The association between chronotype, sleep quality and medication errors among critical care nurses.

Medication administration errors could result in severe complications in critical care units. This study investigated an association between chronotype, sleep quality and medication errors among essential nurses of care in Qazvin teaching hospitals in Iran. In this multicenter, cross-sectional study, all registered nurses of critical care units of Qazvin teaching hospitals were recruited. Data were collected through anonymous questionnaires, including socio-demographic data, Morning-Evening Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and medication errors data. Data were analyzed with SPSS v.24 by using the Chi-square test, Mann-Whitney U test, and logistic regression analysis. P values less than 0.05 were considered significant. The mean age and work experience were 33.12 ± 6.74 and 9.11 ± 5.96, respectively. One hundred sixty-six nurses (96%) have been working in rotating shifts. Nurses with intermediate chronotypes were predominant (n = 122; 70.5%). The majority of nurses (68.2%) had poor sleep quality (n = 118). Logistic regression analysis showed eveningness chronotype was associated with 4.743 fold increased risk of medication error (P < 0.033). No association was found between medication error and sleep quality (p < 0.95). There was no significant relationship between chronotype and sleep quality (P < 0.257). Our study showed that nurses with eveningness chronotype make more medication errors; therefore, considering the individual circadian preference before deciding on their shift timing assignment will be an important issue in reducing nurses' medication errors and improving patient safety in critical care units.

Resilience of first-line nurses during adaptation to the COVID-19 pandemic: A grounded theory study.

AIM: Nurses are a vital resource in providing care to COVID-19 patients. During adaptation to the pandemic, the mental health of nurses was disturbed. The present study aimed to explain the resilience development process and adaptive strategies of first-line nurses during the COVID-19 pandemic. METHODS: This study was conducted based on the grounded theory qualitative approach. Twenty-two Iranian first-line nurses, who were employed in one teaching hospital in Qazvin city, were included via purposive and theoretical sampling. The data were collected through semi-structured interviews and were analyzed based on the Corbin and Strauss approach 2015. RESULTS: The resilience development process of nurses had three stages including initial confrontation with changes, managing conditions and reorganizing, developing resilience. Professional commitment was identified as a core category that affected all stages of resilience development. Negative emotions, nurses' characteristics, and caring challenges were identified as contextual factors which affected the adaptation of nurses to the COVID-19 pandemic and the development of resilience. CONCLUSION: Regarding the importance of professional commitment in the nurses' resilience development and not leaving the profession in the COVID-19 pandemic, it is important to emphasize the ethical values and principles of the nursing profession in practice and especially in the education of nursing students. It is necessary to monitor mental health and provide professional psychological counseling by the healthcare systems; also, nursing managers should follow a supportive leadership style and consider first-line nurses' worries.

A new truck-drone routing problem for parcel delivery by considering energy consumption and altitude.

The high population density in metropolitan areas, high-rise buildings, and changes in people's lifestyles have completely changed the way postal packages are delivered. People no longer go to the ground floor to receive a postal package. In the meantime, the delivery of postal packages through the balconies and windows of the units on the upper floors of the buildings will gradually become inevitable. Hence, a new Vehicle Routing Problem with Drone mathematical model has been developed with the objective of minimizing total delivery time and with the ability to deliver postal packages in the path of drones at different heights. In addition, the drone's energy consumption is computed by taking into account wind speed, the weight of the postal parcel, the weight of the drone's body, and other factors in the drone's path. A two-phase algorithm based on the nearest neighborhood and local search is presented to solve the developed mathematical model in different instances. Several small-sized test problems are designed and solved, and the performance of the heuristic approach is evaluated compared to the outputs of the CPLEX solver. Finally, the proposed model is implemented on a real-world scale to demonstrate the efficacy and applicability of the proposed model as well as the heuristic approach. The results show that the model successfully finds the optimal planning of the delivery routes, especially when we deal with delivery points at different heights.

A comprehensive analysis of gene expression profiling data in COVID-19 patients for discovery of specific and differential blood biomarker signatures.

