Significant up-regulation of lncRNAs in neuromyelitis optica spectrum disorder

Neuromyelitis optica spectrum disorder (NMOSD) is an immune-related demyelinating defect. Long non-coding RNAs (lncRNAs) might influence the pathobiology and progression of NMOSD. The current study assessed expression level of NEAT1, PANDAR, MEG3 and TUG1 lncRNAs in the peripheral blood of NMOSD patients compared with healthy individuals. All mentioned lncRNAs were shown to be over-expressed in total NMOSD cases, male NMOSD cases and female NMOSD cases compared with the matching control subgroups. MEG3 had the most robust over-expression in patients subgroups compared with normal subjects. There was no noteworthy difference in the expression of any of lncRNAs between female and male patients. MEG3 had an ideal performance in the differentiation of NMOSD cases from healthy persons (Sensitivity and specificity values = 100%). Other lncRNAs could also efficiently separate NMOSD cases from control subjects (AUC values = 0.97, 0.89 and 0.88 for PANDAR, NEAT1 and TUG1, respectively). Cumulatively, NEAT1, PANDAR, MEG3 and TUG1 lncRNAs can be considered as appropriate disease markers for NMOSD.

Burnout Rates in Clinical Radiation Oncology and Variations across Professional Subgroups

PURPOSE/OBJECTIVE(S)

Physician and medical professional burnout has emerged as an important issue in clinical medicine and has been shown to negatively affect patient outcomes. The aim of this study is to determine how rates of burnout vary between different radiation oncology professional subgroups.

MATERIALS/METHODS

Participants were selected from those employed in one of the professional subgroups (radiation therapists, nurses, physicists, dosimetrists, and physicians) at two institutions that cover a total of seven sites. 126 individuals were recruited to participate. In addition to demographics, participants were asked to respond to questions regarding professional burnout utilizing the Maslach Burnout Inventory (MBI). Responses were on a seven-point Likert scale with subcategories of Exhaustion, Depersonalization, and Personal Achievement. Each participant's score per subcategory was categorized as either low, moderate, or high. For our primary outcome, frequencies and proportions were reported and Fisher's Exact Test was used to evaluate whether there was a statistically significant difference in proportions in categorized burnout scores across professional subgroups. Secondary analyses were performed comparing burnout across sex, age, and categorized years in position. An alpha level of 0.05 was used for all analyses.

RESULTS

In total, 55 participants responded to the survey: 12 nurses, 8 dosimetrists, 12 physicians, 5 physicists, and 18 radiation therapists for a response rate of 43.6%. Demographics were consistent across professional subgroups with the exception of participant sex (p = .0397), which had a greater proportion of females (72.22%) in the Radiation Therapist subgroup. Among the three subcategories, only Exhaustion had a significant difference between groups (p = .0494) with Dosimetrists (62.50%) and Physicists (40.00%) experiencing the highest level of burnout. For Depersonalization, at least one individual in each subgroup identified high burnout with higher rates among the Dosimetrists (25.00%) and Physicists (40.00%). Similarly, at least one person in each subgroup reported high burnout in Personal Achievement, but the highest response was among Dosimetrists (37.50%). In total, at least 12.75% of participants reported high burnout in at least one subcategory. No statistically significant differences in burnout were detected in our secondary analyses across sex, age, and years in position.

CONCLUSION

Our study showed that burnout rates are moderate in members of the radiation oncology team, with dosimetrists and physicists displaying the highest levels of burnout. In order to better estimate professional burnout, larger studies should be conducted to determine causes of burnout. Furthermore, wellness programs should be encouraged and incentivized to help reduce burnout and improve workplace morale, occupational fulfillment, and effective patient care.

Multidimensional characterization of inducible promoters and a highly light-sensitive LOV-transcription factor

The ability to independently control the expression of different genes is important for quantitative biology. Using budding yeast, we characterize GAL1pr, GALL, MET3pr, CUP1pr, PHO5pr, tetOpr, terminator-tetOpr, Z₃EV, blue-light inducible optogenetic systems El222-LIP, El222-GLIP, and red-light inducible PhyB-PIF3. We report kinetic parameters, noise scaling, impact on growth, and the fundamental leakiness of each system using an intuitive unit, maxGAL1. We uncover disadvantages of widely used tools, e.g., nonmonotonic activity of MET3pr and GALL, slow off kinetics of the doxycycline- and estradiol-inducible systems tetOpr and Z₃EV, and high variability of PHO5pr and red-light activated PhyB-PIF3 system. We introduce two previously uncharacterized systems: strongLOV, a more light-sensitive El222 mutant, and ARG3pr, which is induced in the absence of arginine or presence of methionine. To demonstrate fine control over gene circuits, we experimentally tune the time between cell cycle Start and mitosis, artificially simulating near-wild-type timing. All strains, constructs, code, and data ( https://promoter-benchmark.epfl.ch/ ) are made available.

Quality of Professional Life and Its Association with Emotional Well-Being among COVID-19 Physicians and Nurses

Background

The present study was to compare the professional quality of life (ProQOL) and its association with the emotional well-being among the physicians and nurses in contact with COVID-19 patients in Iran and France.

Materials and Methods

The study was performed on 903 nurses and physicians in contact with COVID-19 patients in Iran and France.he subjects completed their demographics online and then answered questions addressing their job stress and emotion associated with their contact with COVID-19 patients and ProQOL. Finally, the collected data were analyzed using the SPSS software (ver. 25).

Results

According to the results of the present study, the degree of contact with COVID-19 patients had a significant role in compassion satisfaction, burnout, and compassion fatigue, with the coefficient effects of 0.459, 0.688, and 0.433, respectively (P < 0.05). The emotional well-being had a significant role in increasing compassion satisfaction (B = 0.505, P < 0.05).

Conclusion

According to the results of the present study, factors such as contact with a COVID-19 patient, emotional well-being, gender, and marital status had a significant effect on dimensions of ProQOL in both Iran and France. Considering that the entire focus of the physicians and nurses is on the health of COVID-19 patients and they have no concentration on improving their emotional state, it seems that supporting them in terms of psychological self-care and considering its indirect impact on the quality of professional performance are of particular significance.

