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Abstract Background The healthcare system is under increasing pressure to improve service quality and patient outcomes, with nurses playing a crucial role. They are responsible for about 80% of healthcare services in hospitals, and their proficiency directly influences care quality, patient satisfaction, and complication rates. The work environment also significantly impacts nurses’ ability to perform these competencies, highlighting the need for a comprehensive understanding of these factors in healthcare delivery. This study aims to assess the relationship between nursing process competency and the work environment among clinical nurses. Methods This study utilized a cross-sectional correlational design involving 321 clinical nurses from five teaching hospitals in Ardabil, Iran. Data were collected from April to June 2024 using the Competency of Nursing Process Questionnaire (CNPQ) and a work environment questionnaire. Data analysis was conducted using SPSS version 14, employing descriptive statistics and analytical methods, including Independent sample t-tests, ANOVA, and Pearson correlation, to examine relationships between variables. Results The findings revealed significant relationships between overall competency of nursing process and supportive work conditions, particularly fairness in evaluation (r = 0.388, p

Abstract Background Nurses should possess the ability to deliver concise oral presentations. Strong oral presentation skills can improve the quality of nurse-client communication, enhance teamwork among healthcare professionals, and contribute to professional development, leadership, and promotion. This study aimed to determine psychometric evaluation of the Persian version of the oral presentation evaluation scale in nursing students. Methods The study aimed to translate the oral presentation evaluation scale (OPES) into Persian using the standard translation and re-translation method. After the translation, the scale was distributed among 474 nursing students of various levels using the available sampling method. The scale’s reliability was assessed using Cronbach’s alpha coefficient and test-retest repeatability. The construct validity was determined using the confirmatory factor analysis. Results The Persian questionnaire consists of 15 items and is divided into three categories: accuracy of content, effective communication, and speech clarity. The overall score for the content validity index (S-CVI) was 0.94. The three-factor questionnaire’s fitness indices were RMSEA = 0.070, comparative fit index (CFI) = 0.96, goodness-of-fit index (GFI) = 0.91, and adjusted goodness-of-fit index (AGFI) = 0.88. The intra-cluster correlation index (ICC) was 0.965, and Cronbach’s alpha was 0.875. Conclusion The study found that the 15-item oral presentation evaluation scale Persian Survey is reliable for assessing nursing students’ oral presentation skills.

Abstract Aim This study aimed to translate and evaluate the psychometric properties of the Persian version of the Innovative Behavior Inventory-20 (IBI-20) among clinical nurses in northwest Iran. Methods A descriptive survey with psychometric analysis was conducted involving 321 nurses from Ardabil medical training centers. The study employed a stratified proportional sampling method. Data were collected using standard questionnaires, including a demographic profile form and the innovative behavior questionnaire. Descriptive statistics, such as mean, standard deviation, frequency, and percentage, were calculated using IBM SPSS Statistics for Windows, version 26.0. Reliability was assessed through Cronbach’s alpha, McDonald’s omega, and Coefficient H. Confirmatory factor analysis (CFA) and structural equation modeling (SEM) was performed using IBM SPSS version 26.0 and AMOS version 24.0, with a significance level set at p

Abstract Previous research has highlighted the importance of workplace fun in enhancing employee satisfaction and performance, particularly in high-stress professions like nursing. However, a notable gap exists in understanding how workplace fun is perceived and measured among nurses in Persian-speaking countries. This study addresses this gap by translating the Workplace Fun Scale and assessing its psychometric properties among nurses. The findings will provide insights into the scale’s applicability in these contexts and pave the way for healthcare organizations to significantly explore ways to enhance nurses’ enjoyment of work in Persian-speaking countries. This survey, which involved 321 nurses from medical education centers in Ardabil, was conducted with a meticulous and rigorous methodology. Standard questionnaires collected the data, including a demographic form and the translated Workplace Fun Scale. The study examined the three aspects of workplace fun: fun activities, coworker socializing, and manager support for fun. Confirmatory factor analysis was used to validate the structure, and reliability was assessed through retest coefficients, Cronbach’s alpha coefficients, and composite reliability coefficients. The data were analyzed using SPSS version 14 and LISREL version 8.8, ensuring the highest research standards. The validity of both form and content was confirmed through translation and reverse translation. The Workplace Fun Scale showed high internal consistency and reliability, with significant Cronbach’s alpha coefficients, composite reliability, and two-week retest coefficients of 0.859, 0.885, and 0.459, respectively (all at the p

Stevia plant is one of the most important medicinal plants used to control diabetes due to its sweetening properties and low calories. Stevia is cultivated in many parts of the world, and to increase its sweetening properties, the effects of many different factors have been tested on this plant. In this research, we investigated the effect of elements related to metal oxidants on the induction of molecular levels and transcription. Thus, the activity of 3 key genes named CPPS, HDS, and GGDPS in response to six different metal oxidants named Cro3, Pbo, Fe2O3, Ag2O, Bao, and Tio2 was carried out in this research. The results showed that the increased concentration of metal oxides, especially Fe2O3 and TiO2, escalates gene expression in the biosynthesis of sweeteners extracted from stevia leaves. Also, related to all treatments, the higher the concentration, the higher the gene expression. Among all metal oxide treatments, Pbo and Bao resulted in low gene expression for CPPS, HDS, and GGDPS genes. On the other side, control showed the lowest expression regarding all three surveyed genes, indicating that using metal oxides can achieve higher production of sweeteners in stevia plants. The results of this research determined that physiological characteristics are affected by metal oxide treatments. Also, the expression of genes effective in the production of steviol glycosides, which is one of the important sweetening factors of this plant in the leaves, increases under the influence of these treatments. As a result, it can be said that the use of these treatments can have an increasing effect on the amount of sweetening of the plant.

Abstract Background Innovation in nursing involves applying new knowledge to create novel ideas, methods, or technologies, resulting in higher-quality care and improved patient outcomes. Adequate support for innovation is crucial for progress in nursing. This study aimed to translate the Innovation Support Inventory (ISI-12) into Persian and assess its psychometric properties specifically among clinical nurses. Methods A methodological cross-sectional study was conducted from September 2022 to July 2023 to evaluate the face, content, and construct validity of the ISI-12. Construct validity was assessed through confirmatory factor analysis (CFA) and convergent and discriminant validity evaluation using data obtained from 321 clinical nurses. The test–retest stability and internal consistency of the ISI-12 were also evaluated to assess its reliability. Results The Persian version of the ISI-12 validation through confirmatory factor analysis has confirmed its fit with the proposed three-factor model. The ISI-12 demonstrated high reliability, as evidenced by a Cronbach's alpha coefficient (α = 0.969), McDonald's omega coefficient (ω = 0.922), coefficient H (H = 0.979), and mean inter-item correlation (ρ = 0.418). Additionally, the stability of the ISI-12 during two weeks among 40 clinical nurses was found to be excellent, with an ICC of 0.951. Conclusion The Persian version of the ISI-12 is a valid inventory for evaluating the innovation Support of clinical nurses.

