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The novel coronavirus disease 2019 (COVID-19) is the latest evidence of an epidemic disease resulting in an extraordinary number of infections and claimed several lives, along with extensive economic and social consequences. In response to the emergency situation, countries introduced different policies to address the situation, with different levels of efficacy. This paper outlines the protocol for developing a model to analyze the burden of COVID-19 in Iran and the effect of policies on the incidence and cumulative death of the disease. The importance of the model lies in the fact that no study, according to the authors' best knowledge, tried to quantify the impact of the disease on Iran society and the impact of various implemented interventions on disease control. Based on a systematic review of COVID-19 prediction models and expert interviews, we developed a system dynamics model that not only includes an epidemic part but also considers the impact of various policies implemented by the Ministry of Health. The epidemic model estimates the incidence and mortality of COVID-19 in Iran. The model also intends to evaluate the effect of implemented policies on these outcomes. The model reflects the continuum of COVID-19 infection and care in Iran (of which some of its elements are unique) and key activities and decisions in delivering care. The model is calibrated and validated using data published by the Ministry of Health of Iran. Finally, the study aims to provide evidence of the impact of interventions intended to curb COVID-19 in Iran. Insights provided by the model will be necessary for controlling either future waves of the disease or similar future pandemics., (© 2024. The Author(s).)

Context: Advance Care Planning (ACP), as a process for expressing and recording patients' preferences about end-of-life care, has received increasing attention in recent years. However, implementing ACP has been challenging in Iran., Objectives: To assess the readiness for advance care planning and related factors in the general population of Iran., Methods: This cross-sectional study was conducted on the general population of Iran in 2022. The data was collected using demographic information questionnaire and The RACP Scale. The purpose and methodology of the research was explained to all participants, and upon their agreement an informed consent was obtained. Participants were invited to fill out the questionnaires wherever is more convenient for them, either alone or if needed, with the help of the researcher to protect their privacy. Chi-square, fisher exact test and multiple logistic Regression model were used to assess the effective factors on the RACP. The data were analyzed by SPSS software version 26., Results: A total of 641 people with an average age of 36.85 ± 12.05 years participated in this study. Of those, 377 (58.8%) had high RACP. The logistics model showed an association between the chance of readiness for receiving ACP with participants' education level, such that the chance of readiness in those with Master's or Ph.D. degrees was three times higher than those with a diploma (p = 0.00, OR:3.178(1.672, 6.043)). However, the chances of readiness in those with bachelor's degrees was not significantly different from those with a diploma (p = 0.936, OR: 0.984 (0.654, 1.479)). Moreover, the chance of readiness was 1.5 higher in participants over 40 years of age compared with participants under the age of 40 (P = 0.01, OR: 1.571(1.10, 2.23))., Conclusion: According to the findings of this study, it can be concluded that there is a relatively RACP among people in Iranian society. The readiness of individuals for ACP increases by their age and education level. Therefore, by holding appropriate training intervention, we can increase the readiness of the public for ACP to improve their end-of-life outcome., (© 2024. The Author(s).)

Background: The impact of the chronological sequence of events, including cardiac arrest (CA), initial cardiopulmonary resuscitation (CPR), return of spontaneous circulation (ROSC), and extracorporeal cardiopulmonary resuscitation (ECPR) implementation, on clinical outcomes in patients with both out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), is still not clear. The aim of this study was to investigate the prognostic effects of the time interval from collapse to start of CPR (no-flow time, NFT) and the time interval from start of CPR to implementation of ECPR (low-flow time, LFT) on patient outcomes under Extracorporeal Membrane Oxygenation (ECMO)., Methods: This single-center, retrospective observational study was conducted on 48 patients with OHCA or IHCA who underwent ECMO at Hamad General Hospital (HGH), the tertiary governmental hospital of Qatar, between February 2016 and March 2020. We investigated the impact of prognostic factors such as NFT and LFT on various clinical outcomes following cardiac arrest, including 24-hour survival, 28-day survival, CPR duration, ECMO length of stay (LOS), ICU LOS, hospital LOS, disability (assessed using the modified Rankin Scale, mRS), and neurological status (evaluated based on the Cerebral Performance Category, CPC) at 28 days after the CA., Results: The results of the adjusted logistic regression analysis showed that a longer NFT was associated with unfavorable clinical outcomes. These outcomes included longer CPR duration (OR: 1.779, 95%CI: 1.218-2.605, P = 0.034) and decreased survival rates for ECMO at 24 h (OR: 0.561, 95%CI: 0.183-0.903, P = 0.009) and 28 days (OR: 0.498, 95%CI: 0.106-0.802, P = 0.011). Additionally, a longer LFT was found to be associated only with a higher probability of prolonged CPR (OR: 1.818, 95%CI: 1.332-3.312, P = 0.006). However, there was no statistically significant connection between either the NFT or the LFT and the improvement of disability or neurologically favorable survival after 28 days of cardiac arrest., Conclusions: Based on our findings, it has been determined that the NFT is a more effective predictor than the LFT in assessing clinical outcomes for patients with OHCA or IHCA who underwent ECMO. This understanding of their distinct predictive abilities enables medical professionals to identify high-risk patients more accurately and customize their interventions accordingly., (© 2024. The Author(s).)

