Inter-Rater Agreement of Emergency Nurses and Physicians in Emergency Severity Index (ESI) Triage

Introduction: Triage is one of the most important systems in patients prioritizing at the time of arrival to hospital. Based on the severity of the injury and the need for treatment, this system manages patients in the least time which could lead to rotation of patients with high reliability and safety. Currently, the most accepted method for triage is emergency severity index (ESI) system, considered as five-level triage method, too. This method were implemented in Al Zahra Hospital of Isfahan by trained nurses since March to May 2010. This study was aimed to evaluate the accuracy of emergency nursing triage using ESI. Methods: This prospective cross sectional study was carried out on 601 patients referred to Al-Zahra hospital of Isfahan through May 2010. The patients’ triage level were determined by physicians and nurses separately and the results compared. To define the level of agreement between two groups (inter-rater agreement), the kappa index was evaluated. To specify the association between the time interval of initial triage and patient final status, Chi-Square test was applied using SPSS 18 statistical software. Results: There was no significant difference between results of nurses and physicians triage (P<0/0001). The agreement level (kappa index) between two groups was 94% (95% CI: 0.931-0.957). Of 601 patients, 44.1% ones were hospitalized at the emergency department, 52.6% discharged and 3.3% died. The average of time interval between nursing triage and physician visit was 9.55 minutes at the level one triage, 21.64 minutes at level two, 26.03 minutes at level three, 26.93 minutes at level four, and 11.70 minutes at level five. Conclusion: It seems that there is an acceptable inter-rater agreement between emergency nurses and physicians regarding patients’ triage in terms of ESI system

Efficiency measurement of cloud service providers using network data envelopment analysis

An increasing number of organizations and businesses around the world use cloud computing services to improve their performance in the competitive marketplace. However, one of the biggest challenges in using cloud computing services is performance measurement and the selection of the best cloud service providers (CSPs) based on quality of service (QoS) requirements (Duan, 2017). To address this shortcoming in this article we propose a network data envelopment analysis (DEA) method in measuring the efficiency of CSPs. When network dimensions are taken into consideration, a more comprehensive analysis is enabled where divisional efficiency is reflected in overall efficiency estimates. This helps managers and decision makers in organizations to make accurate decisions in selecting cloud services. In the current study, variable returns to scale (VRS), the non-oriented network slacks-based measure (SBM) model and input-oriented and output-oriented SBM models are applied to measure the performance of 18 CSPs. The obtained results show the superiority of the network DEA model and they also demonstrate that the proposed model can evaluate and rank CSPs much better than compared to traditional DEA models

Evaluación de esquemas de microfísica WRF en la simulación de una línea de turbonada sobre IRAN utilizando datos de radar y de reanálisis

Se registró una línea de turbonada en el puerto de Dayyer, al suroeste de Irán, el 19 de marzo de 2017. En el presente documento, hemos simulado los rasgos característicos asociados con la línea de turbonada mediante el modelo de investigación y pronóstico meteorológico (WRF) utilizando cinco microfísicas diferentes (MP) esquemas. Para validar las características simuladas de la línea de turbonada, la reflectividad de la sección transversal de latitud-altura y longitud-altura y el valor de precipitación derivado de la reflectividad observada recopilada por el radar meteorológico Doppler en Bushehr, datos de la estación meteorológica sinóptica en el puerto de Dayyer junto con NCEP-NCAR y ERA -Se utilizaron datos de reanálisisINTERIM. Para verificar la precipitación simulada, se calculó la curva Fractions Skill Score (FSS). El examen de los resultados de la simulación de la presión geopotencial y al nivel del mar muestra que las simulaciones del modelo que utilizan diferentes esquemas de MP concuerdan bien con los reanálisis de verificación. Además, la distribución espacial de las precipitaciones de las simulaciones y las observaciones de verificación no mostraron grandes diferencias. Sin embargo, existen diferencias significativas en los detalles de las simulaciones, como la reflectividad máxima de las celdas convectivas, la extensión vertical de las celdas de tormenta, la velocidad y dirección del viento, los valores de precipitación y las curvas FSS. Sin embargo, todas las simulaciones han mostrado celdas convectivas sobre el puerto de Dayyer en el momento de la aparición de la línea de turbonada, pero solo la simulación del modelo que usa el esquema Lin MP es consistente con la reflectividad del radar y la extensión vertical correspondientes. El gráfico FSS mostró que la habilidad cambia con la escala espacial. Los resultados utilizando el esquema de microfísica Lin cruzaron la línea FSSuniform a escalas más bajas en comparación con otros esquemas de M