Abstract Background Nursing managers have the potential to significantly impact the outcomes of nurses, patients, and organizations. Their competencies for effective performance are crucial. The global nursing workforce is facing a severe shortage of nurses. Dissatisfaction with management is one of the most important reasons for nurses’ inclination to leave their jobs. Therefore, this study examines the relationship between nursing managers’ competencies, job satisfaction and intention to leave among clinical nurses. Methods An analytical cross-sectional study was conducted on 354 nurses in five hospitals affiliated with Ardabil University of Medical Sciences from May to August 2023. This research used web-based software to design demographic information forms, nurse manager competency scale, turnover intention, and single-item job satisfaction questionnaires. The significance level for the study was set at p

Abstract Background Machine learning (ML) has shown exceptional promise in various domains of medical research. However, its application in predicting subsequent fragility fractures is still largely unknown. In this study, we aim to evaluate the predictive power of different ML algorithms in this area and identify key features associated with the risk of subsequent fragility fractures in osteoporotic patients. Methods We retrospectively analyzed data from patients presented with fragility fractures at our Fracture Liaison Service, categorizing them into index fragility fracture (n = 905) and subsequent fragility fracture groups (n = 195). We independently trained ML models using 27 features for both male and female cohorts. The algorithms tested include Random Forest, XGBoost, CatBoost, Logistic Regression, LightGBM, AdaBoost, Multi-Layer Perceptron, and Support Vector Machine. Model performance was evaluated through 10-fold cross-validation. Results The CatBoost model outperformed other models, achieving 87% accuracy and an AUC of 0.951 for females, and 93.4% accuracy with an AUC of 0.990 for males. The most significant predictors for females included age, serum C-reactive protein (CRP), 25(OH)D, creatinine, blood urea nitrogen (BUN), parathyroid hormone (PTH), femoral neck Z-score, menopause age, number of pregnancies, phosphorus, calcium, and body mass index (BMI); for males, the predictors were serum CRP, femoral neck T-score, PTH, hip T-score, BMI, BUN, creatinine, alkaline phosphatase, and spinal Z-score. Conclusion ML models, especially CatBoost, offer a valuable approach for predicting subsequent fragility fractures in osteoporotic patients. These models hold the potential to enhance clinical decision-making by supporting the development of personalized preventative strategies.

Objectives To assess and compare attitudes towards patient safety among physicians and nurses in Iranian governmental teaching hospitals and to identify factors associated with attitudes towards patient safety.Design An institution-based, cross-sectional survey was carried out from July to August 2023.Setting 10 governmental teaching hospitals in Tehran, Iran.Participants The study participants comprised a random sample of 186 nurses and 90 physicians who had worked for at least 6 months in their current hospitals.Outcome measures The primary outcome measures were mean and SD scores for individual items and the nine main patient safety domains assessed by the Attitudes Toward Patient Safety Questionnaire-III. The secondary outcome measure was the proportion of physicians and nurses who responded positively to each item, expressed as percentages for each group.Results Physicians and nurses exhibited moderately positive attitudes towards patient safety (mean scores of 3.79±0.33 and 3.83±0.36, respectively). Both professional groups reported the most positive attitudes in the same dimensions: ‘team functioning’ and ‘working hours as a cause for error’ (mean scores of >4 out of 5). Conversely, the lowest scores were observed in ‘importance of patient safety in the curriculum’, indicating potential gaps in their understanding of patient safety (mean scores of

Aims: Ilium is the most common site of pelvic Ewing’s sarcoma (ES). Resection of the ilium and iliosacral joint causes pelvic disruption. However, the outcomes of resection and reconstruction are not well described. In this study, we report patients’ outcomes after resection of the ilium and iliosacral ES and reconstruction with a tibial strut allograft. Methods: Medical files of 43 patients with ilium and iliosacral ES who underwent surgical resection and reconstruction with a tibial strut allograft between January 2010 and October 2021 were reviewed. The lesions were classified into four resection zones: I1, I2, I3, and I4, based on the extent of resection. Functional outcomes, oncological outcomes, and surgical complications for each resection zone were of interest. Functional outcomes were assessed using a Musculoskeletal Tumor Society (MSTS) score and Toronto Extremity Salvage Score (TESS). Results: The mean age of the patients was 17 years (SD 9.1). At a mean follow-up of 70.8 months (SD 50), the mean functional outcomes were 24.2 points (SD 6.3) for MSTS and 81 points (SD 11) for TESS. The mean MSTS and TESS scores were associated with the iliac resection zone (< 0.001). Nine patients (20.9%) had local recurrence. The recurrence was not associated with the zone of iliac resection (p = 0.324). The two-year disease-free survival of the patients was 69.4%. The mean time to graft union was longer in patients with the I4 resection zone (p < 0.001). The complication rate was 34.9%, and nerve palsy (11.6%) was the most common. The rate of surgical complications was not associated with the resection zone. Conclusion: Reconstruction using tibial strut allograft is an efficient procedure after the resection of the ilium and iliosacral ES. Functional outcomes and complications of iliac ES depend on the resection zone, and inferior outcomes could be generally expected when more segments of the pelvic ring are resected, even if it is reconstructed. Cite this article: Bone Jt Open 2024;5(5):385–393.

Abstract Background Emergency Medical Services (EMS) staff often encounter various safety incidents. Work-related factors can lead to unsafe behaviors and safety incidents. This study assessed unsafe behaviors and their relationship with work-related factors among EMS staff. Methods This descriptive-correlational study used census sampling method to select 284 EMS staff in Ardabil Province, northwest of Iran, from April to June 2023. The data collection tools were demographic and occupational information form, Mearns Unsafe Behavior Scale, Cohen Perceived Stress Scale, Michielsen Fatigue Scale, and Patterson Teamwork Scale. The data were analyzed using the SPSSv-16, descriptive statistics, Pearson correlation, and multiple linear regression. Results The mean of unsafe behavior, fatigue, perceived stress, non-conflict of teamwork, and conflict of teamwork were 15.80 (± 4.77), 20.57 (± 6.20), 16.10 (± 6.13), 117.89 (± 17.24), and 40.60 (± 9.59), respectively. Multiple linear regression analysis showed that “partner trust and shared mental models (PTSMM),” “physical fatigue,” “age,” “type of shift,” “employment status,” and “overtime hours per month” were predictors of general unsafe behavior (P

Abstract Aims The purpose of this study was to evaluate the preparedness of Iranian nurses for potential pandemics. Background Nurses play a critical role in managing pandemics. They require adequate training, proper equipment, and organizational support to be well-prepared. Methods A descriptive cross-sectional study was conducted in Ardabil, Iran, from July to September 2023, involving 233 nurses from five hospitals. The number of nurses required for each hospital was calculated based on the proportion of nurses in each hospital. Data was collected through a paper-based form that included information about the participants' demographic characteristics and their level of pandemic preparedness in health services. The collected data was analyzed using descriptive statistics to determine the demographic characteristics and levels of pandemic preparedness. Pearson's test was also conducted to establish a relationship between different dimensions of pandemic preparedness. Results Most participants relied on clinical measures and supported using human resources and environmental methods to curb the transmission of a pandemic. They felt assured in their ability to explain the preventive measures against the pandemic. However, fewer respondents had access to healthcare improvement programs, and only a few worked remotely from home. Conclusions According to our study, 90.1% of nurses believe hand washing is the most effective way to prevent spreading infections. Additionally, healthcare professionals can use various tools to respond to the pandemic, including screening for COVID-19 at work, health and wellness programs, telecommuting, COVID-19 Safe programs, social media, and posters. Nurses need continuous education in hand hygiene, health programs, remote work options, and pandemic-safe programs to control infections, reduce risks, and optimize patient care during the pandemic.