The optimal strategy balancing risk and speed predicts DNA damage checkpoint override times

Checkpoints arrest biological processes allowing time for error correction. The phenomenon of checkpoint override (also known as checkpoint adaptation, slippage, or leakage), during cellular self-replication is biologically critical but currently lacks a quantitative, functional, or system-level understanding. To uncover fundamental laws governing error-correction systems, we derived a general theory of optimal checkpoint strategies, balancing the trade-off between risk and self-replication speed. Mathematically, the problem maps onto the optimization of an absorbing boundary for a random walk. We applied the theory to the DNA damage checkpoint (DDC) in budding yeast, an intensively researched model checkpoint. Using novel reporters for double-strand DNA breaks (DSBs), we first quantified the probability distribution of DSB repair in time including rare events and, secondly, the survival probability after override. With these inputs, the optimal theory predicted remarkably accurately override times as a function of DSB numbers, which we measured precisely for the first time. Thus, a first-principles calculation revealed undiscovered patterns underlying highly noisy override processes. Our multi-DSB measurements revise well-known past results and show that override is more general than previously thought.

Towards Career Satisfaction by Career Adaptation Model Among Individuals With Visual Impairment

The present study aimed to examine the fit of the career adaptation model for individuals with visual impairment. This study was conducted on 319 individuals with visual impairment. The results demonstrated the relationship between adaptivity and adaption was fully mediated by adaptability and adapting. In addition, career adaptability partially mediated the relationship between adaptivity and adapting. However, the results did not confirm the mediating role of adapting in the relationship between adaptability and adaptation. Finally, the results indicated the full mediator role of adaptability in the association between adaptivity and adaptation. The findings highlighted the important role of adaptability in the career adaptation model to explain career satisfaction. Therefore, intervention programs based on career adaptability can empower individuals with visual impairment and promote career satisfaction.

Designing a Predictive Model for Colorectal Neoplasia Diagnosis Based on Clinical and Laboratory Findings in Colonoscopy Candidate Patients

BACKGROUND

Health authorities have expanded two strategies to diminish CRC-related influence: CR screening and improve diagnostic process in symptomatic patients. The aim of the current study is to design a predictive model to identify the most important risk factors that can efficiently predict patients who have high risk of colorectal neoplasia.

METHOD

A cross-sectional study was constructed to include all patients who had positive test for FIT or had one or more risk factors for colorectal cancer based on the guidelines of detecting high-risk groups for colorectal cancer in Iran. Multivariable binary logistic regression model was constructed for prediction of colorectal neoplasia. We used sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio to check the accuracy. The Hosmer-Lemeshow test, chi-square test, and p value were used to determine the precision of model.

RESULT

Following an AIC stepwise selection model, only nine potential variables, namely gender, watery diarrhea, IBD, abdominal pain, melena, body mass index, depression drug, anti-inflammatory drug, and age, were found to be a predictor of colorectal neoplasia. The best cut-point probability in the final model was 0.27 and results of sensitivity and specificity, based on maximizing these two criteria, were 66% and 62%, respectively.

CONCLUSION

Overall, our model prediction was comparable with other risk prediction models for colorectal cancer. It had a modest discriminatory power to distinguish an individual's neoplasia colorectal risk.

Contributing factors to the total fertility rate declining trend in the Middle East and North Africa: a systemic review

BACKGROUND

The total fertility rate (TFR) in the Middle East and North Africa has experienced a declining trend in recent years. Accordingly, the present study was conducted to provide a clear picture of the most critical factors affecting the TFR decline in this region.

METHODS

This study was a systematic review between the years 2000 and 2016. The different databases like Cochrane, PubMed, Scopus, and Science Direct and the Google Scholar search engine were used. At first, 270 articles and then 18 articles were selected and meticulously read for the final analysis.

RESULTS

The results indicated a declining trend in the TFR in the Middle East and North Africa, as in other parts of the world. Regarding the causes of this declining trend, several factors were identified and categorized into five main factors of health care-related, cultural, economic, social, and political.

CONCLUSIONS

While taking advantage of the experiences, it is necessary to identify the five main factors and their related issues and hence consider them in the population policy-making.

Climate effects on the COVID-19 outbreak: a comparative analysis between the UAE and Switzerland

The main aim of the present study is to disclose the similarities or differences of the climate effects on the COVID-19 outbreak in two countries, which have different climatic conditions. Using the correlation modeling, the results revealed that some climatic factors, such as the ULR, temperature, and CH₄ in the UAE and aerosol index and NO₂ in Switzerland have positive lagged correlations with the outburst of COVID-19 by intensifying role within − 9, − 7, and − 2 days. The mitigating role was also observed for ozone/solar radiation and temperature/long-wave radiation in the UAE and Switzerland, respectively. The initial hypotheses of the research have confirmed the correlations between new cases of COVID-19 and ULR and aerosol indices in the UAE and Switzerland. However, the main finding revealed that the climate effects on the COVID-19 outbreak show different roles in the different countries, locating in dissimilar climatic zones. Accordingly, the COVID-19 can be intensified by increases of the ULR and temperature in an arid region, while it can be exactly mitigated by increases of these factors in a temperate area. This finding may be useful for future researches for identifying the essential influencing factors for the mitigating COVID-19 outbreak.

A convolutional neural network segments yeast microscopy images with high accuracy

The identification of cell borders ('segmentation') in microscopy images constitutes a bottleneck for large-scale experiments. For the model organism Saccharomyces cerevisiae, current segmentation methods face challenges when cells bud, crowd, or exhibit irregular features. We present a convolutional neural network (CNN) named YeaZ, the underlying training set of high-quality segmented yeast images (>10 000 cells) including mutants, stressed cells, and time courses, as well as a graphical user interface and a web application ( www.quantsysbio.com/data-and-software ) to efficiently employ, test, and expand the system. A key feature is a cell-cell boundary test which avoids the need for fluorescent markers. Our CNN is highly accurate, including for buds, and outperforms existing methods on benchmark images, indicating it transfers well to other conditions. To demonstrate how efficient large-scale image processing uncovers new biology, we analyze the geometries of ≈2200 wild-type and cyclin mutant cells and find that morphogenesis control occurs unexpectedly early and gradually.

Effective factors on improving the quality of hospital services in south of Iran

OBJECTIVE

To determine the quality of service being provided in a hospital in southern Iran and to evaluate it from patients' perspective.

METHODS

The cross-sectional study was conducted at a general university hospital in Shiraz, southern Iran, in two phases in 2015. The first phase comprised a survey based on SERVQUAL method-ServQual stands for Service Quality- and collected data from hospitalised patients. In second stage Decision Making Trial and Evaluation (DEMATEL) technique was employed to prioritize quality factors identified in first stage to suggest action. The second phase comprised experts who determined the relationship between 5 quality aspects and 14 criteria in line with DEMATEL matrixes. SPSS 16 was used for data analysis.

RESULTS

Of the 208 subjects in the first phase, 103(49.5%) were men and 105(50.5%) were women. The second phase had 12 experts from among the senior nursing staff. In all the five aspects of service quality, the hospital was not able to meet the expectations of the patients (p<0.001). DEMATEL analysis indicated responsiveness as the most important element for improving service quality, followed by reliability, empathy, assurance and tangibility.

