Knowledge, Attitude, and Practice (KAP) Status toward Clinical Reasoning and Evidence-Based Medicine among the Medical Interns and Gynecology Residents of Iran University of Medical Sciences.

Background: Clinical reasoning and evidence-based medicine (EBM) are important concepts in modern medicine. Objective: We performed this study to investigate the knowledge, attitude, and practice (KAP) status toward clinical reasoning and EBM among the medical interns and gynecology resident physicians of Iran University of Medical Sciences and related factors. Methods: A cross-sectional study (Tehran, Iran, first half of 2022) was conducted based on two researcher-made questionnaires consisting of three components for each including clinical reasoning attitude (CR-A), clinical reasoning knowledge (CR-K), clinical reasoning practice (CR-P), EBM attitude (EBM-A), EBM knowledge (EBM-K), and EBM practice (EBM-P). The related factors were age, gender, educational level, score of general practice education, having research experience, and general practice experience. Results: A total of 60 individuals participated. The mean score was good for CR-A, moderate for CR-K, moderate for CR-P, good for EBM-A, moderate for EBM-K, and moderate for EBM-P. The total score was moderate in both clinical reasoning and EBM. Among the related factors, CR-P was associated with higher educational levels and having experience in general practice (P < 0.05). Research experience was associated with better CR-K and all KAP components for EBM (P < 0.05). Conclusion: The total score and many of the KAP components had moderate status for clinical reasoning and EBM. Planning on the associated factors should be regarded in the future. Such questionnaires are suggested to be validated for use in quasi-experimental studies.

Lacrimal Drainage System and Nasal Cavity Melanoma after Complete Treatment of Conjunctival Melanoma.

Malignant melanoma of the conjunctiva is a rare tumor of the ocular surface with potential fatal consequences and a high likelihood of recurrence. Although routes for extending the tumor, including local, hematogenous, and lymphatogenous, are pretty straightforward, the indirect extension through free-floating tumoral cells to the nasolacrimal duct is not described thoroughly. We report a case of malignant melanoma of the conjunctiva which presented with local recurrence in the intranasal cavity and lacrimal sac two years after the primary surgery (without involvement of the ocular surface and punctum on the second occasion). However, there was no evidence of distant metastasis on either occasion. This case demonstrates the possible noncontiguous spreading route of melanoma tumoral cells and highlights the need for attention to the surgical technique, and careful follow-up to detect further disease activity.

Impact of COVID-19 on the patient referral pattern and conversion rate in the university versus private facial plastic surgery centers.

PURPOSE: To compare the number of referrals and conversion rate between the pandemic and pre-pandemic period. METHODS: The number of referrals and conversion rate between the 10-month pandemic (March-December 2020) and pre-pandemic (March-December 2019) were evaluated in the two university (mainly non-cosmetic) and private (mainly cosmetic) facial plastic surgery centers. Demographics and monthly number and type (cosmetic and non-cosmetic) of the referrals and surgeries were recorded from the both and cosmetic facial injections (botulinum toxin and filler) and the source of referrals (web- and non-web-based) from the private center. The conversion rate was a ratio of the number of the surgeries to the number of referrals. RESULTS: The number of referrals declined by 7.7% in the private center which was significantly higher for the non-cosmetic (26%) than the cosmetic (0.5%) referrals. It was 32% in the university center. The private center conversion rate significantly (P < 0.001) decreased for both the cosmetic (60%) and non-cosmetic (82%) procedures. It was not significantly different between the cosmetic (65%) and non-cosmetic (58%) procedures in the university center. However, the number of cosmetic facial injections (11%) and the web-based referral source (4%) increased. The recovery was better for the number of referrals (better in the private center) than the conversion rate. CONCLUSION: The fall in the conversion rate was statistically significant in the private center. While the number of referrals recovered to almost the pre-pandemic level, the conversion rates, despite recovery, remained at a lower level at the end.

The Role of Salivary C-Reactive Protein in Systemic and Oral Disorders: A Systematic Review.

Background: Blood sampling is expensive, time-consuming, invasive, and requires technical facilities, which can be replaced by more convenient samples such as saliva. C-reactive protein (CRP) is a widely used biomarker in the management of many disorders and plasma CRP (pCRP) is suggested to be replaced by salivary CRP (sCRP). This study aimed to systematically review all available literature on the sCRP levels in systemic and oral disorders and how sCRP and pCRP levels correlate among these patients and healthy individuals. Methods: In this systematic review, a PubMed, Embase, Scopus, and Google Scholar search was conducted on October-2021 to identify all research investigating sCRP levels in systemic and oral disorders. Results: A total of 130 publications were analyzed in the review. Most of the studies reported that sCRP and pCRP levels are correlated, and sCRP is a reliable alternative for pCRP level for the diagnosis and management of medical conditions. sCRP has been measured in many different medical and oral disorders and significantly correlated with disease activity in most cases. Conclusion: Salivary CRP is a good alternative for Plasma CRP levels in most cases.

A strategic scheme for partnership supply networks focusing on green multi-agent transportations: a game theory approach.