IntroductionAspiration represents the most potent method for exploring the potential occurrence of Periprosthetic Joint Infection (PJI). However, dry taps are common. While aspiration under ultrasound (US) guidance in the radiology department has become increasingly popular, hip aspiration is still routinely conducted in the operating room (OR) under x-ray guidance in numerous medical centers. When conducted within the confines of the OR, a dry tap aspiration not only subjects the patient to an unnecessary invasive procedure but also constitutes a substantial strain on OR time and resources. Our objective was to assess whether an outpatient US conducted before aspiration could reliably predict the likelihood of encountering a dry hip aspiration.MethodsIn a prospective study, we enrolled 50 hips who were suspected of PJI and slated for revision total hip arthroplasty and required hip aspiration. Before the aspiration procedure, we conducted an outpatient hip ultrasound (US) to assess the presence of fluid collection. Subsequently, all patients underwent aspiration under fluoroscopy in the OR, irrespective of the ultrasound findings We then assessed the level of agreement between the ultrasound results and the outcomes of hip aspiration.ResultsThe US exhibited a sensitivity of 95.7% (95% CI 69.8–91.8), a specificity of 74.1% (95% CI 52.8–91.8), a positive predictive value of 75.9% (95% CI 50.9–91.3), and a negative predictive value of 95.2% (95% CI 71.3-99.8) in predicting the success of aspiration.DiscussionPre-aspiration outpatient US demonstrates a high degree of accuracy in predicting dry taps in these patients. We recommend its incorporation into the hip aspiration procedure in medical centers where aspiration is performed in the operating room. In the broader context, these findings reinforce the preference for US-guided aspiration within the radiology department over x-ray-guided aspiration in the operating room since about ¼ of the positive USs for hip collection will lead to a dry tap if the aspiration is performed in the OR under fluoroscopy guidance.

Abstract Background Eating behavior is an essential aspect of life that can have long-term effects on health outcomes. Nutrition literacy is crucial for better health and well-being. It empowers individuals to make informed decisions about their nutrition and take control of their eating habits. Objectives This study aimed to assess the relationship between nutritional literacy and eating behavior among nursing students at the nursing faculties of Ardabil University of medical sciences. Methods A cross-sectional correlational study was conducted in Ardabil province, northwest Iran. The study collected data through simple random sampling at nursing schools in Ardabil province, with 224 nursing students participating. The study collected data from a demographic information form, the nutritional literacy self-assessment questionnaire for students (NL-SF12), and the adult eating behavior questionnaire (AEBQ). The data were analyzed using SPSS version 14.0 software. Results Based on the results, nutritional literacy explains 44% of the variance in eating behavior and shows significant explanatory power in two sub-scales of eating behavior. The adjusted R2 values for food approach and food avoidance scales were 0.33 and 0.27, respectively. Conclusion Given the significant relationship between nutritional literacy and eating behaviors among nursing students, nursing faculty managers and health policymakers should develop new public health strategies to increase nutritional literacy among nursing students.

Abstract Background Ensuring patient safety is of paramount importance in healthcare services. Sleep disorders not only have detrimental effects on the health of healthcare students but also significantly impair their performance, leading to an increased risk of medication errors. These errors can pose a grave threat to the safety and well-being of patients. It is crucial to address and mitigate sleep disorders among internship healthcare students to safeguard the quality of care and minimize potential patient harm. Objectives This study aimed to investigate the predictors of Patient Safety Competency (PSC) based on the sleep quality of internship healthcare students. Methods A study was conducted on 331 students from the Ardabil School of Nursing and Midwifery at Ardabil University of Medical Sciences in northwest Iran from August to December 2022. The participants were selected by stratified random sampling. Data were collected using a demographic information form, the Pittsburgh Sleep Quality Index (PSQI), and the Health Professional Education in Patient Safety Survey (H-PEPSS). The collected data were analyzed using SPSS software version 22.0. Person correlation coefficients were used to examine the relationship between PSC level, its dimensions, and sleep quality, while multiple linear regression was conducted to identify the predictors of PSC. Results The competency of nurses in patient safety was average in both classroom and clinical settings. However, their ability to work as a team with other healthcare professionals scored the lowest. In addition, the quality of sleep was found to be a predictor of patient safety competency among healthcare students during their internships. Conclusions It is important to note that healthcare students tend to have moderate patient safety competence (PSC), which is positively correlated with their sleep quality. Therefore, it is vital to identify the key factors that directly affect PSC. This would enable nursing and midwifery faculty administrators to take preventive measures to enhance patient safety competence in both classroom and clinical settings. Additionally, organizing educational workshops that engage students and improve their sleep quality could improve patient care. Practical courses are recommended for health professionals and students in clinical settings to enhance patient safety competencies. Additionally, student internships should receive hands-on training to improve teamwork and rest conditions.

Background & Aims Oral presentation skills play an important role in the personal, academic and professional success. It is the most common method of educational assessment in higher education settings. This study aims to determine the oral presentation competency of nursing students from Ardabil university of medical sciences (AUMS). Materials & Methods This is a descriptive cross-sectional study that was conducted in 2023 on 274 nursing students from AUMS, who were selected using a convenience sampling method. The data collection tool were a demographic form and Chiang’s oral presentation evaluation scale (OPES). The collected data were analyzed in SPSS software, version 20, using independent t-test and one-way analysis of variance. Results The total score of OPES was 58.81±7.75. The scores of the dimensions of accuracy in content, effective communication, and clarity of speech was 4.01±0.348, 3.72±0.658, and 4.02‌±‌0.673, respectively. Competency was higher in Persian speaking students than in Azari-speaking students. Also, students with a history of more oral presentation and reading of public speaking books obtained higher scores. Conclusion Considering the importance of oral presentations for nurses, it is recommended that nursing professors in AUMS and the educational system in Iran pay more attention to promote this skill in Azeri-speaking nursing students.

Abstract The expression pattern, diagnostic value, and association of PD-L1, IFN-γ and TGF-β with bone tumor type, severity, and relapse are determined in this study. 300 human samples from patients with osteosarcoma, Ewing sarcoma, and GCT were enrolled. The PD-L1 gene and protein expression were assessed by qRT-PCR and immunohistochemistry, respectively. ELISA and flow cytometry was used to detect cytokines and CD4/CD8 T cell percentages, respectively. A considerable increase in PD-L1 level was detected in bone tumor tissues at both gene and protein levels that was considerable in osteosarcoma and Ewing sarcoma. A positive correlation was detected regarding the PD-L1 and tumor metastasis and recurrence in osteosarcoma and Ewing sarcoma. The increased IFN-γ level was detected in patients with metastatic, and recurrent osteosarcoma tumors that were in accordance with the level of TGF-β in these samples. The simultaneous elevation of IFN-γ and TGF-β was detected in Ewing sarcoma and GCT, also the CD4 + /CD8 + ratio was decreased significantly in patients with osteosarcoma compared to GCT tumors. The elevated levels of PD-L1, TGF- β, and IFN-γ were associated with bone tumor severity that can provide insights into the possible role of this axis in promoting immune system escape, suppression, and tumor invasion.

Abstract Background The old people population is increasing worldwide. Along with their increasing population, an increase in elder abuse cases is predicted. Elder abuse is a neglected problem, and many cases go unreported. This study was conducted to identify types of elder abuse and examine associated risk factors. Methods This cross-sectional analytical study was conducted on 500 older people in Ardabil (northwestern Iran). Data was collected over three months, from June to September 2020. Data was collected using a demographic information form and the Domestic Elder Abuse questionnaire. The data were analyzed using SPSS software (version 22). Logistic regression was used to identify factors related to elder abuse. Results The results showed that out of the 500 participants, 258 (51.6%) were male, and 242 (48.2%) were female. Among the 500 participants, 377 individuals (75/4%) reported experiencing at least one type of abuse in the past year. The highest rate of elder abuse was observed for emotional neglect (47.2%) and psychological abuse (40.8%), while the lowest rate was measured for rejection (15.4%) and physical abuse (12.4%). The results indicated that elder abuse was significantly associated with chronic illness (OR = 0.601, 95% CI: 0.391–0.922) and having 1–4 children (OR = 1.275, 95% CI: 1.137–1.430). Conclusion Considering the high level of elder abuse and its dangerous effects on the quality of life for older people, it is essential to develop appropriate programs to increase awareness among older people and their families.