CONCLUSIONS

The authorities running the hospital needed to eliminate the negative gap and improve service quality by taking necessary measures.

Social-Cognitive Predictors of Iranian College Students’ Academic Well-Being

The purpose of this study was to examine the application of Lent and Brown’s social-cognitive model in predicting academic well-being of Iranian students. A total of 400 undergraduate students (252 female students and 148 male students) completed the measures of academic satisfaction, self-efficacy, environmental support, goal progress, and personality traits. Path analysis indicated that the modified social-cognitive model provided good fit to the data and accounted for substantial portion of the variance in academic satisfaction. The results of path analysis showed that self-efficacy, goal progress, environmental supports, and resources both directly and indirectly had relationship with academic well-being. It was revealed that only one of the personality traits (conscientiousness) had a direct and significant correlation with students’ academic well-being. However, neuroticism, conscientiousness, and extroversion had indirect and significant correlations with academic well-being through self-efficacy, environmental supports, and resources. According to the obtained findings, this research supported the role of social-cognitive variables in the academic well-being of Iranian students.

Assessing the Status of Yazd Province Medical Emergency and Accident Management Center in Terms of Necessary Standards for Air Emergencies

Background: Air emergency medical services provide advanced medical care to patients and critically injured as soon as possible to reduce injuries and casualties. In this study, the status of the Medical Emergency and Accident Management Center in Yazd Province in terms of the necessary standards for air emergencies was investigated and compared with existing standards. Materials and Methods: The present research was a cross-sectional descriptive study. Using a researcher-made checklist, the required data, such as human resource requirements, physical and environmental space, time, communication equipment, medical equipment, equipment for traffic detection and management, and equipment for technical and safety services, were collected by asking relevant officials and experts. Finally, data analysis was performed using tables and descriptive statistics. Results: The study findings showed that in total, 2 items in the field of human resource requirements, 7 items in physical space and environmental requirements, 2 items regarding time requirements, 4 items regarding communication equipment requirements, 43 items regarding equipment and medicine requirements, including patient cabin equipment, emergency resuscitation kit and Cardiopulmonary Resuscitation (CPR), medicine and jump bag equipment, delivery set, triage bag, dressing equipment and technical and safety service equipment requirements were in accordance with the existing standards. Conclusion: Based on the existing standards, the air emergency in Yazd Province in most areas was satisfactory. Because of the importance of the issue, authorities must take the necessary measures to address the deficiencies and limitations so that the emergency missions be carried out in the best conditions.

Feasibility of implementing public-private partnership (PPP) in the development of hospital services and optimizing resource allocation in Iran

Background

In recent decades, many countries have utilized public–private partnership (PPP) as a development initiative to reform their healthcare sectors. The present study examines the feasibility of implementing public–private partnerships for development of hospital services in Shiraz, Iran.

Methods

This was a descriptive study of questionnaires carried out on one of Iran’s major southern cities (Shiraz) in 2016. Research population comprised of the hospitals affiliated to the Shiraz University of Medical Sciences (SUMS), private hospitals, charities, and healthcare investors. A total of 56 participants were chosen by convenience sampling. Data were collected using a researcher-made questionnaire. The questions` range were defined from 1 to 5. Data analysis was performed in SPSS₂₁ using the Mann–Whitney test, T test, and Chi square test at 0.05 significance level.

Results

The participants from the public sector had a significantly higher level of acquaintance with the concept of PPP and significantly more inclination to participate in such projects (P < 0.05). The mean values of the determinants of successful implementation of PPPs for hospital services were presented from the public and private participants` viewpoints as follows: public sector rated the capacity-creating (2.60 ± 0.39) and the social-cultural (2.58 ± 0.40) component as having a better condition than other determinants however, the private sector rated the financial-capital (2.64 ± 0.46) as the best. Analysis of the mean scores of determinants of implementation of PPP from the viewpoint of public and private sectors showed a significant difference in their views in terms of financial-capital and social-cultural dimensions (P < 0.05).

Conclusions

According to the participants, the requirements for implementation of public–private partnerships for hospital services are not properly met. For any progress to be made in this regard, Iranian authorities and policymakers should devise a new platform for attracting private participation and improving hospitals’ readiness to engage in PPP projects.

Experimental and theoretical studies of frequency response function of dagger-shaped atomic force microscope cantilever in different immersion environments

In this study, the amplitude of frequency response functions of vertical and rotational displacements and resonant frequency of a dagger-shaped atomic force microscope cantilever have been investigated. To increase the accuracy of theoretical model, all necessary details for cantilever and sample surface have been taken into account. In this paper, carbon tetrachloride (CCL₄ ), methanol, acetone, water and air have been considered as the environments. In the most cases, presence and absence of tip-sample interaction force have studied. For a sample cantilever immersed in air, both of the Euler-Bernoulli and Timoshenko beam theories have been compared. The results indicate that the tip-sample interaction force raises the resonant frequency. Increasing the liquid viscosity leads to a decrease in the resonant frequency and the amplitude of frequency response functions of vertical and rotational displacements. Increasing the rectangular and tapered parts lengths, decreases the resonant frequency and amplitude of frequency response functions of vertical and rotational displacements. By increasing the cantilever thickness the resonant frequency and amplitude of frequency response functions of vertical and rotational displacements increases. Theoretical model for air and water has been compared with experimental work. Results show good agreement.

Modelling and optimizing of calcium and non-phytate phosphorus requirements of male broiler chickens from 1 to 21 days of age using response surface methodology

