Optimizing labor duration with pilates: evidence from a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Pilates has captured interest due to its possible advantages during pregnancy and childbirth. Although research indicates that Pilates may reduce labor duration, alleviate pain, and improve satisfaction with the childbirth experience, consensus on these outcomes remains elusive, underscoring the necessity for additional studies. AIM: This systematic review and meta-analysis aimed to assess the impact of Pilates exercises on labor duration among pregnant women. METHODS: The online database was searched to yield the literature using the terms of 'Pilates', 'childbirth', and 'labor duration', and similar terms including PubMed, Clinical Key, Scopus, Web of Science, Embase, and Cochrane Database of Systematic Reviews up to June 25, 2023. Studies were considered eligible if they were randomized or clinical controlled trials (RCTs/CCTs) published in English, focusing on healthy pregnant women without exercise contraindications. The studies needed to include interventions involving Pilates or exercise movement techniques, a comparison group with no exercise, and outcomes related to labor duration, the period of the active phase, and the second stage of delivery. RESULTS: Eleven studies, totalling 1239 participants, were included in the analysis. These studies provided high-quality evidence from exercise only RCTs/CCTs. The findings indicated a significant reduction in the active phase of labor (8 RCTs, n = 1195; Mean Difference [MD] = -56.35, 95% Confidence Interval [CI] [-89.46 to -23.25]) and overall labor duration (8 RCTs, n = 898; MD = -93.93, 95% CI [-138.34 to -49.51]) in pregnant women who engaged in Pilates exercises compared to those who did not but doesn't affect on the duration of the second stage of labor (7 RCTs, n = 1135; MD = -0.11, 95% CI [-7.21 to 6.99]). CONCLUSIONS: While this review primarily addresses the effects of Pilates on healthy and low-risk pregnant women, the findings suggest a potential role for Pilates in shortening labor duration. Therefore, engaging in Pilates or similar physical activities is recommended for pregnant women to potentially facilitate a more efficient labor process.

Which educational messengers do medical students prefer for receiving healthinformation? Development and psychometrics of using health messengers questionnaire.

INTRODUCTION: Individuals vary in their selection of health messengers. This research aimed to construct an instrument to measure the preferences of medical students in selecting health messengers and in the next step to validate the aforementioned questionnaire. METHOD: This research is a descriptive survey with an approach to construct a questionnaire. The statistical population included all students studying at Shiraz University of Medical Sciences in March to June 2022 in the academic year 2021-2022. 500 participants were involved in the study. To determine the types of health messengers and review the texts, a group of 15 primary items consisting of the 6 components of academic sources (2-items), formal news sources (2-items), mass media (3-items), internet search (2-items), social networks and messenger applications (4-items), and informal conversation (2-items) were compiled. A 4-point scale was developed the content validity of which was confirmed using CVI and CVR method and the reliability index was calculated to be 0.818. Factor analysis was also used to determine the construct validity and factor loading of each item. RESULTS: The research covers university students in different medical fields. Using factor analysis, together with KMO = 0.810 and Bartlett's sphericity index P < 0.0001, saturation and the suitability of the test were confirmed. Students' preferences based on factor load were social media (28.92%), official and unofficial health sources(10.76%), academic sources (9.08%), internet search (8.18%), and mass media (7.13%), respectively. Among social media, Telegram (0.85) had the highest factor load followed by Instagram (0.79), and WhatsApp (0.71). CONCLUSION: Medical students are always on the move and naturally prioritize mobile-based methods. They prefer messengers that are free from time and space restrictions. The widespread availability of mobile devices and the ability to search for and access information make it easier to test health information. Therefore, in health policy, attention should be paid to the virtual capabilities, especially mobile-based approaches.

Comparison of the teaching clinical biochemistry in face-to-face and the flex-flipped classroom to medical and dental students: a quasi-experimental study from IRAN.

INTRODUCTION: Biochemistry is one of the main courses of basic sciences in the medical curriculum, along with other difficult subjects that are difficult to learn. The emergence of new technologies has made it possible to test new methods such as e-Learning. In this study, we compared two methods of Flex-Flipped Classroom (FFC) and face-to-face. METHOD: A quasi-experimental research was done which involved both medical and dental students studying the clinical biochemistry course in the joint semester in 2019. A total of 100 medical students were trained in biochemistry through face-to-face teaching, and 60 dental students were trained in the same course through the FFC model. Three researcher-made tools were used to compare the two groups to assess the student's satisfaction, scores, and self-evaluation. The content validity of the tools was checked using the opinions of 10 experts through the CVI index. The results were analyzed using one-sample t-tests, independent t-tests, and ANOVA. RESULTS: Both groups scored significantly more than the cut-off-point (Mean > 3.5) in their average scores of the total and sub-components of the self-evaluation questionnaire (P < 0.05). Face-to-face teaching was viewed more favorably than the FFC teaching except for considering the flexibility (4.14 ± 1.55), but the difference was not significant (P > 0.05). The students' knowledge score in the FFC was slightly higher than that in the face-to-face method, but this difference was not significant(P = 0.758). CONCLUSION: Both face-to-face and FFC methods were effective according to the students, but the level of satisfaction with the face-to-face method was higher. It seems that teacher-student interaction is an important factor in students' preferences. However, the students preferred the flexibility of multimedia. It seems necessary to use the advantages of each method in a model appropriate to the students' conditions and available facilities.