COVID-19 is a newly recognized illness with a predominantly respiratory presentation. Although initial analyses have identified groups of candidate gene biomarkers for the diagnosis of COVID-19, they have yet to identify clinically applicable biomarkers, so we need disease-specific diagnostic biomarkers in biofluid and differential diagnosis in comparison with other infectious diseases. This can further increase knowledge of pathogenesis and help guide treatment. Eight transcriptomic profiles of COVID-19 infected versus control samples from peripheral blood (PB), lung tissue, nasopharyngeal swab and bronchoalveolar lavage fluid (BALF) were considered. In order to find COVID-19 potential Specific Blood Differentially expressed genes (SpeBDs), we implemented a strategy based on finding shared pathways of peripheral blood and the most involved tissues in COVID-19 patients. This step was performed to filter blood DEGs with a role in the shared pathways. Furthermore, nine datasets of the three types of Influenza (H1N1, H3N2, and B) were used for the second step. Potential Differential Blood DEGs of COVID-19 versus Influenza (DifBDs) were found by extracting DEGs involved in only enriched pathways by SpeBDs and not by Influenza DEGs. Then in the third step, a machine learning method (a wrapper feature selection approach supervised by four classifiers of k-NN, Random Forest, SVM, Naïve Bayes) was utilized to narrow down the number of SpeBDs and DifBDs and find the most predictive combination of them to select COVID-19 potential Specific Blood Biomarker Signatures (SpeBBSs) and COVID-19 versus influenza Differential Blood Biomarker Signatures (DifBBSs), respectively. After that, models based on SpeBBSs and DifBBSs and the corresponding algorithms were built to assess their performance on an external dataset. Among all the extracted DEGs from the PB dataset (from common PB pathways with BALF, Lung and Swab), 108 unique SpeBD were obtained. Feature selection using Random Forest outperformed its counterparts and selected IGKC, IGLV3-16 and SRP9 among SpeBDs as SpeBBSs. Validation of the constructed model based on these genes and Random Forest on an external dataset resulted in 93.09% Accuracy. Eighty-three pathways enriched by SpeBDs and not by any of the influenza strains were identified, including 87 DifBDs. Using feature selection by Naive Bayes classifier on DifBDs, FMNL2, IGHV3-23, IGLV2-11 and RPL31 were selected as the most predictable DifBBSs. The constructed model based on these genes and Naive Bayes on an external dataset was validated with 87.2% accuracy. Our study identified several candidate blood biomarkers for a potential specific and differential diagnosis of COVID-19. The proposed biomarkers could be valuable targets for practical investigations to validate their potential.

Ecological risk assessment of trace elements (TEs) pollution and human health risk exposure in agricultural soils used for saffron cultivation.

Contamination of farmland soils by trace elements (TEs) has become an international issue concerning food safety and human health risks. In the present research, the concentrations of TEs including cadmium (Cd), cobalt (Co), chromium (Cr), copper (Cu), manganese (Mn), nickel (Ni), lead (Pb), zinc (Zn) and iron (Fe) in soils of 16 farmlands were determined in Gonabad, Iran. In addition, the human health risks due to exposure to the TEs from the soils were assessed. Moreover, the soil contamination likelihood was evaluated based on various contamination indices including contamination factor [Formula: see text]), enrichment factor (EF), geo-accumulation index (Igeo), and pollution load index (PLI) calculations. The soil mean concentrations for Cd, Co, Cr, Cu, Mn, Ni, Pb, Zn and Fe ranges as 0.102, 6.968, 22.550, 29.263, 475.281, 34.234, 13.617, 54.482 and 19,683.6 mg/kg in farmland soils. The mean concentrations of the TEs decreased in the order of Fe > Mn > Zn > Ni > Cu > Cr > Pb > Co > As > Cd. Levels of all metals in this study were within the FAO/WHO and Iranian soil standards. The HQ values from investigated elements for adults and children in the studied farms were less than the limit of 1, indicating no health risks for the studied subpopulations. The results of the present research indicated no significant carcinogenic health hazards for both adults and children through ingestion, skin contact and inhalation exposure routes. [Formula: see text] values of Ni and Zn in 100% and 6.25% of farmlands were above 1, showing moderate contamination conditions. EF values of metals in farmlands were recorded as "no enrichment", "minimal enrichment" and "moderate enrichment" classes. Furthermore, it can be concluded that the all farms were uncontaminated except Ni (moderately contaminated) based on Igeo. This is an indication that the selected TEs in the agricultural soils have no appreciable threat to human health.

