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In this research, the synthesis of novel derivatives of spiroisatins in high yields was investigated. These new compounds were synthesized using a multicomponent reaction (MCR) of isatin, malononitrile, acetophenone derivatives, diethyl oxalate, primary amines, and Et3N in aqueous media. Under similar conditions, spiropyrroloisatins were prepared using MCRs of synthesized spiroistins. The antioxidant activity of newly synthesized spiroisatins is due to having an NH group which was evaluated by two procedures. Also, the antimicrobial activity of newly generated spiroisatins was evaluated by a disk distribution process utilizing two kinds of Gram‐negative bacteria and Gram‐positive bacteria and bacterial growth was stopped using these compounds. The advantages of this method are short reaction times, high yields of products, and the easy separation of catalyst and product using simple procedures. [ABSTRACT FROM AUTHOR]

Background: Studies show that leaving the hospital with personal consent is increasing. This phenomenon has unpleasant and sometimes irreversible consequences. This study aims to investigate the causes and consequences of leaving the hospital with the personal consent of patients referred to the emergency department of hospitals affiliated with Qom University of Medical Sciences in 2021. Materials and Methods: In this descriptive-analytical study, 345 patients were selected who, with personal consent, left the emergency department of selected hospitals affiliated with Qom University of Medical Sciences in 2021. The study data were collected via a questionnaire and a checklist. The questionnaire comprised demographic variables, patientrelated factors, personnel-related factors, and hospital-related factors. The checklist of the consequences included questions about leaving the hospital with personal consent. The data were analyzed using descriptive and inferential statistics in SPSS software, version 20. Results: Of 345 patients included in the study, 55.9% were male and the mean age of patients was 47.1 years. The most important reasons for leaving the hospital with personal consent were as follows: personal reasons (22.9%), fear of continuing treatment (11.9%), preference to continue the treatment in other medical centers (9.3%), the suggestion of other hospital staff (35.1%), not having the desired doctor (27%), nurses' suggestion (19.4%), lack of care (20.4%), and inadequate hospital space and facilities (14.0%). The consequences of leaving the hospital with personal consent in this study included re-admission and hospitalization (10.3%), mortality (3.4%), heart disease (0.87%), and mental disorders (0.57%). Conclusion: After identifying the reasons for leaving the hospital with personal consent and highlighting the irreparable human and financial consequences, these causes should be eliminated to prevent irreparable and unfortunate consequences. Such causes include personal reasons, fear of continuing the treatment, and lack of care. Fixing the causes requires proper planning and effective actions. [ABSTRACT FROM AUTHOR]

Outlier detection has been widely explored and applied to different real-world problems. However, outlier characterization that consists in finding and understanding the outlying aspects of the anomalous observations is still challenging. In this paper, we present a new approach to simultaneously detect subspace outliers and characterize them. We introduce the Dimension-wise Local Outlier Factor (DLOF) function to quantify the degree of outlierness of the data points in each feature dimension. The obtained DLOFs are used in an outlier ensemble so as to detect and rank the anomalous points. Subsequently, the same DLOFs are analyzed in order to characterize the detected outliers with their relevant subspace and their same-type anomalies. Experiments on various datasets show the efficacy of our method. Indeed, we demonstrate through an experimental evaluation that the proposed approach is competitive compared to the existing solutions in terms of both detection and characterization accuracy. [ABSTRACT FROM AUTHOR]

Ensuring service continuity in safety critical applications is crucial. In some of these applications, multilevel converters play a vital role. In this regard, this research work presents a self-healing fault-tolerant control approach to ensure the resiliency of a neutral-point clamped converter when a semiconductor component encounters an open circuit fault. The defective semiconductor can be a power switch or a clamping diode. By applying the proposed real-time fault-tolerance control, the rated output voltage and output current are restored during post-fault operation. Furthermore, the total harmonic distortion value of the output voltage during application of the real time self-healing control does not increase when compared with that during healthy operation. Since the realization of the proposed control strategy does not require any bidirectional switch, a fast transition between the healthy and fault-tolerant operation is accomplished. Moreover, the proposed structure can ensure service continuity in case of a fault event in the anti-parallel diodes, something which has been overlooked in previously conducted research works. [ABSTRACT FROM AUTHOR]

