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Multidrug-resistant (MDR) Acinetobacter baumannii is a serious global health threat. Burn patients are at high risk to acquire A. baumannii infections from endogenous sources. This study evaluated carbapenem resistance and clonal relatedness of A. baumannii isolated from burn patients and healthcare workers (HCWs).The study was performed in 100 non-duplicated A. baumannii isolates from nasal and hand samples of hospitalized burn patients and HCWs in two hospitals of Iran from June 2020 to August 2021. Antimicrobial susceptibility testing was performed and carbapenemase genes were detected by PCR. Clonal relatedness of A. baumannii isolates was determined by two single-locus sequence-based typing of blaOXA-51-like and ampC and by multilocus sequence typing (MLST).All A. baumannii isolates were found to be MDR while susceptible to colistin. The intI1, conserved segments of class 1 integron (intI1 CS), blaIMP, blaVIM, blaOXA-51-like, and blaOXA-23-like, genes were detected in 32.5%, 29.1%, 36%, 95.3%, 100%, 100%; and 14.3%, 14.3%, 21.4%, 92.9%, 100%, and 85.7% of isolates from patients and from healthcare workers, respectively. The blaOXA-58, and blaOXA-143 were not detected among the isolates. Using dual-locus blaOXA-51-like and ampC sequence-based typing (SBT), the isolates obtained from nasal samples of burn patients were grouped into 3 clusters including blaOXA-317, blaADC-88 (72.1%); blaOXA-64, ampC-25 (18.6%); and blaOXA-69, ampC-1 (9.3%). While only allele type blaOXA-317, blaADC-88 was determined among isolates from HCWs. MLST results showed A. baumannii ST136, ST25, and ST1 from burn patients. However, A. baumannii strains from HCWs belonged to ST136. Our findings indicate high prevalence of globally spreading of MDR A. baumannii ST136 carrying blaOXA-23-like from nasal and hand samples of burn patients and HCWs.

With the migration of the enterprise applications to micro-services and containers, cloud service providers, starting with Amazon in 2014, announced a new computational model called function-as-a-service. In these platforms, developers create a set of fine-grained functions with shorter execution times instead of developing coarse-grained software. In addition, the management of system resources and servers is entrusted to cloud service providers. This model has many benefits, such as reducing costs, improving resource utilization, and helping developers focus on the core logic of applications. But still faces many challenges such as balancing cost, balancing performance, programming models, using current dev tools, containers’ cold start problem, saving data in caches, security issues, privacy concerns, and scheduling challenges like execution time prediction. In this paper, we focus on scheduling and cold start problems. Compromise occurs when keeping warm operating environments which can reduce cold start times but increase costs. In this study, we propose a dynamic waiting time adjustment approach. We aim to create a trade-off by using four different types of decisions at runtime using a heuristic method and analyzing the function dependency graph, functions’ invocation frequency, and other environmental parameters. The proposed method shows a 32% improvement over the fixed-time method (i.e. the method used by Apache OpenWhisk). This comparison is made from the cumulative measurement viewpoint which is a combination of response time, turnaround time, cost, and utilization.