Clear Cell Renal Cell Carcinoma: A Comprehensive in silico Study in Searching for Therapeutic Targets.

INTRODUCTION: Clear cell renal cell carcinoma (ccRCC) is recognized as one of the leading causes of illness and death worldwide. Understanding the molecular mechanisms in ccRCC pathogenesis is crucial for discovering novel therapeutic targets and developing efficient drugs. With the application of a comprehensive in silico analysis of the ccRCC-related array sets, the main objective of this study was to discover the top molecules and pathways in the pathogenesis of this cancer. METHODS: ccRCC microarray datasets were downloaded from the Gene Expression Omnibus database, and after quality checking, normalization, and analysis using the Limma algorithm, differentially expressed genes (DEGs) were identified, considering the adjusted p value <0.049. The intensity values of the identified DEGs were introduced to the Weighted Gene Co-Expression Network Analysis (WGCNA) algorithm to construct co-expression modules. Functional enrichment analyses were performed using the DEGs in the disease-correlated module, and hub genes were identified among the top genes in a protein-protein interaction network and the disease most correlated module. The expression analysis of hub genes was done by utilizing GEPIA, and the GSCA server was used to compare the expression patterns of hub genes in ccRCC and other cancers. DGIdb database was utilized to identify the hub gene-related drugs. RESULTS: Three datasets, including GSE11151, GSE12606, and GSE36897, were retrieved, merged, normalized, and analyzed. Using WGCNA, the DEGs were clustered into eight different modules. Translocation of ZAP-70 to immunological synapse, endosomal/vacuolar pathway, cell surface interactions at the vascular wall, and immune-related pathways were the topmost enriched terms for the ccRCC-correlated DEGs. Twelve genes including PTPRC, ITGAM, TLR2, CD86, PLEK, TYROBP, ITGB2, RAC2, CSF1R, CCR5, CCL5, and LCP2 were introduced as hub genes. All the 12 hub genes were upregulated in ccRCC samples and showed a positive correlation with the infiltration of different immune cells. According to the DGIdb database, 127 drugs, including tyrosine kinase inhibitors, glucocorticoids, and chemotaxis targeting molecules, were identified to interact with the hub genes. CONCLUSION: By utilizing an integrative bioinformatics approach, this experiment shed light on the underlying pathways in the pathogenesis of ccRCC and introduced several potential therapeutic targets for repurposing or developing novel drugs for an efficient treatment of this cancer. Our next step would be to assess the gene expression profiles of the identified hubs in different cell populations in the tumor microenvironment.

Nurses' professional commitment in COVID-19 crisis: A qualitative study.

Background: Professional commitment is an important factor in employee performance. COVID-19 outbreak has seriously affected the nurses working conditions. Numerous factors can affect nurses' professional commitment in this situation.Aim: To explore the nurses' lived experiences, attitudes, views and perceptions toward professional commitment and factors affecting it in the Covid-19 crisis.Method, Setting and Participants: This qualitative study was conducted using phenomenological approach and content analysis method. Twenty-five nurses were interviewed using semi structured in-depth interviews. Conventional content analysis was used to analyze collected data.Ethical considerations: Ethical approval was obtained from the Ethics Committee of Qazvin University of Medical Sciences.Results: Five themes were extracted as follows: "Collaborative empathetic commitment", "Loyal commitment", "Sacrificial commitment", "Commitment with doubt and concern" and "humanistic commitment".Discussion and Conclusion: The Covid-19 crisis has caused major changes in nurses' working conditions, which have also affected the concept of professional commitment to the nursing profession and revealed new concepts. Identifying internal and external factors that can enhance nurses' commitment to the profession in critical situations such as the Covid-19 outback is of particular importance.

Symptom Disclosure Process Among Iranian Women With Self-discovered Breast Cancer.

