The effect of motor imaginary combined with Transcranial Direct Current Stimulation (TDCS) on balance in middle-aged women with high fall risk : a double-blind randomized controlled trial

Introduction. The risk of falling and its subsequent injuries increases with aging. Impaired balance and gait are important contributing factors to the increased risk of falling. A wide range of methods was examined to improve balance, but these interventions might produce small effects or be inapplicable for this population. The current study aimed at investigating the effect of motor imaginary (MI) training combined with transcranial direct current stimulation (tDCS) over the cerebellum on balance in middle-aged women with high fall risk. Methods. Thirty subjects aged 40-65 years old were divided into two groups including intervention (n=15) and sham control (n=15). The participants completed a 4-week program 3 times per week. The intervention group performed MI training combined with tDCS over the cerebellum, and the control group performed MI training combined with sham tDCS over the cerebellum. Static and dynamic balance were measured at baseline and after completing the 4-week program using balance error scoring system (BESS) and Y balance testing, respectively. Result. A one-way analysis of covariance and paired t-tests were used to analyze the data. Significant improvement was observed in both balance tests in the intervention group after the implementation of the 4-week intervention program compared to the control group. The within-group analysis showed that both static and dynamic balance improved significantly from the baseline values only in the intervention group (p0.05). Conclusion. The results of the study indicate that MI training combined with tDCS over the cerebellum can lead to balance improvement in middle-aged women with high fall risk. © 2023 Esmaeil Mozafaripour et al

Development of Professional Ethics Curriculum in the Operating Room for the Current Era of Surgery: A Mixed Method Study

Introduction: The rapid advancement of intricate technologies and the emergence of novel surgical methodologies necessitate nuanced ethical decision-making under high-stress scenarios. Consequently, cultivating an understanding of professional ethics within the surgical environment is crucial for all practitioners involved in patient care. This study was initiated with the aim of designing a comprehensive curriculum for Iranian medical schools, focusing on professional ethics within the operating room. Methods: This mixed-method exploratory research was executed in distinct qualitative and quantitative phases. The first stage involved conducting 12 structured interviews with Iranian faculty members who were experts in education of professional ethics and operating room staffs for assessing the current needs and reviewing extant curricula. The subsequent quantitative phase entailed evaluating the elements of each curriculum axis via the Delphi method. Results: The qualitative phase led to the identification of 45 primary codes, 14 subcategories, and 5 primary categories. The quantitative phase confirmed 3 instructional goal domains, 12 instructional content areas, 8 teaching methodologies, and 10 evaluation methods through the Delphi process. These confirmed components were eventually incorporated into various theoretical and clinical courses as longitudinal integration themes. Conclusion: Based on our findings, we recommend the development of educational objectives targeting cognitive, affective, and psychomotor domains and the longitudinal integration of a professional ethics course

Explanation of the professional development process of general surgery residents in the operating rooms: A situational analysis

Introduction: Numerous factors and elements are effective in the professional development of any field of study, including the educational structure, the individual characteristics of learners, and the educational atmosphere prevalent in the educational environment. Understanding each of these factors and elements and the relationships among them can guide educational system administrators in the direction of professional development. Surgical residents’ professional development is no exception to this rule. As a consequence, the present research sought to explain and suggest a model for surgical assistant professional growth in Iranian operating rooms.Methods: The present research was a grounded theory study based on a post-positivist approach, in which data analysis was performed using Clark’s situational analysis methodology by drawing three maps, situational map, social worlds/arenas map, and positional map.Results: In the presence of human and non-human factors, cultural, political, historical, and social components, the ordered situational map demonstrated the complexity of the operating room learning environment. The social worlds/arenas map confirmed the existence of several communities of practice wherein surgical residents were present with different power roles, and the positional map showed role of the educational level in the acquisition of thecompetence in the professional development pathway. Finally, the Triple Helix model of professional development was extracted, which has three components: psychological identity, social identity, and surgical competency.Conclusion: The surgical residents’ professional development in operating rooms occurs due to the acquisition of surgicalcompetency along with the growth of individuals and socialization. As a result, all factors and components impacting the residents’ competence development process in this learning environment must be identified and their linkages clarified

Challenges, Opportunities and Future Directions of Dental Education in COVID-19 Pandemic: A Qualitative Study

Background: With the onset of the COVID-19 pandemic and the impossibility of face-to-face learning, universities sought alternative methods to continue education and adapt to the upcoming conditions. Although technology development and virtual education methods created many opportunities in dental education, these modern solutions were not free of problems.Objectives: The current study explored the challenges, opportunities, and future directions of dental education from the experience of dental students, faculty members, and the dean of Alborz Dental School during the COVID-19 pandemic.Methods: The current qualitative study was conducted in 2021 using the content analysis method and in-depth semi-structured interviews with faculty members and students of Alborz Dental School. Purposive sampling was implemented to collect data with maximum variability in the faculty and student groups. In addition, 19 semi-structured interviews were transcribed verbatim immediately after each interview. The results were analyzed using MAXQDA version 10 software through the content analysis method.Results: The results of data analysis in the evaluation of challenges and opportunities of dental education from the experience of dental students, faculty members, and the dean of Alborz Dental School during the COVID-19 pandemic detected three emerging categories: opportunities, challenges, and future direction with subcategories of e-learning, clinical training, infrastructures, and personal life.Conclusion: Despite creating new learning opportunities during the COVID-19 pandemic, faculty members and dental students faced many challenges. Therefore, identifying these challenges, taking advantage of opportunities, and using faculty members' and students' experiences and suggestions can improve the learning experience and quality of education during the post-pandemic era

