Efficacy of Carboplatin Alone and in Combination with ABT888 in Intracranial Murine Models of BRCA-Mutated and BRCA-Wild-Type Triple-Negative Breast Cancer

Patients with breast cancer brain metastases have extremely limited survival and no approved systemic therapeutics. Triple negative breast cancer (TNBC) commonly metastasizes to the brain and predicts poor prognosis. TNBC frequently harbors BRCA mutations translating to platinum sensitivity potentially augmented by additional suppression of DNA repair mechanisms through poly(ADP-ribose)polymerase (PARP) inhibition. We evaluated brain penetrance and efficacy of Carboplatin +/− the PARP inhibitor ABT888, and investigated gene expression changes in murine intracranial (IC) TNBC models stratified by BRCA and molecular subtype status

The impact of Health Sector Evolution Plan on the performance of hospitals in Iran: Evidence from the Pabon Lasso model

Purpose The Health Sector Evolution Plan (HSEP) is the most recent reform in Iran's health care system that was launched in May 2014 in all university-affiliated hospitals to reduce health care expenditure for patients, while improving the efficiency and quality of hospital services. The purpose of this paper is to evaluate the impact of the HSEP on the performance of 15 hospitals affiliated with Kermanshah University of Medical Sciences (KUMS), located in the western region of Iran. Design/methodology/approach The Pabon Lasso model was used to measure the performance of hospitals before and after the implementation of the HSEP in 2013-2014 and 2015-2016, respectively. Three indicators of average length of stay (ALoS), bed occupancy rate (BOR) and bed turnover rate (BTR) were analyzed by the Pabon Lasso model. Findings The results showed that the average ALoS, BTR and BOR before the introduction of the HSEP were 2.59 days, 92 times and 57 percent, respectively, and the corresponding figures for these indicators after the implementation of the HSEP were 2.61 days, 98.9 times and 59.9 percent. The results indicated that before the introduction of the HESP, 40 percent of hospitals were in zone 1 (poor performance: low BTR and BOR and high ALoS), 27 percent in zone 2, 20 percent in zone 3 (good performance: high BTR and BOR and low ALoS) and 13 percent in zone 4. After the HSEP, the proportion of hospitals in zones 1-4 was 33, 27, 20 and 20 percent, respectively. Originality/value This study is the first to use the Pabon Lasso model technique to evaluate the impact of the HSEP on hospitals affiliated with KUMS

The Role of Melatonin on Metabolic Factors related to Periodontal Disease in Patients with Type 2 Diabetes Mellitus

BACKGROUND AND OBJECTIVE: Regarding to various controlling and therapeutic interventions, the risk of periodontal disease in diabetics is three times that of non-diabetics. Because of the central role of oxidative stress in the pathogenesis of diabetes, interest in the use of antioxidants, including melatonin, as a complete therapeutic approach has increased. Therefore, this review study was performed to investigate the role of melatonin on metabolic factors associated with periodontal disease in patients with type 2 diabetes. METHODS: This review study was conducted on various databases including Scopus, PubMed, Science Direct, Google Scholar and Persian databases such as Magiran and SID and keywords such as type 2 diabetes, periodontal disease, melatonin, hyperglycemia, lipid profile, hypertension, obesity, and Inflammatory factors were carried out from 2000 to 2018. FINDINGS: A review of studies indicates that melatonin supplementation can reduce progressive damage of periodontal tissue, blood glucose levels, lipid profiles, hypertension, obesity and inflammatory factors in T2DM patients with periodontal disease, and therefore it has a significant role in improving of these patients. On the other hand, it has been shown that increased blood glucose can reduce the production of melatonin from the pineal gland in diabetic patients. Therefore, the supplementation with melatonin in these patients can play a useful role in increasing the production of melatonin in the body by reducing blood glucose levels. CONCLUSION:The obtained results showed that melatonin supplementation with its antioxidant role can have a beneficial role in improving the survival of T2DM patients with periodontal disease by balancing inflammatory and anti-inflammatory cytokines