BACKGROUND: Breast cancer is the most common malignancy among Iranian women. Symptom disclosure plays an important role in help-seeking behavior among women with self-discovered breast cancer. OBJECTIVE: The aim of this study was to explain how symptoms are disclosed by Iranian women. METHODS: This study was conducted based on the grounded theory qualitative approach. Twenty-two Iranian women with breast cancer, who discovered the symptoms themselves and were referred to 2 teaching hospitals in Tehran and Qazvin, were included via purposive and theoretical sampling. The data were collected through semistructured interviews and were analyzed based on the Corbin and Strauss approach. RESULTS: The process of symptom disclosure had 5 stages including identifying the symptoms, evaluating and interpreting the symptoms, weighing the disclosure conditions, selecting the disclosure audience, and disclosing. The perceived threat was identified as the core category. On the basis of the level of threat perception and the seriousness of the symptoms, the 3 patterns of immediate disclosure, delayed disclosure, and nondisclosure were recognized. CONCLUSION: Perceived threat is the main motivator for rapid disclosure in Iranian women with potential breast cancer symptoms and leads to a better follow-up of the symptoms. Therefore, increasing women's awareness about breast cancer symptoms, treatments, and non-follow-up consequences leads to a better perception of the threat level. IMPLICATIONS FOR PRACTICE: According to these findings, it is very important to increase Iranian women's awareness about the symptoms of breast cancer (especially the nonspecific ones). For this purpose, it is necessary to design educational interventions.

Predictors of cognitive emotion regulation strategies: Iranian nurses.

BACKGROUND: Nurses have a challenging job and encounter more stressful situations. In response to these situations, they demonstrate adaptive or maladaptive cognitive emotion regulation strategies (CERS). As there is a lack of literature regarding the factors predicting the selection of CERS, the present study aimed to investigate the role of age, sex, marital status, working experience, type of ward, and education level in predicting these strategies in Iranian nurses. MATERIALS AND METHODS: A descriptive correlational study was conducted to examine predictive factors' emotion regulation strategies used by 193 nurses who worked at six hospitals under the supervision of Qazvin University of Medical Sciences in 2018. The study population were selected by stratified random sampling method. Data were collected by two questionnaires, one demographic questionnaire and the other was Cognitive Emotion Regulation Questionnaire conducted by Garnefski (α = 0.8). Data analysis was performed using correlation and multiple linear regression. RESULTS: The results showed that there is a significant relationship between the "type of ward" and "age" with adaptive and maladaptive strategies. In the multiple linear regression model, two variables of age (P = 0.03) and type of ward (P = 0.04) were able to predict 23% of variance CERS. CONCLUSIONS: Based on the results of this study, health-care providers and hospital managers should pay attention to factors related to adaptive and maladaptive CERS.

Speech signal analysis of alzheimer's diseases in farsi using auditory model system.

In recent years, extensive studies have been conducted on the diagnosis of Alzheimer's disease (AD) using the non-invasive speech signal recognition method. In this study, Farsi speech signals were analyzed using the auditory model system (AMS) in order to recognize AD. For this purpose, after the pre-processing of the speech signals and utilizing AMS, 4D outputs as function of time, frequency, rate, and scale range were obtained. The AMS outcomes were averaged in term of time to analyze the rate-frequency-scale for both groups, Alzheimer's and healthy control subjects. Thereafter, the maximum of spectral and temporal modulation and frequency were extracted to classify by the support vector machine (SVM). The SVM achieves higher promising recognition accuracy with compare to prevalent approaches in the field of speech processing. The acceptable results demonstrate the applicability of the proposed algorithm in non-invasive and low-cost recognizing Alzheimer's only using the few extracted features of the speech signal.

Detection of nucleobases on borophene nanosheet: A DFT investigation.

In this paper, we present a computational study investigating the electronic properties of DNA nucleobases (Adenine, Guanine, Cytosine and Thymine) on χ3 borophene using a combination of density functional theory (DFT) and non-equilibrium Green's function (NEGF) formalism.The adsorption energy, equilibrium distance, net charge of transfer, and density of states (DOSs) are obtained at different molecule orientations and selective positions.The most stable geometries of DNA molecules on χ3 borophene are also determined.By using (NEGF) formalism, the electronic transmission and electrical current are calculated separately as a function of applied bias voltage for each nucleobase. We find that attaching this molecule to borophene changes the electrical conductivity.Results indicate the strong potential of borophene in adsorption of the DNA molecules, meaning this two-dimensional material could be a suitable candidate for future DNA sequencing devices.