Background: Acinetobacter baumannii is known as one of the major causes of nosocomial infections, especially in intensive care units and burn patients. The emergence of antimicrobial resistance in burn wound bacterial pathogens is a severe health crisis. Detection of carbapenem resistance and genetic elements in A. baumannii associated with burn patients and hospital environments play a key role in the control and alerting in clinical settings. Purpose: In this study, the prevalence of OXA-type carbapenemases was investigated in A. baumannii strains isolated from burn patients and from a hospital environment in Tehran, 2021. Methods: A total of 85 non-duplicate A. baumannii isolates (53 from various surfaces of the hospital environment and 32 from burn patients) were recovered in the Burns Hospital in Tehran. The A. baumannii isolates were screened for antibiotic susceptibility and the presence of the most common OXA-type carbapenemase genes. Results: A. baumannii was isolated from 38.5% of hospital patient burn wounds and 22.1% of surfaces, including burn units (15.6%) and intensive care units (52.4%). Antibiotic susceptibility results showed that (100%) of burn patient isolates were resistant to imipenem, while (100%) of ICU isolates and (96.8%) of burn isolates were resistant to imipenem. All clinical isolates were identified as MDR and XDR, whereas all (100%) and 98.1% of environmental isolates were identified as MDR and XDR, respectively. All studied A. baumannii isolates carried blaOXA-51-like gene. Moreover, 50 (94.3%) and 49 (92.5%) of environmental isolates, 32 (100%) and 30 (93.7%) of burn patient isolate harbored blaOXA-23-like and blaOXA-24/40–like genes, respectively. None of the isolates carried the blaOXA-58 or blaOXA-143 genes and all isolates had at least 2 OXA-type carbapenemase genes. Conclusion: Our results suggest that surfaces in the hospital environment, particularly in ICUs, are contaminated with MDR or XDR A. baumannii strains. They may be considered a potential reservoir for the colonization of hospital patients. In addition, OXA-type carbapenemases, including OXA-23-like and OXA-24/40-like, appear to be one of the major mechanisms of carbapenem resistance in the clinical and environmental A. baumannii strains.

BackgroundProfessional identity (PI) is a key factor behind nurses' ability to provide quality care. PI assessment requires valid and reliable tools.AimThis study aimed to translate into Persian the 9-item Macleod Clark Professional Identity Scale (MCPIS) and evaluate its psychometric properties among Iranian nursing students.MethodsIn this methodological study, SMCPIS was translated into Persian through forward–backward translation. The face and content validity of the translated scale were respectively assessed by 10 nursing students and a panel of 10 experts. Then, 171 nursing students completed MCPIS and Nurse Self-Concept Questionnaire. Collected data were used for construct validity assessment through confirmatory factor analysis and criterion validity assessment through correlation analysis. Reliability assessment was also performed through the internal consistency and the test-retest methods.FindingsConfirmatory factor analysis revealed good fit model for the scale. Criterion validity, measuring convergent validity, assessment also showed a significant correlation between the scores of MCPIS and Nurse Self-Concept Questionnaire (r = −0.2, P = .07). Cronbach's alpha and test–retest correlation coefficient were .87 and .72, respectively. Students' MCPIS scores ranged from 15 to 54 with a median of 44 (in the possible range of 9–54).ConclusionThe Persian MCPIS is a valid and reliable tool for PI assessment. Further studies are recommended to produce evidence supporting the validity and reliability of the scale.

Background: Breast cancer disease and its classic treatment lead to decrease in patients' quality of life (QOL). This systematic review aimed to compare the effectiveness of complementary and alternative medicines (CAMs) categories on the QOL of women with breast cancer. Methods: English clinical trials from PubMed, Emabase, Scupos, and Google Scholar databases were searched electronically by the end of 2018 with the Cochrane Collaboration protocol. Two researchers independently extracted data such as participants' characteristics, CAM methods, QOL assessment tools. CAMs were classified into three categories of dietary supplements, herbal medicine, and mind-body techniques. Results: During the initial search, 1186 articles were found. After reviewing titles, abstracts, and full texts based on inclusion and exclusion criteria, 28 clinical trials were included in the systematic review, 18 of which was randomized controlled trial (RCT). Participants included women with breast cancer who were undergoing the first three phases of breast cancer or postcancer rehabilitation. Among CAM interventions, one article used a dietary supplement, and the other 27 articles included a variety of mind-body techniques. Twenty-seven studies showed improved QOL (P > 0.05). Conclusion: The findings may indicate the potential benefits of CAMs, especially mind-body techniques on QOL in breast cancer patients. Further RCTs or long-term follow-up studies are recommended. Moreover, the use of similar QOL assessment tools allows for more meta-analysis and generalizability of results, especially for the development of clinical guidelines.