The skeleton is the main site of P and Ca deposition; therefore, accurate estimation of Ca and P requirements is necessary to maintaining health and optimum performance of broiler chickens. A response surface methodology (RSM) using a central composite design (CCD) was used for evaluating and optimizing of Ca and non-phytate P (NPP) requirements of broiler chickens for optimal performance, ileal nutrient digestibility and bone mineralization from 1 to 21 days of age. A total of 750 one-day-old male broiler chickens (Ross 308) were randomly distributed into 50 cages including 9 treatments, each replicated 5 times (except central treatment with 10 replicates) and 15 birds in each cage by CCD. The dietary Ca levels of 4.3, 5.6, 8.6, 11.7 and 13.0 g/kg and NPP of 2.5, 2.9, 4.0, 5.0 and 5.4 g/kg were used for nine treatments of CCD. The results indicated that the linear and quadratic effects of NPP, quadratic effects of Ca and Ca × NPP were significant for average weight gain (AWG, P < 0.05), average feed intake (AFI, P < 0.05), feed conversion ratio (FCR, P < 0.05) and Ca and P apparent ileal digestibility (AID, P < 0.05); however, the linear effect of Ca was significant only for FCR (P < 0.05). On the other hand, tibia and toe ash were affected by NPP (linear and quadratic, P < 0.01) and Ca (quadratic, P < 0.01). The second-order polynomial regression model was significant for AWG (R2 = 0.93, P < 0.001), AFI (R2 = 0.88, P < 0.001), FCR (R2 = 0.78, P < 0.001), AID of Ca (R2 = 0.78, P < 0.001) and P (R2 = 0.88, P < 0.001), tibia ash (R2 = 0.86, P < 0.001) and toe ash (R2 = 0.85, P < 0.001). The multi-objective optimization indicated that broiler chickens from 1 to 21 days of age need 7.03 and 4.47 g/kg of Ca and NPP, respectively, to achieve optimal AWG, FCR, tibia and toe ash. However, the dietary Ca and NPP levels can be reduced to 6.57 and 3.95 g/kg with a slight negative impact on performance and bone mineralization, respectively. In conclusion, the findings indicate that using multi-objective optimization model such as RSM provides more information regarding optimum Ca and NPP requirements of broiler chickens, considering the complex interaction between these two minerals. While the NPP levels are in line with current recommended requirements, Ca levels are considerably lower and suggest that current recommended Ca requirements may be in excess of the needs of the broiler.

Serogroups, and drug resistance of nontyphoidal Salmonella in symptomatic patients with community-acquired diarrhea and chicken meat samples in Tehran

BACKGROUND

Salmonella is considered as a main cause of community-acquired diarrhea in humans, however, sources of the multi-drug resistant (MDR) strains and their link with the disease are not well known.

AIMS

This study aimed to investigate the frequency, serogroup diversity, and antimicrobial susceptibility patterns of Salmonella strains in poultry meat and stool samples of patients with community acquired diarrhea in Tehran.

METHODS

We compared the frequency of non-typhoidal Salmonella serogroups, the similarities of their resistance patterns to 10 antimicrobial compounds, the prevalence of extended spectrum β-lactamase (ESBL) and ampicillinase C (AmpC) genetic determinants, and class 1 and 2 integrons in 100 chicken meat and 400 stool samples of symptomatic patients in Tehran during June 2018 to March 2019.

RESULTS

Salmonella was isolated from 75% and 5.5% of the chicken meats and human stool samples, respectively. The chicken meat isolates mainly belonged to serogroup C (88%, 66/75), while the human stool isolates were mainly related to serogroup D (59.1%, 13/22). The MDR phenotype and the most common rates of resistance to antibiotics, including tetracycline, trimethoprim/sulfamethoxazole (TS) and azithromycin, were detected in 4.5% and 45.3%, 59% and 13.6%, 43% and 9.1%, 42% and 9.1% of the human stool and chicken meat samples, respectively. Carriage of bla _CTX, bla _SHV, and bla _PER genes in the meat isolate with ESBL resistance phenotype and bla _ACC, bla _FOX, and bla _CMY-2 among the 7 meat strains with AmpC resistance phenotype was not confirmed using polymerase chain reaction (PCR). High prevalence of class 1 and 2 integrons was characterized and showed a correlation with resistance to TS and chloramphenicol.

CONCLUSION

These findings showed a lack of association between chicken meats and human isolates due to discrepancy between the characterized serogroups and resistance phenotypes.

Albumin Usage in Iran

BACKGROUND

Human albumin is an expensive therapy with inappropriate use in many clinical conditions. Inappropriate use of albumin imposes a substantial economic burden on the healthcare system and society. Drug use evaluation (DUE) is one method of assessing the appropriateness of drug use which has been powered by increasing concern about the cost-effectiveness of drugs. The objective of this study is to systematically review the appropriateness of albumin utilization in Iranian hospitals.

METHODS

We searched the PubMed, MEDLINE, EMBASE, SCOPUS, and Google Scholar for articles in English and SID, Magiran, Medlib, and Irandoc for articles in Persian from 1997 to 2018. Studies on the DUE of albumin in Iranian hospitals were included in this study. Articles conducted outside Iran, editorials, letters and review articles were excluded.

RESULTS

In total, eight studies were selected for the final review. The majority of the papers were conducted in Tehran. In most studies, the highest albumin consumption was related to the intensive care unit. The most frequent reasons for prescribing albumin were edema, hypoalbuminemia, volume expansion after heart surgery, ascites, cardiac surgery and cirrhosis. Of the studies included, five studies evaluated the costs of drug use.

CONCLUSION

Our findings show that inappropriate use of albumin imposes a relatively high additional cost on the society. The included studies show that the percentage of inappropriate use of albumin is relatively high in Iran and this abuse is an essential problem in Iranian hospitals. Prescription based on standard guidelines could improve rational use of albumin and lead to savings in treatment costs.

A Langevin equation that governs the irregular stick-slip nano-scale friction

Friction force at the nanoscale, as measured from the lateral deflection of the tip of an atomic force microscope, usually shows a regular stick-slip behavior superimposed by a stochastic part (fluctuations). Previous studies showed the overall fluctuations to be correlated and multi-fractal, and thus not describable simply by e.g. a white noise. In the present study, we investigate whether one can extract an equation to describe nano-friction fluctuations directly from experimental data. Analysing the raw data acquired by a silicon tip scanning the NaCl(001) surface (of lattice constant 5.6 Å) at room temperature and in ultra-high vacuum, we found that the fluctuations possess a Markovian behavior for length scales greater than 0.7 Å. Above this characteristic length, the Kramers-Moyal approach applies. However, the fourth-order KM coefficient turns out to be negligible compared to the second order coefficients, such that the KM expansion reduces to the Langevin equation. The drift and diffusion terms of the Langevin equation show linear and quadratic trends with respect to the fluctuations, respectively. The slope 0.61 ± 0.02 of the drift term, being identical to the Hurst exponent, expresses a degree of correlation among the fluctuations. Moreover, the quadratic trend in the diffusion term causes the scaling exponents to become nonlinear, which indicates multifractality in the fluctuations. These findings propose the practical way to correct the prior models that consider the fluctuations as a white noise.

Conceptualizing and determining core clinical competencies in nursing students: a qualitative study

AIM

This study aimed to conceptualize and explain the core clinical competencies of nursing students in Iran.

BACKGROUND/INTRODUCTION

Despite the national and international efforts to modify nursing curricula such that the students' clinical competencies are improved, there is still a widespread concern about this issue, perhaps due to the impact of factors other than the curriculum itself, such as the lack of a clear definition for the concept of clinical competency and its main components in nursing students.

