Necessary prerequisites for evidence-based practice:results of investigating nurses'informatics competency and information literacy skills

This study aimed to evaluate the correlation between nursing informatics(NI)competency and information literacy skills for evidencebased practice(EBP)among intensive care nurses.This cross-sectional study was conducted on 184 nurses working in intensive care units(ICUs).The study data were collected through demographic information,Nursing Informatics Competency Assessment Tool(NICAT),and information literacy skills for EBP questionnaires.The intensive care nurses received competent and low-moderate levels for the total scores of NI competency and information literacy skills,respectively.They received a moderate score for the use of different information resources but a low score for information searching skills,different search features,and knowledge about search operators,and only 31.5%of the nurses selected the most appropriate statement.NI competency and related subscales had a significant direct bidirectional correlation with information literacy skills for EBP and its subscales(P<0.05).Nurses require a high level of NI competency and information literacy for EBP to obtain up-to-date information and provide better care and decision-making.Health planners and policymakers should develop interventions to enhance NI competency and information literacy skills among nurses and motivate them to use EBP in clinical settings.

A Cascade Analysis of Community Transmission Risks for HIV among People Who Inject Drugs Living with HIV in Iran

There are 22 times as many people living with HIV in the population of drug users as in the general population.This is because the injection and sexually risky behaviors prevalent in this population.Having multiple sexual partners and maintaining sexual networks with people who inject drugs (PWIDs),can increase the risk of contracting a sexually transmitted infection^([1]).More than 65%of all HIVrelated cases in Iran can be traced back to people who inject drugs (PWID),and the number is estimated to be between 200,000 and 230,000 in Iran overall.Effective prevention,resources allocation and monitoring require an accurate estimate of the population of people who use illicit drugs^([2]).

Patient Migration for Hospital Utilization: Case of Iran

Introduction: Adequate information about patient using health care facilities is a critical element in planning activities and allocation resources in health sector. In Iran, with performing family physician plan and attempt to reform referral system, the study of mobility of patients between regions (patient migration) has more importance. The aims of the study are: 1) to describe patients’ migration across cities of Iranian Kerman province;2) to analyze the role of possible determinants affecting the mobility flows. Methodology: using hospital inpatient records of all public hospitals around Kerman province during 2011, we run logit models that compare patients who were admitted in hospital and received health services in cities where they lived and patients received them out of their local hospitals. We studied 21 patient groups according to ICD10 chapters (Appendix 1) to compute the effect of geographic distance, kind of insurance, number of physiccians involved, hospital bed and patient demographic factors. Results: About 40 percent of hospital admissions in Kerman are emigrant patients that quality or quantity of local provided services didn’t satisfy. Constant negative coefficients of geographic distance, hospitals physician and bed and positive coefficients for insurance in all groups do not show any difference in patient migration, between groups. Discussion: According to results of this research, existence of local services, distance, kind of illness and other factors are not more important than patients’ feeling about services in their migration. Paying no attention to this reality in planning health system reforms, especially referral systems, leads to important problems for health system in equity, patient satisfaction and finance aspects.

Ultrasound-guided erector spine plane block (ESPB) utilization in managing refractory renal colic pain in the emergency department

Due to the acute and terrible pain that patients with renal colic experience,the most essential therapeutic priority for these patients in the emergency department(ED)is to reduce pain.[1]Although numerous medications are utilized to reduce pain in patients with acute renal colic,no therapy has yet been developed to totally and quickly relieve pain.[2,3]Intravenous opioids and nonsteroidal anti-inflammatory drugs(NSAIDs)are commonly administered intravenously to control pain in these patients in the ED;however,the need for frequent monitoring for possible complications and relatively slow-acting features render these strategies undesirable.

Prediction of malaria cases in the southeastern Iran using climatic variables:An 18-year SARIMA time series analysis

