Comparison of the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses: A cross-sectional-correlation study.

INTRODUCTION: Nurses' sensitivity to moral issues, especially in emergency and intensive care units is essential for providing complex nursing care. Therefore, the present study aimed to determine the correlation between moral sensitivity and clinical competence in emergency and intensive care nurses. METHODS: The present multi-center cross-sectional correlational study was conducted in 2022 on 180 nurses in five emergency departments and four intensive care units of general hospitals affiliated to Semnan University of Medical sciences. The study tools include a demographic questionnaire, 25 item Lutzen Moral Sensitivity Questionnaire (MSQ), and a standardized Competency Inventory for Registered Nurses (CIRN). Data were analyzed by mean, standard deviation and MANOVA, Pearson's correlation coefficient test. RESULTS: The two groups did not have significant differences in demographic characteristics (p < 0.05). Majority of two emergency department nurses (83.9%) and Intensive care nurses (81.8%) had a moderate level of moral sensitivity. Also, clinical competence of majority of emergency department nurses (73.3%) and Intensive care nurses (75.8%) were in moderate level. There was significant positive relationship between moral sensitivity with Clinical competence in emergency department nurses (p ≤ 0.01, r = 0.61). No significant relationship was observed between moral sensitivity and the clinical competence of intensive care nurses (p > 0.05, r = 0.15). CONCLUSIONS: There is need for improving the level of knowledge of nurses about moral principles and increasing moral sensitivity which can expand the components of clinical competence, especially in intensive care units.

0.5-V Nano-Power Shadow Sinusoidal Oscillator Using Bulk-Driven Multiple-Input Operational Transconductance Amplifier.

This paper presents a low-frequency shadow sinusoidal oscillator using a bulk-driven multiple-input operational transconductance amplifier (MI-OTA) with extremely low-voltage supply and nano-power consumption. The proposed oscillator is composed using two-input single-output biquad filter and amplifiers. The condition and the frequency of oscillation of the shadow oscillator can be controlled electronically and independently using amplifiers. The circuit is designed in Cadence program using 0.18 µm CMOS technology from TSMC. The voltage supply is 0.5 V and the power consumption of the oscillator is 54 nW. The total harmonic distortion (THD) of the output signals is around 0.3% for 202 Hz. The simulation results are in accordance with theory.

Student's perception of E-learning during COVID-19 pandemic and its positive and negative learning outcomes among medical students: A country-wise study conducted in Pakistan and Iran.

Background: Since the emergence of coronavirus diseases 2019 (COVID-19) not only have social and the economical dimension of life been disturbed but it has also shattered educational activities as well. Due to fear of disease spread educational institutes are forced to implement online educational systems to teach their pupils. This study aims to explore the student's perceptions related to E-learning and their positive and negative outcome among medical students in Pakistan and Iran. Method: ology: This cross-sectional questionnaire-based study was conducted at Rawalpindi Medical University, Rawalpindi, Pakistan, and Islamic Azad University of Medical Sciences Tehran, Iran. This study involved 402 medical students of Rawalpindi Medical University, Rawalpindi, Pakistan (n = 202), and Islamic Azad University of Medical Sciences Tehran, Iran (n = 200) who were actively involved in the online mode of education. A self-administered validated questionnaire was used for data collection. Descriptive statistics and chi-square analysis was used and analysis was done through SPSS V.23. A P-value of 0.05 was taken as significant. Results: A total of 402 students were enrolled, 202 from Pakistan and 200 from Iran. About 68.2% of the students were acquainted with moderate levels of IT skills. About 75.8% of the students were not showing any previous experience with E-learning. The most common advantage of E-learning was the ability to stay at home. The technical problem was the most common disadvantage in our study. Finally, face-to-face learning in terms of increasing knowledge, skill, and social competence was considered the best mode of learning both by Pakistani and Irani students. Country-wise effectiveness of face-to-face learning in terms of increasing knowledge is statistically significant (p-value = 0.019). Acceptance of E-learning is statistically associated with the country of learning (p-value = 0.020). E-learning was rated as enjoyable by 51.5% of the students. Conclusion: E-learning has its associated advantages and disadvantages as perceived by medical students but still face-to-face learning is considered the most effective form of learning as responded by medical students.

