Artificial Neural Network to Modeling Zero-inflated Count Data: Application to Predicting Number of Return to Blood Donation.

BACKGROUND Traditional statistical models often are based on certain presuppositions and limitations that may not presence in actual data and lead to turbulence in estimation or prediction. In these situations, artificial neural networks (ANNs) could be suitable alternative rather than classical statistical methods. STUDY DESIGN  A prospective cohort study. METHODS The study was conducted in Shahrekord Blood Transfusion Center, Shahrekord, central Iran, on blood donors from 2008-2009. The accuracy of the proposed model to prediction of number of return to blood donations was compared with classical statistical models. A number of 864 donors who had a first-time successful donation were followed for five years. Number of return for blood donation was considered as response variable. Poisson regression (PR), negative binomial regression (NBR), zero-inflated Poisson regression (ZIPR) and zero-inflated negative binomial regression (ZINBR) as well as ANN model were fitted to data. MSE criterion was used to compare models. To fitting the models, STATISTICA 10 and, R 3.2.2 was used RESULTS: The MSE of PR, NBR, ZIPR, ZINBR and ANN models was obtained 2.71, 1.01, 1.54, 0.094 and 0.056 for the training and 4.05, 9.89, 3.99, 2.53 and 0.27 for the test data, respectively. CONCLUSIONS The ANN model had the least MSE in both training, and test data set and has a better performance than classic models. ANN could be a suitable alternative for modeling such data because of fewer restrictions

Physicians' and Nurses' Opinions about the Impact of a Computerized Provider Order Entry System on Their Workflow

INTRODUCTION: In clinical practices, the use of information technology, especially computerized provider order entry (CPOE) systems, has been found to be an effective strategy to improve patient care. This study aimed to compare physicians' and nurses' views about the impact of CPOE on their workflow. METHODS: This case study was conducted in 2012. The potential participants included all physicians (n = 28) and nurses (n = 145) who worked in a teaching hospital. Data were collected using a five-point Likert-scale questionnaire and were analyzed using SPSS version 18.0. RESULTS: The results showed a significant difference between physicians' and nurses' views about the impact of the system on interorganizational workflow (p = .001) and working relationships between physicians and nurses (p = .017). CONCLUSION: Interorganizational workflow and working relationships between care providers are important issues that require more attention. Before a CPOE system is designed, it is necessary to identify workflow patterns and hidden structures to avoid compromising quality of care and patient safety

Application of Learning Theories in Clinical Education

Introduction: The purpose of education is learning. Several theories have been raised about learning, which have tried to explain how learning occurs. They help teachers to choose teaching methods, prepare learning environment and determine students' activities. Given the importance of learning theories in education, this study aimed to review application of learning theories in nursing education. Methods: In this study, some related published literatures during 2000-2010 were selected using key words including learning, theory and nursing education. Then the selected materials were reviewed for extracting application of learning theories in nursing education. Application of behavioral learning theories, cognitive theories (including Gestalt theory, information processing, Ausubel meaningful learning, constructivism, Bandura's social learning) and adult learning theory in nursing education were discussed in this article. Results: Some applications of behavioral theories are teaching in a sequential, simple to complex pattern teaching the skills using behavioral objectives for determining learning outcomes and assessment and providing teaching plan using the nursing process and nursing care plans and positive reinforcement. Principles of Gestalt theory have been used in mental organization towards simplicity, directed balance and equilibrium, and selective stimulus perception. Writing narratives and portfolio are samples of the application of constructive theory. Role models have been used in social cognitive theory. Based on adult learning theory, learners should be active and taught material should be applicable for them. Conclusion: Each learning theory has the particular application. Nursing educators must apply proper learning theories regarding students' experience and target material

Comparing Strengths and Weaknesses of Learning Theories

چكيده مقدمه: آموزش در علوم پزشكي در حال تغيير است. بنابراين نياز است كه مدرسان عملكردهاي خود را ارزيابي و براي به حداكثر رساندن يادگيري تلاش كنند. تئوريهاي يادگيري ميتواند ديدگاه هايي در مورد يادگيري فراهم كنند. هدف از اين مطالعه بررسي نقاط قوت و ضعف هر يك از تئوريهاي يادگيري شامل تئوريهاي رفتاري، شناختي و انسانگرايانه با مرور متون مرتبط است. روشها: در اين مطالعه برخي از متون مرتبط با تئوريهاي يادگيري شامل كتب و مقالات انتخاب شدند. سپس متون انتخاب شده از نظر نقاط قوت و ضعف تئوريهاي يادگيري مورد بررسي قرار گرفتند. يافتهها: نتايج نشان داد كه تئوريهاي رفتاري ساده هستند، كاربرد آنها آسان است و فراگير بر يك هدف واضح و مشخص متمركز ميشود. تئوريهاي يادگيري شناختي نظير خبرپردازي، گشتالت و سازندهگرايي موجب ارتقاي تفكر انتقادي و حل مسأله در فراگير ميشوند و فراگير ميتواند بهتر با موقعيتهاي واقعي زندگي روبرو شود. در تئوري انسانگرايانه تمركز يادگيري مربوط به نيازهاي فرد است كه نياز غايي آن خود شكوفايي و خوديابي است. يادگيري خود-راهبر يكي از مهمترين و مشهورترين اصول آموزشي اين رويكرد است كه نهايتاً منجر به خود هدايتي در فراگير ميشود. نتيجهگيري: هر تئوري به يك جنبه از يادگيري ميپردازد و بنابراين هر كدام داراي نقاط قوت و ضعف خاصي هستند. لازم است مدرسان و طراحان آموزشي به اين موارد جهت استفاده بهتر از تئوريها توجه كنند