How Iranian people perceived the COVID-19 crisis? Explored findings from a qualitative study: current concerns, ethics and global solidarity

Abstract Objectives: This nation-wide project aimed to investigate the common perceptions and concerns regarding COVID-19 outbreak in Iran.        Methods: This qualitative study was conducted in Iran from February to March 2020 via an online open-ended questionnaire. The participants were also selected using convenience and snowball sampling methods. As well, the data collection process continued until data saturation was achieved. Thematic content analysis was utilized to analysis the transcribed texts.   Results: The statements retrieved also represented the most challenging psychological stress experienced by the participants. Four themes were accordingly recognized based on the content analysis including stressful conditions, health concerns, social and political concerns, and economic concerns. Throughout the study, a major proportion of the participants commented that psychological disorders such as fear, anxiety, stress, and ennui were their main challenges regarding this pandemic. Furthermore, lack of social responsibility, worries about high-risk and susceptible groups, decreased economic power of the public, financial hardships for low-income groups, shortage of healthcare facilities, and adverse effects of disinfectants were expressed as the main concerns.    Conclusions: As a whole, it is evident that people have confronted with several challenges and need help together with effective policies and strategies during and after this pandemic to reduce their current concerns. The study findings provided a favorable ground to develop and adopt the required policies in Iran and other countries. It was concluded that creating local, national, and global solidarity in such epidemics is an inevitable necessity.&nbsp

The Energy-Saving Potential of Air-Side Economisers in Modular Data Centres: Analysis of Opportunities and Risks in Different Climates

This study examines the feasibility of utilising outside air for ‘free cooling’ in modular data centres through the implementation of an air-side economiser, as an alternative to traditional mechanical cooling systems. The objective is to offset the energy consumption associated with cooling by leveraging the natural cooling capacity of the ambient air. To investigate this potential, a 90-kW modular data centre is employed as the base case for model validation and analysis of energy reduction possibilities. The research employs dynamic thermal modelling techniques to assess the efficacy of the air-side economiser in four distinct climatic zones: Stockholm, Dubai, San Francisco, and Singapore, representing diverse worldwide climates. The model is meticulously calibrated and validated using power usage effectiveness (PUE) values obtained from the Open Compute Project. Simulation runs are conducted to evaluate the energy-reduction potential achievable with the air-side economiser compared to conventional mechanical air-conditioning systems. The results indicate significant energy reductions of up to 86% in moderate climates, while minimal reductions are observed in dry and hot climates. This comprehensive analysis offers valuable insights into the intricate relationship between modular data centres, their operational characteristics, and the viability of employing air-side economisers for free cooling and energy efficiency across different climatic conditions. The contribution of this publication to this field of science lies in its exploration of the practicality and energy-saving potential of air-side economisers in modular data centres. By utilising dynamic thermal modelling and empirical validation, this study provides evidence-based insights into the effectiveness of this cooling strategy, shedding light on its applicability in various climates. The findings contribute to the understanding of energy-efficient cooling solutions in data-centre design and operation, paving the way for more sustainable practices in the field

Operating Room Students, Graduates and Faculty Members’ Experiences of the Curriculum of Operating Room Noncontinuous Undergraduate Program: A Qualitative Study

Introduction: One of the basic principles of the educational process is the periodic review of the curriculum for each discipline and at each academic level. Because of previous work experience, the operating room non-continuous undergraduates have to retake some courses they have already passed. Therefore, the purpose of this study was to investigate the operating room students, graduates and faculty members’ experiences of the curriculum of operating room noncontinuous undergraduate program. Methods: This qualitative study was conducted in 2016-17 using the conventional content analysis method. Subjects were selected by means of purposive sampling. Data were collected through 13 semi-structured interviews. Interview transcriptions were analyzed in MaxQDA2 software using the content analysis method. Results: The data were classified into three main categories namely “disproportionate structure of the curriculum” with the subcategories of inappropriate organization of teaching content, teaching method and ineffective apprenticeship; “deterrents” with the subcategories of employment during education, family management, and difficult commuting; and “motivational factors” with the subcategories of financial growth, job promotion, and social identity. Conclusion: Results suggest that it is necessary to reform the structure and implementation of the curriculum of operating room noncontinuous undergraduate program so that it will be commensurate with learners’ needs

Psychometric evaluation and localization of STEEM tool for surgical technologists in Iran

