The effects of exercise and protein-energy supplements on body composition and muscle function in frail elderly individuals: a long-term controlled randomised study

Fighting against inactivity and inadequate nutritional intake are of utmost importance in the elderly. To our knowledge, the few studies which have been performed were conducted for only a short period and the results do not permit formal conclusions to be drawn. We therefore tried to fill this gap in our knowledge by determining whether an intervention combining an acceptable progressive exercise programme and nutritional supplements would be feasible for a long-term period in the very frail elderly, and would bring about concomitant benefits in body composition and muscle power. Accordingly, this exercise and nutritional combination was assessed in the frail elderly in a 9-month randomised trial with a factorial design. Fifty-seven elderly volunteers over 72 years, from sixteen retirement homes in Lyon, France participated in the study. Dietary supplements were compared with placebo, and physical exercise was compared with memory training. Main outcome measures were fat-free mass (FFM) and muscle power. FFM was determined by labelled water, and muscle power was measured by a leg-extensor machine. At 9 months, the compliance was 63 % for exercise sessions, and 54 % for nutritional supplements. In patients with dietary supplements, muscle power increased by 57 % at 3 months (P=0.03), and showed only a tendency at 9 months; although FFM increased by 2.7 % at 9 months, the difference was not significant (P=0.10). Exercise did not improve muscle power at 9 months, but improved functional tests (five-time-chair rise, P=0.01). BMI increased with supplements (+3.65 %), but decreased with placebo (-0.5 %) at 9 months (P=0.007). A long-term combined intervention is feasible in frail elderly individuals with a good rate of compliance. Nutritional supplements and exercise may improve muscle function. Despite no significant results on FFM, due to the limited number of volunteers, combined intervention should be suggested to counteract muscle weakness in the frail elderly.

Incidence of aflatoxins in Iran pistachio nuts

Aflatoxins (AF) are highly toxic and carcinogenic secondary fungal metabolites and have been detected in various food commodities including pistachio nuts. Pistachio nuts were produced in Iran during March 2002-February 2003 analyzed for aflatoxin B1 (AFB1), aflatoxin B2 (AFB2), aflatoxin G1 (AFG1) and aflatoxin G2 (AFG2) using immunoaffinity column and quantitated by HPLC and/or TLC-scanner. In this regard, 3356 pistachio nut samples were collected. After dividing samples to sub-samples, 10,068 AF analyses were done. Among 10,068 samples analyzed, AFB1 was detected in 3699 samples (36.7% of the total) with the mean and median of 5.9 (+/-41.7) ng/g and 0.1 ng/g, respectively. Total AF (AFT) was detected in 2852 samples (28.3% of the total) with the mean and median of 7.3 (+/-53.2)ng/g and 0.4 ng/g, respectively. AFB1 level in 1191 samples (11.8%) was above the maximum tolerated level (MTL) of AFB1 in pistachio nut in Iran (5 ng/g). Regarding AFT, the mean contamination level (7.3 ng/g) was lower than MTL of AFT in pistachio nut in Iran as well as lower than the proposed draft maximum level of Codex Committee on Food Additives and Contaminants for AFT (15 ng/g), and only 7.5% of samples had levels above the MTL.