Spiritual Intelligence and Post-abortion Depression: A Coping Strategy.

Loss of pregnancy is a major stressor which can cause mental disorders. In stressful conditions, spiritual intelligence can be used as a coping strategy to manage and cope with the stressor. It may also produce positive outcomes in spontaneous abortion. This study aimed to assess the relationship of spiritual intelligence with depression after spontaneous abortion. This cross-sectional descriptive-correlational study was done in 2015-2016 on 185 women with spontaneous abortion who were hospitalized in the postnatal care ward of Kowsar teaching hospital, Qazvin, Iran. Data collection was performed in two steps. In the first step, a demographic and obstetric characteristics questionnaire and the Spiritual Intelligence Self-Report Inventory were completed by participants during their hospital stay. In the second step, i.e., 7 days after spontaneous abortion, the Edinburgh Postnatal Depression Scale was completed for each participant over the phone. Variables which were found in univariate analysis to have a significant correlation with depression were entered into multiple logistic regression analysis to assess their roles in predicting depression. Most women were depressed (54%). Multiple logistic regression analysis revealed that the significant predictors of depression were women's educational status (OR 0.419; CI 0.18-0.93), gestational age at the time of abortion (OR 1.121; CI 1.02-1.22), and the personal meaning production dimension of spiritual intelligence (OR 0.82; CI 0.73-0.91). Spiritual intelligence is significantly correlated with post-abortion depression. Developing and following strategies for promoting spiritual intelligence can alleviate depression, stress, and anxiety after spontaneous abortion and also help manage complicated pregnancies.

Protocols for decellularization of human amniotic membrane.

Human amniotic membrane (HAM) has been used as a very promising biological-based product in health centers, especially for skin and cornea wound healing applications. The excellent properties of this membrane make it a potential candidate in treatment of various skin injuries such as bedsores, burn wounds and diabetic ulcers. Such properties are cytobiocompatibility, a structure very similar to normal skin composed of extracellular matrix (ECM) proteins, various growth factors involved in normal wound healing process and antibacterial agents. HAM contains epithelial cells, fibroblasts and mesenchymal stem cells. Therefore, the successful decellularization of HAM with minimal negative effects on its ECM components is very important to avoid graft rejection and shows improved performance. To date, several approaches have been conducted for decellularization of HAM, which is mainly based on enzyme-, detergent- or mechanical procedures with various ranges of success. Here, we describe a systematic detergent-based decellularization protocol as main protocol. We also explain the enzyme- and mechanical-based methods as the alternative protocols for decellularization of HAM.

Disordered eating attitudes among Iranian university students of medical sciences: The role of body image perception.

BACKGROUND: Disordered eating attitudes and behaviors have become an issue of worldwide concern. AIM: This research was designed to investigate the role of body image satisfaction in the relationship with eating attitudes among students of Qazvin University of Medical Sciences in Iran. METHODS: In this cross-sectional study, 385 Qazvin university students of medical sciences were recruited by randomized stratified sampling in 2014. The students completed a three-part questionnaire (socio-demographic, Eating Attitudes Test and Body Shape Questionnaire) in their classrooms. We used hierarchical generalized linear models to identify variables significantly associated with Eating Attitudes Test scores. RESULTS: The mean age of the students was 21.80 ± 2.98 years. Mean scores for the Eating Attitudes Test and Body Shape Questionnaire were 66.75 ± 29.8 and 11.86 ± 10.97 respectively; 18.5% of students had a score of 20 and above (≥ 20) that indicated disordered eating attitudes or as being at risk of eating disorders. In the multiple regression model, the Eating Attitudes Test was related to screening body image dissatisfaction (ß = 0.122, P < 0.001). Body mass index was negatively related to the Eating Attitudes Test score (ß= -0.488, P < 0.016), and diet was significantly correlated with an increased Eating Attitudes Test score (ß = 5.803, P < 0.001). CONCLUSIONS: The risk of eating disorders is relatively high among Iranian university students. It can be a warning to health policy makers and should be the focus of special attention. In the present study, the most important factor related to abnormal eating attitudes was body image dissatisfaction. Regarding the complexity of the causes of eating disorders, various preventive and therapeutic interventions are necessary to avoid the dissemination in society of an idealized view of excessive thinness and further unfavorable outcomes in college students.