Objective:To predict future trends in the incidence of malaria cases in the southeast of Iran as the most important area of malaria using Seasonal Autoregressive Integrated Moving Average(SARIMA)model,and to check the effect of meteorological variables on the disease incidence.Methods:SARIMA method was applied to fit a model on malaria incidence from April 2001 to March 2018 in Sistan and Baluchistan province in southeastern Iran.Climatic variables such as temperature,rainfall,rainy days,humidity,sunny hours and wind speed were also included in the multivariable model as covariates.Then,the best fitted model was adopted to predict the number of malaria cases for the next 12 months.Results:The best-fitted univariate model for the prediction of malaria in the southeast of Iran was SARIMA(1,0,0)(1,1,1)12[Akaike Information Criterion(AIC)=307.4,validation root mean square error(RMSE)=0.43].The occurrence of malaria in a given month was mostly related to the number of cases occurring in the previous 1(p=1)and 12(P=1)months.The inverse number of rainy days with 8-month lag(β=0.3292)and temperature with 3-month lag(β=-0.0026)were the best predictors that could improve the predictive performance of the univariate model.Finally,SARIMA(1,0,0)(1,1,1)12 including mean temperature with a 3-month lag(validation RMSE=0.414)was selected as the final multivariable model.Conclusions:The number of malaria cases in a given month can be predicted by the number of cases in the prior 1 and 12 months.The number of rainy days with an 8-month lag and temperature with a 3-month lag can improve the predictive power of the model.

Predicting cutaneous leishmaniasis using SARIMA and Markov switching models in Isfahan, Iran: A time-series study

Objective:To determine the potential effect of environment variables on cutaneous leishmaniasis occurrence using time-series models and compare the predictive ability of seasonal autoregressive integrated moving average(SARIMA)models and Markov switching model(MSM).Methods:This descriptive study employed yearly and monthly data of 49364 parasitologically-confirmed cases of cutaneous leishmaniasis in Isfahan province,located in the center of Iran from January 2000 to December 2019.The data were provided by the leishmaniasis national surveillance system,the meteorological organization of Isfahan province,and Iranian Space Agency for vegetation information.The SARIMA and MSM models were implemented to examine the environmental factors of cutaneous leishmaniasis epidemics.Results:The minimum relative humidity,maximum relative humidity,minimum wind speed,and maximum wind speed were significantly associated with cutaneous leishmaniasis epidemics in different lags(P<0.05).Comparing SARIMA and MSM,Akaikes information criterion(AIC),and mean absolute percentage error(MAPE)in MSM were much smaller than SARIMA models(MSM:AIC=0.95,MAPE=3.5%;SARIMA:AIC=158.93,MAPE:11.45%).Conclusions:SARIMA and MSM can be a useful tool for predicting cutaneous leishmaniasis in Isfahan province.Since cutaneous leishmaniasis falls into one of two states of epidemic and non-epidemic,the use of MSM(dynamic)is recommended,which can provide more information compared to models that use a single distribution for all observations(Box-Jenkins SARIMA model).

Determining the Technical Efficiency of Specialty Ophthalmology Hospital Using SFA and DEA: 2009-2011

Introduction: During the last decade, the health sector of many countries in general has been faced significantly with the increase of health care costs and in particular with the growth in hospital costs, that a significant part of it is due to the inefficient use of resources. The present study has been calculated the technical efficiency of the Specialty Ophthalmology Hospital of Tehran University of Medical Sciences by the comprehensive data analysis methods and stochastic frontier analysis. Methods: In this article, the technical efficiency of the Specialty Ophthalmology Hospital of Tehran University of Medical Sciences has been calculated by the years of 2009 to 2011, by the comprehensive data analysis methods and stochastic frontier analysis. For this purpose, the form of input-oriented data envelopment analysis approach was used by assuming the variable Productivity to scale and stochastic frontier analysis method and from the five output, the occupied bed days, outpatient admissions, inpatient admissions, inpatient days and bed occupancy factor, and from the six output, it means active beds, number of doctors, nurses, and other personnel, budget and equipment costs were used for the study. For data analyzing, Deap software, edit 1/2 and Frontier edit 1/4, was used. Result: The results of a comprehensive data analysis method showed: 1) The capacity of improving technical efficiency in the studied sector is 34% (average technical efficiency is 0.663 parts);and 2) some of the sectors are met the excess inputs (factors of production). Technical efficiency using stochastic frontier analysis was equal to 0.937. In fact, the stochastic frontier analysis showed the inefficiency is less than the actual value. Conclusion: Reducing excess capacity factors (factors of production) should be conducted in the form of a comprehensive plan and by considering all regarded aspects, that this reduction plays a major role in the hospital and health sector costs reduction.

