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Introduction: The lack of a fixed and clear protocol causes confusion for nurses resulting in care performance delay in the emergency room (ER). Given that the purpose of triage is to examine the patient upon arrival in ER for the rapid classification and prioritization of emergency patients in need of treatment, it seems that the development and implementation of hospital triage standards can greatly affect this purpose. Objective: The present study was conducted to review the experiences of experts in hospital triage in terms of determining the standards of hospital ER triage. Methods: This qualitative research was conducted through content analysis method based on Donabedian model. Participants include experts (Politician, Nurse Supervisor, Nurse, Midwife, Faculty of Nursing, Emergency Medicine Specialist) working in educational and private hospitals and single-specialized ERs. Data were collected through in-depth and semi-structured interviews lasting between 25-60 minutes. The main interview questions were: What are the structural standards of a good triage? What are the process standards for a good triage? What are the standards of a good triage? Data analyzed through Content Directed Analysis with Shannon and Hsieh approach. Results: Totally, 21 experts the mean age of 46.9±1.8 (ranged from 30 to 57) years and the mean work experience of 18.9± 8.21 years were participated, of whom 16 (76.2%) persons were male. From the analysis, we extracted 48 codes, 14 subcategories and 3 main categories of "structural standards", "process standards" and "outcome standards". Conclusions: Guidelines are needed so that the nurse in charge of triage can quickly and accurately undertake the important responsibility of patient triage. Additionally, having structure and process and outcome standards improves triage performance.

In this article, I demonstrate that temporal domination over subjects and producers in capitalist society is Marx’s central category in the critique of political economy. Hartmut Rosa who is well known in the critical tradition for his works on social acceleration refers to Marx’s value theory to explain the economic motor of social acceleration in the sphere of production and distribution, but he does not reach the very depth of Marx’s critique of abstract time domination and considered it as a subordinate and marginal aspect of Marx’s theory. I argue that Marx’s critique of class exploitation and commodification of social relations, in the final analysis, consists in the critique of domination of time over man. In particular, I articulate their relationship by representing the Hegelian onto-logical couple of essence and appearance; it is demonstrated that class exploitation as an internal and substantial structure of capitalism posits the temporal domination as an form of appearance which presupposes the first. Moreover, this article shows that class domination has taken a more inverted and mysterious form in digital capitalism through new time appropriation strategies. This implies that in contrast to Rosa who considers social acceleration above and beyond class boundaries, it still reinforces class exploitation and acts through it.

Background: Thyroid functional disorders are relatively common in the general population. Different factors play a role in the development of thyroid disorders. These factors can be associated with the deterioration of the oxidation state of the body and the induction of oxidative stress. Thyroid hormones play an important role in the oxidation state. Objectives: Regarding the role of oxidative stress in different pathologies and the development of various complications, including thyroid disorders, we aimed to compare the biochemical and oxidative stress parameters in hypo and hyperthyroid rat models. Methods: Twenty-one male Wistar rats were assigned into three groups of control, hypothyroid, and hyperthyroid. Hypothyroidism and hyperthyroidism were inducted with PTU (propylthiouracil) and LTX (levothyroxine), respectively. After five weeks of induction, serum biochemical factors and oxidative stress parameters, such as TAC (total antioxidant capacity), MDA (Malondialdehyde), and the thiol group, were measured in these groups. Results: The means of TAC, MDA and UA (uric acid) in the hyperthyroid group were significantly higher than those in the hypothyroid group (P < 0.01, P < 0.01, P < 0.05) but the mean of thiol in the hypothyroid group was significantly higher than that of the hyperthyroid group (P < 0.01). Also, the mean of TAC level in the hypothyroid group was significantly lower than the control group (P < 0.05) and the mean of thiol group in the hypothyroid group was significantly higher than the control group (P < 0.05), but there was no other significant difference between the groups compared to the control group. Among the biochemical parameters, the mean LDH (lactate dehydrogenase) in the hyperthyroid group also showed a significant difference in comparison to the hypothyroid group (P < 0.05), but there was no significant difference between the groups in the mean of the other biochemical parameters. Conclusions: According to the results of this study, hypothyroidism and hyperthyroidism are associated with a disturbance in the oxidation state of the body, and the use of antioxidants can help improve these diseases, especially in hyperthyroidism, due to enhanced metabolism and production of more free radicals.