Background: Patient engagement in patient safety is aimed at increasing the awareness and participation of patients in error-prevention strategies. The aim of this project was to improve the patient safety with the patient engagement within the local context of a maternity hospital by implementing best practice. Methods: A clinical audit was conducted using the JBI Practical Application of Clinical Evidence System tool. The current project was conducted in surgical ward of Shahid-Beheshti maternity hospital, Iran. The sample size was 46 patients and 46 healthcare practitioners for both the baseline and follow-up. In phase 1, four audit criteria were used and a baseline audit was conducted for this project. In phase 2, barriers to compliance were identified, and strategies were adopted to promote best practice. In phase 3, a follow-up audit was conducted. Results: The results showed varying levels of compliance with the four criteria used in this project. The criterion 1, which was related to training of healthcare practitioners on how they can support patients, has the highest compliance at 87% in baseline and follow up data collection. Furthermore, compared with the baseline data (criterion 2 = 52%; criterion 3 = 37%; criterion 4 = 61%), compliance with criteria 2, 3, and 4 notably improved at 85, 76, and 92%, respectively. Conclusions: The present project successfully implements patient engagement in Iran and reveals varying results on compliance and the increasing knowledge of healthcare practitioners and patients on evidence-based patient engagement in order to improve the patient safety. The used strategies can facilitate implementation of evidence based procedures in clinical practice. [ABSTRACT FROM AUTHOR]

Multilevel inverters are increasingly used in industrial applications in which service continuity is crucial. This paper presents an original approach to ensure the fault-tolerant operation of neutral-point-clamped (NPC) inverters in the case of an open-circuit fault event in a clamping diode, which is rarely investigated in the conducted research work. The proposed fault-tolerant strategy meets the following criteria: restoring rated output voltage and current during post-fault operation, realizing fault-tolerant operation without additional components, maintaining rated total harmonic distortion (THD) during fault-tolerant operation, and fast transition between faulty operation and remedial operation. In the proposed approach, prior to applying the appropriate remedial action, identification of the defective clamping diode is required. In this respect, a very fast and simple logic-based fault diagnosis is presented whose implementation does not need any additional components and external circuit. Moreover, it does not require any component modeling and complicated calculations. The proposed strategy is validated by simulation and experimentation. [ABSTRACT FROM AUTHOR]

The fault diagnosis in multilevel converters is of great importance since they are comprised of more solid-state switches, compared with the conventional two-level converters. In this article, we propose a fast and efficient real-time fault detection and faulty component identification for an open-switch fault diagnosis based on the failure-mode algorithm for a single-phase five-level neutral-point-clamped inverter. Component modeling, complicated calculations, and load parameters are not required for realizing the proposed approach. Furthermore, the proposed strategy does not require any extra sensors. The signals already available in the control system, such as the applied switching pattern and terminal voltage, fulfill the fault diagnosis. Thanks to the proposed fault detection strategy, any misdiagnosis arising from noise existence, response time of the sensors, turn on and turn off delay times of the power switches, and measurement errors are avoided. The simulations and experiments are carried out to confirm the performance and effectiveness of the presented strategy. [ABSTRACT FROM AUTHOR]

Context: In some studies, Fresh Frozen Plasma (FFP) transfusion in severely ill patients was accompanied with an increase in the risk of nosocomial infection. However, there are no comprehensive data in terms of FFP transfusion and its relationship with nosocomial infection in heart surgery. Hence, the present systematic review and meta-analysis aimed to investigate the relationship between FFP transfusion and nosocomial infection risk in the patients undergoing cardiac surgery. Evidence Acquisition: Study selection: The present study included all the studies, which probed into nosocomial infection after FFP transfusion in patients with cardiac surgery. Data sources: Medline, Web of Science, Embase, Central, and Scopus electronic databases were searched to the end of March 2019. Results: Finally, five articles and three abstracts that studied nosocomial infection were entered into the present systematic review. FFP increased the rate of nosocomial infection in cardiac surgery in one article, but this was not the case in the remaining four articles. The three abstracts also reported that FFP increased the rate of nosocomial infection in cardiac surgery. Conclusion: The studies indicated that the benefit of FFP administration outweighed the probable risk of infection. Indeed, none of the studies indicated a strong relationship between FFP transfusion and infection rate after cardiac surgery. [ABSTRACT FROM AUTHOR]