Abstract Background The objective of this study was to assess the expression profile of CD44v6, a potential cancer stem cell marker, and its diagnostic and predictive significance in three distinct types of primary bone tumors. Methods In this study, we utilized real-time qRT-PCR and immunohistochemistry to examine the gene and protein levels of CD44v6 in a total of 138 fresh bone tissues. This included 69 tumor tissues comprising osteosarcoma (N = 23), chondrosarcoma (N = 23), and GCT (N = 23), as well as 69 corresponding non-cancerous tumor margins. Furthermore, we investigated the circulating level of CD44v6 by isolating peripheral blood mononuclear cells from 92 blood samples. Among these, 69 samples were obtained from patients diagnosed with primary bone tumors, while the remaining 23 samples were from healthy donors. The primary objectives of our investigation were to assess the correlation between CD44v6 expression levels and clinic-pathological features of the patients, as well as to evaluate the diagnostic and predictive values of CD44v6 in this context. Results In patients with osteosarcoma and chondrosarcoma tumors, both the gene and protein expression of CD44v6 were found to be significantly higher compared to the GCT group. Furthermore, the circulating level of CD44v6 was notably elevated in patients diagnosed with osteosarcoma and chondrosarcoma in comparison to the GCT group and patients with malignant tumor characteristics. Additionally, we observed a strong correlation between the gene and protein levels of CD44v6 and important tumor indicators such as tumor grade, metastasis, recurrence, and size at the tumor site. CD44v6 shows potential in differentiating patients with bone tumors from both control groups and tumor groups with severe and invasive characteristics from those with non-severe features. Importantly, the expression level of CD44v6 also demonstrated predictive value for determining tumor grade and the likelihood of recurrence. Conclusion CD44v6 is likely to play a role in the development of primary bone tumors and has the potential to serve as a diagnostic biomarker for bone cancer. However, to obtain more accurate and conclusive findings, further mechanistic investigations involving larger population samples are necessary.

Background: High level of stress experienced by residents is one of the important factors of the reduction in their efficiency and the increase in their error rate and poor clinical performance.Objectives: The present study was conducted to review, identify and categorize the most important stressors of residents.Methods: In this narrative review study, English articles were reviewed by electronic search of Education Resources Information Center (ERIC), PubMed, ProQuest, Scopus and Google Scholar search engine over the last 10 years (2013-2022).Results: Based on the data, 89 stressors were extracted from 12 articles, and then divided into six categories of "stressors related to care and treatment, stressors related to interpersonal and intrapersonal communication, social stressors, stressors related to course management and planning, stressors related to teaching and learning and stressors related to residents' drive and desires".Conclusion: The identification and categorization of stressors in the present study made it possible that the planners and practitioners of residency courses can design and implement effective solutions to reduce the negative impacts of residents' stressors and, as a result, provide better conditions for their learning and training during the course.

BackgroundHealthcare professionals have a crucial responsibility to provide optimal patient care. However, maintaining silence within an organization can often lead to ethical dilemmas and negatively impact the quality of care. Healthcare professionals must speak up and ensure their concerns are heard and addressed to promote a safe and ethical healthcare environment. This study aimed to translate and assess the psychometric properties of the Persian version of the Organizational Silence Behavior Scale (OSBS-P) for clinical nurses.MethodsA methodological study was conducted on 338 clinical nurses to evaluate the psychometric properties of the Persian version of the 32-item OSBS-P. A multilevel approach was used: forward-backward translation, face and content validity, construct validity (confirmatory factor analysis), and reliability (internal consistency and stability) of the Persian version of the OSBS-P were analyzed, respectively.ResultsThe psychometric evaluation demonstrated that the Persian version of OSBS-P is not only understandable but also retains the conceptual integrity of the original English version. Confirmatory factor analysis validated its alignment with the proposed four-factor model, indicating robust construct validity. The OSBS-P's reliability was excellent, with a Cronbach's alpha coefficient of α = 0.969, and stability was confirmed with an intraclass correlation coefficient (ICC) of 0.951 (95% CI, 0.919-0.945).ConclusionThe OSBS-P is a valid tool for evaluating the organizational silence behavior of clinical nurses.

Abstract Background Previous studies have shown that a disease outbreak may cause high stress among healthcare workers. However, the vast majority of those studies applied a variable-centered approach, in which relationships between the variables are believed to be identical across the studied population. The main purpose of this study was to identify latent profiles of healthcare workers with similar combinations of levels of various work-related stressors during the coronavirus disease 2019 (COVID-19) pandemic and to examine their predictors. Methods A cross-sectional paper-and-pencil study was conducted among a convenience sample of 297 emergency department (ED) nurses and 219 emergency medical services (EMS) staff members working in 10 hospital EDs and 52 EMS centers in Ardabil province, Iran. Data were collected using the Health and Safety Executive Management Standards Indicator Tool (HSE-MS IT). Results Using the latent profile analysis (LPA), five work-related stress profiles were identified: “high stress with a good understanding of one’s job role” (11.1%), “moderate stress” (41.9%), “relatively high stress with average demands and a very low understanding of one’s job role” (23.8%), “low stress” (18.0%), and “generally low stress but with very high job demands and relational conflicts” (5.2%). Age, marital status, service location, workplace, and the number of overtime hours significantly predicted profile membership. Conclusion The results of the study suggest the importance of incorporating various sources of stress and using the person-centered approach when investigating the work-related stress of healthcare workers during disease outbreaks. Identifying sociodemographic and work-related predictors of profile membership may be useful for preparing interventions that will be better suited to healthcare workers’ needs.

Objective Critically ill patients often require intrahospital transfer (IHT) for diagnostic and therapeutic procedures. However, this process carries potential risks and can harm the patient’s safety. This study aimed to assess the safety of IHT for critically ill patients by gathering feedback from emergency and intensive care unit (ICU) nurses.Design A cross-sectional study.Setting A study was conducted in Ardabil City, Iran’s educational and medical hospitals. The study involved 288 emergency and ICU nurses. The data were collected through a paper-based form, which included demographic and work-related characteristics and an IHT safety scale.Results The mean score of IHT was 75.2±15.53. The results of multiple regression analysis showed that work experience (B=0.291, p=0.011), perception of IHT safety (B=0.196, p=0.003), education level (B=−0.123, p=0.038) and equipment checker (B=−0.121, p=0.045), variables were the predictors of IHT safety.Conclusion The study found that the safety level during the interhospital transfer (IHT) was low. Hospitals aim to create a safe environment that minimises the risks associated with IHT. Therefore, they must identify potential risks during the transfer process and take necessary measures to mitigate them. Practical strategies that can be employed include using experienced nursing staff, conducting equipment checks, ensuring a complete understanding of the tools and technologies involved in the transfer process, and increasing awareness of IHT safety.

Avicenna is renowned as a rational philosopher, often regarded as the leader of peripatetic scholars. In addition to his philosophical acclaim, he was a skilled physician. Moreover, he held noteworthy views in mysticism and theology. This research aims to delve into his theological perspectives using a descriptive-analytical approach, which involves investigating his writings and the views of his contemporaries. It becomes evident that Avicenna’s extensive body of work, his reputation as a peripatetic philosopher, and his strongly rationalistic approach, which extends beyond the confines of religion, pose challenges when examining his inter-religious and theological views. Despite his unwavering commitment to his philosophical methodology and propositions, Avicenna did adopt certain conspicuous theological positions and religious approaches that extend beyond his philosophical thinking. This research seeks to explore the various dimensions of these theological and religious views comprehensively. It approaches Avicenna as a devoted Muslim philosopher, shedding light on this intriguing aspect of his intellectual legacy.