Force/velocity and power/velocity relationships in squat exercise

The purpose of this study was to describe the force/velocity and power/velocity relationships obtained during squat exercise. The maximal force (F0) was extrapolated from the force/velocity relationship and compared to the isometric force directly measured with the aid of a force platform placed under the subject's feet. Fifteen international downhill skiers [mean (SD) age 22.4 (2.6) years, height 178 (6.34) cm and body mass 81.3 (7.70) kg] performed maximal dynamic and isometric squat exercises on a guided barbell. The dynamic squats were performed with masses ranging from 60 to 180 kg, which were placed on the shoulders. The force produced during the squat exercise was linearly related to the velocity in each subject (r2 = 0.83-0.98, P < 0.05-0.0001). The extrapolated F0 was 23% higher than the measured isometric force (P < 0.001), and the two measurements were not correlated. This may be attributed to the position of the subject, since the isometric force was obtained at a constant angle (90 degrees of knee flexion), whereas the dynamic forces were measured through a range of movements (from 90 degrees to 180 degrees). The power/velocity relationship was parabolic in shape for each subject (r2 = 0.94-0.99, P < 0.01-0.0001). However, the curve obtained exhibited only an ascending part. The highest power was produced against the lightest load (i.e., 60 kg). The maximal power (Wmax) and optimal velocity were never reached. The failure to observe the descending part of the power/velocity curve may be attributed to the upper limitation of the velocities studied. Nevertheless, the extrapolation of Wmax from the power/velocity equation showed that it would be reached for a load close to body mass, or even under unloaded conditions.

Compassion Satisfaction, Burnout, and Secondary Traumatic Stress Among Critical Care Nurses in Iran

Introduction: This study investigated the relationship between compassion fatigue and compassion satisfaction among Iranian nurses working in critical care units. Method: A cross-sectional, descriptive survey using the Professional Quality of Life instrument was administered to 400 nurses working in the intensive care units of Iranian hospitals. Results: High risk levels of burnout and secondary traumatic stress existed among 42% and 96% of participants, respectively. Significant positive relationships were detected between burnout and secondary traumatic stress. An inverse relationship was detected between measures of compassion fatigue and compassion satisfaction. Discussion: To ensure culturally congruent care, it is important to evaluate professional quality of life within the context of specific cultures and societies. Iranian critical care nurses are at risk for burnout and secondary traumatic stress. Personal self-care and organizational wellness approaches that consider cultural norms should be designed to boost compassion satisfaction and reduce negative effects of stressful work environments.

Factors facilitating nurses to deliver compassionate care: a qualitative study

BACKGROUND

Compassion is an important ethical foundation of all healthcare professionals especially for nursing. However, there is little understanding of factors which could help and motivate nurses to deliver compassionate care in modern healthcare practices today. Moreover, a cultural context may affect the way compassionate care is delivered by healthcare professionals.

AIMS AND OBJECTIVES

This study aimed to explore what facilitates compassionate care in daily practice from the unique perspective of Iranian nurses.

RESEARCH METHODS

This qualitative exploratory study was conducted in four hospitals. In this study, 16 nurses were selected from various wards. Data were collected by in-depth, face-to-face interviews. For data analysis, a conventional content analysis approach was used.

RESULTS

As the most important theme, the theme 'deepening individual's capacity for compassionate care' emerged, which consisted of three categories: the personal system of values and beliefs, patient experience and positive role models of compassion.

CONCLUSIONS

Addressing and developing nurses' capacity for compassion is possible by providing organisational support and professional education, next to recruiting nurses with a high motivation to relieve patient suffering. These recommendations would help to provide high-quality compassionate care in healthcare practices. Moreover, nurses could improve their individual capacity for compassion by following their value and belief system and by considering their colleagues as a role model of compassionate practice.

Simultaneous detection of 12 mycotoxins in cereals using RP-HPLC-PDA-FLD with PHRED and a post-column derivatization system

