Continuous optimization via simulation using Golden Region search

Simulation Optimization (SO) is the use of mathematical optimization techniques in which the objective function (and/or constraints) could only be numerically evaluated through simulation. Many of the proposed SO methods in the literature are rooted in or originally developed for deterministic optimization problems with available objective function. We argue that since evaluating the objective function in SO requires a simulation run which is more computationally costly than evaluating an available closed form function, SO methods should be more conservative and careful in proposing new candidate solutions for objective function evaluation. Based on this principle, a new SO approach called Golden Region (GR) search is developed for continuous problems. GR divides the feasible region into a number of (sub) regions and selects one region in each iteration for further search based on the quality and distribution of simulated points in the feasible region and the result of scanning the response surface through a metamodel. The experiments show the GR method is efficient compared to three well-established approaches in the literature. We also prove the convergence in probability to global optimum for a large class of random search methods in general and GR in particular

Knowledge, Practice and Self-Efficacy in Evidence-Based Practice among Midwives in East Iran

Objectives: The successful implementation of evidence-based practice (EBP) can lead to appropriate and effective midwifery care during pregnancy, childbirth and in the postnatal period. However, levels of knowledge and confidence in one’s ability to apply EBP are related to its effective implementation. This study aimed to investigate levels of knowledge, practice of and self-efficacy towards the use of EBP among midwives in East Iran.Methods: This cross-sectional study took place between January and February 2016 and involved 98 midwives employed at two hospitals and all four urban health care centres in Torbat-e Heydariyeh, Iran. Two subscales of the Evidence-Based Practice Questionnaire were used to assess participants’ knowledge and practice of EBP, respectively, while a modified version of a previously described scale was used to determine self-efficacy. Results: A total of 76 midwives participated in the study (response rate: 77.6%). Mean knowledge, practice and self-efficacy scores were 4.48 ± 0.94, 3.53 ± 0.68 and 2.80 ± 0.81, respectively. Significant relationships were found between mean selfefficacy, practice and knowledge scores and proficiency in English language (P = 0.001 each) and statistical methods (P <0.050 each). Additionally, significant relationships were found between knowledge and practice of EBP and proficiency in the use of databases (P <0.050 each). Knowledge and self-efficacy scores were significantly correlated with practice (P = 0.001 each). Conclusion: These findings demonstrate a need for improvement in the self-efficacy, practice and knowledge of EBP among midwives in East Iran. Interventions that promote these factors may help increase the use of EBP in this population

The relationship of the psychological coping and adjustment strategies of infertile women with the success of assisted reproductive technology

Background: The success of assisted reproductive techniques plays a very important role in the quality of life of infertile couples and decreases the negative behavior states of infertility. Objective: This study aimed at determining the relationship between psychological coping and adjustment strategies with the success of assisted reproductive technology (ART). Materials and Methods: This correlational study was conducted on 204 women visiting Milad Infertility Center in Mashhad during 2015-2016. The research instruments included Fertility Adjustment Scale and Infertility Coping Strategies Scale. The positive result of two pregnancy tests within 48 hours was considered as the success of ART. Results: The mean and standard division score of adjustment in the group achieved treatment success (34.3±8.2) exceeded the group failed (33.6±8.8), the difference was not statistically significant (p= 0.381). Also, there was no significant difference between groups in the median and interquartile range of total coping strategies 81 (13) vs. 79.5 (12.25), (p= 0.369). Based on the logistic regression model for one increased transferred embryo, the chance of getting pregnant is 1.3 times, and for each unit increase in FSH level, the chance of ART success decreases 18%. Conclusion: The results of this study showed that there is no relationship between psychological coping and adjustment strategies with ART success. However, the number of transferred fetus and tirthday FSH are introduced as factors that are related to the success of ART. Key words: Infertility, Psychological adjustment, Coping skills, (ART)

Next generation of growth-sparing techniques: preliminary clinical results of a magnetically controlled growing rod in 14 patients