Hiccups that last more than 48 hours are known as persistent hiccups. A 38-year-old man presented to the emergency with a 3-day history of persistent hiccups, and after partial treatment and normal test results, he was discharged from the emergency. After 22 hrs, he was brought to the emergency again with a complaint of stuttering and was admitted with a chance of stroke. A 50% stenosis development in the right carotid artery was reported, and the MRI results were normal. After 20 hrs of admission, the patient's stutter was thoroughly treated, and he was discharged with the diagnosis of TIA. Persistent hiccups can be a precursor to a stroke. [ABSTRACT FROM AUTHOR]

In this paper, a five-level neutral-point-clamped (NPC) inverter with short-circuit fault-tolerant capability is presented. Based on the proposed approach, in order to ensure service continuity subsequent to a short-circuit fault event in a switch, two steps are carried out. First of all, destructive consequences arising from short-circuit fault in a power switch is prevented. Afterwards, according to the defected component, remedial actions are taken. The proposed strategy does not require any redundant component. The service continuity is acquired by applying a remedial control and modifying switching commands applied to the power switches. Using the proposed approach helps to restore the rated voltage and rated current at the terminal, and there is no limit for modulation index during fault-tolerant operation under remedial control. Furthermore, compared to healthy operation, harmonic content of the terminal voltage and current is not deteriorated during fault-tolerant operation. Moreover, additional components, such as bidirectional switches and contactors, are not employed in this strategy. Only some fast fuses are placed in the converter circuit for protection purposes which do not impose a noticeable cost compared to the bidirectional switches and contactors. [ABSTRACT FROM AUTHOR]

Network anomaly detection systems (NADSs) play a significant role in every network defense system as they detect and prevent malicious activities. Therefore, this paper offers an exhaustive overview of different aspects of anomaly-based network intrusion detection systems (NIDSs). Additionally, contemporary malicious activities in network systems and the important properties of intrusion detection systems are discussed as well. The present survey explains important phases of NADSs, such as pre-processing, feature extraction and malicious behavior detection and recognition. In addition, with regard to the detection and recognition phase, recent machine learning approaches including supervised, unsupervised, new deep and ensemble learning techniques have been comprehensively discussed; moreover, some details about currently available benchmark datasets for training and evaluating machine learning techniques are provided by the researchers. In the end, potential challenges together with some future directions for machine learning-based NADSs are specified. [ABSTRACT FROM AUTHOR]

This paper presents a multi-objective optimal rotor design for an interior permanent magnet synchronous motor (IPMSM) based on finite element analysis. Due to the importance of torque characteristic in electromagnetic design of IPMSMs, the main efforts of this study are focused on finding a proper trade-off for its torque profile challenges. In this regard, in order to attain high average torque and low torque ripple, the influence of several key factors, such as the permanent magnet (PM) arrangements, PM positions and PM sizes, are examined. Subsequently, according to the outcomes of the performed sensitivity analysis, the appropriate variation interval of the parameters as well as their initial values is determined. Employing such a deterministic optimization algorithm, which does not need large sample points, minimizes the finite element computational cost and leads to accelerate the convergence process. The two-dimensional finite element model (FEM) of an IPMSM is used to perform a sensitivity analysis and establish a multi-objective FEM-based optimization. [ABSTRACT FROM AUTHOR]