Objectives In the nursing education system, evolution is required to train qualified and professionally competent nurses who can face workplace challenges and evolving needs of societies. This study aimed to explore effective factors and challenges of the formation of transformational education in the nursing education system. Methods This was a qualitative study with a grounded theory approach. Twenty-four individuals participated through purposive and theoretical sampling. The authors collected data using semi-structured interviews and analyzed them by Corbin, J., & Strauss, A. (2015). Basics of qualitative research: Techniques and procedures for developing grounded theory (4th ed.). Los Angeles: Sage Publication grounded-theory method. Results Findings showed the process of formation of transformational education which encompasses four concepts including, “transformational leadership”, “effective learning”, “necessity of foresight in education”, and “inhibitors of educational transformation”. Transformational education is a complex and multidimensional education. Conclusions Implementation of this education requires preparing transformational leaders, planning to empower faculty members and students, and preparing for the challenges facing the education system.

ObjectivesEdication management is a process in which medications are selected, procured, delivered, prescribed, reviewed, administered and monitored to assure high-quality patient care and safety. This paper explores clinicians’ attitudes towards medication management which is both open to influence and strongly linked to successful changes in mediation behaviour. We aimed to investigate effects of engaging in participatory action research to improve emergency medicine clinicians’ attitudes to safety in medication management.SettingEmergency department of one university affiliated hospital.ParticipantsA total of 85 clinicians including nurses and physicians partook as participants. Eight managers and clinicians participated as representatives.DesignData are drawn from two-cycle participatory action research. Initially, a situation analysis on the current medication management and clinician views regarding medication management was conducted using three focus groups. Evaluation and reflection data were obtained through qualitative interviews. All qualitative data were analysed using content analysis.ResultsClinicians initially expressed negative attitudes towards existing and new plans for medication management, in that they were critical of current medication-related policy and procedures, as well as wary of the potential relevance and utility of potential changes to medication management. Through the action research, improvement actions were implemented including interprofessional courses, pharmacist-led interventions and the development of new guidelines regarding medication management. Participants and their representatives were engaged in all participatory action research stages with different levels of involvement. Extracted results from evaluation and reflection stages revealed that by engaging in the action research and practice new interventions, clinicians’ attitude towards medication management was improved.ConclusionsThe results support the impact of participatory action research on enhancing clinicians’ positive attitudes through their involvement in planning and implementing safety enhancing aspects of medication management.

A hybrid molecular simulation, as a combination of molecular dynamics and Grand Canonical Monte Carlo simulation, is performed to investigate the storage capacity of hydrogen in carbon nanostructure adsorbents. Pure graphene sheet, nitrogen-doped graphene sheet, palladium-decorated graphene sheet and nitrogen-doped graphene sheet decorated with palladium atoms are selected for this purpose. Palladium is added to the structure in atomic and nanoparticle forms. Initially, all selected systems are optimized using density functional theory (DFT). The atomic charges of various structures are incorporated in the hybrid simulation. Then, hybrid simulations of hydrogen adsorption in different structures are performed at a temperature of 300 K in the pressure range of 1–40 bar. Simulation results show that among various structures, the simultaneous doping of graphene sheet with nitrogen atom and decoration of sheets by palladium atoms could increase the storage capacity by about 437% in comparison to pure graphene. In addition, the atomic form of palladium is more efficient than its nanoparticle form. Finally, comparing the adsorption capacity of the proposed structure with the target set by the US Department of Energy for 2020 indicates that proposed nanostructure can improve this target for hydrogen storage in comparison with previous carbon structure materials.