Objective: Renal cell carcinoma (RCC) is the most common type of kidney cancer. VEGF inhibitors and mTORs are the most common therapeutic options among the different classes of available treatments. In this study, the effectiveness of Everolimus was compared to Temsirolimus, and Everolimus plusLenvatinib in renal cell carcinoma patients by review of the international clinical evidence., Materials and Methods: A systematic review was conducted and all relevant published clinical studies on the efficacy and cost-effectiveness of Everolimus, Temsirolimus, and Lenvatinib plus Everolimus were searched comprehensively in electronic databases including Pubmed, Scopus, Medline, Cochrane Library, and ISI web of science. The Q score and I2 test checked the Heterogeneity and publication bias test, respectively. Egger's test and Begg's test were used to checking publication bias. The hazard ratio (HR) of included studies and subclass analysis were estimated by fixed and random effect models., Results: Out of 1816 found studies, ultimately, were included considering inclusion and exclusion criteria. None of these studies evaluated all three treatment strategies together and each study was about one strategy. Only one study was found for Everolimus plus Lenvatinib, so it was excluded from meta-analysis. Overall, data from 526 patients on Temsirolimus and 648 patients on Everolimus were included in Meta-Analysis. Accordingly, the efficacy of Everolimus and Temsirolimus was not statistically significant in assessed outcomes (PFS, TTSF, and death). However, Everlimus is superior to Temsirolimus in OS (Q = 3.61, p-value: 0.462, I2 = 0%). No heterogeneity or bias was detected., Conclusion: According to the results of this study, Everolimus could be related to an increase of OS versus Temsirolimus as a second line treatment of ORCC patients., (© 2023. The Author(s).)

Background: While of predominant abundance across vertebrate genomes and significant biological implications, the relevance of short tandem repeats (STRs) (also known as microsatellites) to speciation remains largely elusive and attributed to random coincidence for the most part. Here we collected data on the whole-genome abundance of mono-, di-, and trinucleotide STRs in nine species, encompassing rodents and primates, including rat, mouse, olive baboon, gelada, macaque, gorilla, chimpanzee, bonobo, and human. The collected data were used to analyze hierarchical clustering of the STR abundances in the selected species., Results: We found massive differential STR abundances between the rodent and primate orders. In addition, while numerous STRs had random abundance across the nine selected species, the global abundance conformed to three consistent < clusters>, as follows: <rat, mouse>, <gelada, macaque, olive baboon>, and <gorilla, chimpanzee, bonobo, human>, which coincided with the phylogenetic distances of the selected species (p < 4E-05). Exceptionally, in the trinucleotide STR compartment, human was significantly distant from all other species., Conclusion: Based on hierarchical clustering, we propose that the global abundance of STRs is non-random in rodents and primates, and probably had a determining impact on the speciation of the two orders. We also propose the STRs and STR lengths, which predominantly conformed to the phylogeny of the selected species, exemplified by (t)10, (ct)6, and (taa4). Phylogenetic and experimental platforms are warranted to further examine the observed patterns and the biological mechanisms associated with those STRs., (© 2022. The Author(s).)

Background: Nurse stations are one of the primary units for supporting effective functioning of any hospital. They are important working environments that demand adherence to known ergonomic principles for the well-being of both staff and patients. The aim of this study was to develop a psychometrically tested tool for the assessment of the ergonomic conditions of nurse workstations in hospitals., Methods: Ten hospitals, with a total of 133 nurse stations participated in this mixed-methods research. The domains and items of the tool were developed based on a literature review, an experts' panel, and interviews with nurses., Results: The final nurse station ergonomic assessment (NSEA) tool has good psychometric properties. Validity was assessed by face validity and content validity. Reliability was evaluated using inter-rater agreement and test-retest reliability analyses with a four-week interval between assessments. The NSEA is comprised of 64 items across eight domains: layout and location (7 items), workspace (11 items), security-safety (5 items), environmental conditions (8 items), counter (8 items), chair (13 items), desk (9 items), and monitor (3 items)., Conclusions: The NSEA adds to the literature a tool for managers to ensure they comply with legal requirements and support best practice for those working on hospital wards. The NSEA can be used to identify challenges for healthcare professionals who use nurse stations and support the execution of targeted interventions to improve human-environment interactions.