Abstract Background Electrocardiogram (ECG) interpretation is a core clinical skill that helps to rapid diagnosis of potentially life-threatening diseases. Misinterpretation of the electrocardiogram can lead to inappropriate clinical decisions with adverse outcomes. The main aim of this survey was to assess the competency of electrocardiogram interpretation and related factors among healthcare professionals and students of Ardabil University of Medical Sciences. Methods This descriptive cross-sectional study included 323 staff and students of Ardabil University of Medical Sciences in northwestern Iran. Data were collected randomly from November to January 1400 using the Badell-Coll ECG Interpretation Competency Questionnaire and analyzed using SPSS V.14. Statistical analysis included descriptive statistics, independent t-test, ANOVA, Pearson correlation coefficient and multiple linear regression. Results The results showed that the mean and standard deviation of electrocardiogram interpretation competency of health professional staff and students was 5.13 ± 2.25 (maximum score = 10). The large number of participants wasn’t able to identify normal sinus rhythm (n = 251, 77.3%), acute myocardial infarction (n = 206, 63.8%) and pathological Q waves (n = 201, 62.2%). The results of multiple linear regression showed that the variables of education level, self-assessment of electrocardiogram interpretation competence, work experience, and type of hospital were able to predict the competence of ECG interpretation in participants. Conclusions Our findings showed that the participants’ level of electrocardiogram interpretation competency was low. Hence, regular, standard training and education are recommended. Also, managers and educators of the health system should consider the role of positive self-assessment and exposure to ECG interpretation in improving the competence of staff and students to interpret ECG.

Abstract This study is aimed to unravel the status of local and circulating β-catenin in different primary bone tumors and its relevance to tumor types, severity, and chemotherapy. The β-catenin mRNA expression level and the expression of the protein (intensity level) were evaluated in tumor tissue and peripheral blood mononuclear cells of 150 patients with different types of primary bone tumors (78 malignant and 72 benign tumors) using Real-Time PCR and immunohistochemistry. The β-catenin mRNA expression level and the expression of the protein were increased in bone tumors which was positively correlated with the tumor malignancy. Amongst osteosarcoma, Ewing's Sarcoma, chondrosarcoma, osteochondroma, Giant Cell Tumor, and exostosis tumors, the osteosarcoma, and Giant Cell Tumor groups showed the highest level of β-catenin expression. The β-catenin expression in malignant bone tumors was significantly correlated with tumor grade, size, metastasis, tumor recurrent, and the level of response to chemotherapy. A similar pattern of β-catenin gene expression and its association with tumor characteristics was detected in the patient's peripheral blood cells. The simultaneous increase in the expression of the β-catenin gene and protein in tumor tissue and in circulating blood cells and its relationship with tumor severity indicates the possible promoting role of β-catenin in primary bone tumor pathogenesis.

Abstract Aims This study aimed to assess predictors of patient safety competency among emergency nurses. Background The role of emergency nurses is to provide high-quality health care to patients and ensure their safety. The patient safety competency includes the absence of unnecessary or potential harm when providing health care to patients. In providing health care, effective teamwork can affect patient safety and outcomes. Psychological safety is essential to effective teamwork. Psychological safety allows health care workers to accept the interpersonal risks needed to perform effective teamwork and maintain patient safety. Methods This study was cross-sectional correlational research. Using convenience sampling methods, 254 emergency department nurses from five educational hospitals were enrolled in the study. Patient Safety in Nursing Education Questionnaire was used to measure the patient safety competency, the teamwork questionnaire to examine the teamwork, and Edmondson psychological safety questionnaire was used to measure psychological safety. Descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson’s r correlation coefficient, and multivariate stepwise linear regression analysis were applied using SPSS 14.0. Results Participants’ mean patient safety competency score was 2.97 (1-4). Between 18 independent variables evaluated in the multiple regression analysis, seven had a significant effect on the patient safety competency of emergency nurses (R2: 0.39, p

Background: Post-Traumatic Stress Disorder (PTSD) is a mental disorder that can result from direct or indirect contact with traumatic events. The current study aimed to evaluate PTSD and its related factors in nurses caring for COVID-19 patients. Materials and Methods: This study was a descriptive correlational study. Using convenience sampling methods, 395 nurses were enrolled in the study. The study instruments included demographic information, Impact of Event Scale-Revised (IES-R), and General Health and Job Content Questionnaire (JCQ). Data were analyzed using the Pearson correlation test, t-test, ANOVA, and multiple regression analysis. Results: The mean (SD) age and work experience of the participants were 33.79 (6.74) years and 9.47 (6.47) years, respectively. Most nurses (86.60%) experienced PTSD. Multiple linear regression results showed general health (R2 = 0.51, p = 0.001), job insecurity (R2 = 0.51, p = 0.042), decision latitude (R2 = 0.51, p = 0.037), and high age (R2 = 0.51, p = 0.049) to be associated with an increase in PTSD, and having high social support (R2 = 0.51, p = 0.043) was associated with a decrease in PTSD in nurses. Conclusions: Nurses have experienced high levels of PTSD after the fatal outbreak of COVID-19 disease. Stressful conditions associated with an increased likelihood of this disorder should be identified, and coping skills such as decision latitude (control) and social support should be strengthened to prevent the symptoms of this disorder in nurses.

IntroductionThe present study tried to provide insights into the expression pattern and diagnostic significance of the IGF-1 axis main mediators in three main primary bone tumor types with different degrees of severity.MethodsThe real-time qRT-PCR (to analyze IGF-1R gene expression), the immunohistochemistry (to measure IGF-1R protein), and the ELISA assay (to assess the circulating level of IGF-1, IGFBP-1, and IGFBP-3) were applied to confirm this hypothesis. A total number of 180 bone tissues (90 tumors and 90 noncancerous adjacent tissues) and 120 blood samples drained from 90 patients with bone tumors and 30 healthy controls were enrolled in the study. The association of insulin-like growth factor (IGF)-1 axis expression pattern with the patient’s clinical pathological characteristics and tumor aggressive features, the diagnostic and predictive values were assessed for all tumor groups.ResultsA significantly elevated level of IGF-1R gene and protein was detected in bone tumors compared to the noncancerous bone tissues that were prominent in osteosarcoma and Ewing sarcoma compared to the GCT group. The positive association of the IGF-1R gene and protein level with tumor grade, metastasis, and recurrence was detected in the osteosarcoma and Ewing sarcoma groups. The circulating level of IGF-1, IGFPB-1, and IGFBP-3 were increased in osteosarcoma and Ewing sarcoma and GCT groups that were correlated significantly to the tumor severity. The ability of the IGF-1 axis to discriminate between bone tumors also malignant and benign tumors was considerable.DiscussionIn summary, our data suggested that IGF-1R, IGF-1, IGFBP-1, and IGFBP-3 levels are associated with bone tumor malignancy, metastasis, and recurrence that might serve as biomarkers for osteosarcoma and Ewing sarcoma recurrence.