Background: Stroke is the most common debilitating neurological disease in adults. Therefore, rehabilitation is a major consideration to reduce costs and relief disabilities. Biofeedback, a newly recommended method is claimed to be able to improve the consequences following stroke by enhancement the understanding of the psychological functions of the body. Objectives: The purpose of this study was to investigate the effect of biofeedback on the motor– muscular situation in rehabilitation of stroke patients Methods: The present study was a randomized clinical trial that was started in May 2016 and completed in September 2016. The sample of this study included all the patients with stroke attending the physiotherapy center of Imam Raza hospital in Mashhad, Iran. The participants were randomly divided into 2 groups (case and control group) after considering the inclusion and exclusion criteria. In the intervention group, biofeedback (2 times a week for 15 sessions, each session lasting 20 minutes) was performed.Before the intervention demographic information questionnaire was complete by all participants. Then a check list of main variables such as hands muscle strength, muscle stiffness (spasticity), balance and ability to walk was complete by a physician. In the 7th session of the exercise and in the end of intervention (14th session), again, the main variables of the check list were reassessed by the researcher. The statistical analysis was done by Statistical Package for the Social Sciences (SPSS) software version 16. Results: the mean score of balance evaluation in pre-intervention had not any significant differences (p=0.503), but in post intervention evaluation, this score in intervention group versus control group showed significant differences (p=0.014).the mean score of muscle strength,Results showed that by eliminating the effects of muscular strength before the intervention, this variable in both intervention and control groups after the intervention, had improvement and significant difference (p=0.005).Comparison the average spasticity, showed that spasticity evaluation score before and after intervention had no significant difference between the two groups (p=1.00) Conclusion: Considering the findings of this study, the biofeedback therapy is a promising treatment modality in improvement the motor– muscular condition following stroke.

Background and aim Prompt identification of traumatic brain injury (TBI) is vital for patients in critical condition; however, it is not clear which acuity scoring tools are associated with short-term mortality. The aim of this study was to determine the accuracy of acuity scoring tools and 24-h mortality among TBI patients in both prehospital and hospital settings. Methods This study was an observational, prospective cohort, in which patients with TBI were followed from the accident scene to the hospital. Vital signs and acuity scoring tools, including the Revised Trauma Score (RTS), Injury Severity Score (ISS), National Early Warning Score (NEWS), Shock Index (SI), Modified Shock Index (MSI) and Trauma and Injury Severity Score (TRISS), were collected both on the scene as well as at the hospital. A logistic regression was performed to ascertain the effects of clinical parameters on the likelihood of survival of patients with TBI regarding 24-h mortality. Results: A total of 185 patients were included in this study. The mortality rate was 14% (25/185). The logistic regression model was statistically significant at χ 2 =60.8, p=0.001. A hierarchical forward stepwise logistic regression analysis showed that age, hospital RTS and prehospital NEWS significantly improved mortality predictions. The model explained the 51.2% variance in survival of patients with TBI. Conclusions The NEWS and the RTS may be used to triage TBI patients for prehospital and hospital emergency care, respectively. Therefore, because traditional vital signs criteria may be of limited use for the triage of TBI patients, it is recommended that acuity scoring tools be used in such cases.