Purpose: Despite to high burden of road traffic injuries (RTIs), the RTI epidemiology has received less attention with rare investments on robust population cohorts. The PERSIAN Traffic Safety and Health Cohort (PTSHC) was designed to assess the potential causal relationships between human factors and RTI mortality, injuries, severity of the injury, hospitalised injury, violation of traffic law as well as offer the strongest scientific evidence., Participants: The precrash cohort study is carried out in four cities of Tabriz, Jolfa, Shabestar and Osku in East Azerbaijan province located in northwest Iran. The participants were people who sampled among the general population. The cluster sampling method was used to enrol the households in this study. The PTSHC encompasses a wide and comprehensive range and types of data. These include not only the common cohort data collections such as medical examination measures, previous medical history, bio assays and behavioural assessments but also includes data obtained using advanced novel technologies, for example, electronic travel monitoring, driving simulation and neuro-psycho-physiologic laboratory assessments specifically developed for traffic health field., Findings to Date: A total of 7200 participants aged 14 years and above were enrolled at baseline, nearly half of them being men. The mean age of participants was 39.2 (SD=19.9) years. The majority of participants (55.4%) belonged to the age group of 30-56 years. Currently, approximately 1 200 000 person-measurements have been collected., Future Plans: PSTHC will be used to determine the human-related risk factors by adjusting for the vehicle and land-use-related factors. Therefore, a lot of crashes can be prevented using effective interventions. Although this cohort provides valuable data, it is planned to increase its size to achieve the highest level of evidence with higher generalisability. Also, according to the national agreement this cohort is going to be extended to several geographical regions in second decade., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Despite recent progress regarding inexpensive medical approaches, many individuals suffer from moderate to severe pain globally. The discovery and advent of exosomes, as biological nano-sized vesicles, has revolutionized current knowledge about underlying mechanisms associated with several pathological conditions. Indeed, these particles are touted as biological bio-shuttles with the potential to carry specific signaling biomolecules to cells in proximity and remote sites, maintaining cell-to-cell communication in a paracrine manner. A piece of evidence points to an intricate relationship between exosome biogenesis and autophagy signaling pathways at different molecular levels. A close collaboration of autophagic response with exosome release can affect the body's hemostasis and physiology of different cell types. This review is a preliminary attempt to highlight the possible interface of autophagy flux and exosome biogenesis on pain management with a special focus on neuropathic pain. It is thought that this review article will help us to understand the interplay of autophagic response and exosome biogenesis in the management of pain under pathological conditions. The application of therapies targeting autophagy pathway and exosome abscission can be an alternative strategy in the regulation of pain., 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 The Author(s).)

Background: Cohort studies play essential roles in assessing causality, appropriate interventions. The study, Post-crash Prospective Epidemiological Research Studies in IrAN Traffic Safety and Health Cohort, aims to investigate the common health consequences of road traffic injuries (RTIs) postcrash through multiple follow-ups., Methods: This protocol study was designed to analyse human, vehicle and environmental factors as exposures relating to postcrash outcomes (injury, disability, death, property damage, quality of life, etc). Population sources include registered injured people and followed up healthy people in precrash cohort experienced RTIs. It includes four first-year follow-ups, 1 month (phone-based), 3 months (in-person, video/phone call), 6 and 12 months (phone-based) after crash. Then, 24-month and 36-month follow-ups will be conducted triennially. Various questionnaires such as Post-traumatic Stress Disorder Questionnaire, Patient Health Questionnaire, WHO Disability Assessment Schedules, Cost-related Information, etc are completed. Counselling with a psychiatrist and a medical visit by a practitioner are provided accompanied by extra tools (simulator-based driving assessment, and psychophysiological tests). Through preliminary recruitment plan, 5807, 2905, 2247 and 1051 subjects have been enrolled, respectively at the baseline, first, second and third follow-ups by now. At baseline, cars and motorcycles accounted for over 30% and 25% of RTIs. At first follow-up, 27% of participants were pedestrians engaged mostly in car crashes. Around a fourth of injuries were single injuries. Car occupants were injured in 40% of collisions., Discussion: The study provides an opportunity to investigate physical-psychosocial outcomes of RTIs, predictors and patterns at follow-up phases postinjury through longitudinal assessments, to provide advocates for evidence-based safety national policy-making., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: There is no comprehensive meta-analysis on the value of physiological scoring systems in predicting the mortality of critically ill patients. Therefore, the present study intended to conduct a systematic review and meta-analysis to collect the available clinical evidence on the value of physiological scoring systems in predicting the in-hospital mortality of acute patients., Method: An extensive search was performed on Medline, Embase, Scopus, and Web of Science databases until the end of year 2020. Physiological models included Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), modified REMS (mREMS), and Worthing Physiological Score (WPS). Finally, the data were summarized and the findings were presented as summary receiver operating characteristics (SROC), sensitivity, specificity and diagnostic odds ratio (DOR)., Results: Data from 25 articles were included. The overall analysis showed that the area under the SROC curve of REMS, RAPS, mREMS, and WPS criteria were 0.83 (95% CI: 0.79-0.86), 0.89 (95% CI: 0.86-0.92), 0.64 (95% CI: 0.60-0.68) and 0.86 (95% CI: 0.83-0.89), respectively. DOR for REMS, RAPS, mREMS and WPS models were 11 (95% CI: 8-16), 13 (95% CI: 4-41), 2 (95% CI: 2-4) and 17 (95% CI: 5-59) respectively. When analyses were limited to trauma patients, the DOR of the REMS and RAPS models were 112 and 431, respectively. Due to the lack of sufficient studies, it was not possible to limit the analyses for mREMS and WPS., Conclusion: The findings of the present study showed that three models of RAPS, REMS and WPS have a high predictive value for in-hospital mortality. In addition, the value of these models in trauma patients is much higher than other patient settings., Competing Interests: The authors declared no conflict of interest.

