Validation of the North American Chest Pain Rule in Prediction of Very Low-Risk Chest Pain; a Diagnostic Accuracy Study

Introduction: Acute coronary syndrome accounts for more than 15% of the chest pains. Recently, Hess et al. developed North American Chest Pain Rule (NACPR) to identify very low-risk patients who can be safely discharged from emergency department (ED). The present study aimed to validate this rule in EDs of two academic hospitals.Methods: A prospective diagnostic accuracy study was conducted on consecutive patients 24 years of age and older presenting to the ED with the chief complaint of acute chest pain, during March 2013 to June 2013. Chest pain characteristics, cardiac history, electrocardiogram findings, and cardiac biomarker measurement of patients were collected and screening performance characteristics of NACPR with 95% confidence interval were calculated using SPSS 21.Results: From 400 eligible patients with completed follow up, 69 (17.25 %) developed myocardial infarction, 121 (30.25%) underwent coronary revascularization, and 4 (2%) died because of cardiac or unidentifiable causes. By using NACPR, 34 (8.50%) of all the patients could be considered very low- risk and discharged after a brief ED assessment. Among these patients, none developed above-mentioned adverse outcomes within 30 days. Sensitivity, specificity, positive prediction value, and negative prediction value of the rule were 100% (95% CI: 87.35 - 100.00), 45.35 (95% CI: 40.19 - 50.61), 14.52 (95% CI: 10.40 – 19.85), and 100 (95% CI: 97.18 - 100.00), respectively.Conclusions: The present multicenter study showed that NACPR is a good screening tool for early discharge of patients with very low-risk chest pain from ED

Explaining social norms intervening on the sense of identity in the neighborhoods of Iran’s cities (A case study in Kuti Neighborhood, Bushehr)

Existence of neighborhoods in the structure of the cities in Iran, as a key element of the body of the city, balances social life in cities. However, todays, the residents of metropolis, are not associated with their neighborhood space and do not have a clear and specific definition of neighborhood in their mental picture. In addition, neighborhoods have lost their past features and always induce lack of identity in citizens. Hence, the present study aimed to identify social norms intervening on the sense of identity in the neighborhoods of Iran’s cities. It seems to have a sense of belonging and peace and security provide a close relationship between people and the environment, also religious and cultural symbols are the other factors influencing the formation of identity in the neighborhoods by creating a mental picture for residents. In this study, both qualitative and quantitative methods were used. To do so, at first the concept of identity was identified through the study of documents of experts’ ideas and social factors affecting identity were extracted. Then, the criteria identified by questionnaire and systematic random sampling among 190 residents of the neighborhood of Kuti in Bushehr province were evaluated and reviewed. The results of the evaluation and analysis of the comments indicated that there is a significant relationship between the criteria of sense of belonging, mental picture, a sense of peace and dependency and signs of identity and each of the factors with different effectiveness affects the identity of the neighborhoods

Validity of Triage Performed by Nurses Educated by Train-of-Trainer‬ Workshop Participants; a Cross-sectional Study for Assessment of Cascade Training System

Introduction: In 2010, a national triage train-of-trainer (TOT) workshop was held in Tehran, Iran. Objective: The present study aimed to assess the validity of the triage performed by the nurses educated by those who participated in TOT workshop. Method: This cross-sectional study was carried out in 6 teaching hospitals from 4 universities in Iran. Inter-rater and intra-rater reliability of performed triage by participations was measured. Thirteen nurses were randomly selected. Thereafter, at the end of each working shift, patient data recorded in the daily data registry forms were collected. Then, duration of hospital stay, number of cases admitted to general wards or intensive care units, number of cases discharged from the ED within 12 hours and mortality rate were compared with the triage level determined by the nurse. Results: In total, 30 nurses with a mean age of 28.4 ± 3.7 years were enrolled. In this study, 1491 triage cases (61.6% male) were evaluated, of which 4.2% were triaged as level 1, 18.3% as level 2, 37.1% as level 3, 20.4% as level 4 and 20.0% as level 5. The following outcome was observed: 3.64% were discharged, 6.29% were hospitalized, 3% died and 2.3% were discharged against medical advice without completing treatment. The correlation of determined triage level and patients’ duration of hospitalization was significant based on one-way ANOVA test (p = 0.000). The outcome of the patients significantly correlated with the level of triage determined by the study nurses (p = 0.000). Conclusion: Based on the findings, it appears that triage performed by the study nurses educated by those who participated in TOT workshop through cascade training system had perfect validity