Numerical simulations of oceanographic characteristics of the Persian Gulf and Sea of Oman using ROMS model

1978-1989In this paper, oceanographic characteristics of Oman Sea has been simulated using oceanographic model ROMS. The study area was limited from Arvand Roud in the north of Persian Gulf to RAAS AL HAD in the south east of Oman Sea. Oceanographic parameters on the study area were simulated by the ROMS model for 7 years period and the results were analyzed in comparison to satellite data in the study area in different seasons. Propagation pattern of Indian Ocean Surface Water (IOSW) in to the Persian Gulf and Oman Sea was considered for examination using the ROMS model. The model outputs for surface currents and temperature show the similar pattern as compared to remote sensing data and previous work

The Prediction Incidence of the Three Most Common Cancers Among Iranian Military Community During 2007-2019: a Time Series Analysis.

Objective. Cancers are one of the most important public health problems in Iran. Because of the importance of cancers, the purpose of the current study was to the prediction of the future incidence of the most common cancers among Iranian military community (MC) by using the time series analysis during 2007 to 2019.Methods. In the current cross-sectional study, all registered cancers among Iranian MC entered the study. To select the best model of prediction, various methods including autocorrelation function (ACF), partial autocorrelation function (PACF), and Akaike information criterion (AIC) statistics were used. All analysis was performed by using ITSM, stata14, and Excel2010 software.Results. The most prevalent cancers among Iranian MC were breast, prostate, and colon cancers respectively. The time series analysis was shown that the trend of all mentioned cancers in Iranian MC will increase in the coming years.Conclusion. the trend of most prevalent cancers among Iranian MC was increasing but the different factors like the growth of population size and improving the registration system

Dryland river regime shifts in Iran: Drivers and feedbacks

peer reviewedIn the Anthropocene, human activities have created unprecedented changes and nonlinear relationships between humans and nature. These changes can be much faster and more intense in arid and semiarid areas that have been affected by intense human activities. Iran has climates from very humid to very dry, but arid and semiarid climates cover the country's largest area. Many of these arid areas have undergone severe changes in their surface and groundwater ecosystems in recent years, which have caused severe damage to humans and the environment in the area and surrounding areas. Therefore, in this study, using the theory of regime shifts, the time series of the Zayandeh-Rud River Basin in the center of Iran were analyzed. First, the data of the desired time series in the period of 1986–2018 was arranged seasonally. Then, using the sequential t-test method, regime shifts in these time series were identified, and then, causal loop diagrams of these shifts and their drivers and feedbacks were interpreted. The results showed that in the time series of quantity and quality of surface water and groundwater level in the studied stations and aquifers, regime shifts can be identified. Regime shifts were also identified in the time series of agricultural land area. These shifts have occurred with the increase in human activities since the early 1950s in the metropolis of Isfahan, the increase in agricultural and industrial exploitation, and consequently, the increase in population. When this reinforcing feedback loop becomes dominant, the Zayandeh-Rud River system has shifted from a regime of rich water resources to a regime of poor water resources. However, by recognizing and systematically analyzing these shifts, the Zayandeh-Rud River system can be directed toward a sustainable system through structural reform, negotiation, and redefining goals

An Investigation on Polymerization of Ethylene by Ziegler-Natta Catalyst in the Presence of a Promoter: Polymerization Behavior and Polymer Microstructure

The effect of a halocarbon (ethyl chloride) as a promoter on a Ziegler-Natta catalyst composed of‌ T‌iCl4 (catalyst), AlEt3 (activator) and Mg(OEt)2 (support) in the polymerization of ethylene have been investigated. In addition, the impact of this compound on the structural and thermal properties of the produced polyethylene has been studied. The catalyst activity and polymerization rate increased almost up to twice when a suitable molar ratio of ethyl chloride to triethylaluminum (TEA) was used. There was no change in the type of the profile of the polymerization rate during the polymerization time. A reduction in the polymer molecular weight was observed in the presence of the promoter and hydrogen. In addition, the MWD curve shifted toward lower values in the presence of ethyl chloride. Furthermore, a numerical method was used to obtain the most probable chain-length distribution, number   average molecular weight and weight fraction corresponding to each site type in the presence and absence of the promoter. Since, the catalyst had an irregular shape, the produced polymer also showed a similar morphology. In addition, the promoter used in the polymerization did not have any effect on the produced polymer morphology. The DSC results indicated that the presence of the promoter in the polymerization led to a decrease in the melting point of the produced polymer; whereas, there were no remarkable changes in the crystallization temperature of the polymers. Copyright © 2018 BCREC Group. All rights reserved Received: 2nd October 2017; Revised: 5th April 2018; Accepted: 26th April 2018 How to Cite: Gholami, Y., Abdouss, M., Abedi, S., Azadi, F., Baniani, P., Arsalanfar, M. (2018). An Investigation on Polymerization of Ethylene by Ziegler-Natta Catalyst in the Presence of a Promoter: Polymerization Behavior and Polymer Microstructure. Bulletin of Chemical Reaction Engineering & Catalysis, 13 (3): 412-419 (doi:10.9767/bcrec.13.3.1574.412-419) Permalink/DOI: https://doi.org/10.9767/bcrec.13.3.1574.412-41