METHODS

This qualitative study was conducted using conventional content analysis. The participants were selected through purposive sampling and included 14 senior students of bachelor of nursing, four nurses working in teaching hospitals and six clinical instructors. Individual semi-structured interviews were used for data collection. After recording and transcribing the interviews, content analysis was used to extract the concepts.

FINDINGS

The main theme of the study was 'multidimensionality of the concept of clinical competency,' which had six main categories, namely 'adoption of and adaptation with the nursing practice,' 'nursing knowledge,' 'self-direction in clinical learning,' 'patient care skills,' 'professional ethics' and 'the development of professional behaviours.'

DISCUSSION/CONCLUSION

Clinical competency and its dimensions among students comprise a multidimensional concept. Having a clear and comprehensive understanding of this concept and focusing on its core axes may be the most important step in improving students' clinical competency.

IMPLICATIONS FOR NURSING, HEALTH AND EDUCATION POLICY

Policymakers and nursing education authorities can identify the problems existing in the students' clinical competency and provide them with practical solutions for a standard professional education through a clear understanding of the concept of clinical competency and its dimensions.

Can public-private partnership (PPP) improve hospitals' performance indicators?

Background: This study was conducted to compare the main performance indicators of Hasheminejad hospital before and after implementing PPP model.

Methods: This cross sectional study was conducted in Iran in 2015. Performance indicators of Hasheminejad hospital, the only Iranian unit that implemented PPP model, were applied. Data were collected based on a researcher-designed checklist after ensuring its validity and reliability. Data were analyzed applying SPSS21, and the Shapiro-Wilk test was used to examine the relevant data normalization. After confirming the normality of the data, descriptive statistics and paired t test were used to analyze the data at a significant level of 0.05.

Results: Dramatic variations were observed in the status of the studied indicators after the implementation of PPP in Hasheminejad hospital, and the changes were statistically significant in all these indicators (p<0.05).

Conclusion: It seems that implementing PPP in Hasheminejad hospital can be considered as a successful experience in Iran’s health sector. The significant improvement in this hospital’s performance indicators can emphasize the effective role of PPP in administration of this hospital. However, service quality and patient satisfaction should be considered as qualitative indicators, along with the present quantitative indicators because better judgment about the changes was achieved in this hospital after implementing PPP.

Systemic and tumor-directed therapy for oligometastatic prostate cancer: study protocol for a phase II trial for veterans with de novo oligometastatic disease

BACKGROUND

The treatment paradigm for metastatic hormone-sensitive prostate cancer (mHSPC) patients is evolving. PET/CT now offers improved sensitivity and accuracy in staging. Recent randomized trial data supports escalated hormone therapy, local primary tumor therapy, and metastasis-directed therapy. The impact of combining such therapies into a multimodal approach is unknown. This Phase II single-arm clinical trial sponsored and funded by Veterans Affairs combines local, metastasis-directed, and systemic therapies to durably render patients free of detectable disease off active therapy.

METHODS

Patients with newly-diagnosed M1a/b prostate cancer (PSMA PET/CT staging is permitted) and 1-5 radiographically visible metastases (excluding pelvic lymph nodes) are undergoing local treatment with radical prostatectomy, limited duration systemic therapy for a total of six months (leuprolide, abiraterone acetate with prednisone, and apalutamide), metastasis-directed stereotactic body radiotherapy (SBRT), and post-operative fractionated radiotherapy if pT ≥ 3a, N1, or positive margins are present. The primary endpoint is the percent of patients achieving a serum PSA of < 0.05 ng/mL six months after recovery of serum testosterone ≥150 ng/dL. Secondary endpoints include time to biochemical progression, time to radiographic progression, time to initiation of alternative antineoplastic therapy, prostate cancer specific survival, health related quality-of-life, safety and tolerability.

DISCUSSION

To our knowledge, this is the first trial that tests a comprehensive systemic and tumor directed therapeutic strategy for patients with newly diagnosed oligometastatic prostate cancer. This trial, and others like it, represent the critical first step towards curative intent therapy for a patient population where palliation has been the norm.

TRIAL REGISTRATION

Clinicaltrials.gov identifier: NCT03298087 (registration date: September 29, 2017).

Evaluation of safety and antifungal activity of Lactobacillus reuteri and Pediococcus diacetilactis isolates against aflatoxigenic Aspergillus flavus

Biocontrol of moulds by lactic acid bacteria (LAB) instead of antibiotics and chemical preservatives is a new approach in veterinary medicine. The aims of present research were to perform molecular identification of dominant sourdough LAB isolates and to evaluate their in vivo safety and in vitro antifungal properties for using as biopreservative agents. Sequencing results of PCR products led to identification of Lactobacillus reuteri and Pediococcus diacetilactis as LAB isolates. Antifungal activity of the isolates and their cell-free culture filtrate (CCF) were also confirmed against aflatoxigenic Aspergillus flavus, respectively by overlay and spore spot methods. Accordingly, antagonistic effect of P. diacetilactis and its CCF were significantly (P<0.05) higher than L. reuteri and CCF of mentioned LAB isolate. Clinical chemistry and haematological findings in mice fed LAB demonstrated also insignificant difference vs control mice and were in the normal range, which confirmed the safety of LAB isolates. By considering the importance of safe, food grade biocontrol agents, L. reuteri and P. diacetilactis isolates and their CCF may be considered as an alternative for antibiotics and other chemical preservatives in food and feed processing chain

Alternative healthy eating index and risk of hip fracture: a systematic review and dose-response meta-analysis

BACKGROUND

A high adherence to healthy dietary patterns, such as an alternative healthy eating index (AHEI), has been suggested to have protective effects on bone mineral density and to decrease the incidence of fractures, although the evidence for this is not clear. We conducted a dose-response meta-analysis of available observational studies aiming to assess the association between adherence to a healthy dietary pattern, as assessed by the AHEI score, and risk of hip fracture in the general population.

METHODS

Studies published up to March 2018 were identified on the basis of a literature search in PubMed, Scopus and ISI Web of Science databases using Mesh and non-Mesh relevant keywords. Relative risks (RRs) with 95% confidence intervals (CIs), the linear and nonlinear relationships were calculated using random-effects models.

RESULTS

In the meta-analysis of five effect sizes, as obtained from four studies (265 771 participants with 6938 cases of incident hip fracture), we found that a higher AHEI score was associated with a 31% reduced risk of hip fracture (pooled RR = 0.69; 95% CI = 0.52-0.91) in high versus low intake meta-analysis. In addition, there were inverse relationships between AHEI score and risk of hip fracture, such that a five-unit increase in the score of AHEI was associated with a reduction in the risk of hip fracture in linear (pooled RR = 0.97; 95% CI = 0.95-0.99) and nonlinear (Pnonlinearity < 0.001) models, respectively.