Introduction: There is still no consensus on the value of Manchester Acute Coronary Syndromes (MACS) decision rule in detecting acute coronary syndrome (ACS). Therefore, the purpose of the present systematic review and meta-analyzes is to summarize the clinical evidence in the evaluation of the value of MACS in the diagnosis of ACS., Methods: A literature search was performed on the Medline, Embase, Scopus, and Web of Science databases. Outcomes included acute myocardial infarction (AMI) and major adverse cardiac event (MACE). Data were analyzed in the STATA 14.0 statistical program and the results were reported as summary receiver operating characteristics (SROC), sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio with 95% confidence interval (95% CI)., Results: Finally, 8 articles included in the meta-analysis. The area under the SROC of MACS was excellent in rule out of AMI (AUC = 0.99, 95% CI: 0.97 to 0.99) and MACE (AUC = 0.97, 95% CI: 0.95 to 0.98). The sensitivity and specificity of the troponin-only MACS/history electrocardiogram alone MACS (HE-MACS) in the rule out of AMI were0.99 (95% CI: 0.98-0.99) and 0.22 (95% CI: 0.11-0.37), respectively, and for the original MACS were in order 0.99 (95% CI: 0.98-0.99) and 0.26 (95% CI: 0.20-0.34),. The sensitivity and specificity of the troponin-only MACS / HE-MACS in the rule out of MACE were 0.94 (95% CI: 0.92-0.96) and 0.22 (95% CI: 0.12-0.39) compared to the 0.99 (95% CI: 0.98-0.99) and 0.27 (95% CI: 0.22-0.33) for the original MACS., Conclusion: The findings of this study showed that original MACS, troponin-only MACS, and HE-MACS are able to rule out AMI and MACE. However, further studies are needed in developing countries to confirm its external validity., Competing Interests: There was no conflict of interest.

Introduction: Falling is reported to be the most common cause of mortality due to trauma in individuals over the age of 75 years. The present study is designed with the aim of determining the demographics of fall-related trauma among the elderly presenting to emergency department (ED)., Methods: The present prospective cross-sectional study was carried out on all elderly patients ≥ 60 years old presenting to ED of a major referral trauma center in North West of Iran during 1 year. Demographic data, location and height of falling, duration of hospitalization, trauma severity and in-hospital outcome of the patients were gathered and reported via descriptive statistics., Results: 228 patients with the mean age of 70.96 ± 5.2 years were studied (53.9% female). Most patients were in the 66-70 years age range (32.6%) and had a history of hypertension (22.3%), who had visited following a fall inside the house (69.3%), due to slipping (73.7%), and from a height equal to or less than 2m (71.9%). 6 (2.6%) patients died in the hospital. Mean trauma severity of patients based on ISS, RTS, and TRISS were 10.65 ± 3.95 (3-19), 7.84 ±.21 (1.4-14.5) and 1.66 ±1.31 (-1.49-3.82), respectively. Regarding need for hospitalization, only ISS shows a significant difference between outpatients and inpatients (p = 0.023). Patients who died had a significantly higher trauma severity based on ISS (p < 0.0001) and RTS (p < 0.0001)., Conclusion: Based on the findings of the present study, slipping and syncope are the most common causes of falling in the studied elderly that had mostly happened inside the house and from a height less than 2m. Therefore, most patients were in the mild to moderate range of trauma severity. ISS and RTS were significantly higher in the 6 (2.6%) patients who died.