A new method for the simultaneous quantification of 12 mycotoxins was developed and optimized using reverse phase high performance liquid chromatography (RP-HPLC) with a photodiode array (PDA) and fluorescence detector (FLD), a photochemical reactor for enhanced detection (PHRED) and post-column derivatization. The mycotoxins included aflatoxins (AFB(1), AFB(2), AFG(1), and AFG(2)), ochratoxin A (OTA), zearalenone (ZEA), deoxynivalenol (DON), fumonisins (FB(1), FB(2), and FB(3)), T-2 and HT-2 toxins. A double sample extraction with a phosphate-buffered saline solution (PBS) and methanol was used for co-extraction of mycotoxins, and a multifunctional immunoaffinity column was used for cleanup. Optimum conditions for separation of the mycotoxins were obtained to separate 12 mycotoxins in FLD and PDA chromatograms with a high resolution. The method gave recoveries in the range 72-111% when applied to spiked corn samples. The limits of detection (LOD) were 0.025 ng/g for AFB(1) and AFG(1), 0.012 ng/g for AFB(2) and AFG(2), 0.2 ng/g for OTA, 1.5 ng/g for ZEA, 6.2 ng/g for FB(1), FB(3) and HT-2 toxin, 9.4 ng/g for FB(2) and T-2 toxin, and 18.7 ng/g for DON. In addition, the limits of quantification (LOQ) ranged from 0.04 ng/g for AFB(2) and AFG(2) to 62 ng/g for DON. The method was successfully applied to the determination of these mycotoxins in 45 cereal samples obtained from the Malaysian market. The results indicated that the method can be applied for the multi-mycotoxin determination of cereals.

Oncology patients' and professional nurses' perceptions of important nurse caring behaviors

BACKGROUND

Caring is the essence of nursing. Caring to be meaningful needs to be based on mutual agreement between nurses and patients as to what constitutes nurse caring behaviors. As a result, healthcare professional can enhance patients' satisfaction of care by providing appropriate caring behavior. However, previous research that combined multiple types of patients, nurses and institutions demonstrated disagreement in prioritizing important behaviors. This paper reports a study that aimed at determining the caring behaviors which oncology patients and oncology nurses perceive to be the most important.

METHODS

This study is a comparative descriptive design that was conducted in an Iranian oncology centre. Convenience sampling was used to recruit 200 patients and 40 nurses to take part in the study. Data were collected over a period of 4 months in 2009 using the Caring Assessment Questionnaire, developed by Larson. Caring behaviors (n = 57) were ranked on a 5-point Likert-type scale and ordered in six subscales: "Being accessible", "Explains and facilitates", "Comforts", "Anticipates", "Trusting relationship", "Monitors and follows through". The data were analyzed using SPSS software version 13.0. The overall mean was calculated for each subscale to determine the rank distribution of the subscales. The nonparametric Mann-Whitney U test analysis of variables was used to compare patients' and nurses' scores on subscales.

RESULTS

The results demonstrate that both groups considered the same order of importance of caring, the high ranking of "Monitors and Follows through and "Being Accessible" and the low ranking of "Comforts" and "Trusting Relationships". Also, Patients only ranked "Being accessible" (p = 0.04) and "Explains and facilitates" (p = 0.03) higher than nurses.

CONCLUSIONS

The oncology patients and nurses perceived highly physical aspects of caring and the results provide for nurses to be aware of the need, during their interactions with patients, to validate the effect their intended caring has upon patients. By so doing and with further refinement of the concept of caring for nursing in studies such as this, the practical aim of making patients feel cared for can be achieved.

Infrared Spectroscopy of Single-Walled Carbon Nanotubes

By using the spectral moments method, we calculate the infrared spectra of chiral and achiral single-walled carbon nanotubes (SWCNTs) of different diameters and lengths. We show that the number of the infrared modes, their frequencies, and intensities depend on the length and chirality of the nanotubes. Furthermore, the dependence of the infrared spectrum as a function of the size of the SWCNT bundle is analyzed. These predictions are useful to interpret the experimental infrared spectra of SWCNTs.

Un-met supportive care needs of Iranian breast cancer patients

BACKGROUND

Assessment of supportive needs is the requirement to plan any supportive care program for cancer patients. There is no evidence about supportive care needs of Iranian breast cancer patients. So, the aims of present study were to investigate this question and s predictive factors.

MATERIALS AND METHODS

A descriptive- correlational study was conducted, followed by logistic regression analyses. The Supportive Care Needs Survey was completed by 136 breast cancer patients residing in Iran following their initial treatment. This assessed needs in five domains: psychological, health system and information, physical and daily living, patient care and support, and sexuality.