Spatio-temporal history of H9N2 viruses in Iran and neighbor countries by Bayesian analysis and molecular characterization

Objective: To delineate the H9N2 influenza virus circulation within Iran and its neighboring countries, the potential source of the epidemic in these countries, and its date of origin.Methods: We obtained all hemagglutinin(HA) and neuraminidase(NA) nucleotide sequences of influenza H9N2 available up to December 25, 2020 from Iran and its neighboring countries(i.e., Pakistan, Afghanistan, Turkmenistan, Armenia, Azerbaijan, Turkey, and Iraq). We also performed a Bayesian Markov chain Monte Carlo method to infer the evolutionary dynamic and the most recent common ancestor for the HA and NA sequences.Results: H9N2 epidemic may have started in Iran and Pakistan much earlier than the other investigated countries in the region, and an ongoing bidirectional dispersion of the virus between the investigated countries was also observed. The mean time of the most recent common ancestor of H9N2 viruses was 1988 for HA, and 1992 for NA.Conclusions: Strains from investigated countries rooted in Pakistan and Iran. Regular surveillance of H9N2 viruses, especially in the live bird markets, enhancing the biosecurity of poultry industry and screening newly arriving immigrants and tourists from neighboring countries at border should be considered to control spread of the virus. Furthermore, surveillance of viral molecular evolution should be initiated for effective prevention of epidemic and pandemic spreads.

A Comparative Study of Quality of Family, Social Relationships and Type D Personality in Cardiovascular Patients and Non-Patients

This study aims to compare the quality of family and social relationships and Type D personality in cardiovascular patients with normal people. In this research, 300 individuals (n = 150 male, 150 female) are divided in two groups of patient (n = 150) and non-patients (n = 150) were selected as samples from the author’s offices (both private and his office in Mazandaran Heart Center). They attended in this study filling the questionnaires of “Pierce Quality relations” and “Personality Inventory (DS14)”. In order to analyze data, First observations were described by the help of descriptive statistics methods including tables, graphs, and indices of central tendency and distribution. Then, observations were described by inferential statistics methods such as univariate and multivariate analysis of variance and then were analyzed by SPSS. Out of the 300 participants, 108 patients (36%) had the mean age of 52 to 63 years old and 30 patients (10%) were 30 to 40 years old. This study showed that there is a significant difference between cardiovascular patients and control group in terms of quality of family and social relationships and Type D personality (P < 0.01). Cardiovascular patients have lower quality of family and social relationships, social support, as well as lower depth of relationships, and also higher relationship conflict than normal people. Also cardiovascular patients have higher type D personality than normal people (P < 0.01). In general, research findings indicate the importance of psychological factors associated with coronary artery disease.

Tioxolone niosomes exert antileishmanial effects on Leishmania tropica by promoting promastigote apoptosis and immunomodulation

Objective: To explore the antileishmanial effect of tioxolone and its niosomal form against Leishmania tropica. Methods: Tioxolone niosomes were prepared by the hydration method and were evaluated for morphology, size, release study, and encapsulation efficiency. The cytotoxicity of tioxolone and its niosomal form was measured by MTT assay, leishmanicidal activity against promastigote and amastigote by MTT assay, apoptosis by flow cytometry, IL-12, IL-10 and metacaspase gene expression levels by q-PCR. Results: Span/Tween 40 and Span/Tween 60 niosomes had good physical stability as depicted in their size distribution curves and high encapsulation efficiency(>99%). The release profile of the entrapped compounds showed Fickian’s model of tioxolone delivery based on diffusion through lipid bilayers. With the IC50 value for amastigote as(24.5±2.1) μg/mL and selectivity index as 10.5, the Span/Tween 60 niosome(NT2) had a superior effect to other drugs. The CC50 value and IC50 of promastigote value for NT2 were(257.5±24.5) μg/mL and(164.8±20.6) μg/mL, respectively. The flow cytometric analysis showed that tioxolone and niosomal forms induced apoptosis of Leishmania tropica promastigotes in a dose-dependent manner. NT2 increased the expression level of IL-12 and metacaspase genes and decreased the expression level of the IL-10 gene.Conclusions: Niosomes of tioxolone play an immunomodulatory role in increasing Th1 cytokine profile and inhibiting the Th2 cytokine profile. It could be used for treatment of anthroponotic cutaneous leishmaniasis.

Case fatality rate of coronavirus disease 2019(COVID-19) in Iran-a term of caution

Coronavirus disease 2019 (COVID-19) has spread to 72 countries by the time of writing this report on 4th March 2020[1].On 20th February 2020,the first two confirmed deaths from COVID-19were reported in Iran.Till 4th March 2020,2 922 confirmed and92 death cases have also been reported till 4th March 2020 in Iran(Figure 1)[1].A key question that remains unanswered or controversial among the public,media,and researchers is the exact COVID-19 case fatality rate (CFR) in Iran.Why does the CFR in Iran appear to be higher compared to the rest of the world until now?Or why the fatality rate is high at the beginning of the epidemic in Iran?