CONCLUSIONS

Adherence to the AHEI (as an indicator of diet quality) was associated with a reduced risk of hip fracture.

Psychological factors of healthful diet promotion among diabetics: an application of health action process approach

Background and aim

Worldwide, type 2 diabetes mellitus (T2DM) prevalence has increased. Non-healthful diet is one of the main reasons to T2DM growth. This study aims to determine the efficacy of the health action process approach (HAPA) in explaining healthful diet (HD) in T2DM patients.

Methods

This cross-sectional study was conducted based on HAPA in Isfahan, Iran between July and December 2015. Participants were recruited by convenience sampling method. HAPA inventory was administered to 203 Isfahan diabetics. Intentions, outcome expectancies, risk perception, action self-efficacy, action and coping planning, maintenance and recovery self-efficacy, and dietary style were the constructs measured. Structural equation modeling (SEM) in AMOS 21 was used to test the hypothesis.

Results

The results based on the common fit indices revealed that the HAPA fitted the data acceptably well among the T2DM patients and within dietary behavior (p<0.001), RMSEA=0.082, CFI=0.903, NFI=0.899). Action self-efficacy was the best predictor of intention (β=2.49, p<0.001). Result revealed action and coping planning (β=5.36, p=0.027) and recovery self-efficacy (β=5.67, p=0.021) significantly predicted behavior.

Conclusions

Our findings provide preliminary support for the practical usage of the HAPA model for predicting HD intention and behavior among T2DM patients. Randomized controlled trials should be performed in the future in order to involve causality.

Radical Prostatectomy, External Beam Radiotherapy, or External Beam Radiotherapy With Brachytherapy Boost and Disease Progression and Mortality in Patients With Gleason Score 9-10 Prostate Cancer

IMPORTANCE

The optimal treatment for Gleason score 9-10 prostate cancer is unknown.

OBJECTIVE

To compare clinical outcomes of patients with Gleason score 9-10 prostate cancer after definitive treatment.

DESIGN, SETTING, AND PARTICIPANTS

Retrospective cohort study in 12 tertiary centers (11 in the United States, 1 in Norway), with 1809 patients treated between 2000 and 2013.

EXPOSURES

Radical prostatectomy (RP), external beam radiotherapy (EBRT) with androgen deprivation therapy, or EBRT plus brachytherapy boost (EBRT+BT) with androgen deprivation therapy.

MAIN OUTCOMES AND MEASURES

The primary outcome was prostate cancer-specific mortality; distant metastasis-free survival and overall survival were secondary outcomes.

RESULTS

Of 1809 men, 639 underwent RP, 734 EBRT, and 436 EBRT+BT. Median ages were 61, 67.7, and 67.5 years; median follow-up was 4.2, 5.1, and 6.3 years, respectively. By 10 years, 91 RP, 186 EBRT, and 90 EBRT+BT patients had died. Adjusted 5-year prostate cancer-specific mortality rates were RP, 12% (95% CI, 8%-17%); EBRT, 13% (95% CI, 8%-19%); and EBRT+BT, 3% (95% CI, 1%-5%). EBRT+BT was associated with significantly lower prostate cancer-specific mortality than either RP or EBRT (cause-specific HRs of 0.38 [95% CI, 0.21-0.68] and 0.41 [95% CI, 0.24-0.71]). Adjusted 5-year incidence rates of distant metastasis were RP, 24% (95% CI, 19%-30%); EBRT, 24% (95% CI, 20%-28%); and EBRT+BT, 8% (95% CI, 5%-11%). EBRT+BT was associated with a significantly lower rate of distant metastasis (propensity-score-adjusted cause-specific HRs of 0.27 [95% CI, 0.17-0.43] for RP and 0.30 [95% CI, 0.19-0.47] for EBRT). Adjusted 7.5-year all-cause mortality rates were RP, 17% (95% CI, 11%-23%); EBRT, 18% (95% CI, 14%-24%); and EBRT+BT, 10% (95% CI, 7%-13%). Within the first 7.5 years of follow-up, EBRT+BT was associated with significantly lower all-cause mortality (cause-specific HRs of 0.66 [95% CI, 0.46-0.96] for RP and 0.61 [95% CI, 0.45-0.84] for EBRT). After the first 7.5 years, the corresponding HRs were 1.16 (95% CI, 0.70-1.92) and 0.87 (95% CI, 0.57-1.32). No significant differences in prostate cancer-specific mortality, distant metastasis, or all-cause mortality (≤7.5 and >7.5 years) were found between men treated with EBRT or RP (cause-specific HRs of 0.92 [95% CI, 0.67-1.26], 0.90 [95% CI, 0.70-1.14], 1.07 [95% CI, 0.80-1.44], and 1.34 [95% CI, 0.85-2.11]).

CONCLUSIONS AND RELEVANCE

Among patients with Gleason score 9-10 prostate cancer, treatment with EBRT+BT with androgen deprivation therapy was associated with significantly better prostate cancer-specific mortality and longer time to distant metastasis compared with EBRT with androgen deprivation therapy or with RP.

Multiscaling behavior of atomic-scale friction

The scaling behavior of friction between rough surfaces is a well-known phenomenon. It might be asked whether such a scaling feature also exists for friction at an atomic scale despite the absence of roughness on atomically flat surfaces. Indeed, other types of fluctuations, e.g., thermal and instrumental fluctuations, become appreciable at this length scale and can lead to scaling behavior of the measured atomic-scale friction. We investigate this using the lateral force exerted on the tip of an atomic force microscope (AFM) when the tip is dragged over the clean NaCl (001) surface in ultra-high vacuum at room temperature. Here the focus is on the fluctuations of the lateral force profile rather than its saw-tooth trend; we first eliminate the trend using the singular value decomposition technique and then explore the scaling behavior of the detrended data, which contains only fluctuations, using the multifractal detrended fluctuation analysis. The results demonstrate a scaling behavior for the friction data ranging from 0.2 to 2 nm with the Hurst exponent H=0.61±0.02 at a 1σ confidence interval. Moreover, the dependence of the generalized Hurst exponent, h(q), on the index variable q confirms the multifractal or multiscaling behavior of the nanofriction data. These results prove that fluctuation of nanofriction empirical data has a multifractal behavior which deviates from white noise.