The global burden of cancer attributable to risk factors, 2010-19 : a systematic analysis for the Global Burden of Disease Study 2019

Background Understanding the magnitude of cancer burden attributable to potentially modifiable risk factors is crucial for development of effective prevention and mitigation strategies. We analysed results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 to inform cancer control planning efforts globally. Methods The GBD 2019 comparative risk assessment framework was used to estimate cancer burden attributable to behavioural, environmental and occupational, and metabolic risk factors. A total of 82 risk-outcome pairs were included on the basis of the World Cancer Research Fund criteria. Estimated cancer deaths and disability-adjusted life-years (DALYs) in 2019 and change in these measures between 2010 and 2019 are presented. Findings Globally, in 2019, the risk factors included in this analysis accounted for 4.45 million (95% uncertainty interval 4.01-4.94) deaths and 105 million (95.0-116) DALYs for both sexes combined, representing 44.4% (41.3-48.4) of all cancer deaths and 42.0% (39.1-45.6) of all DALYs. There were 2.88 million (2.60-3.18) risk-attributable cancer deaths in males (50.6% [47.8-54.1] of all male cancer deaths) and 1.58 million (1.36-1.84) risk-attributable cancer deaths in females (36.3% [32.5-41.3] of all female cancer deaths). The leading risk factors at the most detailed level globally for risk-attributable cancer deaths and DALYs in 2019 for both sexes combined were smoking, followed by alcohol use and high BMI. Risk-attributable cancer burden varied by world region and Socio-demographic Index (SDI), with smoking, unsafe sex, and alcohol use being the three leading risk factors for risk-attributable cancer DALYs in low SDI locations in 2019, whereas DALYs in high SDI locations mirrored the top three global risk factor rankings. From 2010 to 2019, global risk-attributable cancer deaths increased by 20.4% (12.6-28.4) and DALYs by 16.8% (8.8-25.0), with the greatest percentage increase in metabolic risks (34.7% [27.9-42.8] and 33.3% [25.8-42.0]). Interpretation The leading risk factors contributing to global cancer burden in 2019 were behavioural, whereas metabolic risk factors saw the largest increases between 2010 and 2019. Reducing exposure to these modifiable risk factors would decrease cancer mortality and DALY rates worldwide, and policies should be tailored appropriately to local cancer risk factor burden. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.Peer reviewe

Performance Measurement of Cloud Service Suppliers and Cloud Supply Chain

University of Technology Sydney. Faculty of Engineering and Information Technology.Over the past decade, cloud computing has received much consideration from both practitioners and academics. Nonetheless, the rapid increase in the industrial use-cases of cloud computing and the sharp increase in the number of cloud service providers (CSPs) have resulted in many challenges in performance measurement and the selection of the optimal CSPs according to quality of service (QoS) requirements. To date, there is no reliable approach for the performance assessment of CSPs and quantitative models are rarely used to support such decisions. In addition, the existing approaches to CSP performance measurement suffer from several limitations and drawbacks such as requiring complex calculations, being effort-intensive and being time-consuming. Furthermore, the existing approaches are unable to find slight differences between CSPs in a cloud marketplace owing to the high level of competition. These limitations are major obstacles to applying the existing approaches to assess CSPs. To address these issues in the existing literature, the objective of this study is to develop performance evaluation models based on the Data Envelopment Analysis (DEA) approach that can act as a proxy for many conventional performance assessment problems in cloud computing. The obtained results show that the models proposed in this study are extremely effective in measuring the efficiency of CSPs. Furthermore, the proposed models can deal with different types of data simultaneously in the efficiency measurement of CSPs and cloud supply chains, giving decision makers the ability to estimate the performance of CSPs efficiently