Background: Medication management is a cyclic and multidisciplinary approach to enhance safe medication therapy. This paper explores clinician attitude toward medication management which is both open to influence and strongly linked to successful changes in mediation behavior.Purpose: To investigate effects of engaging in participatory action research to improve emergency medicine clinicians’ attitudes toward implementing effective medication management.Methodology: Data are drawn from two-cycle participatory action research. Within the study, a total of 85 clinicians including nurses and physicians from emergency department of one university affiliated hospital participated as participants. Eight managers and clinicians participated as representatives. Initially, a situation analysis on the current medication management and clinician views regarding medication management was conducted using three focus groups. Evaluation and reflection data were obtained through qualitative interviews. All qualitative data were analyzed using content analysis. Results: Clinicians initially expressed negative attitudes toward existing and new plans for medication management, in that they were critical of current medication-related policy and procedures, as well as wary of the potential relevance and utility of potential changes to medication management. Through the action research, improvement actions were implemented including interprofessional courses, pharmacist-led interventions, and the development of new guidelines regarding medication management. Participants and their representatives were engaged in all participatory action research stages. Extracted results from evaluation and reflection stages revealed that by engaging in the action research and practice new interventions, clinicians’ attitude toward medication management was improved. Conclusion: The results support the impact of participatory action research on enhanced clinicians’ positive attitudes through involvement in planning and implementing medication management actions.

Background Improving the competencies of nurses requires improving educational methods through the use of novel methods in teaching and learning. We aim to explore the perceptions of stakeholders (including nursing education directors, faculty members and nursing students) of the requirements of implementing innovative educational approaches in nursing. Methods In this qualitative descriptive study, 19 participants, including educational directors, faculty members, and undergraduate and graduate nursing students, were selected through the purposeful sampling method. Achieving the theoretical saturation in extracted categories was considered as a criterion for determining the sample size and the completion of sampling. The data were collected from December 2019 to May 2020 in nursing schools of Tehran, Iran, through in-depth semi-structured individual face-to-face interviews and were then analyzed based on the Graneheim and Lundman method. Results Using qualitative content analysis, eight sub-themes and three themes were extracted. The extracted themes were ‘novel educational policymaking’, ‘Innovative education-oriented platform’, and ‘managing barriers of innovative educational approaches’. Conclusions Developing and implementing innovative educational approaches entail providing appropriate context, structure, and required facilities by the policymaking system and educational authorities. In addition, developing capacity and related competencies of faculty members and students as the major stakeholders in employing these approaches is crucial.

Aim To explore the extent to which action research assists developing medication safety behaviours among emergency medicine staff. Background Health care staff involved in medication therapy are frequently required to implement progressive changes. To permanently improve medication safety, we must consider staff behaviour. This study utilizes action research to engage health care workers and engender behavioural changes. Method Two cycles of action research were implemented. Data were collected through pre- and post-medication safety surveys, unstructured interviews and field notes. Staff in the emergency department worked together to progress the study cycles. Results The pre-evaluation phase revealed deficiencies in staff medication safety behaviour. Subsequent to the implementation of safety initiatives, pre- to post-evaluation comparison indicated significant improvement in medication safety behaviours. In response to qualitative reflection phase data in reflection, ward pharmacists were placed in the emergency department and anew policy on responding to medication error was developed. Analysed field notes revealed improved safe patient care, enhanced pharmaceutical knowledge and changes in the emergency department climate. Conclusions Through action research, this study introduced actions to improve medication safety behaviours in the emergency department. Staff involvement led to changed safety behaviours. Implication for nursing management This study advises nurse managers of the benefit of pharmacist-led medication therapy, interprofessional medication safety courses and active communication between front-line staff and managers regarding medication safety.

The preparation and characterization of binary spinel nickel cobaltite, NiCo2O4 are presented by two methods. The prepared NiCo2O4 nanocomposites were tested for 1,3-dipolar cycloaddition reaction of different benzyl halides with phenylacetylene. The heterogeneity of the NiCo2O4 catalytic system was investigated using a hot filtration test, indicating that there is virtually no catalyst leaching into the reaction solution under the applied reaction conditions. Furthermore, our results show that the catalytic system can be reused four times without significant loss of stability or any additional treatment.