Economic burden of smoking in Iran: A prevalence-based annual cost approach

Objectives: The burden of smoking on the health system and society is significant. The current study aimed to estimate the annual direct and indirect costs of smoking in Iran for the year 2014. Methods: A prevalence-based diseasespecific approach was used to determine costs associated with the three most common smoking-related diseases: lung cancer (LC), chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD). Data on healthcare utilization were obtained from an original survey, hospital records and questionnaires. The number of deaths was extracted from the global burden diseases study (GBD). The human capital approach was applied to estimate the costs of morbidity and mortality due to smoking-related diseases, classified as direct (hospitalization, outpatients and nonmedical costs) and indirect (mortality and morbidity). Results: The total economic cost of the three most common smoking-attributable diseases in Iran was US1.46 billion in 2014, including US1.05 billion (71.7) in indirect and US0.41 billion (28.3) in direct costs. Direct costs of the three smoking-related diseases accounted for 1.6 of total healthcare expenditures and total costs were about 0.26 of Iran's gross domestic product (GDP) in 2014. Conclusions: Our study indicated that smoking places a substantial economic burden on Iranian society. Therefore, sustained smoking cessation interventions and tobacco control policies are required to reduce the magnitude and extent of smoking-attributable costs in Iran

Time Management Behaviors and Emotional Intelligence in Head Nurses in Emergency and Intensive Care Units

Background: Time management is of particular importance in nursing. One of the most effective variables associated with time management is emotional intelligence (EI). This study assessed the relationship between time management and EI and the level of EI and time management skills in head nurses in emergency and intensive care units. Methods: A cross-sectional study was conducted on all head nurses in the emergency and intensive care units of nine educational hospitals at Isfahan University of Medical Sciences in Iran in 2015 using Bradberry-Greaves’ EI and Macan’s Time Management Questionnaires. Results: Participants’ total time management score was (104.15 ± 6.98); total EI score was (128 ± 15.80). There was no significant relationship between overall EI and time management skills. There was a significant relationship between age and the emotional self-awareness dimension of EI (p =.027) and the mechanics dimension of time management (p =.037), and between work experience and overall time management skills (p =.049) and the mechanics dimension of time management (p =.038). Conclusions: Specific EI and time management skills may help head nurses to cope with the challenges they face, which may improve the quality of nursing care. Nursing leaders should consider the importance of time management and EI in increasing motivation and satisfaction of nursing staff and improving quality of care. © Copyright 2022 Creative Health Care Management

Determinants of willingness to practice medicine in underdeveloped areas: Evidence from a survey on Iranian medical students

Purpose: Appropriate access to formally-trained health workers for people living in rural and underdeveloped areas is a continuing challenge worldwide. The purpose of this paper is to investigate the willingness of formally-trained health workers to practice in underdeveloped areas and its main determinants among medical students in the western provinces of Iran. Design/methodology/approach: A total of 753 medical students from four provinces in western Iran (Kermanshah, Ilam, Lorestan and Kurdistan) were surveyed cross-sectionally in 2017. A self-administrated questionnaire was used to collect data on sociodemographic characteristics, willingness to practice in underdeveloped areas, intrinsic (e.g. desire to help others and self-interest in medicine) and extrinsic (e.g. the high income of physicians and social prestige) motivations of the study population. Multivariable logistic regression was used to identify the main determinants of willingness to practice in underdeveloped areas among medical students after their graduation. Findings: The results indicated that 58.3 percent of students were willing to practice in underdeveloped areas. While 59 percent of the study population had a strong extrinsic motivation to study medicine, the remaining 41 percent of the study population had a strong intrinsic motivation to study medicine. The logistic regression results indicated that low parental professional and educational status, an experience of living in rural areas and having strong intrinsic motivation were associated with greater willingness to practice in underdeveloped areas. Originality/value: This is the first study to investigate the willingness to practice in underdeveloped areas and its main determinants among medical students in the west of Iran. © 2019, Emerald Publishing Limited