Validity of Triage Performed by Nurses Educated by Train-of-Trainer‬ Workshop Participants; a Cross-sectional Study for Assessment of Cascade Training System

Introduction: In 2010, a national triage train-of-trainer (TOT) workshop was held in Tehran, Iran. Objective: The present study aimed to assess the validity of the triage performed by the nurses educated by those who participated in TOT workshop. Method: This cross-sectional study was carried out in 6 teaching hospitals from 4 universities in Iran. Inter-rater and intra-rater reliability of performed triage by participations was measured. Thirteen nurses were randomly selected. Thereafter, at the end of each working shift, patient data recorded in the daily data registry forms were collected. Then, duration of hospital stay, number of cases admitted to general wards or intensive care units, number of cases discharged from the ED within 12 hours and mortality rate were compared with the triage level determined by the nurse. Results: In total, 30 nurses with a mean age of 28.4 ± 3.7 years were enrolled. In this study, 1491 triage cases (61.6% male) were evaluated, of which 4.2% were triaged as level 1, 18.3% as level 2, 37.1% as level 3, 20.4% as level 4 and 20.0% as level 5. The following outcome was observed: 3.64% were discharged, 6.29% were hospitalized, 3% died and 2.3% were discharged against medical advice without completing treatment. The correlation of determined triage level and patients’ duration of hospitalization was significant based on one-way ANOVA test (p = 0.000). The outcome of the patients significantly correlated with the level of triage determined by the study nurses (p = 0.000). Conclusion: Based on the findings, it appears that triage performed by the study nurses educated by those who participated in TOT workshop through cascade training system had perfect validity

Factors Affecting Loneliness in Older Adults: Evidence from Ardakan Cohort Study on Aging (ACSA)

Introduction: Elderly people usually feel lonely that can have adverse health effects. The purpose of current paper is to determine the loneliness score in the elderly population of the Ardakan Cohort and the factors affecting it. Methods: This is a cross sectional study using data from the Ardakan Cohort Study on Ageing (ACSA). Loneliness was measured using a 6-item De Jong Gierveld short scales. The 11-item Duke Social Support Index (DSSI) was used to measures social support of aging. living arrangement, demographic factors and self-rated health was also collected using a checklist. Linear regression was used to examine the relationship between loneliness and predictor factors. The data was analyzed with Stata software version 17 and a p-value of 0.05 was considered as a significant level. Results: Among the 5,188 participants, 48.13% were male and most of the participants were over 60 years old. Total score of loneliness was 3.27±1.45(95% CI: 3.24 to 3.31). Among covariates, age (p value=0.000), sex (p value=0.000), marital status (p value=0.046), education (p value=0.001) and economic status (p value=0.001) have significant association with loneliness score. People with good self-rated health had a lower loneliness score (p value<0.001). The score of social support has an inverse association with the score of loneliness (p value<0.001). Adults who lived with others had a higher loneliness score (p value<0.001). Conclusion: According to the results, elderly people who have more social support and have better self-rated health feel less lonely.  

Why Do Emergency Medicine Residents Experience Burn Out? A qualitative study

Objective: Emergency medicine residents are a high–risk group for burnout syndrome. This was a qualitative study with content analysis on emergency medical residents with 2 aims: evaluating the incidence of occupational burnout syndrome and identifying the points of view and attitudes of emergency medical residents about factors related to occupational burnout syndrome. Method: For this study, 2 sessions of focus group discussions were set up at Imam Khomeini hospital affiliated to Tehran University of Medical Sciences. Each session took 90 minutes, and 20 emergency medicine residents in their first or second year of emergency medicine residency participated in the sessions. Data were coded   by MAXQDA10 software. Results: Data were categorized in 4 themes as follow: (1) the characteristics of emergency medicine; (2) ambiguity in residents’ duties; (3) educational planning; and (4) careers. Data on the proposed solutions by residents were analyzed and coded in 3 groups including (1) changes in personal life; (2) arrangement in shifts; and  (3) educational issues. Conclusion: According to findings of this qualitative study, most of emergency medicine residents have experienced exhaustion sometime during the course of their residency. Psychological supports may help the residents to cope with their career difficulties and probable burn out

High expression of Talin-1 is associated with tumor progression and recurrence in melanoma skin cancer patients.