RESULTS

Patient perceived needs were highest in the health systems and information (71%), and physical and daily living (68%) domains. Logistic regression modeling revealed that younger participants have more un-met needs in all domains and those with more children reported fewer un-met needs in patient care and support domains. In addition, married women had more un-met supportive care needs related to sexuality.

CONCLUSIONS

The high rate of un-met supportive care needs in all domains suggests that supportive care services are desperately required for breast cancer patients in Iran. Moreover, services that address informational needs and physical and daily living needs ought to be the priority, with particular attention paid to younger women. Further research is clearly needed to fully understand supportive care needs in this cultural context.

Development of an accurate molecular mechanics model for buckling behavior of multi-walled carbon nanotubes under axial compression

In the present paper, an analytical solution based on a molecular mechanics model is developed to evaluate the elastic critical axial buckling strain of chiral multi-walled carbon nanotubes (MWCNTs). To this end, the total potential energy of the system is calculated with the consideration of the both bond stretching and bond angular variations. Density functional theory (DFT) in the form of generalized gradient approximation (GGA) is implemented to evaluate force constants used in the molecular mechanics model. After that, based on the principle of molecular mechanics, explicit expressions are proposed to obtain elastic surface Young's modulus and Poisson's ratio of the single-walled carbon nanotubes corresponding to different types of chirality. Selected numerical results are presented to indicate the influence of the type of chirality, tube diameter, and number of tube walls in detailed. An excellent agreement is found between the present numerical results and those found in the literature which confirms the validity as well as the accuracy of the present closed-form solution. It is found that the value of critical axial buckling strain exhibit significant dependency on the type of chirality and number of tube walls.

Experiences of Iranian Nursing Students Regarding Their Clinical Learning Environment

PURPOSE

The aim of this study was to explain the experiences of Iranian nursing students regarding their clinical learning environment (CLE).

METHODS

Twenty-one nursing students participated in this qualitative study. Data were collected using semistructured interviews and analyzed using conventional content analysis.

RESULTS

Analysis of interviews identified six categories: educational confusion, absence of evaluation procedures, limited educational opportunities, inappropriate interactions with nursing staff, bullying culture, and discrimination. Systematic and consistent methods were not used in clinical education and evaluation of nursing students. In addition, there were inadequate interactions between nursing students and health-care staff, and most students experienced discrimination and bullying in clinical settings.

CONCLUSION

Findings showed that the CLE of Iranian nursing students may be inadequate for high-level learning and safe and effective teaching. Addressing these challenges will require academic and practice partnerships to examine the systems affecting the CLE, and areas to be addressed are described in the six themes identified.

Polymorphism of Crystalline α-Quaterthiophene and α-Sexithiophene: Ab Initio Analysis and Comparison with Inelastic Neutron Scattering Response

Phonons in the alpha-quaterthiophene (4T) and alpha-sexithiophene (6T) polymorph phases are investigated using the direct method combined with density functional theory (DFT)-based total energy calculations. The simulation of inelastic neutron scattering spectra (INS) on the LT and HT polymorph phases of 4T and 6T enable the corresponding spectral signatures of these materials to be identified. In particular, there are two fingerprints: (i) the low-frequency vibrational modes (frequencies lower than 200 cm(-1)) and (ii) the vibrational modes in the 600-900 cm(-1) frequency range. The good agreement with the INS experimental data allows us to assign unambiguously the origin of all features (first-order and high-order processes) of these spectra and to predict that the LT phase is the phase measured experimentally both on the 4T and 6T materials. Moreover, the broad background in the 600-1400 cm(-1) frequency range and the well-defined features which appear around 940 cm(-1) in the calculated INS spectra of 4T/HT and 6T/HT are assigned to multiphonon contributions. This multiphonon contribution at 940 cm(-1), which is absent in the 4T/LT and 6T/LT INS spectra, also constitutes a fingerprint of the HT phases. Finally, the calculated dispersion curves of the two polymorph phases of 4T and 6T are given.