Major severe acute respiratory coronavirus-2 (SARS-CoV-2) vaccine-associated adverse effects; benefits outweigh the risks.

INTRODUCTION: Since its emergence, there have been huge efforts to design vaccines against coronavirus disease 2019 (COVID-19) to inhibit its interpersonal spread. Global vaccine development is the most promising cost-effective method for overcoming the epidemic. However, following reports of post-vaccination thromboembolic adverse effects, there have been raising concerns about the safety profile of the COVID-19 vaccine. AREAS COVERED: We aimed to review the recent Food and Drug Administration (FDA)-approved vaccines and identify the organ-based major complications of COVID-19 vaccines based on reliable published studies. To find high-quality and large-scale observational, clinical trial, and cohort studies, PubMED, Scholar, Embase, and Web of Science were searched using keywords: COVID-19, SARS-CoV-2, vaccine, Pfizer (BNT162b2), Johnson and Johnson (Ad26.COV2), Moderna (mRNA-1273), Oxford AstraZeneca (ChAdOx1nCoV19), Coronavac (Sinovac), BBIBP-CorV (Sinopharm), adverse effect, and complication. To include all relevant articles, backward searching was also done on similar article citations. Case reports, studies including less than 10 participants, and biased articles were excluded. EXPERT OPINION: Based on data from high-quality and population-based studies, major adverse effects are divided into four major organ-specific groups, including cardiovascular, neurologic, hematologic, and immune-allergic side effects. The incidence of most of these side effects is not different between vaccinated and normal populations, and currently, the benefits of vaccination against COVID-19 are greater than the mortality and morbidity risks of COVID-19 infection. However, further studies, specifically systematic review and meta-analysis, are still indicated to investigate further unknown side effects of these vaccines and the existence of causality between the vaccine and reported adverse events.

CROW-based Fano structures for all optical switching devices.

In this paper, an improved optical Fano switch based on coupled resonator optical waveguides (CROWs) is presented. The new topological design is employed to achieve steeper and highly asymmetric Fano resonances (FRs). Physically, in the proposed structures, due to the increase in the effective refractive index at the center of the CROW, a confined mode arises in the continuum background according to the variational theorem and leads to FR. The results show that in CROW-based Fano switches, the Fano spectrum is improved by tuning the number of nanocavities. The ratio between the slope ratio and linewidth shows an improvement of 55.25% from single to CROW5. As an important application of FR, an ultra-compact device with a CROW-based Fano structure is demonstrated. The results of the numerical finite difference time domain simulation agree well with the theoretical coupled mode theory.

Timing jitter reduction of silicon hybrid harmonically mode-locked ring laser using an integrated sampled-grating DBR.

An integrated sampled-grating silicon hybrid mode-locked ring laser is proposed for 20-GHz super-mode noise suppression. The dynamics, phase noise, and timing jitter are investigated using a delay differential equation (DDE) model. The results show that the 20-GHz harmonic regime of the proposed structure is significantly increased when the sampled-grating structure is included. Additionally, a better selectivity of the optical modes by a sampled-grating distributed Bragg reflector (SGDBR) leads to more suppression of super-mode noise compared to the long-ring structures with a spectral filter which were previously reported. Compared to previous works, the phase noise is improved by approximately 6 dB and the timing jitter is decreased to less than a third.

Investigation of Mechanical and Microstructural Properties of Welded Specimens of AA6061-T6 Alloy with Friction Stir Welding and Parallel-Friction Stir Welding Methods.

The present study investigates the effect of two parameters of process type and tool offset on tensile, microhardness, and microstructure properties of AA6061-T6 aluminum alloy joints. Three methods of Friction Stir Welding (FSW), Advancing Parallel-Friction Stir Welding (AP-FSW), and Retreating Parallel-Friction Stir Welding (RP-FSW) were used. In addition, four modes of 0.5, 1, 1.5, and 2 mm of tool offset were used in two welding passes in AP-FSW and RP-FSW processes. Based on the results, it was found that the mechanical properties of welded specimens with AP-FSW and RP-FSW techniques experience significant increments compared to FSW specimens. The best mechanical and microstructural properties were observed in the samples welded by RP-FSW, AP-FSW, and FSW methods, respectively. Welded specimens with the RP-FSW technique had better mechanical properties than other specimens due to the concentration of material flow in the weld nugget and proper microstructure refinement. In both AP-FSW and RP-FSW processes, by increasing the tool offset to 1.5 mm, joint efficiency increased significantly. The highest weld strength was found for welded specimens by RP-FSW and AP-FSW processes with a 1.5 mm tool offset. The peak sample of the RP-FSW process (1.5 mm offset) had the closest mechanical properties to the base metal, in which the Yield Stress (YS), ultimate tensile strength (UTS), and elongation percentage (E%) were 76.4%, 86.5%, and 70% of base metal, respectively. In the welding area, RP-FSW specimens had smaller average grain size and higher hardness values than AP-FSW specimens.