BACKGROUND: Talin-1 as a component of multi-protein adhesion complexes plays a role in tumor formation and migration in various malignancies. This study investigated Talin-1 in protein levels as a potential prognosis biomarker in skin tumors. METHODS: Talin-1 was evaluated in 106 skin cancer (33 melanomas and 73 non-melanomas skin cancer (NMSC)) and 11 normal skin formalin-fixed paraffin-embedded (FFPE) tissue samples using immunohistochemical technique on tissue microarrays (TMAs). The association between the expression of Talin-1 and clinicopathological parameters, as well as survival outcomes, were assessed. RESULTS: Our findings from data minings through bioinformatics tools indicated dysregulation of Talin-1 in mRNA levels for skin cancer samples. In addition, there was a statistically significant difference in Talin-1 expression in terms of intensity of staining, percentage of positive tumor cells, and H-score in melanoma tissues compared to NMSC (P = 0.001, P \u3c 0.001, and P \u3c 0.001, respectively). Moreover, high cytoplasmic expression of Talin-1 was found to be associated with significantly advanced stages (P = 0.024), lymphovascular invasion (P = 0.023), and recurrence (P = 0.006) in melanoma cancer tissues. Our results on NMSC showed a statistically significant association between high intensity of staining and the poor differentiation (P = 0.044). No significant associations were observed between Talin-1 expression levels and survival outcomes of melanoma and NMSC patients. CONCLUSION: Our observations showed that higher expression of Talin1 in protein level may be significantly associated with more aggressive tumor behavior and advanced disease in patients with skin cancer. However, further studies are required to find the mechanism of action of Talin-1 in skin cancers

Diversity, Equity, and Inclusion (DEI) in Operations Research and Analytics University Programs

Despite the fact that the US population is becoming more diverse, women and minorities remain underrepresented in OR/Analytics fields. As a result, many different disciplines have shifted their program emphasis to include strategies that help them represent society more accurately. This study project\u27s main goal is to better comprehend DEI among OR/Analytics university programs at undergrad and graduate academic levels. The study\u27s participants were the program directors of academic OR/Analytic programs in the US. 376 program directors were surveyed by Qualtrics with 49 institutionally reviewed and validated items. Analyses were conducted using quantitative and descriptive statistics. The results reveals that, despite some improvement, women and minority students and faculties representation continue to be underrepresented in OR/Analytics programs

Advancing Diversity, Equity, and Inclusion (DEI) principles in the Operations Research, Operations Management, and Supply Chain Management Literature

We seek to better understand how operations research and operations management scholars engage with concepts of diversity, equity and inclusion in their research. We evaluate peer-reviewed articles in four different volumes to understand how authors exploit opportunities to address DEI across a range of application areas and analytic methods - even if a paper’s topic does not specifically address DEI. We also perform a systematic review of articles whose titles or abstracts contain evidence of DEI-related content to understand the types of diversity dimensions that appear in these works. Through a critical approach and a focus on intersectionality, we identify unmet opportunities to incorporate DEI‐related themes into research where such perspectives can amplify the theoretical, empirical and application‐oriented impact of this work

Diversity, Equity and Inclusion in Operations Research and Analytics University Programs

We identify the need for baseline data on socio-demographic characteristics, diversity, equity and inclusion (DEI)-related characteristics of curricula and DEI-related programmatic supports of university programs in operations research and analytics. We describe a survey project to collect such baseline data and present preliminary results. These results provide the basis for tools and insights by which the profession may evaluate individual and organizational outcomes associated with DEI policies and enable meaningful comparisons between OR/analytics and other disciplines regarding progress towards DEI goals