Geographic Information Systems (GIS), an Informative Start for Challenging Process of Etiologic Investigation of Diseases and Public Health Policy Making

Background: The public health has been always concerned of the immediate environment of human as causal factors for different diseases and health outcomes. Epidemiology, as one of the fundamental basis of public health, is concerned of how diseases are distributed in terms of geographical, chronological, and human population characteristics and employees the descriptive nature of such spread to draw conclusion on the etiology of health or disease utcome for further policy making on prevention of disease or promotion of health.Methods: In this paper, we present the importance of GIS technology in epidemiology from both descriptive and etiologic standpoints and elaborate how this technology can stand in the forefront of disease and health outcome measures in the coming decades. The paper will address the history of geo-related health and disease issues. The mapping tool as a traditionally strong resource in the public health will be explored. The advances in Information Technology and one of its best utilized offshoot, GIS, in Health and disease will be discussed. How the huge repository of generated or ever generating geo-related data and information is utilized to address etiology of diseases or to help public health authorities in making informed policy making decisions are explored.Results: The utilization of GIS technology in diseases with intermittent host such as malaria, yellow fever, or other parasitic diseases has already been well established. The GIS technology and its utilization in chronic and degenerative diseases such as cancer, diabetes, and aging are under development and new frontiers are discovering. The limitation of GIS technology in addressing host environment interaction in micro-environment (at the molecular biology and tissue pathogenicity level) and gene–environment interaction (at the individual level) will further be discussed.Conclusion: We then distress on the efficient use of GIS both in the etiologic investigation of diseases and health events as well as the utilization of the GIS technology as a administrative tool in the help of public health authorities and policy makers in strategic management of health of a community or emergency management of man-made or technological disasters (e.g., wars) or naturally occurring disasters (e.g., earthquake and floods).

Radiotherapy versus radical prostatectomy for Gleason score 9-10 prostate adenocarcinoma: A multi-institutional comparative analysis of 1001 patients treated in the modern era

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Background: To compare the outcomes of a modern cohort of patients with Gleason Score (GS) 9-10 prostate adenocarcinoma (CaP) following treatment with external beam radiotherapy (EBRT), extremely dose-escalated radiotherapy (as exemplified by EBRT with a brachytherapy boost [EBRT+BT]), and radical prostatectomy (RP). Methods: One-thousand-and-one patients with biopsy GS 9-10 CaP who received definitive treatment between 2000 and 2013 were included (347 treated with EBRT, 330 with EBRT+BT, and 324 with RP). Kaplan-Meier analysis and multivariate Cox regression compared 5- and 10-year rates of distant metastasis-free survival (DMFS), cancer-specific survival (CSS), and overall survival (OS). Prostate cancer-mortality (PCSM) rates were compared with a competing risk analysis. Results: The median followup periods were 4.8, 6.4, and 5.1 years among patients receiving EBRT, EBRT + BT, and RP. The median doses among EBRT and EBRT+BT patients were equivalent to 78 Gy and 90 Gy in 2 Gy fractions. Over 90% of patients treated with EBRT or EBRT+BT received ADT (median durations of 18 months and 12 months, respectively). Nearly 40% of RP patients received postoperative RT, primarily in the salvage setting. Five- and 10-year DMFS rates were significantly higher with EBRT+BT (91.6% and 81.3%) than with EBRT (79.6% and 65.8%; p < 0.0001) or RP (77.9% and 60.1%; p < 0.0001). Five- and 10-year PCSM rates were significantly lower with EBRT+BT (3.8% and 14.1%) than with EBRT (10.3% and 25.2%; 5- and 10-year hazard ratios of 0.38 and 0.47; p = 0.003) or RP (8.9% and 20.3%; 5- and 10-year hazard ratios of 0.39 and 0.55; p = 0.02). Overall 5- and 10-year OS rates were 85.7% and 64.7% and were similar between cohorts (p > 0.1). Conclusions: Extremely dose-escalated radiotherapy offered improved systemic control and reduced PCSM when compared with either EBRT or RP. Notably, this was achieved despite a significantly shorter median duration of ADT than in the EBRT arm. This is hypothesis generating as it suggests that improved local control via dose-escalation may have systemic control and survival implications even for patients with very high risk disease.

A plant-inspired robot with soft differential bending capabilities

We present the design and development of a plant-inspired robot, named Plantoid, with sensorized robotic roots. Natural roots have a multi-sensing capability and show a soft bending behaviour to follow or escape from various environmental parameters (i.e., tropisms). Analogously, we implement soft bending capabilities in our robotic roots by designing and integrating soft spring-based actuation (SSBA) systems using helical springs to transmit the motor power in a compliant manner. Each robotic tip integrates four different sensors, including customised flexible touch and innovative humidity sensors together with commercial gravity and temperature sensors. We show how the embedded sensing capabilities together with a root-inspired control algorithm lead to the implementation of tropic behaviours. Future applications for such plant-inspired technologies include soil monitoring and exploration, useful for agriculture and environmental fields.

Quality of Life Outcomes in Laryngeal and Oropharyngeal Cancer Patients after Chemoradiation

OBJECTIVE: The purpose of this study was to compare quality of life issues in patients with advanced laryngeal versus oropharyngeal cancer after treatment with chemoradiation.

DESIGN: A cohort study of 31 patients with laryngeal or oropharyngeal squamous cell carcinoma treated with chemoradiation completed the University of Washington quality of life instrument version 4 (UW-QOL v4). Statistical analysis was performed with Wilcoxon rank sum and chi-square tests.

SETTING: Academic tertiary care center.

RESULTS: Both groups reported similar impairment in the domains of swallowing, chewing, and taste. Oropharyngeal cancer patients reported significantly worse quality of life in the domain of saliva ( P < 0.007).

CONCLUSION: Swallowing, chewing, and taste were adversely affected by chemoradiation for both groups. Oropharyngeal patients experienced significantly worse problems with saliva than laryngeal patients. These patients reported high levels of satisfaction with health-related quality of life issues.

SIGNIFICANCE: Specific head and neck subsites have different morbidities when treated with primary chemoradiation for advanced tumors.

Experiences of selected countries in the use of public-private partnership in hospital services provision

OBJECTIVE

To review the experiences of selected countries in the use of public-private partnership in the provision of hospital services.

METHODS

This comparative study was conducted in 2015 in Iran. To collect data, valid databases as well as articles, theses, reports and related books in the field of private-sector partnership in hospital services were employed. Using purposive sampling, countries such as the United Kingdom, Spain, Canada, Turkey, Australia and Lesotho, which had successful experiences in the field of application of the public-private partnership in hospital services, were included. Likewise, the only experience in Iran in this field was also reviewed. Studies done between 1980 and 2015 were examined. The results obtained from each country were compared.

RESULTS

Implementing public-private partnership had great and valuable outcomes and achievements for governmental hospitals. Moreover, clinical and nonclinical service delivery, hospital utilisation and management along with building, repairing and supportive operations through public-private partnership contracts can be differently divided among the partners. Furthermore, duration of the projects ranged from 12 to 40 years in different countries, depending on the type of the model used.