Abstract Aims Because of the direct contact nurses have with patients, they are exposed to more stressful events during the outbreak of infectious diseases, which increases their turnover intention, highly impacting not only nurses, but also patients and organizations. The present study aimed to identify the predictors of turnover intention based on psychosocial factors in nurses of Ardabil pre‐hospital emergency and educational and medical centres during the COVID‐19 outbreak. Design The present descriptive‐analytical study was conducted in June, 2020. Methods A total of 479 nurses working in Ardabil pre‐hospital emergency and educational and medical centres to fight COVID‐19 were recruited for this study using the census method. Data were collected using the Demographic Information Questionnaire, Turnover Intention Questionnaire, Weiss & Marmar Impact of Event Scale‐Revised (IES‐R), General Health Questionnaire (12 C‐GHQ) and Job Content Questionnaire (JCQ). Data were analysed with SPSSv.22 software using correlation, t test, analysis of variance, multiple regression and descriptive tests. Results The mean turnover intention score of nurses was 41.73 with a standard deviation of 12.11. The results of correlation coefficient revealed a positive relationship between PTSD, general health, job demand and job strain with turnover intention (p ≤ .01) and a positive and significant relationship between social support and turnover intention (p ≤ .01). Multiple regression analysis showed that the variables of gender, marital status, work position, decision latitude, social support, job strain, general health and post‐traumatic stress disorder (PTSD) were predictors of turnover intention. Conclusion Job stressors during the COVID‐19 outbreak have led to an increase in nurses’ turnover intention. Identifying and managing the factors related to job stressors will make it possible to prevent nurses’ turnover intention in such critical situations.

Background and purpose: Due to the high rate of diabetes in the community and the importance of herbal supplements and exercise in its treatment, the present study aimed at evaluating the effects of hydroalcoholic extract of olive leaf on coronary artery function in streptozotocin-induced diabetic male rats with and without exercise training. Materials and methods: In this experimental study, 50 male Wistar rats (250-300 g) were randomly divided into five groups (n=10 per group): 1. Healthy control (CO), 2. Diabetic control (DC), 3. Diabetic control + Exercise training (DC+EX), 4. Diabetic control + Olea europaea L. (D+OIL), 5. Diabetic + exercise training + Olea europaea L. (DC+EX+OIL). Diabetes was induced by intraperitoneal injection of nicotinamide-streptozotocin. The rats in D+OIL and DC+EX+OIL groups performed submaximal exercise on treadmill for 5 days a week/ 8 weeks and received 200 mg/kgbw Olea europaea L. extract by gavage at 8 AM daily for 8 weeks. Twenty-four hours after the last training session, Isolated hearts were perfused using the Langendorff method and hemodynamic parameters were assessed. Then, levels of antioxidant enzymes and lipoproteins in the blood were measured. Results: Olive leaf extract with 8 weeks of exercise training led to increased activity of superoxide- dismutase and catalaseenzymes and increased lipoprotein levels of LDL and HDL in diabetic rats but it had no effect on improving LDL levels. It also prevented increased response to coronary artery stenosis due to diabetes and increased response to coronary artery dilator. Conclusion: Current study could be helpful in increasing the tendency to use exercise and olive leaf extract in treatment of diabetic patients and preventing cardiovascular complications including coronary artery endothelial disorders in these patients.

Abstract Cancers are serious life-threatening diseases which annually are responsible for millions of deaths across the world. Despite many developments in therapeutic approaches for affected individuals, the rate of morbidity and mortality is high. The survival rate and life quality of cancer patients is still low. In addition, the poor prognosis of patients and side effects of the present treatments underscores that finding novel and effective complementary and alternative therapies is a critical issue. Melatonin is a powerful anticancer agent and its efficiency has been widely documented up to now. Melatonin applies its anticancer abilities through affecting various mechanisms including angiogenesis, apoptosis, autophagy, endoplasmic reticulum stress and oxidative stress. Regarding the implication of mentioned cellular processes in cancer pathogenesis, we aimed to further evaluate the anticancer effects of melatonin via these mechanisms.

Background and aimsPre-hospital emergency technicians face many problems in the workplace daily, so the ability to solve or overcome them in the workplace is essential. This article aimed to assess the predictors of problem-solving skills among emergency medical services staff in Iran.MethodsThis study was cross-sectional correlational research. Using convenience sampling methods, 140 emergency medical services (EMS) staff were enrolled in the study. Response time was assessed using ASAYAR software, problem-solving skills (PSS) were measured using the Hepner Petersen Problem Solving Questionnaire (PSI), and cognitive emotion regulation strategies were assessed using the Garnfsky Cognitive Emotion Regulation Questionnaire. Descriptive statistics, t-test, one-way analysis of variance (ANOVA), Pearson's r correlation coefficient, and multiple linear regression analysis were applied using SPSS 14.0.ResultsThe results of our study showed that the total mean score for problem-solving skills was 136.84 (14.65) (range, 175–107 points). Multiple linear regression indicated that refocusing on planning, positive evaluation, stress management courses, delays and their causes, positive refocusing, catastrophizing, and acceptance were effective predictors of problem-solving skills in emergency personnel, accounting for 54% of the total variances.ConclusionThis study is one of the first studies in this field. Based on our findings, individuals who consider their emotions and feelings when solving problems are better able to use the process of thinking and problem-solving skills. Therefore, by training people in the field of emotional regulation skills, the skills to solve problems technicians can be increased.

The aim of this study was to investigate the antibacterial effects of 445 nm blue diode lasers and erbium chromium lasers on the biofilm of Enterococcus faecalis in root canal dentin with different thicknesses. Dentin slices with thicknesses of 300, 500, and 1,000 microns were prepared; and after the biofilm formation, they were randomly divided into four groups: group A : Er, Cr:YSGG laser radiation; group B: 445 nm diode laser radiation; group C : laser radiation in three cycles; and control group D: 5 samples of each thickness were selected as a positive control group. Er, Cr:YSGG and diode lasers alone did not significantly reduce the number of bacteria in any of the thicknesses. Only in 1 mm thick sections, the group exposed with the both Er, Cr:YSGG laser and 445 nm diode laser (66%) significantly reduced the number of bacteria. There was a significant difference in a thickness of 0.3 mm compared to a thickness of 1 mm, indicating that these lasers had a better effect at a thickness of 0.3 mm than at 1 mm parts (P-value < 0.008). It seems that these lasers can be used as an adjunct to conventional chemical methods in cleaning infected canals.

Purpose: The development of novel and efficient biomarkers for primary bone cancers is of grave importance. Methods: The expression pattern of osteopontin (OPN) was investigated in the 153 patients with benign (n = 72) and malignant (n = 81) primary bone cancers. Both local and circulating OPN mRNA expression levels and their protein concentration in serum and tumor site were assessed using real-time qRT-PCR, ELISA, and immunohistochemistry techniques, respectively. As a control, 29 healthy individuals were considered. The number of 153 tumor tissue specimens and the 153 paired margins were taken on surgical resection from the patients. 153 blood samples were also drained from all participants, then peripheral blood mononuclear cells (PBMC) and sera were separated. Results: The mean mRNA expression was significantly higher in all of the cancerous tissues than the paired margins and the PBMC of the patients than the controls. Consistently, the protein concentrations of OPN in serum and tumor tissues were significantly higher in the patients. Furthermore, the malignant cases had significantly elevated the mRNA levels and the protein compared to the benign cases. OPN could potentially differentiate the patients from the controls with 100% sensitivity and specificity in serum. Moreover, OPN could predict some of the malignant cases' clinicopathological features, including metastasis, recurrence, grade, and response to chemotherapy. Conclusions: In conclusion, OPN might be involved in the pathogenesis of primary bone tumors and can be considered as a potential biomarker to bone cancer diagnosis.