Proposal of phase noise and jitter reduction in a long-ring hybrid silicon mode-locked laser by intracavity reflectors.

We propose a harmonically hybrid silicon mode-locked ring laser using intracavity reflectors (ICRs) to suppress supermode noise. The dynamic and noise properties of the structure are investigated using a delay differential equation model. The results of the dynamic show that a 20 GHz harmonic regime of the structure is significantly increased compared to a without intracavity-reflector structure. Additionally, the phase noise of the proposed structure (PS) is improved to about 8 dB. Furthermore, an analysis shows that timing jitter reduction has periodic behavior by changing the harmonic inter-spike interval time (TISI).

Circuit level implementation of photonic crystal devices.

Different types of photonic crystal components have been modeled by approximate RLC circuits. The proposed lumped circuits exploit the analogy of photonic crystal elements and RLC circuits. They are either coupled to each other or inserted like lumped circuits to imitate wave propagation within the photonic devices. Different examples such as side-coupled waveguide-cavity systems, side-coupled cavity-cavity systems, and improved structures are investigated for evaluating the theory. It is shown that the proposed circuits are exact enough to be substituted into the complicated calculations of numerical methods. In addition, the presented practical and straightforward procedure can be employed for flexible and efficient design. The results are verified using the finite-difference time-domain numerical simulations and coupled-mode theory for various devices.

Broad-Spectrum Preclinical Antitumor Activity of Chrysin: Current Trends and Future Perspectives.

Pharmacological profile of phytochemicals has attracted much attention to their use in disease therapy. Since cancer is a major problem for public health with high mortality and morbidity worldwide, experiments have focused on revealing the anti-tumor activity of natural products. Flavonoids comprise a large family of natural products with different categories. Chrysin is a hydroxylated flavonoid belonging to the flavone category. Chrysin has demonstrated great potential in treating different disorders, due to possessing biological and therapeutic activities, such as antioxidant, anti-inflammatory, hepatoprotective, neuroprotective, etc. Over recent years, the anti-tumor activity of chrysin has been investigated, and in the present review, we provide a mechanistic discussion of the inhibitory effect of chrysin on proliferation and invasion of different cancer cells. Molecular pathways, such as Notch1, microRNAs, signal transducer and activator of transcription 3 (STAT3), nuclear factor-kappaB (NF-κB), PI3K/Akt, MAPK, etc., as targets of chrysin are discussed. The efficiency of chrysin in promoting anti-tumor activity of chemotherapeutic agents and suppressing drug resistance is described. Moreover, poor bioavailability, as one of the drawbacks of chrysin, is improved using various nanocarriers, such as micelles, polymeric nanoparticles, etc. This updated review will provide a direction for further studies in evaluating the anti-tumor activity of chrysin.

Demand management to cope with routes disruptions in location-inventory-routing problem for perishable products.