Help-seeking behaviour for cancer symptoms: an evolutionary concept analysis.

BACKGROUND: Cancer survival largely depends on its early diagnosis. Therefore, assessing help-seeking behaviours among people with potential symptoms of cancer is essential. AIM: This study aimed to analyse the concept of help-seeking behaviour for cancer symptoms. METHODS: This concept analysis was conducted using Rodger's evolutionary method. An online literature search was conducted in the PubMed, Scopus and Cochrane databases to find relevant articles published from 2000 to 2017 in English peer-reviewed journals. In total, ninety articles were included in the study. Through thematic analysis, the data were analysed for the definitions, attributes, antecedents and consequences of the concept of help-seeking behaviour for cancer symptoms. RESULTS: The concept of help-seeking behaviour for cancer symptoms includes a chain of behaviours and is defined as the process of informed decision-making for seeking medical help and using healthcare services after the detection of the first potential cancer symptoms. The attributes of the concept of help-seeking behaviour for cancer symptoms include process, problem-centeredness, intentional action and interpersonal interaction. Antecedents of the concept of help-seeking behaviour for cancer symptoms were broadly categorised as its facilitators and barriers, among which old age, young age, marriage, low education level, positive family history of cancer, fear over cancer, low perceived threat, symptom disclosure to significant others are both facilitator and barrier. The consequences of the concept of help-seeking behaviour for cancer symptoms were also broadly categorised in the two main categories of positive consequences and adverse consequences. CONCLUSIONS: Help-seeking behaviour is a multidimensional time-dependent and context-bound concept which is usually defined based on the concept of time in order to facilitate its measurement. It is generally used for assessing patients' delay in seeking medical help. The findings of this study provide better understanding about the concept of help-seeking behaviour for cancer symptoms and its implications for research and practice.

Advances in perinatal stem cells research: a precious cell source for clinical applications.

Perinatal tissues possess numerous types of stem (stromal) cells, which are considered effective candidates for cell therapy. These tissues possess common characteristics of both embryonic and adult stem cells, and cell therapists have begun to use perinatal stem cells to treat several diseases. Despite their benefits, these cells are considered biological waste and usually discarded after delivery. This review highlights the characteristics and potential clinical applications in regenerative medicine of perinatal stem cell sources - cord blood hematopoietic stem cells, umbilical cord mesenchymal stem cells, amniotic membrane stem cells, amniotic fluid stem cells, amniotic epithelial cells and chorionic mesenchymal stem cells.

In vitro and in vivo investigation of a novel amniotic-based chitosan dressing for wound healing.

It is more than a decade that amniotic membrane has been used as a wound dressing because of its anti-inflammatory, anti-microbial, anti-fibrotic, anti-scarring properties, as well as its pain relieving and epithelialization promoting features. However, amniotic membrane had limited applications because it needs to suture in surgery, is highly fragile, firmly adhere to the wound and may cause bleeding and pain when changing the bandage. This study investigated the possibility of development of a novel amniotic-based chitosan gel dressing as a potential wound repair substrate with marked efficacy. In this experiment, amniotic gel prepared based on chitosan/PVP gel containing human amniotic membrane extract (AME-Gel) was investigated in terms of wound-healing efficacy and scar preventive effects in a rat burn model. The levels of re-epithelialization and dermal regeneration were examined by histological assessment using H&E and Masson's trichrome staining. Also, we clarified the mechanism of healing and cytokine-releasing activities of AME as well as its effect on epithelization, angiogenesis, and fibroblast growth and migration. Our results revealed that AME-Gel induces epidermal and dermal regeneration at a shorter time through formation of granulation tissue, enhancement of fibroblast proliferation, and improvement of blood capillary formation concomitant with developing collagen bundles. Therefore, AME-Gel could be considered a simple and easy to be used as a biological dressing for any type of superficial burn wounds, without any adverse effects.

The role of amniotic membrane extract eye drop (AMEED) in in vivo cultivation of limbal stem cells.