Relief network design problem (RNDP): A scoping review, challenges, and opportunities

The Relief Network Design Problem (RNDP) is particularly important in emergency management. Any uncertain factors caused by natural disasters, the equity measurement in network design, and the adequate analysis of relief behavior will affect the efficiency of the relief network. This paper provides a comprehensive basis to support this view. The scope of the review allowed for exploring all existing literature on RNDP, where screening for titles, abstracts, keywords, and main contents, a total of 629 relevant articles are preserved. To construct the review work, existing research perspectives on the Relief Logistics Network Design Problem (RLNDP) as well as the Relief Transport Network Design Problem (RTNDP) are addressed, and their research focus and main research approaches are discussed. The existing studies on RNDP seem to be reached a bottleneck on how to design a humanitarian relief network. Hence, this paper contributes to the existing body of knowledge by summarizing the literature in the field, identifying gaps, analyzing future challenges, and providing solutions for future research. Specifically, this review reveals that while a large number of studies have considered uncertainty in the network design, they have not considered it at both the management level and the residents' level. In addition, equity is often mentioned, but the definition of humanitarian equity is unclear, as most studies consider equity at the management level. In real disaster relief scenarios, people do not only wait for relief, but self-evacuation is also a main behavior in the relief process, yet there are few studies that consider it in the network design. This review also emphasizes the relief network design structure problem, and the interdependence and coupling of the relief infrastructure transport or logistics facility network with other networks, such as the electric network, energy network, etc., deserves to be focused. In summary, five valuable research highlights are proposed based on a review of the existing literature: (1) Explore uncertainties from both the government management and disaster victim perspectives and integrate them into network design approaches. (2) Define and consider relief equity from both the government management and disaster victim perspectives. (3) Analyze self-evacuation behavior in the emergency relief phase and explore how it affects RNDP. (4) Optimize the transfer point location and relief routing from the perspective of management and humanitarian equity. (5) Strengthen the resilience of disaster relief interdependent network

Effectiveness of Problem-Focused Coping Strategies on the Burden on Caregivers of Hemodialysis Patients

Background: Studies have shown that family caregivers of hemodialysis patients experience high levels of burden. However, these caregivers are often neglected, and no studies are available on the effectiveness of coping strategies on the burden of care among these caregivers. Objectives: This study aimed to examine the effectiveness of problem-focused coping strategies (communication skills, anger management, and deep breathing) on the burden on caregivers of hemodialysis patients. Patients and Methods: A randomized controlled clinical trial was conducted on 76 family caregivers of hemodialysis patients referred to Shahid Hasheminejad hemodialysis center in Tehran, Iran. The subjects were equally allocated into two groups of 38. Through a coin-tossing method, caregivers of patients who referred on even or odd days of the week were randomly assigned into the intervention group or the control group, respectively. The intervention group received four training sessions on problem-focused coping strategies, but the control group did not receive any intervention. Both groups answered the caregiver’s burnout inventory at the start and six weeks after the last educational session. Descriptive statistics, chi-square, Fisher’s exact test, independent-samples t-test, and Mann-Whitney U test were used to analyze the data. Results: The majority of caregivers (54%) were in the age range of 35 - 55 years, female (68.4%), and married (70%). No significant difference was found between the baseline mean caregivers’ burden scores of the intervention and control groups (88.56 ± 11.74 vs. 84.97 ± 15.13, P = 0.308). However, the mean caregivers’ burden in the intervention group decreased, and the two groups were significantly different at the end of the study (58.77 ± 6.64 vs. 87.84 ± 11.74, P < 0.001). Conclusions: The current study showed the effectiveness of problem-focused coping strategies on reducing the burden on caregivers of hemodialysis patients. Authorities and policymakers in the healthcare system are responsible for developing strategies to integrate educational programs, such as the program implemented in the current study, into the country’s healthcare system

Changes in postural and trunk muscles responses in patients with chronic nonspecific low back pain during sudden upper limb loading