Mis-triage including undertriage and overtriage is associated with morbidity and mortality. It is not clear what the extent of mis-triage rates among traumatic patients is. The aim of this study is to determine of mis-triage (undertriage and overtriage) in traumatic patients. This study was a systematic review about mis-triage rate among trauma patients. The following electronic databases were searched (Web of Knowledge, Scoups, PubMed, Cochrane library) from conception through February 1, 2018. Search terms included trauma, undertriage, and over-triage. Inclusion criteria were studies which report overtriage or undertriage rate in regard to triage of trauma patients; patients older than 18 years old, English-written papers. Irrelevant papers as well as conference abstract, letter, editorial, thesis and studies on special population were excluded. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Checklist was used to examine review process. Twenty-one papers were included in this study. Sample size ranged from 244 to 550683 trauma patients. Fourteen studies originated from USA. Definition of mis-triage was summarized into four categories: ISS used to define undertriage error, formula for mis-triage (1—sensitivity), need for life-saving emergency intervention and patients triaged to a non-trauma center. Undertriage rate ranged from 1 to 71.9% and overtriage rate ranged from 19 to 79%. The standardization of mis-triage definitions is vital to estimate true rate of mis-triage among different studies and clarify the role of triage scales. The trauma triage scales need to be further developed to provide more valid and reliable results.

Introduction: Immobilization in the elderly can reduce the size and strength of muscle mass and ultimately lead to sarcopenia, the severity and progression of which can be prevented by exercise. However, due to physical and mental conditions, the elderly may be unable to take full advantage of regular exercise. Therefore, fun exercise through motivation and effective participation of older adults is likely to have positive effects on decreasing the volume and power of muscle mass. The aim of this study was to determine the effect of fun physical activities on the progression of sarcopenia among elderly residents in nursing homes. Methods: This study was a two-group randomized controlled trial conducted in 2014. Sixty three older adults were recruited by the random sampling. The elderly in the fun physical exercise group did the exercise for 8 weeks, three times a week for 20 minutes at a time, and in the control group, the adults did the routine exercises. The Berg Balance Scale, a dynamometer, and the Six-Minute Walk Test were used to measure sarcopenia criteria (balance, muscle strength, distance traveled).The statistical analysis was done by SPSS version 13. Results: The results showed that the mean score of the sarcopenia criterion (balance, distance walked, muscles strength) was significantly increased in the fun physical exercise group than in the control group. Conclusion: The fun physical activity reduces sarcopenia progression through improving balance, increasing distances walked, and strengthening muscles.

A simple one-pot synthesis of functionalized 4-hydroxyquinoline derivatives is presented which as the advantage of neutral conditions.

(2) in the presence of Ph3P (20 mol-%) leads to dialkyl (Z) -a nd(E)-2-(4-hydroxyquinolin-3-yl)-2-butenedioates 3a‐c and dialkyl (Z) -a nd (E)-2-(4-hydroxy2-methylquinolin-3-yl)-2-butenedioates 3d‐f in good yields (Scheme 1). The reaction of 1 with dialkyl acetylenedicarboxylate 2 in the presence of Ph3P in boiling toluene was completed within 24 h. The 1 Ha nd 13 C NMR spectra of the crude products clearly indicated the formation of 3 .T he 1 H NMR spectra of 3a exhibited signals for methoxy and methine protons, together with characteristic multipletsfor the aromatic protons.The 13 CN MR spectrum of (Z)-3a or (E)-3a showed 15 distinct resonances in agreement with the proposed structure. Partial assignments of these resonances are given in the Experimental Section. The structural assignments of compounds (Z)-3 and (E)-3 made on the basis of their 1 Ha nd 13 C NMR spectra were supported by the IR spectra. The carbonyl region of these compounds displayed characteristic absorption bands. NMR spectroscopywas employed to distinguish between (Z)-3 and (E)-3 .T heZ and E configuration of theolefinicdoublebondin3a‐fisbasedonthechem ical shift of the olefinic proton[21]. The 1 H NMR spectra of (Z)-3 showed the olefinic proton signal at 6.11‐ 6.75ppm,whilethe(E)-3isomer exhibitedtheolefinic proton at 6.83‐8.03 ppm. Although the mechanistic details of the reaction are not clearly known, a plausible rationalization may be advanced to explain the product formation. Pre