In today's competitive world, with the increase in the complexity of supply chains, supply chain vulnerability to disruptions has increased. In this research, a multi-period location-inventory-routing (LIR) problem of perishable products is investigated under the disruption of routes in some periods. To make a resilient supply chain, two types of pricing namely dynamic pricing and disruptive pricing are applied to manage demands along with location, inventory, and routing decisions. In this regard, an integrated LIR model is developed considering disruption in routes, price-sensitive demand, and a product with a certain life-time. In this model, the price of retailers is a descending function of the time and product lifetime. The proposed model is devised as a mixed-integer non-linear programming model that maximizes the total profit of the supply chain. Due to the NP-hard nature of the problem, the research has developed an efficient genetic algorithm to solve large-sized problems. Computational experiments conducted indicating that the projected GA has an average gap of less than 2.66% from the optimal solution within a reasonable time. The performance of the integrated model, the efficiency of the proposed resilient strategy, and the impact of shelf-life are investigated in a case study. Results revealed that the integrated model for dynamic pricing and LIR decisions enjoys 79.33% improvement in the total expected profit for the supply chain under disruption compared to static pricing. As expected, by increasing the product's shelf-life, the profit of the supply chain increases in all pricing policies. It should be noted that applying the dynamic pricing policy, compared to the product's lifetime, enjoys a greater impact on supply chain profit under disruption. Moreover, there is a necessity to choose an appropriate pricing policy for markets with a different value of price elasticity.

Modeling and analysis of distributed feedback quantum dot passively mode-locked lasers.

In this paper, we investigate numerically two proposed monolithic distributed feedback quantum dot passively mode-locked lasers (DFB-QDMLLs) with and without gratings in the saturable absorber (SA) section in order to enhance two important performances of QDMLLs for ultrahigh-bit-rate and single-mode applications. We find out that depending on the length of the grating, optical pulses with durations of about 3-8 ps at approximately 2nd and 4th harmonics of cavity round-trip frequencies can be generated by the proposed structures. We also compare the temporal and spectral behaviors of these structures under specified bias conditions and SA lengths. It is shown that DFB-QDMLLs have the ability to generate optical pulses with more peak power than grating-embedded saturable absorber (GESA-DFB-QDMLL) structures which generate shorter pulses with narrower spectral bandwidths. We also show that DFB-QDMLLs operate in a larger range of absorber voltages while the other structure is very sensitive to absorber voltage and operates well for middle ranges of this parameter.

Intravenous and peritonsillar infiltration of ketamine for postoperative pain after adenotonsillectomy: a randomized placebo-controlled clinical trial.

OBJECTIVE: To evaluate the efficacy of preoperative intravenous or peritonsillar infiltration of ketamine for postoperative pain control in children following adenotonsillectomy. PATIENTS AND METHODS: 78 children between 5 and 18 years of age who were scheduled for elective adenotonsillectomy were randomly assigned to four groups: group 1 (n = 19) received intravenous ketamine (0.5 mg/kg), group 2 (n = 21) intravenous normal saline, group 3 (n = 19) ketamine (0.5 mg/kg) injected through the tonsillar capsule, and group 4 (n = 19) normal saline injected in the same location. The incidence of postoperative pain and vomiting as well as the severity of postoperative pain were compared between study groups during the 6-hour postoperative period using a visual analog scale (VAS) at rest, upon swallowing saliva, drinking liquids and eating ice cream. RESULTS: There were no demographic differences between the four groups. The incidence of postoperative pain was significantly lower in groups 1 [7 (36.8%) vs. 10 (47.6%); p = 0.032] and 3 [5 (31.5%) vs. 12 (63.2%); p = 0.001] compared with their controls. The amount (in milligrams) of pethidine and metoclopramide used for pain and nausea control was significantly lower in groups 1 (12.5 ± 5.3 vs. 19.6 ± 9.6 mg, p = 0.038, and 2.9 ± 1.1 vs. 4.6 ± 2.6 mg, p = 0.042, respectively) and 3 (8.6 ± 3.1 vs. 21.6 ± 8.4 mg, p < 0.001, and 1.6 ± 0.9 vs. 5.3 ± 3.2 mg, p = 0.002, respectively) compared with their controls. These values were also higher in group 1 compared with group 3. The VAS scores on swallowing saliva (3.9 ± 2.7 vs. 2.7 ± 1.2; p = 0.018), on drinking liquids (3.7 ± 2.6 vs. 2.8 ± 1.6; p = 0.013) and on eating ice-cream (4.3 ± 2.4 vs. 2.8 ± 1.5; p = 0.001) were also significantly higher in group 1 compared with group 3. CONCLUSIONS: Our results show that peritonsillar infiltration of ketamine was more effective in reducing the postoperative pain severity, need for analgesics and need for antiemetics. Thus, peritonsillar infiltration of ketamine is suggested for postoperative pain control in those undergoing adenotonsillectomy.