Exposure of Iranian emergency medical technicians to workplace violence: a cross-sectional analysis

OBJECTIVES

Emergency medical technicians (EMTs) in Iran experience concerning levels of workplace violence, although until now there has been no investigation of this phenomenon. The objectives of the present study were to describe the exposure of Iranian EMTs to workplace violence and to identify the importance of related factors from their viewpoint.

METHODS

In this descriptive, exploratory study, 160 EMTs agreed to participate in a survey that collected data regarding their exposure to the following forms of workplace violence: verbal abuse, physical assault, cultural harassment, sexual harassment and sexual assault.

RESULTS

A total of 138 questionnaires were returned, representing a response rate of 86%. The majority of participants 75% (n = 103) experienced at least one form of workplace violence in the 12 months before completing the questionnaire. The most frequently reported form of workplace violence was verbal abuse (71%), followed by physical assault (38%) and cultural harassment (9%). Violence resulting in serious injuries was reported by only 4% of participants, with no more than 8% of participants experiencing workplace violence that included the use of weapons. The most reported response to workplace violence was to 'invite the offender to calm down'. Participants took this approach because they believed that 'follow up of workplace violence is ineffectual' (34%), considered the workplace violence as a common in their job (30%), and did not know whom to report workplace violence to (13%).

CONCLUSION

Iranian EMTs experience a considerable amount of workplace violence. The present study highlights the recommendation for formal training programmes and clearer protocols about how to manage workplace violence, especially verbal abuse in the Iranian prehospital setting.

Far- and Mid-Infrared of Crystalline 2,2‘-Bithiophene: Ab Initio Analysis and Comparison with Infrared Response

Infrared intramolecular vibrations and lattice modes in the crystalline phase of 2,2'-bithiophene (2T) are investigated using the direct method combined with density functional theory (DFT)-based total energy calculations. For the first time, the far- and mid-infrared responses have been calculated from the Gamma-point modes and the Born effective charge tensors of the 2T crystalline phase. The relative good agreement between the calculated and experimental infrared spectra allows us to assign the origin of the main features of the experimental spectra, which is of particular interest in the far-infrared domain. These assignments are useful for understanding all the properties of the 2T crystalline phase in which phonon-phonon and electron-phonon interactions play an important role.

Challenges of the preceptors working with new nurses: A phenomenological research study

INTRODUCTION

Preceptors play an important role in the transition of new nurses to the practice setting, however, preceptorship experience has been perceived as stressful by preceptors. This study aimed to explore the lived experiences of nurse preceptors working with new nurses.

METHOD

This qualitative study used the hermeneutic phenomenological design to explore the experiences of six nurse preceptors working with new nurses in a tertiary pediatric teaching hospital in Northwest of Iran, who were recruited by purposive sampling. Data were collected using in-depth semi-structured individual interviews between July 2014 and March 2015, and analyzed using the Diekelmann's seven-stage method.

RESULTS

Data analysis revealed three themes: 1) preceptorship as a challenging and stressful role; 2) lack of support; and 3) lack of appreciation. Preceptorship as 'a challenging and stressful role' was the constitutive pattern that unified the themes.

CONCLUSION

The preceptorship of new nurses is challenging and stressful. Preceptors endure several roles concurrently, thus, their workload should be balanced appropriately in order not to compromise with one another and evade burnout. The preceptors need to be well supported and their contribution be appropriately recognized. Setting clear objectives and realistic expectations, and having clear policies and guidelines in place should help develop a preceptorship program that is more likely to bring about positive outcomes for both preceptors and new nurses.