BACKGROUND: Limbal stem cell transplantation (LSCT) is the definitive treatment for total limbal stem cell deficiency (LSCD). This study evaluates the anatomical and visual outcomes of a surgical technique supplemented by amniotic membrane extract eye drop (AMEED) for in vivo cultivation of limbal stem cells (LSCs). METHODS: One small limbal block (2 × 1 mm) harvested from the contralateral healthy eye was transferred to the diseased eye, which had been already covered by cryopreserved amniotic membrane (N = 20). The patients were categorized into case and control groups. AMEED was administered postoperatively only for patients in the case group (N = 14). Sequential penetrating keratoplasty (PKP) was performed in 4 eyes of the case group for optical clarity. Visual acuity, epithelial healing, corneal clarity and regression of conjunctivalization/vascularization were evaluated after surgery. The corneal buttons of post-PKP eyes were evaluated for LSC markers. RESULTS: In the case group, the mean corrected distance visual acuity (CDVA) was 20/400 before surgery, which improved to 20/40 and 20/50 at the last follow-up in eyes with and without PKP, respectively. Epithelial defects healed in all eyes of the case group during 2 weeks after surgery. Corneal conjunctivalization/vascularization regressed dramatically in all patients of the case group 2-3 months after surgery. In PKP cases, all transplanted corneas were clear at the last follow-up. LSC markers were expressed on the surface of all trephined corneal buttons. All eyes in the control group developed persistent epithelial defect. CONCLUSION: This study suggests that amniotic membrane extract may be helpful for in vivo cultivation of limbal stem cells.

Assessing Emergency Nurses' Clinical Competency: An Exploratory Factor Analysis Study.

BACKGROUND: Nursing as a clinical discipline is developing in the emergency wards. Health care systems should continuously assess and prioritize indicators of clinical competency in these wards. The lack of clear standards of clinical competency indicators challenges evaluation. The purpose of this study was to determine clinical competency indicators and its priority based on nurses' views in educational and therapeutic centers in Guilan. MATERIALS AND METHODS: The Q methodology was conducted in three phases, that is, phase I (determining the clinical competency indicators), phase II (classifying clinical competency indicators by an expert panel), and phase III (prioritizing clinical competency indicators). The subjects were selected by convenience sampling among nurses working in the emergency wards of teaching hospitals affiliated to Guilan in 2013. Finally, clinical competency indicators were prioritized using exploratory factor analysis. RESULTS: In the prioritizing phase, data were collected from 710 nurses over two months. Five factors with 30 general competencies were found in three domains: communication, professional maturity, and personality characteristics. Six factors with 37 specific competencies were also found in two domains: scientific and technical capabilities and basic clinical skills that can provide a structured instrument for assessing clinical competence in emergency nurses. CONCLUSIONS: Achieved competencies can be used as a reference for nursing education and practice in emergency. Further research on health care system is needed in order to achieve a reliable and valid instrument.

Health-Related Quality of Life and Related Factors in Children and Adolescents With Epilepsy in Iran.

The effects of epilepsy may disturb the ability of the child and family to function and has detrimental effects on health-related quality of life (HRQOL). We determined HRQOL and related factors in children and adolescents with epilepsy in Iran. This cross-sectional study was performed in a private neurology pediatric clinic in Guilan Province (North of Iran). We evaluated 108 children and adolescents with epilepsy. Data were collected by interview with parents and review of medical records. Generic and specific HRQOL was evaluated by Child Health Questionnaire and QOL in Childhood Epilepsy Questionnaire, respectively. The mean of overall generic HRQOL score was 71.05 ± 11.31. The lowest score was related to parental impact: emotional (52.59 ± 15.49). The average total specific HRQOL score was 71.95 ± 11.16. The lowest score dedicated to general health (51.21 ± 18.25). In multivariate regression analysis, duration of epilepsy (p < .016) was independently associated with generic HRQOL scores. Variables were independently associated with specific HRQOL scores including gender (p < .003), duration of epilepsy (p < .011), and family history of epilepsy (p < .005). We found that epilepsy duration was the strongest predictor of both generic and specific HRQOL in children and adolescents with epilepsy. This will be useful for clinicians in epilepsy management, which will enhance HRQOL.