Background and aims Upper limb amputations cause numerous physical and psychosocial challenges including disruptions to quality of life as well as limitations in participation in society. While there is a great deal of literature on patients undergoing lower limb amputation, information on upper limb amputation is limited. This study aimed, therefore, to explore care needs in patients undergoing upper limb amputation. Materials and methods An integrative review was conducted. The five-stage framework introduced by Whittemore and Knafl was used: problem identification, literature search, data evaluation, data analysis and presentation of results. Searches were performed based on predefined inclusion and exclusion criteria for online and unpublished research between 2008 to 2018. Data was extracted using CASP and STROBE checklists and analyzed using conventional inductive content analysis. Results Conventional content analysis method, applied to the full texts of the final articles, included 21 articles (4 qualitative articles and 17 quantitative articles). The care needs identified included 33 care needs in 6 domains: social needs, health care system, rehabilitation program, necessity of self-care, assisting in timely and correct decision-making and patient and family education. Conclusion Rehabilitation plans should be made for all patients, with special attention to male workers. This should begin at the time of admission and continue after their discharge. Routine follow up after discharge is essential. Care must be provided by a multidisciplinary team with timely and accurate referral and with consideration of culture and individual factors.

In this study, transition metals (TM) such as palladium (Pd) have been introduced on co-doped graphene and defect graphene sheets with nitrogen and boron ad-atoms to investigate the potentials of new adsorbents for hydrogen storage. The first principle studies using density functional theory (DFT) and DFT-D3 correction dispersion were undertaken to calculate the adsorption energy of hydrogen molecule on the graphene sheet. The results showed that applying Pd transition metal could enhance adsorption energy of hydrogen molecules towards pristine sheet. The main problem in applying transition metal on graphene sheets was concerned with clustering. However, the current defects in graphene sheets prevent clustering event. Our simulation results suggested that these defects reduced hydrogen adsorption and substitute dopants such as nitrogen and boron together on graphene sheets could improve the adsorption energy. Thus, two various forms of Pd decorated N B co-doped as hexagonal and double carbon vacancy (DCV) were introduced as new structures for hydrogen storage. A physical adsorption, which is appropriate for reversible hydrogen storage, was implemented for both novel adsorbents. In the two various forms of N B co-doped structures, DCV had the optimum adsorption behavior as adsorption energy level and density of state (DOS) phenomena. Moreover, the results of adsorption energy using DFT method were consistent with that of DFT-D3 correction dispersion and higher amounts of adsorption energy in DFT-D3 method were obtained. Finally, results introduced Pd decorated N B co-doped graphene sheets as a novel material for hydrogen storage.

Background Nursing students' perceptions of their professional preparedness help them perform their independent nursing role with self-confidence. Objectives To develop and psychometric testing of an instrument, the “Perceived Professional Preparedness of senior Nursing Students” questionnaire. Design Mixed-method exploratory study. Methods We conducted this study in two phases: (1) development of initial questionnaire through interview and literature review; (2) evaluation of psychometric properties of the instrument to introduce a reliable, valid tool. Settings and participants We assessed qualitative and quantitative face validity of initial questionnaire by administering it to 10 nursing students. Then, a panel of 10 nursing specialists determined the Content Validity Index. After modifying items, we assessed the construct validity of the 45-item questionnaire. A sample of 159 senior nursing students completed the questionnaire, and we conducted exploratory and confirmatory factor analysis using this data. To assess the test-retest reliability, 30 students completed the instrument twice with a two-week time interval. Results The Content Validity Index with the modified Kappa coefficient was calculated as ≥0.72, which is considered satisfactory. In exploratory factor analysis using the maximum likelihood method and varimax rotation, we extracted 19 items in four factors. This structure included 61.91% of the total variance. The factors were clinical competency, evidence-based practice, framework-oriented performance, and patient-centered care. Cronbach's alpha coefficient and McDonald's omega values higher than 0.70 and inter-class correlation coefficient above 0.90 for all factors confirmed reliability. Confirmatory factor analysis indicated a suitable fitting of the final developed model. Conclusion The developed questionnaire is a valid, reliable tool to assess the perceived preparedness of senior nursing students for transition to the clinical setting. Further psychometric testing for this questionnaire on larger populations and in different contexts is suggested.