Session 3A - Early Onset Scoliosis: Paper no. 33SUMMARY: Growth-sparing techniques are commonly used for the treatment of progressive EOS. The standard growing rod (GR) technique requires multiple surgeries for lengthening. The preliminary results of MCGR has shown the comparable outcomes to standard GR without the need for repeated surgery which can be expected to reduce the overall complication rate in GR surgery. INTRODUCTION: The growing rod (GR) technique for management of progressive Early-Onset Scoliosis (EOS) is a viable alternative but with a high complication rate attributed to frequent surgical lengthenings. The safety and efficacy of a non-invasive Magnetically Controlled Growing Rod (MCGR) has been previously reported in a porcine model. We are reporting the preliminary results of this technique in EOS. METHODS: Retrospective review of prospectively collected multi-center data. Only patients who underwent MCGR surgery and at least 3 subsequent spinal distractions were included in this preliminary review. Distractions were performed in clinic without anesthesia or analgesics. T1-T12 and T1-S1 height and the distraction distance inside the actuator were analyzed in addition to conventional clinical and radiographic data. RESULTS: Patients (N=14; 7 F and 7 M) had a mean age of 8y+10m (3y+6m to 12y+7m) and underwent a total of 14 index surgeries (SR: index single rod in 5 and DR: dual rod in 9) and 91 distractions. There were 5 idiopathic, 4 neuromuscular, 2 congenital, 2 syndromic and one NF. Mean follow-up (FU) was 10 months (5.8-18.2). Mean Cobb changed from 57° pre-op to 35° post-op and correction was maintained (35°) at latest FU. T1-T12 increased by 4 mm for SR and 10 mm for DR with mean monthly gain of 0.5 and 1.39, respectively. T1-S1 gain was 4 mm for SR and 17 mm for DR with mean monthly gain of 0.5 mm for SR and 2.35 mm for DR. The mean interval between index surgery and the first distraction was 66 days and thereafter was 43 days. Complications included one superficial infection in (SR), one prominent implant (DR) and minimal loss of initial distraction in three after index MCGR (all SR). Overall, partial loss of distraction was observed following 14 of the 91 distractions (one DR and 13 SR). This loss was regained in subsequent distractions. There was no neurologic deficit or implant failure. CONCLUSION: MCGR appears to be safe and provided adequate distraction similar to the standard GR technique without the need for repeated surgeries. DR patients had better initial curve correction and greater spinal height. No major complications were observed during the short follow-up period. The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an ‘off label’ use).postprin

Work-related musculoskeletal disorders and their associated factors in nurses: A cross-sectional study in iran

Background Work-related musculoskeletal disorders (WMSDs) in nursing are regarded as an important factor for creating tension since they may often cause discontent, leave profession, and provide incorrect services to their clients. The present study aimed to determine WMSDs and their related factors among the nursing staff in university hospitals affiliated to Shiraz University of Medical Sciences (SUMS). Methods In the present descriptive cross-sectional study, 300 nurses in SUMS were selected based on systematic random sampling. To this aim, demographic information, and Nordic musculoskeletal disorder questionnaires were used for data collection. The data were analysed by descriptive and analytical tests (mean, standard deviation, independent t-test, and ANOVA) by SPSS/21 software. Results Based on the findings of WMSDs, low back disorders (88.33%) were more prevalent. In addition, a significant relationship was observed between WMSDs in different areas of the body with age, sex, and work experience and hours (P < 0.05). Conclusion Regarding the high prevalence of WMSDs among nurses, it is recommended to adopt interventional program for preventing WMSDs by reducing working hours and physical pressure control. Keywords: nurse, work-related musculoskeletal disorders, health care worker

Comparing Quality of Life of Elderly Menopause Living in Urban and Rural Areas.

OBJECTIVES: The present study aimed to compare the quality of life of elderly menopause living in urban/rural areas of Abadeh, Iran. METHODS: This descriptive and cross-sectional study was conducted on 312 urban and 68 rural elderly population using the two-stage (systematic random classification) and objective-based sampling methods. Data were collected by Leiden-Padua questionnaire for assessment of quality of life in elderly menopause. SPSS software (version 21) and descriptive-analytical tests were used for data analysis. RESULTS: The results showed that the overall quality of life was 37.5 and 34.2 in rural and urban areas, respectively, and no statistically significant difference was observed between them. However, there was statistically significant difference in the mean score of depression and anxiety, cognitive function, social function, life satisfaction, and sexual activity in urban and rural elderly menopause (P < 0.001). CONCLUSIONS: It seems necessary to pay more attention to the elderly menopause to improve their quality of life and consider proper planning for their empowerment and coping skills training. KEYWORDS: Elderly; Menopause; Quality of life; Rural population; Urban populatio