Introduction: Clinical education is one of the most important parts of medical and paramedical education that prepares students for practicing clinical skills. Evaluation of the clinical learning environment with a suitable instrument plays an important role in increasing student motivation and learning. This also applies to the assessment of the clinical environment of the operating room. In search of such a suitable instrument, this study aimed at investigating the psychometric properties of Surgical Theatre Educational Environment Measure (STEEM) among surgical technology students of Iran University of Medical Sciences and Alborz University of Medical Sciences in 2018. Methods: This was a descriptive-analytic study conducted from July 2017 to July 2018. After translation and retranslation of the STEEM tool, its face validity and content validity were measured by the relevant experts panel. Then, it was distribute damong 201 surgical technology students. The construct validity of the instrument was investigated using exploratory factor analysis and its reliability was confirmed using Cronbach's alpha and Pearson correlation coefficient. Data were analyzed using SPSS 19. Result: The study of face, content, and construct validity resulted in providing STEEM questionnaire with 5 subscales and 30 questions covering 55.6% of the total variance. Conclusion: The findings of this study indicated that the Persian and native versions of STEEM had appropriate validity and reliability, and could be used to measure the operating environment of the Iranian Operating Room from the standpoint of surgical technology students. Keywords: measurement, Educational environment, Operating room, Educational measurement, STEEM

Effect of preoperative education on recovery time of laparoscopic cholecystectomy: a randomized clinical trial

Background: Nowadays, new methods are emerging each month for a better operation with fewer complications. Laparoscopic surgery have remarkable advantages, Compared to open, such as smaller incision, less manipulation of the digestive system, less postoperative pain, fewer wound complication and faster discharge from the hospital. Therefore it is preferred by patients and surgeons and is replacing the traditional open surgical methods. However, any operation causes significant panic for patients and lack of knowledge about the surgical method is found to cause poor surgical outcomes, such as recovery time after the surgery we evaluated the effect of preoperative education on the recovery time of laparoscopic cholecystectomy candidates. Methods: This randomized clinical control trial was performed at Imam Khomeini and Alborz Hospitals in Karaj from February 2010 till January 2011. Using randomized sampling method, 100 female candidates for laparoscopic cholecystectomy were divided into two equal groups of case and control. The case group received detailed information about operating room’s condition, surgical equipment, anesthesia method, advantages and disadvantages of laparoscopic procedures, and patient’s role in self-care at recovery, whilst the control group received no education before the surgery. The two groups were compared regarding recovery time based on Aldrete modified checklist and mean time to reach the Aldrete consciousness score of 9 and the incidence of nausea was assessed among them. Results: The analysis showed that there was a significant difference between the mean time to reach Aldrete consciousness modified checklist score of 9 between the case and control group (18.04±3.87 vs. 29.66±5.44, respectively, P<0.001), therefore the case group had shorter recovery time than the control group. 10 of the case group (20%) and 3 of the control group (6%) had nausea after recovery (P=0.037, OR=0.255 (CI 95%: 0.066-0.992)). Conclusion: Preoperative education of patients can significantly decrease the recovery time after laparoscopic cholecystectomy surgery. Therefore, it is strongly recommended to include the preoperative education in routine care of laparoscopic cholecystectomy patients for better surgical outcomes

Assessment of neonatal mortality in the Neonatal Intensive Care Unit in Sabzevar City for the period of 2006–2013

Introduction: The neonatal mortality rate (NMR) is an essential index in the assessment of community health. With the rapid advancement of neonatal care, the causes of death in this group and the overall mortality rate have changed. For these reasons, the aim of this study was to determine the current NMR and its causes in Sabzevar City’s Neonatal Intensive Care Unit (NICU). Methods: This cross-sectional study was conducted in the NICU at Sabzevar Hospital from 2006 through 2013. Based on previous studies, the sample size was determined to be 365 neonates who were admitted to the NICU and died before they were discharged. The study tool was a researcher-developed checklist related to deceased neonates in the NICU. The checklist was confirmed based on the validity of its content and its inter-rater reliability. We used chi-squared, the Mann-Whitney U test, and the Spearman correlation to analyze the data. Results: The NMR in Sabzevar’s NICU was 6.44 per 1000 during the seven-year period; this rate included the following cases per 1000 live births: very early mortality (2.16), early mortality (3.33), and late mortality (0.96). Among 58,270 live births, 3,667 of the neonates were admitted to the NICU during the seven-year period, which was equivalent to 62.93 admissions per 1000 live births. Of the 3,667 neonates admitted to the NICU, 375 (10.23%) died before they were discharged. The most recurrent diagnoses were respiratory distress syndrome (46%), followed by sepsis (12%). The one-sample chi-squared test as a goodness-of-fit test (95% CI) showed that the mortality rates were significantly different based on gender (p = 0.004), birth weight (p < 0.001), gestational age (p < 0.001), different causes of death (p < 0.001), and different years of death (2006 -2013) (p < 0.001). There also was a significant difference between the duration of survival (very early mortality, early mortality, and late mortality) (p < 0.001). Conclusion: Neonatal mortality in the present study was comparable with that reported in similar studies in Iran and in other countries. The strong association between the mortality rate in the NICU with premature birth and low birth weight indicates the necessity of prenatal care aimed at preventing pre-term labor. Comprehensive programs from antenatal care and care at and after birth are recommended, including the investigation of the risks for neonatal death and offering preventive strategie