) in various scalp positions. However, traditional EEG-based systems lead to high complexity with many channels, and some channels have critical information for the identification system while others do not. Several studies have proposed a single objective to address the EEG channel for person identification. Unfortunately, these studies only focused on increasing the accuracy rate without balancing the accuracy and the total number of selected EEG channels. The novelty of this paper is to propose a multiobjective binary version of the cuckoo search algorithm (MOBCS-KNN) to find optimal EEG channel selections for person identification. The proposed method (MOBCS-KNN) used a weighted sum technique to implement a multiobjective approach. In addition, a KNN classifier for EEG-based biometric person identification is used. It is worth mentioning that this is the initial investigation of using a multiobjective technique with EEG channel selection problem. A standard EEG motor imagery dataset is used to evaluate the performance of the MOBCS-KNN. The experiments show that the MOBCS-KNN obtained accuracy of 93.86% using only 24 sensors with AR20 autoregressive coefficients. Another critical point is that the MOBCS-KNN finds channels not too close to each other to capture relevant information from all over the head. In conclusion, the MOBCS-KNN algorithm achieves the best results compared with metaheuristic algorithms. Finally, the recommended approach can draw future directions to be applied to different research areas., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Zaid Abdi Alkareem Alyasseri et al.)

Water splitting is a helpful way of converting renewable electricity into fuel. The oxygen evolution reaction (OER) is a slow reaction that provides low-cost electrons for water reduction reactions. Thus, finding an efficient, low-cost, stable, and environmentally friendly OER catalyst is critical for water splitting. Here, sodium cobalticarborane ( 1 ) is introduced as a promising precatalyst for forming an OER cobalt-based catalyst. The cobalt-based catalyst was characterized by several methods and is suggested to be Co(III) (hydr)oxide. Using fluorine-doped tin oxide, glassy carbon, platinum, and gold electrodes, the OER activity of the cobalt-based precatalyst was investigated. The overpotential for the onset of OER in the presence of 1 is 315 mV using fluorine-doped tin oxide electrodes. The onsets of OERs in the presence of 1 using gold, platinum, and glassy carbon electrodes in KOH solutions (1.0 M) turned out to be 275, 284, and 330 mV, respectively. The nanoparticles on the gold electrodes exhibit significant OER activity with a Tafel slope of 63.8 mV/decade and an overpotential at 541 mV for 50 mA/cm 2 . In the case of the glassy carbon electrodes, a Tafel slope of 109.9 mV/decade and an overpotential of 548 mV for 10 mA/cm 2 is recorded for the catalyst. This paper outlines an interesting approach to synthesize cobalt oxide for OER through a slow decomposition of a precatalyst.

Out-of-pocket (OOP) payments are perceived as the most regressive means of health financing. Using the panel-data approach and region-aggregated data from Statistics Poland, this research investigated associations between socio-economic factors and OOP health spending in 16 Polish regions for the period 1999-2019. The dependent variable was real (inflation-adjusted) monthly OOP health expenditure per person in Polish households. Potential independent variables included economic, labour, demographic, educational, health, environmental, and lifestyle measures based on previous research. A set of panel-data estimators was used in regression models. The factors that were positively associated with OOP health spending were disposable income, the proportions of children (aged 0-9) and elderly (70+ years) in the population, healthcare supply (proxied by physicians' density), air pollution, and tobacco and alcohol expenditure. On the other hand, the increased unemployment rate, life expectancy at age 65, mortality rate, and higher sports participation were all related to lower OOP health spending. The results may guide national strategies to improve health-care allocations and offer additional financial protection for vulnerable groups, such as households with children and elderly members.

The contamination of fresh meat and meat products like sausages with potentially toxic elements (PTEs) is a worldwide health concern. Consequently, the related investigations concerning the levels of PTEs in sausages among databases such as Scopus, Cochrane, and PubMed were investigated 1 January 2000 to 20 August 2020. Furthermore, the concentration of PTEs in sausages was meta-analyzed based on the random effect model (REM). The findings indicated that the rank order of PTEs in sausage was Fe (432.154 μg/kg) > Cu (152.589 μg/kg) > Zn (93.813 μg/kg) > Cr (6.040 μg/kg) > Pb (1.524 μg/kg) > Ni (0.525 μg/kg) > Cd (0.115 μg/kg) > As (0.066 μg/kg). Our results showed that the PTE concentration in sausages was lower than the permitted limit except for Pb in samples reported from Nigeria, China, and Turkey. Therefore, continuous monitoring of PTEs in such products was recommended., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

In this work, articles regarding the concentration on potentially harmful elements (PHEs) in fillet trout (rainbow and brown) fishes were retrieved from Cochrane, Scopus, and PubMed databases between 1 January 1983 and 30 April 2020. The pooled concentration of PHEs in fillet trout fishes was meta-analyzed using a random-effect model (REM) and following the non-carcinogenic and carcinogenic risks was calculated using the Monte Carlo simulation (MCS) method. The meta-analysis of 42 articles (43 data report) revealed that a sort of PHEs in fillet trout was 19,996.64 μg/kg ww for Fe; 1834.75 μg/kg ww for Co; 772.21 μg/kg ww for Cu; 335.78 μg/kg ww for Ni; 290.46 μg/kg ww for Se; 226.20for Cr; 178.11 μg/kg ww for Pb; 77.40 μg/kg ww for Hg; 19.40 μg/kg ww for Cd; and 3.66 μg/kg ww for inorganic As. The non-carcinogenic risk assessment indicated that the lowest and highest hazard index (HI) in the adults was Pakistan (0.0012) and Turkey (0.2388), respectively, and in children was Pakistan (0.0057) and Turkey (1.114), respectively. The non-carcinogenic risk was acceptable for adult consumers in all countries (HI > 1 value) but non-carcinogenic risk for children was not acceptable in Turkey. The sort of countries based on carcinogenic risk in the adults due to inorganic As was China (1.44E-06) > Iran (9.14E-08) > Turkey (4.45E-08) > Portugal (9.04E-10). The carcinogenic risk was threshold for adult consumers in China (CR < 10 -6 ). Consumption of fillet trout (rainbow and brown) content of PHEs in many countries cannot endanger the health of consumers.

Background: Employees who describe themselves as happy in their work are more likely to be motivated to fulfil their professional duties. Therefore, it is important that healthcare organisations and managers understand how to promote a sense of happiness among nurses., Aim: To investigate the relationship between the concepts of psychological capital, interactional justice, supervisor support and workplace happiness, and how they are mediated by employees' trust in their supervisors., Method: Self-report questionnaires were used to obtain data from nurses on the variables of trust in supervisor, psychological capital, interactional justice, supervisor support and happiness at work. The questionnaires were distributed to 250 nurses working in hospitals in the city of Hamedan, Iran, and a total of 200 respondents completed and returned them. The data were then applied to a proposed model for promoting employees' workplace happiness, which was evaluated using data analysis software., Results: The results showed that the model correctly identified a pathway for promoting workplace happiness in nurses. Moreover, it was found that psychological capital, interactional justice and supervisor support led to improved workplace satisfaction through the mediating role of nurses' trust in their supervisors., Conclusion: The findings of this study indicate that paying attention to employees' psychological capital, interactional justice and supervisor support, as well maintaining employees' trust in their supervisors, could assist healthcare organisations and managers to achieve organisational targets such as increased job satisfaction., Competing Interests: None declared, (© 2021 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)