The COVID-19 pandemic has considerably changed the workplace and social relationships of nurses. As potential factors, uncertainty, stigma, and exposure of nurses' families to risk have disturbed the process of providing healthcare services for patients infected by COVID-19. Accordingly, this study aimed at determining the impact of psychological factors on stigma among frontline nurses fighting COVID-19. The extant paper was carried out based on the descriptive-analytical method for April-June 2020. A total of 312 nurses working in educational-medical centers in Ardabil, Iran, were selected using the census method to participate in this research. To collect data, demographic features, stigma, mental health, perceived stress, and hardiness questionnaires were used. The collected data were analyzed using statistical correlation tests, multivariate regression, and descriptive tests through SPSS v.22 Software. The mean score of stigma in nurses equaled 28.36 ± 10.55. Results of the correlation coefficient showed a positive relationship between the mean score of stigma and stress (P ≤ 0.01) as well as the negative relationship between mental health and hardiness (P ≤ 0.01). Multivariate regression analysis indicated that mental health could be the predictor of stigma. Therefore, these factors should be identified and controlled to mitigate stigma under such critical circumstances.

Purpose: The status of the local and circulating SOX9, a master regulator of the tumor fate, and its relevance to tumor types, severity, invasion feature, response to therapy, and chemotherapy treatment were surveyed in bone cancer in the current study. Methods: The SOX9 expression level was evaluated in tissue and peripheral blood mononuclear cells from patients with different types of malignant and benign bone tumors also tumor margin tissues using Real-Time PCR. The protein level of SOX9 was assessed using immunohistochemistry and western blot analysis. Also, the correlations of the SOX9 expression level with the patient’s clinical and pathological features were considered. Results: The remarkable overexpression of SOX9 was detected in bone tumors compared to tumor margin tissues (P

Introduction: Cocaine-induced midline destructive lesions (CIMDL) are complications of regular nasal cocaine inhalation. CIMDL can mimic systemic diseases with positive anti-neutrophil cytoplasmic antibodies (ANCA), such as granulomatosis with polyangiitis (GPA). Case Report: In this article, we describe the case of a young woman who presented with nasal perforation induced by cocaine, along with positive perinuclear ANCA test (proteinase 3 antigen), misdiagnosed as limited GPA. The patient was treated with immunosuppressive therapy, which partially improved her symptoms. Admittance of cocaine use aided in the diagnosis of CIMDL. This patient was advised to stop cocaine use. Three-month follow-up revealed no further complications. Conclusion: Considering the seropositivity of ANCA in both CIMDL and GPA, early diagnosis of CIMDL and its differentiation from GPA is crucial, and clinicians play an important role in this regard. Lack of distinct histologic characteristics of vasculitis or unresponsiveness to standard therapeutic regimens may favor the diagnosis of CIMDL syndrome. It is crucial to recognize that these conditions may have similar presentations, so that undesired and potentially toxic treatments can be prevented.

Objective: Trabecular Bone Score (TBS) is an index of bone microarchitecture that provides additional skeletal information to areal Bone Mineral Density (aBMD). Recently TBS data has been used to optimize the Fracture Risk Assessment Tool (FRAX) predictive value. The aim of this study was to evaluate the clinical value of TBS on FRAX algorithm. Materials and Methods: Among total of 358 postmenopausal Iranian women (mean age 61.3 ± 9.5 years) tested for aBMD and TBS, 184 osteopenic women were identified. Thoracolumbar spine X-ray done in all participants revealed twenty-one vertebral fractures. For the osteopenic group, FRAX and TBS adjusted FRAX (FRAX-TBS) were calculated and compared. Results: Mean TBS of the patients was 1.31 (±0.11). A significant correlation was found between TBS and spine aBMD (r = 0.50, p

Introduction: Education and research are two thinking based processes. Nowadays, the main function of educational institutions is evaluated by thinking. This study aimed to determine the dominant thinking styles among medical and dental students of Ilam University of Medical Sciences (IUMS). Materials and methods: This cross-sectional study was conducted on all medical and dental students of IUMS in the academic year of 2016-2017. Data was collected by Sternberg’s standard thinking style inventory and a demographic data questionnaire. Data analysis was carried out with the software SPSS 20 using descriptive statistical analysis methods and t-test. Results: In total, 497 students of IUMS participated in the study. Among whom 395 (79.5%) were medicals students and 102 (20.5%) were dental students. The findings showed significant differences between the legislative and executive thinking styles of medical and dental students (P=0.042 and P=0.024 respectively), more specifically, the mean score of legislative thinking style was found to be higher among dental students than that of medical students, and the opposite relation was found in the mean scores of executive thinking style. Comparison of mean scores of thinking style dimensions between medical and dental students showed significant differences in some but not all dimensions. Conclusion: Considering the differences found in thinking styles of medical and dental students and their effects in emergence of unique behavioral and decision-making characteristics in medical and dental students, educational planners and professors should attempt to adjust their teaching methods and professional approach according to students individual features in terms of thinking style and preferences so as to foster the growth and flourish of their thinking, academic, and clinical capabilities. The results of the study showed significant differences between the legislative and executive thinking styles of medical and dental students, also regarding the different dimensions of thinking styles of medical and dental students, some significant differences in some but not all dimensions were reported.

Objective Colorectal cancer (CRC) is one of the most common cancers and a major cause of cancer-related death worldwide. The early diagnosis of colorectal tumors is one of the most important challenges in cancer management. MicroRNAs (miRNAs) have provided new insight into CRC development and have been suggested as reliable and stable biomarkers for diagnosis and prognosis. The aim of this study was to analyze the differential expression of miRNAs at different stages of CRC searching for possible correlation with clinicopathological features to examine their potential value as diagnostic biomarkers. Materials and Methods In this case-control study, plasma and matched tissue samples were collected from 74 CRC patients at stage II-IV as well as blood samples from 32 healthy controls. After exhaustive study of the current literature, eight miRNAs including miR-200c, 20a, 21, 31,135b, 133b,145 and let-7g were selected. The expression level of the miRNAs was assayed by quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). Statistical analysis, including t test , Mann-Whitney U, Kruskall-Wallis tests and receiver operating characteristic (ROC) curve was applied, where needed. Results Significantly elevated levels of miR-21, miR-31, miR-20a, miR-135b, and decreased levels of miR- 200c, miR-145 and let-7 g were detected in both plasma and matched tissue samples compared to the healthy group (P0.05). ROC for tissue miRNAs showed an area under the ROC curve (AUC) of 0.98 and P

Background: Postpartum bilateral femoral neck fracture (BFNF) is a rare condition. We here report a case of BFNF due to excessive corticosteroid consumption, twin pregnancy, immobility, and vitamin D deficiency. Case: This is a report of a 32-yr-old woman with bilateral femoral insufficiency fracture five days after emergency cesarean section due to preterm labor, twin pregnancy, and the history of a previous cesarean section at 33 wk. Antenatal repeated courses of betamethasone injections for fetal lung maturity, daily oral use of prednisolone for the history of miscarriage, immobilization, and vitamin D deficiency were the important contributing factors in her past medical history and lab investigations. The bone mineral density examination showed low bone density for the expected age. Conclusion: Clinicians, who deal with pregnant women, should consider the diagnosis of bilateral femoral insufficiency fracture in any pregnant women with pelvic pain. Awareness of risk factors of BFNF might help to reduce the rate of this complication.