CONCLUSIONS

A successful experience in the use of the public-private partnership in the provision of hospital services was observed.

Clinical Outcomes for Patients with Gleason Score 9-10 Prostate Adenocarcinoma Treated With Radiotherapy or Radical Prostatectomy: A Multi-institutional Comparative Analysis

BACKGROUND

The long natural history of prostate cancer (CaP) limits comparisons of efficacy between radical prostatectomy (RP) and external beam radiotherapy (EBRT), since patients treated years ago received treatments considered suboptimal by modern standards (particularly with regards to androgen deprivation therapy [ADT] and radiotherapy dose-escalation]. Gleason score (GS) 9-10 CaP is particularly aggressive, and clinically-relevant endpoints occur early, facilitating meaningful comparisons.

OBJECTIVE

To compare outcomes of patients with GS 9-10 CaP following EBRT, extremely-dose escalated radiotherapy (as exemplified by EBRT+brachytherapy [EBRT+BT]), and RP.

DESIGN, SETTING, PARTICIPANTS

Retrospective analysis of 487 patients with biopsy GS 9-10 CaP treated between 2000 and 2013 (230 with EBRT, 87 with EBRT+BT, and 170 with RP). Most radiotherapy patients received ADT and dose-escalated radiotherapy.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Kaplan-Meier analysis and multivariate Cox regression estimated and compared 5-yr and 10-yr rates of distant metastasis-free survival, cancer-specific survival (CSS), and overall survival (OS).

RESULTS AND LIMITATIONS

The median follow-up was 4.6 yr. Local salvage and systemic salvage were performed more frequently in RP patients (49.0% and 30.1%) when compared with either EBRT patients (0.9% and 19.7%) or EBRT+BT patients (1.2% and 16.1%, p<0.0001). Five-yr and 10-yr distant metastasis-free survival rates were significantly higher with EBRT+BT (94.6% and 89.8%) than with EBRT (78.7% and 66.7%, p=0.0005) or RP (79.1% and 61.5%, p<0.0001). The 5-yr and 10-yr CSS and OS rates were similar across all three cohorts.

CONCLUSIONS

Radiotherapy and RP provide equivalent CSS and OS. Extremely dose-escalated radiotherapy with ADT in particular offers improved systemic control when compared with either EBRT or RP. These data suggest that extremely dose-escalated radiotherapy with ADT might be the optimal upfront treatment for patients with biopsy GS 9-10 CaP.

PATIENT SUMMARY

While some prostate cancers are slow-growing requiring many years, sometimes decades, of follow-up in order to compare between radiation and surgery, high-risk and very aggressive cancers follow a much shorter time course allowing such comparisons to be made and updated as treatments, especially radiation, rapidly evolve. We showed that radiation-based treatments and surgery, with contemporary standards, offer equivalent survival for patients with very aggressive cancers (defined as Gleason score 9-10). Extremely-dose escalated radiotherapy with short-course androgen deprivation therapy offered the least risk of developing metastases, and equivalent long term survival.

Equity analysis of hospital beds distribution in Shiraz, Iran 2014

BACKGROUND

One of the important aspects of equity in health is equality in the distribution of resources in this sector. The present study aimed to assess the distribution of hospital beds in Shiraz in 2014.

METHODS

In this retrospective cross-sectional study, the population density index and fair distribution of beds were analyzed by Lorenz curve and Gini coefficient, respectively. Descriptive data were analyzed using Excel software. We used Distributive Analysis Stata Package (DASP) in STATA software, version 12, for computing Gini coefficient and drawing Lorenz curve.

RESULTS

The Gini coefficient was 0.68 in the population. Besides, Gini coefficient of hospital beds' distribution based on population density was 0.70, which represented inequality in the distribution of hospital bedsamong the nine regions of Shiraz.

CONCLUSION

Although the total number of hospital beds was reasonable in Shiraz, distribution of these resources was not fair, and inequality was observed in their distribution among the nine regions of Shiraz.

A Qualitative Study to Identify Skills and Competency Required for Hospital Managers

INTRODUCTION

Hospital managers aim to improve the efficiency and effectiveness of their institutions through leadership and guidance of medical personnel. Fulfilling these objectives requires a holistic approach to both the management of people and institutional prioritization. The aim of this study was to identify the skills and competencies that hospital managers must demonstrate in order to achieve their objectives.

METHODS

In 2015, a regional, multi-center qualitative study was undertaken in Shiraz, Iran. Interviews and focus group discussions were conducted with university hospital managers, senior managers, faculty members, and post-graduate students, and the results were analyzed using the content analysis method by MAXQDA software.

RESULTS

Eight key skill themes (communication, experience, appreciation of institution logistics/infrastructure, management skills, motivation, systematic problem solving, ethics, and financial/legal awareness) were identified among the hospital managers. The common challenges that face hospital institutions include problems with hierarchical and organizational structure, excessive rules and regulations, lack of resources, poor post-graduate education, and overall management. Recurring themes with respect to how these could be addressed included changing the culture and belief structure of the hospital, restructuring the organizational hierarchy, and empowering the people.

CONCLUSION

In our cohort, practical skills, such as communication and experience, were considered more important than theoretical skills for the effective management and administration of hospitals. Therefore, we suggest that practical, skill-based training should be emphasized for students of these disciplines so they will be better suited to deal with real world challenges. Further organizational improvements also can be attained by the active and constructive involvement of senior university managers.

Value of Radiation Therapy in Addition to Surgery for Cancer of the Head and Neck

This historically controlled study evaluates radiation therapy in 119 patients—With squamous cell carcinomas of the head and neck—who underwent surgery alone (SA) or surgery plus radiation (S + R). The primary tumor control and nodal control, in patients with negative surgical margins who had surgery alone (SA), were 63% in the oral cavity, 60% in the oropharynx, and 67% in the hypopharynx. The same rates for S + R group and negative surgical margins were 100%, 73%, and 100%. Combining the patients with negative and positive surgical margins, control of the tumor and nodal control were the same in the oral cavity for both treatment groups (41% for SA and 44% for S + R) and increased with the addition of radiation in the oropharynx (30% for SA to 65% for S + R) and hypopharynx (33% for SA to 86% for S + R), in spite of higher percentages of T3 and T4 tumor and positive lymph nodes in the S + R group. The lower control rate in patients who had surgery alone could be due (in part) to inadequate surgery at the primary site (42% local excision) and lack of neck dissection (35% for SA vs. 77% for S + R). Postoperative radiation therapy to the primary site and neck is shown to effectively reduce local recurrence in patients with oral cavity and oropharynx cancer, regardless of surgical margins.