Comparing Quality of Life of Elderly Menopause Living in Urban and Rural Areas

Objectives: The present study aimed to compare the quality of life of elderly menopause living in urban/rural areas of Abadeh, Iran. Methods: This descriptive and cross-sectional study was conducted on 312 urban and 68 rural elderly population using the two-stage (systematic random classification) and objective-based sampling methods. Data were collected by Leiden-Padua questionnaire for assessment of quality of life in elderly menopause. SPSS software (version 21) and descriptive-analytical tests were used for data analysis. Results: The results showed that the overall quality of life was 37.5 and 34.2 in rural and urban areas, respectively, and no statistically significant difference was observed between them. However, there was statistically significant difference in the mean score of depression and anxiety, cognitive function, social function, life satisfaction, and sexual activity in urban and rural elderly menopause (P < 0.001). Conclusions: It seems necessary to pay more attention to the elderly menopause to improve their quality of life and consider proper planning for their empowerment and coping skills training

The Effect of Spiritual Care on Perceived Stress and Mental Health Among the Elderlies Living in Nursing Home

The aim of this study was to investigate the effect of spiritual care on the perceived stress and mental health of the elderlies living in nursing home in Isfahan. This is a semi-experimental study with pretest and posttest design with control group. Ninety eligible elderlies living in the nursing home were divided into intervention and control groups through census and random allocation. The interventional spiritual care was conducted for the intervention group for 90 days. After conducting the spiritual care, the majority of the elderlies (62.22%) in the intervention group had a low perceived stress level and the majority of the subjects (64.44%) in the control group had a high perceived stress level. Therefore, after performing spiritual care, a significant difference was observed at the perceived stress level of the two groups (X 2 = 3.22 and P = 0.001). The results of mental health level indicated that the mean score of the general health questionnaire was ranged between 10.95 and 27.2. After performing care, a significant difference was observed in mental health level of both groups, and 31.11% and 53.33% of the participants were suspected to general disorder in the intervention and control groups, respectively. Based on the results, there was a significant difference in the mental health level of both groups after the implementation of spiritual care (X 2 = 6.56 and P = 0.001). Further, a significant negative correlation was found between the perceived stress and mental health (r = − 0.241 and P = 0.01). Considering the spiritual health as one of the health dimensions influencing the psychosocial variables of elderlies seems necessary. Policymakers and planners of health area contribute to the improvement of mental health level by using comprehensive care approach with an emphasis on the spiritual dimension of care for the elderly people

Effect of Laughter Therapy on Depression and Quality of Life of the Elderly Living in Nursing Homes

Background: Mental disorders are common among the elderly with serious symptoms of depression and social isolation. This study was conducted to investigate the effect of laughter therapy (LT) on depression and quality of life (QOL) of the elderly living in Abadeh nursing homes. Methods: This is a controlled semi-experimental study with a pre-test, post-test design. Ninety eligible ones of the elderly living in the Abadeh nursing homes and from July to September 2017, entered the study. Some of the criteria for entering the study include being over 60 years old, orientation, not having blindness and deafness, lack of physical and mental problems. After determining the intervention and control groups, the scale of depression and QOL was administered to the subjects and their scores were collected in the pre-test. Results: Most of the study samples were in the intervention (35.55%) and control (37.77%) group in the age range of 60–69 years. In both intervention and control groups, respectively, 31.11% and 68.88% elderly were males and females. The mean scores of depression in the intervention group after LT (M = 2.57) were lower than those before the intervention (M = 6.87) [CI = −5.58–(–3.02)] and also the results of independent t-test showed a statistically significant difference before and after the intervention between the two groups (P < 0.001). The mean score of dimensions of QOL after LT was higher than that before in the intervention and there was a statistically significant difference in all dimensions with paired t-test (P < 0.001). Conclusion: Since the implementation of this programme could improve the mental status and QOL of the elderly, this method of therapy can be used as an alternative or complementary model to enhance the health of the elderl

Sexual Function and Factors Affecting Menopause: A Systematic Review

The purpose of this review study is to evaluate sexual function and its effective factors in menopause. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words of "menopause," "postmenopause," "postmenopausal," "premenopause," "pre-menopausal period," "sexual function," "sexual health," "sexuality," "sexual and gender disorders," "sexual development," "sexual dysfunction," "sexual disorders," "sexual behavior and "sexual activity" were used in combination with the Boolean operators OR and AND. After reviewing the selected articles, 27 papers were selected based on the criteria for entering the study and the goals set. The results of the reviewed articles showed that, in the physical domain, the factors affecting sexual function can be mentioned, age, hormonal changes, medical problems and reproductive history. Sexual disorders in menopause can be affected by some of the individual and social characteristics and psychological problems. Considering the fact that many psychological and social injuries occur in this period following sexual disorders; therefore, policies and programs for improving the quality of life of women in menopause should be aimed at eliminating sexual dysfunction, correcting attitudes and negative emotions and help to women for more comfortable in menopause