Stevia rebaudiana bertoni is a plant with sweetening properties. This medicinal plant is perennial and from Asteraceae family. Its leaves contain glycoside compounds of a sugar part and non-sugar sectors. One of the glycosides compounds is Rebaudioside‌A which has a greater importance in market. Several key regulating genes including copalyl diphosphate synthase (CPPS) (AF034545.1), geranylgeranyl diphosphate synthase (GGDPS) (DQ432013.3), (E)-4-hydroxy-3-methylbut-2-enyl diphosphate synthase (HDS) (FJ755689.1), UDP glucosyltranserase 85C2(UGT85C2)(AY345978.1), UDPglucosyltranserase–74G1 (UGT74G1) (AY345982.1) and UDP glucosyltranserase–76G1 (UGT76G1) (KC631816.1) are involved in the biosynthesis Rebaudioside A. This experiment was conducted to evaluate the effect of silver oxide Ag2O on the mRNA level of these genes in the stevia rebaudiana. The experiments repeated 3 times and with concentrations of 50, 100 and 200 µM. Increasing concentrations of 50 micromoles of silver oxide up to 100 micromoles leads to an increase in the expression levels of all the studied genes. Also according to the expression profile of these genes and the results of HPLC there is a significant increase on the expression level of the genes and production of Rebaudioside‌A under Ag2O treatment. In general, it was found that increasing the concentration of Ag2O can lead to an increase in the level of mRNA for the chosen genes. On the other hand, the low expression of the genes studied under control conditions (No Treatment), compared to the treatment with Ag2O, revealed that the treatment can lead to higher sweetener glycoside components in the Stevia leaves. The physiological assay showed that Ag2O treatment in concentrations of 100 and 200 µM have more positive effect on chlorophyll, protein, carbohydrates and carotenoids in Stevia.

Introduction: Establishing an effective teacher-student relationship may affect the quality of learning. Such a complex human relationship may be influenced by various factors in addition to teacher and student. Aim: The present study aimed at investigating the influence of teacher characteristics on the Teacher-student relationship from students’ perspective. Materials and Methods: In this descriptive-survey research, statistical population included 1500 students at Ilam University of Medical Sciences Ilam, Iran. Out of which 281 students were selected by simple random sampling, they received and completed series of questionnaires. Data was collected using a researcher-made questionnaire containing 37 Likert type items from which five items measured demographic profile of participants and 32 items measured impact of teacher’s characteristics upon the teacher-student relationship. Data was analysed by SPSS software version 16 using descriptive statistics, t-test and One way ANOVA. Results: The current study included 281 students (117 (41.6%) male, 164 (58.4%) female) studying at Ilam University of Medical Sciences. The effect of teachers' characteristics on the teacherstudent relationship from the students’ perspective in three areas (personal, professional and scientific) scored 4.37±0.54, 4.05±0.27, and 3.91±0.44, respectively. The highest score was related to “respect for students” (Mean=4.74, SD=0.55) and the lowest score was dedicated to ‘gender’ (Mean=2.40, SD= 0.64). Effect of other studied parameters was also higher than the average level. Conclusion: The findings indicated that teacher-student relationship and consequently the quality of education was overshadowed by the overall characteristics of teacher (namelypersonal, professional and scientific). Notably, coupled with the professional and scientific properties of the teacher, his/ her communication skills may also help to provide a favourable learning condition for the students. Therefore, attention to the education of scientific as well as professional skills of the teachers in interaction with students through appropriate workshops and training courses is a matter of great necessity.

Emerging technologies of information and communications have been severely affected the society particularly impact on educational systems and new directions ( E-Learning). E-learning rapidly become a significant issue and its place has stabilized in the educational structure of many countries and now learning modern methods being influence to all educational and commercial institutions of the world. Currently e-learning has many changes in higher education and introduced as a new model of a modern educational system and changed learning concepts in the past . In this review paper, after introduction of e-learning system and its main components including CMS and LMS, the world 's newest learning management systems has been studied . Finally the latest version of the Blackboard learning management system is presented .

Introduction: Lesson plan is one of the key factors in the education process. The main purpose of lesson plan is to facilitate teaching and learning by establishing a good communication platform. This study performed a content analysis of the lesson plans developed by faculty members of Ilam University of Medical Sciences. Methods: In this cross – sectional study, all 108 lesson plans developed by the faculty of Ilam University of Medical Sciences in the first and second semesters in 2009 were analyzed. The data was collected by a checklist covering 13 dimensions. Data analysis was done using t-test, and ANOVA. Results: Maximum and minimum ratios of the lesson plans belonged to schools of health (43.5%) and medicine (12%), respectively. The total average score of evaluation of the lesson plans developed was 67.94±16.57 (out of 100). The most common mistakes were related to objectives (45.4%), and evaluation methods (25.9%). The greatest shortcomings were related to dimensions of general and class regulations and policies (58.3%), preparation of learners before class sessions (55.6%), and assignments (40.7%). The dimensions of objectives in the lesson plans (89.9%), teaching methods (82.4%), and references recommended (82.4%) gained the highest scores. There was a significant relationship between faculty members’ academic ranks and evaluation scores of their lesson plans (p=0.03, CI95% =0.6-16.0). Conclusion: Based on the findings of the study, holding lesson plan workshops and using a standardized lesson plan templates could provide an appropriate basis for developing better lesson plans by the faculty.

This paper aims to report on the implementation of internal evaluation in the departments of the college of human sciences (theology, Persian language and literature, and accounting and economics) in Ilam University, Iran, inorder to improve educational quality. This paper points out the findings obtained from a case study of implementing internal evaluation, encompassing 12 steps, in the departments of a university in Iran. Qualitative and quantitative methodologies were used to collect data from the heads, faculty members, students, alumni, and library staff of the departments, as well as the immediate managers of the alumni. The methods of data collection included interviews, group discussions, questionnaires, and checklists. The results of the study show that two departments, Theology and Persian Language and Literature, were desirable in terms of the quality of the seven criteria under evaluation (department management and structure, faculty members, students, alumni, teaching and learning processes, implemented courses, equipment and resources of libraries), and the of Accounting and Economics was quite desirable in this respect. The study also indicated that there were differences among the departments in terms of the quality of the factors under evaluation.

Transient osteoporosis of pregnancy (TOP) is a rare, yet under-reported condition that threatens pregnant women in the third trimester of a usually uneventful pregnancy. It is known to be the consequence of drastic loss of bone mass and elevated rates of bone turnover caused by fetal consumption of calcium and vitamin D from the maternal skeleton (1, 2). Meanwhile, the transient nature of osteoporosis cannot generally be determined at the time of the event, mainly due to the lack of bone mineral density (BMD) history. With respect to our published article “Undesired effect of excessive betamethasone administration during pregnancy: A rare case” in volume 16, issue 3 of your journal (3), we were highly concerned about TOP based on the characteristics of the fracture. However, due to lack of adequate information of previous BMD, this concern could not be supported at that time and postpartum bilateral femoral neck fracture was the reported diagnosis instead. Therefore, we prescribed teriparatide in addition to calcium and vitamin D supplementation for the management of low BMD of the patient, which was discontinued after three months due to the high cost of the drug for her. In order to rule out the main cause of bilateral femoral neck fracture in our patient, we followed the patient for 30 months after the surgery, when her ability to walk was completely returned to normal and she had no other complaint as well. We repeated the BMD of the patients to find out if she needs any osteoporosis medication. An 11% improvement was observed in the last lumbar spine BMD of the patient when compared with the earlier BMD performed at the time of bilateral femoral neck fracture diagnosis (BMD=0.906 g/cm2, T score=-1.3 versus BMD=0.816 g/cm2, T score=-2.1, respectively). According to the provided evidence, especially improvement of follow-up BMD, we are convinced that this case could be truly considered as TOP, which was resolved after pregnancy and elimination of its concomitant risk factors (vitamin D deficiency, immobility, and excess steroid consumption). Although we prescribed teriparatide for the management of low BMD of the patient, our evaluations revealed that osteoporosis will spontaneously resolve in such cases. Hence, the clinical message of these findings could be to avoid unnecessary osteoporosis treatment in premenopausal pregnant women through the definitive diagnosis of TOP.