Relationship between Sleep Disorders, Pain and Quality of Life in Patients with Rheumatoid Arthritis

INTRODUCTION

Rheumatoid arthritis as one of the most common autoimmune diseases is known to be one of the leading causes of disability. Sleep disorders have direct influence on patient's life. According to studies, sleep problems are known to have negative impact on well-being and functioning, but the exact nature of relationship between sleep disorders and Rheumatoid arthritis is not completely understood. This study aimed to investigate the relationship between sleep disorders, pain and quality of life in patients with rheumatoid arthritis patients.

METHODS

In a descriptive -correlative study, 210 patients with rheumatoid arthritis referred to Tabriz medical university clinics selected by convenience sampling and were assessed by Sleep Disorders Questionnaire (SDQ), Epworth Sleepiness Scale (ESS), SF-36 Quality of Life Questionnaire and Visual Analog Scale (VAS). Data were analyzed using SPSS-13 by descriptive statistics such as frequency, mean (SD) and inferential statistics including Spearman correlation analysis, linear regression, χ(2),t-test and ANOVA.

RESULTS

The mean age of participants was 48.41(12.92) years in which most of them (74%) were female. The mean (SD) quality of life was 40.51(22.94), sleepiness 13.14 (5.6) and pain 6.09 (2.14). There was significant negative relationship between some sleep disorders such as (naps, apnea, asphyxia,…) and pain with quality of life but pain severity had more effect on QOL compared to sleep problems. Furthermore, participants had low quality of life with more restriction in physical (mean=34.71) and general health (mean=34.42).

CONCLUSION

Sleep problems and pain were associated with poor quality of life in Rheumatoid Arthritis patients.

Raman Scattering in Crystalline Oligothiophenes: A Comparison between Density Functional Theory and Bond Polarizability Model

Raman intensity of intramolecular and lattice modes of crystalline alpha-bithiophene (alpha-2T) are investigated within density functional theory using a nonlinear response formalism. First, comparison between the calculated Raman spectrum and the experimental data allows the assignment of the main Raman lines over the whole frequency range. Then, a bond polarizability (BP) model, limited to first neighbors, is built. We show that, although the BP model cannot reproduce the changes of dielectric susceptibility under individual atomic displacements, it is accurate enough to reproduce the profile of the unpolarized nonresonant Raman spectrum of alpha-2T powder. Finally, the BP model, fitted on our first-principles results on alpha-2T, is applied with success to the alpha-quaterthiophene polymorph phases and alpha-sexithiophene, demonstrating on practical examples that first-principles and BP approaches are powerful complementary tools to calculate the nonresonant Raman spectrum of alpha-2T and make reasonable predictions on larger oligothiophenes.

Compassionate Nursing Care Model: Results from a grounded theory study

Compassion, as an indicator for quality care, is highly valued by patients and healthcare professionals. Compassionate care is considered a moral dimension of nursing practice and an essential component of high quality care. This study aimed to answer these questions: (1) What are the facilitators and barriers of providing compassionate nursing care in the clinical setting? (2) Which strategies do nurses use to provide compassionate care? (3) What is the specific model of compassionate care for the nursing context? A grounded theory approach was used in this study. A total of 21 nurses working in diverse clinical settings participated in the study. Purposive and theoretical sampling was used to select the participants. Data were collected by in-depth face to face interviews and analyzed by the constant comparative method. Ethical approval was gained from the Ethical Review Board of Tabriz University of Medical sciences. The analysis resulted in the development of three main themes: (a) contextual factors affecting compassionate care, (b) the compassionate care actions, and (c) the consequences of compassionate care. The main dimensions of compassionate care are demonstrated in a Compassionate Nursing Care Model. Nurses' ability on providing compassionate care is influenced by individual and organizational factors that may facilitate or inhibit this type of care. Leadership and nurse managers should remove the barriers which diminish the nurses' ability to provide compassionate care and support them to engage in compassionate care programs. Identifying and recruiting compassionate nurses, developing their compassionate capacity, and providing role models of compassion could improve the flourishing of person-centered and compassionate care in clinical settings. The Compassionate Nursing Care Model (CNCM) provides a model to guide nursing care and research.