Criteria for the selection of complementary private health insurance: the experience of a large organisation in Iran

Background Expenses related to employee's health benefit packages are rising. Hence, organisations are looking for complementary health financing arrangements to provide more financial protection for employees. This study aims to develop criteria to choose the most appropriate complementary health insurance company based on the experience of a large organisation in Iran. Methods This study was conducted in 2021 in Iran, in the Foundation of Martyrs and Veterans Affairs to find as many applicable criteria as possible. To develop a comprehensive list of criteria, we used triangulation in data sources, including review of relevant national and international documents, in-depth interviews of key informants, focus group discussion, and examining similar but unpublished checklists used by other organisations in Iran. The list of criteria was prioritised during focus group discussions. We used the best-worst method as a multi-criteria decision making method and a qualitative consensus among the key informants to value the importance of each of the finalised criteria. Findings Out of 85 criteria, we selected 28 criteria to choose an insurer for implementing complementary private health insurance. The finalised criteria were fell into six domains: (i) Previous experience of the applicants; (ii) Communication with clients; (iii) Financial status; (iv) Health care providers' network; (v) Technical infrastructure and workforce; (vi) and Process of reviewing claims and reimbursement. Conclusion We propose a quantitative decision-making checklist to choose the best complimentary private health insurance provider. We invite colleagues to utilise, adapt, modify, or develop these criteria to suit their organisational needs. This checklist can be applied in any low- and middle-income country where the industry of complementary health insurance is blooming

Acoustophoresis of monodisperse oil droplets in water:Effect of symmetry breaking and non-resonance operation on oil trapping behavior

Acoustic manipulation of particles in microchannels has recently gained much attention. Ultrasonic standing wave (USW) separation of oil droplets or particles is an established technology for microscale applications. Acoustofluidic devices are normally operated at optimized conditions, namely, resonant frequency, to minimize power consumption. It has been recently shown that symmetry breaking is needed to obtain efficient conditions for acoustic particle trapping. In this work, we study the acoustophoretic behavior of monodisperse oil droplets (silicone oil and hexadecane) in water in the microfluidic chip operating at a non-resonant frequency and an off-center placement of the transducer. Finite element-based computer simulations are further performed to investigate the influence of these conditions on the acoustic pressure distribution and oil trapping behavior. Via investigating the Gor’kov potential, we obtained an overlap between the trapping patterns obtained in experiments and simulations. We demonstrate that an off-center placement of the transducer and driving the transducer at a non-resonant frequency can still lead to predictable behavior of particles in acoustofluidics. This is relevant to applications in which the theoretical resonant frequency cannot be achieved, e.g., manipulation of biological matter within living tissues

Acoustophoresis of monodisperse oil droplets in water:Effect of symmetry breaking and non-resonance operation on oil trapping behavior

Acoustic manipulation of particles in microchannels has recently gained much attention. Ultrasonic standing wave (USW) separation of oil droplets or particles is an established technology for microscale applications. Acoustofluidic devices are normally operated at optimized conditions, namely, resonant frequency, to minimize power consumption. It has been recently shown that symmetry breaking is needed to obtain efficient conditions for acoustic particle trapping. In this work, we study the acoustophoretic behavior of monodisperse oil droplets (silicone oil and hexadecane) in water in the microfluidic chip operating at a non-resonant frequency and an off-center placement of the transducer. Finite element-based computer simulations are further performed to investigate the influence of these conditions on the acoustic pressure distribution and oil trapping behavior. Via investigating the Gor’kov potential, we obtained an overlap between the trapping patterns obtained in experiments and simulations. We demonstrate that an off-center placement of the transducer and driving the transducer at a non-resonant frequency can still lead to predictable behavior of particles in acoustofluidics. This is relevant to applications in which the theoretical resonant frequency cannot be achieved, e.g., manipulation of biological matter within living tissues