Clostridium perfringens beta toxin is only produced by types B and C and plays an important role in many human and animal diseases, causing fatal conditions that originate in the intestines. We compared the expression of C. perfringens type B vaccine strain recombinant beta toxin gene in the Escherichia coli strains RosettaTM(DE3) and BL21(DE3). The beta toxin gene was extracted from pJETβ and ligated with pET22b(+). pET22β was transformed into E. coli strains BL21(DE3) and RosettaTM(DE3). Recombinant protein was expressed as a soluble protein after isopropyl β-D-1-thiogalactopyranoside (IPTG) induction in strain RosettaTM(DE3) but not in BL21(DE3). Expression was optimised by growing recombinant cells at 37 °C and at an induction of 0.5 mM, 1 mM, 1.5 mM IPTG. Expression was evaluated using sodium dodecyl sulfate Polyacrylamide gel electrophoresis (SDS-PAGE). The recombinant protein was purified via Ni-NTA and was analysed using western blot. We concluded that E. coli strain RosettaTM(DE3) can enhance the expression of C. perfringens recombinant beta toxin.Keywords: C. perfringens beta toxin (CPB); expression; RosettaTM; BL21

Background: Acute Lymphoblastic Leukemia (ALL) is the most common malignancy among children for whom radiotherapy and chemotherapy are used for treatment. When hypothalamus-pituitary axis is exposed to radiotherapy, children′s hormone level and quality of life are influenced. The aim of this study is to determine late effects of radiotherapy on hormonal level in these patients. Materials and Methods: In this study 27 children with ALL, who have been referred to Shahid Ramezanzadeh Radiation Oncology Center in Yazd-Iran and received 18-24 Gy whole brain radiation with Cobalt 60 or 9 MV linear accelerator, were assessed. These patient′s basic weight, height and hormonal levels were measured before radiotherapy and also after different periods of time. Results: GHD (growth hormone deficiency) after clonidine stimulation test was observed in 44% (n=12) and that in 50% of them (n =6), less than 1 year, had been passed from their radiation therapy. None of these patients demonstrated hormone deficiency in other axes. Conclusions: This study showed that even application of a 18-24 Gy radiation dose might influence growth hormone levels; therefore, we recommend reduction of radiotherapy dose in such patients whenever possible.

Background: There is limited data about the effects of smoking cessation (SC) strategies among the candidates for coronary artery bypass graft (CABG) surgery. Objectives: This study aimed to compare the effects of nicotine replacement therapy (NRT) and nursing counseling (NC) on SC among the candidates for CABG. Methods: This randomized controlled trial was made in the heart center of Afshar hospital, Yazd, Iran. Sixty candidates for elective bypass graft were recruited and were randomly allocated either to a NC or a NRT group. Study interventions were implemented from 3 weeks before to 3 weeks after the surgery. Before and after hospitalization for the surgery, patients in the counseling group received telephone counseling while during their 1-week hospital stay, they received face-to-face counseling. Patients in the NRT group received nicotine gums before and after hospitalization and were treated with nicotine patches during their 1-week hospital stay. Data were collected through three questionnaires. The Chi-square and the independent-sample t tests were run to analyze the data. Results: SC rate in the counseling group was significantly higher than the NRT group (63.3% vs. 33.3%; P = 0.038). Moreover, cessation rate among the participants with lower nicotine dependency was significantly greater than those with moderate-to-severe dependency (P = 0.01). Conclusion: NC is more effective than NRT in improving SC rate among the candidates for CABG.