Background: This study was conducted with the aim of developing a standard and valid questionnaire to evaluate the behavioral factors affecting musculoskeletal disorders among adolescent students based on the educational and ecological diagnosis phase of the PRECEDE model., Methods: Based on the PRECEDE model and by using available resources and a panel of experts, a reservoir of items was proposed. The content validity of the questions was measured using content validity ratio (CVR) and content validity index (CVI). 400 Iranian first-year female high school students completed the questionnaire. The construct validity was assessed using confirmatory factor analysis (CFA). The reliability of the questionnaire was evaluated using Cronbach's alpha coefficient., Results: The age range of study students was 13.69 ± 0.86 years. The final developed questionnaire included 25 items in three dimensions: knowledge (9 items), attitude (10 items) and enabling factors (6 items). The mean scores of CVI and CVR were 0.97 and 0.92, respectively. The results of CFA confirmed the three-factor structure of the questionnaire. The Cronbach's alpha coefficients of the dimensions of knowledge, attitude and enabling factors were 0.65, 0.80 and 0.71, respectively., Conclusions: The present questionnaire had appropriate psychometric properties and could be used as a valid tool in evaluating the factors affecting the development of musculoskeletal disorders among adolescent students.

Background and Aim: A number of studies have investigated the effects of individual foods and/or nutrients on rheumatoid arthritis (RA), but research focusing on whole dietary patterns remains limited. The association of dietary patterns and rheumatoid arthritis is therefore not well elucidated. This study aims to determine existing relationships between major identified dietary patterns and RA., Methods: This matched case-control study was conducted on 297 individuals in Isfahan, Iran. The presence of RA was determined by an expert rheumatologist, based on the American College of Rheumatology definitions, 2010. A 168-item questionnaire was used to collect dietary data. Major dietary patterns were identified using the factor analysis method., Results: Two major dietary patterns, namely, healthy and western dietary patterns, were identified. Lower adherence to the healthy dietary pattern was associated with increased risk of RA (OR = 2.80; 95% CI 1.74-4.67; P  < 0.001). The association remained significant even after taking other confounders into account (OR = 2.85; 95% CI 1.12-7.45; P  = 0.03). A positively significant association was also observed between adherence to western dietary pattern and RA in the fully-adjusted final model (OR = 2.22; 95% CI 1.04-4.72; P  = 0.03)., Conclusions: The study suggests that there is an inverse association between adherence to a healthy dietary pattern and the odds of RA, and a positive significant relationship was found between western dietary pattern and RA. Further studies are required to confirm these findings., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background: In the context of growing health concerns over antibiotic resistance, the evaluation of the minimum inhibitory concentration (MIC) of vancomycin for Streptococcus pneumoniae (S. pneumoniae) strains resistant to ceftazidime becomes important for guiding health policy makers. The aim of this study was to determine vancomycin MIC of ceftazidime resistant S. pneumoniae strains., Methods: Fifty identified serotypes of ceftazidime resistant S. pneumoniae strains were included in the study. The vancomycin MIC of the above mentioned bacteria was determined based on the 0.5 McFarland standards, by using a microdilution broth and the Etest method., Results: The results showed that out of 50 ceftazidime resistant strains of S. pneumoniae, 46 strains (92%) have shown a vancomycin MIC ≤0.19 - 0.1.5 μg/ml and only four strains (8%) have shown a vancomycin MIC equal to 1.5 μg/ml and the related maximum zone of inhibition was of 10 millimeter diameters., Conclusions: The results of this investigation point out the emergence of S. pneumoniae strains with a vancomycin MIC ≥1.5 μg/ml, which were resistant to ceftazidime. This finding uncovers a major health concern: a vancomycin MIC higher than 1.5 μg/ml and maximum zone of inhibition of only 10 millimeter. These findings represent an important warning for health authorities globally, concerning the treatment of patients, as the occurrence of S. pneumoniae strains with decreased vancomycin susceptibility has been demonstrated.