Competition to gain more market share leads to the development of a dynamic environment and the fulfillment of an improvement cycle in supply networks. In this paper, as the first attempt, two strategic periods based on the introduction and growth phases of supply networks are considered. Each of these periods has its own characteristics and develops different competitive structures. The allocation of market share between competing supply networks is carried out on the extent of their relationships with green orientations in the network. The ownership of supply sources in these networks is replaced by that of relationships (partnership supply) developed by some parent brands. The efforts of each parent brand towards establishing green supply relationships lead to a greater market share for it. Further to competition between the supply networks, co-petition within each network also results in the emergence of different virtual alliance structures. The performance history of each brand and its subsidiary partners in the first period is included in the second period's assessments and leads to the development or decline of the network. Another dimension of the paper lies in the development of multi-agent transportation arising from the green requirements. Two gaming-based heuristic algorithms are proposed for handling the decentralized decision-making structures in the multi-period multi-stage platform under discussion. To evaluate the taken approach, a real-world inspired case is taken into account. The numerical results prove the better performance of the proposed scheme towards green coverage of the network and, thereupon, increased market share.

Burst train generator of high energy femtosecond laser pulses for driving heat accumulation effect during micromachining.

A new method for generating high-repetition-rate (12.7-38.2 MHz) burst trains of femtosecond laser pulses has been demonstrated for the purpose of tailoring ultrashort laser interactions in material processing that can harness the heat accumulation effect among pulses separated by a short interval (i.e., 26 ns). Computer-controlled time delays were applied to synchronously trigger the high frequency switching of a high voltage Pockels cell to specify distinctive values of polarization rotation for each round-trip of a laser pulse cycling within a passive resonator. Polarization dependent output coupling facilitated the flexible shaping of the burst envelope profile to provide burst trains of up to ∼1 mJ of burst energy divided over a selectable number (1 to 25) of pulses. Individual pulses of variable energy up to 150 µJ and with pulse duration tunable over 70 fs to 2 ps, were applied in burst trains to generate deep and high aspect ratio holes that could not form with low-repetition-rate laser pulses.

The Effect of Date Seed (Phoenix dactylifera) Extract on Paraoxonase and Arylesterase Activities in Hypercholesterolemic Rats.

BACKGROUND: Paraoxonase 1 (PON1) is a high- density lipoprotein (HDL)-associated enzyme, displaying esterase and lactonase activity. The PON1 is involved in a variety of inflammatory diseases, metabolizing toxic oxidized lipids and detoxifying of organophosphorus insecticide compounds and nerve agents. OBJECTIVES: The aim of this study was to investigate the effects of methanolic date seed extract (DSE) on paraoxonase and arylesterase activities in hypercholesterolemic rats. MATERIALS AND METHODS: Experiments were conducted in two groups of normal and hypercholesterolemic rats and continued for four weeks. Two weeks after receiving the normal and hypercholesterolemic diet, different dosages of DSE were administered during the last two weeks of the treatment. Blood samples were taken from animals before administration of DSE (at day 14) and at the end of the experimental period (at day 28). Paraoxonase and arylesterase activities of PON1 enzyme were assayed by kit using paraoxone and phenylacetate as the substrates. Relative changes in serum paraoxonase and arylesterase activities and total antioxidant capacity (TAOC) were compared between the two groups during this interval. RESULTS: Administration of DSE significantly increased serum paraoxonase and arylesterase activities in treated hypercholesterolemic groups compared to untreated ones. There was a significant difference in the TAOC of serum between the normal diet and hypercholesterolemic groups. However, DSE did not change the TAOC in hypercholesterolemic groups significantly. CONCLUSIONS: DSE increases serum paraoxonase and arylesterase activities. These beneficial effects may be subjected to the presence of natural antioxidants such as phenolic compounds in the date seed. Despite this, DSE did not increase TAOC in treated hypercholesterolemic groups compared to the untreated ones based on ABTS (2,2'-azino-di-(3-ethylbenzothiazoline)-6-sulfonic acid) radical reduction assay. This indicates that the hypercholesterolemic diet, apart from DSE and atorvastatin effects, may be responsible for the serum TAOC reduction. However, it is concluded that DSE may be useful in decreasing the symptoms of diseases resulting from the low activity of paraoxonase.

Time dynamics of burst-train filamentation assisted femtosecond laser machining in glasses.

Bursts of femtosecond laser pulses with a repetition rate of f = 38.5MHz were created using a purpose-built optical resonator. Single Ti:Sapphire laser pulses, trapped inside a resonator and released into controllable burst profiles by computer generated trigger delays to a fast Pockels cell switch, drove filamentation-assisted laser machining of high aspect ratio holes deep into transparent glasses. The time dynamics of the hole formation and ablation plume physics on 2-ns to 400-ms time scales were examined in time-resolved side-view images recorded with an intensified-CCD camera during the laser machining process. Transient effects of photoluminescence and ablation plume emissions confirm the build-up of heat accumulation effects during the burst train, the formation of laser-generated filaments and plume-shielding effects inside the deeply etched vias. The small time interval between the pulses in the present burst train enabled a more gentle modification in the laser interaction volume that mitigated shock-induced microcracks compared with single pulses.