Economic efficiency of radiology wards using data envelopment analysis: Case study of Iran

Background: In evaluating the activities and performance of radiology units, the main aim of applying feasible scientific methods is to use technological and human resources optimally. One of the suitable scientific methods in this field is determining the technical, economic, and allocative efficacy of these centers. We aimed to assess the economic efficiency of radiology units of hospitals affiliated to Shiraz University of Medical Sciences, southern Iran. Methods: In this descriptive-analytical cross-sectional study, the technical, economical, and allocative efficiency of 27 radiology units of public hospitals was assessed using data envelopment analysis. The input oriented envelopment form with the assumption of the varied outputs with respect to the scale was used. Related forms were filled using the existing information in the archives of radiology centers. Input variables in this study were the number of radiology devices, the number of expert personnel, the number of technicians, equipment maintenance and depreciation costs, and the salaries of the experts and technician. Output variables included the number of admitted patients and the number of photographic film. Then, data were analyzed using the DEAP software for calculating the various forms of efficiency. Results: The mean scores of economic, technical, and allocative efficiencies of radiology units were 0.749, 0.880, and 0.852, respectively. The final score of economical efficiency was lower than the technical and allocative efficiency scores. Only 15% of radiology units were economically efficient. Conclusion: Economical efficiency can be attained when resources are used in the best possible way and not wasted. Therefore, a combination of inputs that comprise the lowest costs should be selected.

Evaluation of Environmental Sound Pressure Level,Drawing of Noise-Isosonic Map Using Surfer V.19,and Prioritization of Engineering Noise Control Methods Using the Analytic Hierarchy Process(AHP):A Field Study in CGS Stations

Noise pollution is one of the most significant harmful physical factors in the industrial and occupational environments.Due to the high costs of exposure to excessive noise;continuous sound evaluation,propose and implement noise control plans in occupational environments is necessary.Thus,the present study aimed to review environmental sound measurements,drawing of noise maps,and prioritizing the engineering noise control methods using the Analytic Hierarchy Process(AHP).This study was a descriptive-analytical study that aimed to assess occupational noises and present a control plan in the City Gas Stations(CGSs)of Kerman,Iran in 2021.The present study was done in two phases.In the first phase,six CGSs were investigated to measure and evaluate the noise.In addition,the noise map of a CGS was drawn using the Surfer software.Finally,the AHP was used in the second phase of the research to prioritize the control measures.In this phase,four criteria and ten alternatives were identified.According to first phase results,the sound pressure level(SPL)of the stations varied from 76 to 98 dBA.Besides,the majority of the studied stations had a sound level higher than 85 dBA(danger zone).The second phase of the study showed that out of the four evaluated criteria,the executability criterion had the highest impact and the cost criterion had the lowest impact on the selection of control measures with a weight of 0.587 and 0.052,respectively.Based on the results of prioritization of the alternatives,using a silenced regulator(weight of 0.223)and increasing the thickness of the tube(weight of 0.023)had the highest and lowest priorities among the alternatives,respectively.The use of engineering noise control methods such as using silenced regulators was the best way to control the noises of CGSs.Additionally;it is noteworthy that AHP is a practical method for prioritizing alternatives to achieve the most accurate decision-making.The results of AHP can be of great help to health and safety experts and managers in choosing the sound engineering control measures more precisely.

Integrative multi-platform meta-analysis of hepatocellular carcinoma gene expression profiles for identifying prognostic and diagnostic biomarkers

Hepatocellular carcinoma(HCC),as one of the most com-mon types of primary liver cancer(PLV),accounts for approximately 75%e90%of all PLV cases identified worldwide.^(1)Currently,the most effective treatment for HCC patients constitutes liver transplantation.However,due to high rates of recurrence a poor prognosis is predicted.^(2)Therefore,accurate HCC biomarkers are ur-gently needed to develop innovative therapeutics.Most of earlier investigations to identify biomarkers have been severely limited by sample size.

CYCLICAL ECONOMIC GROWTH--RE--EXAMINING THE GOODWIN MODEL

This paper aims at re-examining the properties of the-celebrated Goodwin model in econmics.We improve the results of Flaschel by applying the bifurcation method of Iooss and Joseph. It isshown that under appropriate conditions endogeneous limit cycles appear after structural changeshave teken place in the economic system.