Background: Alterations in the neuromuscular control of the spine were found in patients with chronic low back pain (CLBP). Sudden loading of the spine is assumed to be the cause of approximately 12 of lower back injuries. However, some aspects of this problem, such as alterations in the sensory-motor control of the spine, remain questionable. This study investigated postural and neuro- motor changes in trunk muscles during sudden upper limb loading in patients with CLBP. Methods: Electromyography of the erector spinae (ES) and transverses abdominis/internal oblique (TrA/IO) and external oblique (EOA) muscles were recorded in 20 patients with CLBP and 20 asymptomatic individuals with eyes open (EO) and eyes closed (EC) conditions. Moreover, measurements of the center of pressure (COP) and vertical ground reaction force (GRF) or Fz were recorded using a force plate. Data were analyzed using paired t-test and independent t-test at the significance level of 0.05. Results: In patients with CLBP, decreased electrical activity of the ES muscle was observed under both the EO and EC conditions and that of the TrA/IO muscle was observed under the EO condition (p < 0.05). Other findings included a shorter peak latency of the ES muscle in the EO condition and a greater increase in the peak latency of the ES muscle following the EC condition (p < 0.05). No significant differences were observed in COP and GRF measurements between the groups. Conclusion: Electrical muscle activity may indicate less stiffening or preparatory muscle activity in the trunk muscle of patients with CLBP. Altered latency of the muscle may lead to microtrauma of lumbar structures and CLBP

Effect of oral evening primrose capsules on ripening of the cervix in nulliparous Iranian pregnant women (A randomized trial)

Introduction: Ripening of the cervix and uterine contractions are two basic factors of a successful delivery. Lack of ripening of the cervix is considered to be one of the problems of delivery. Thus, the present research was designed to determine the effect of oral evening primrose capsules on the ripening of cervix in nulliparous women. Materials and methods: This research has been conducted with the triple-blind randomized trial method on 80 nulliparous women in the 40th week of pregnancy (6th day + 40 weeks) visiting the prenatal clinic Prenatal clinic Shahid Akbarabadi educational and medical center of Iran University of Medical Sciences in 2015. Samples were divided into two equal groups of medicine and placebo with the randomized allocation method. Each of the participants took a bottle containing 14 1000mg oral evening primrose capsules (2 capsules per day, each 12 twelve hours for a week) or the placebo containing 14 1000mg oral capsules of paraffin in similar bottles. Data collecting tools include: demographic specifications questionnaire and the form of the records of the examinations. Data was analyzed through statistical tests and SPSS software version 16 using descriptive inferential statistic. Findings: Similarity of the two groups in terms of individual specifications and Bishop Score before the intervention were reviewed in the two groups and no significant statistical difference was seen between the two groups. The mean of the Bishop score for those who had taken 10 or more capsules after the intervention did not show a statistically significant difference (p=0.110). Conclusion: Consumption of evening primrose did not show a considerable improvement in the score. It is recommended to do more comparative studies in this field in later weeks of pregnancy due to the conflicts of the studies

Effect of alveolar ridge preservation with PDFDBA on orthodontic tooth movement rate, formation of gingival invagination and root resorption: A randomized, controlled pilot study

Tooth extraction results in resorptive remodeling of the alveolar bone, but alveolar ridge preservation procedure maintains the original shape of the extraction socket. This may be beneficial for space closure by orthodontic tooth movement (OTM). In the current pilot study for randomized controlled clinical trial the effect of alveolar ridge preservation with partial demineralized freezedried bone allograft (PDFDBA) on OTM rate, formation of gingival invagination and root resorption was evaluated. Both mandibular first premolars of 6 patients were extracted due to orthodontic treatment. In a split-mouth study design, alveolar ridge preservation was performed on one side, while the other side served as a control and the extraction socket healed naturally. After 6 weeks of healing period, the canines were moved to the extraction site to close the extraction space. Eight weeks later, the amount of OTM was measured. After space closure, the extraction sites were examined for the presence of gingival invagination. Root resorption was evaluated on digital panoramic radiographs. Photographs were taken for documentation. There was no significant difference in OTM rate between the ridge preserved areas and naturally healed sockets. Gingival invagination formed in 5 of 6 naturally healed sockets; none of the ridge preserved areas showed formation of gingival invagination. No root resorption was observed in any of the teeth adjacent to the extraction sites. Alveolar ridge preservation with PDFDBA has no effect on the rate of OTM and root resorption but prevents formation of gingival invagination during orthodontic space closure

On a Derivative-Free Variant of King’s Family with Memory

The aim of this paper is to construct a method with memory according to King’s family of methods without memory for nonlinear equations. It is proved that the proposed method possesses higher R-order of convergence using the same number of functional evaluations as King’s family. Numerical experiments are given to illustrate the performance of the constructed scheme