Lesson learned from assessing teachers' and students' perspectives regarding the quality of e-learning in medical education during the pandemic: a mixed-methods study.

BACKGROUND: The evaluation of e-learning systems ensures the provision of quality training. The goal was to identify the perspectives of teachers and students on e-learning in medical education during the COVID-19 pandemic at Shiraz University of Medical Sciences (SUMS), Iran. METHODS: This study utilized a convergent mixed methods research design with a two-phase approach to collect and analyze data between June and August 2022. In the first stage, a cross-sectional descriptive study was conducted to evaluate the quality of e-learning systems from the perspective of 400 students. In the second stage, semi-structured interviews were conducted with 10 virtual education professors and 10 student representatives to identify the strengths, weaknesses, opportunities, and threats of virtual education. A validated questionnaire was administered to assess the quality of the e-learning system, and data were analyzed using SPSS-21. Qualitative data were subjected to content analysis. RESULTS: Our findings revealed that the student support system, the course structure, and the infrastructure and technology subscales' mean scores were significantly higher than the average level (P < 0.001). However, the professors' methods of teaching and learning strategies were unsatisfactory. The results of the present study showed that the evaluation mean score was significantly higher among, younger, female, and undergraduate students. Virtual education has strengths and weaknesses, and innovative approaches are needed to enhance student engagement. The lack of appropriate infrastructure and virtual teaching tools for teachers and students is a significant challenge that needs to be addressed. Blended learning is effective in medical education, and the shift from teacher-centered to learner-centered teaching approaches is an opportunity to explore innovative teaching approaches. CONCLUSION: From the perspective of students, the quality of eLearning systems at the universities was moderate. Virtual education offers both benefits and drawbacks, and there is a requirement for innovative solutions to enhance student engagement and lessen boredom.

Melatonin strongly enhances the Agrobacterium- mediated transformation of carnation in nitrogen-depleted media.

With the rising demand for new cultivars of carnation, efficient transformation protocols are needed to enable the bioengineering of new traits. Here, we established a novel and efficient Agrobacterium-mediated transformation system using callus as the target explant for four commercial carnation cultivars. Leaf-derived calli of all cultivars were inoculated with Agrobacterium tumefaciens strain LBA4404 containing the plasmid pCAMBIA 2301 harboring genes for ß-glucuronidase (uidA) and neomycin phosphotransferase (nptII). Polymerase chain reaction (PCR) and histochemical assays confirmed the presence of uidA and ß-glucuronidase (GUS), respectively in transgenic shoots. The effect on transformation efficiency of medium composition and the presence of antioxidants during inoculation and co-cultivation was investigated. The transformation efficiency was increased in Murashige and Skoog (MS) medium lacking KNO3 and NH4NO3, and also in MS medium lacking macro and micro elements and Fe to 5% and 3.1% respectively, compared to 0.6% in full-strength medium. Transformation efficiency was increased dramatically to 24.4% across all carnation cultivars by the addition of 2 mg/l melatonin to nitrogen-depleted MS medium. Shoot regeneration was also doubled in this treatment. The establishment of this efficient and reliable transformation protocol can advance the development of novel carnation cultivars through molecular breeding approaches.

The eNOS-G894T genetic polymorphism and risk of preeclampsia: A case-control study, an updated meta-analysis, and a bioinformatic assay.

OBJECTIVES: Preeclampsia (PE) is a leading cause of maternal death worldwide and involves vascular endothelial dysfunction. The aim of this study was to investigate the association of the G894T polymorphism in the endothelial nitric oxide synthase (eNOS) gene and the risk of preeclampsia in a case-control design in an Iranian population, which was followed by a meta-analysis and an in silico approach. METHODS: In the case-control study, 300 people including 135 pregnant women with preeclampsia and 165 healthy pregnant women were included. The genotype of G894T polymorphism was determined by the PCR-RFLP method. We searched authoritative scientific databases to find eligible studies for meta-analysis. The odds ratio with a 95% confidence interval was estimated to find the strength of the association of the mentioned polymorphism with the risk of preeclampsia. In addition, the effect of G894T transversion on eNOS gene function was evaluated by some bioinformatics tools. RESULTS: Our case-control data showed that the G894T polymorphism is associated with an increased risk of preeclampsia. In the meta-analysis, 33 eligible studies were included, and the results showed that the G894T polymorphism is associated with an increased risk of preeclampsia in the overall analysis and some stratified analyses. In addition, the structural analysis showed that the G894T variant can affect the splicing process as well as the protein stability. CONCLUSIONS: Based on the results, the aforementioned polymorphism may be a risk factor for preeclampsia and could be considered a potential molecular biomarker for screening susceptible individuals.

Which virtual education methods do e­students prefer? Design and validation of Virtual Education Preferences Questionnaire (VEPQ).

BACKGROUND: With the prevalence of new technologies and evolving student learning styles, virtual teaching methods have become increasingly popular. As a result, more and more students are opting to learn online. However, one common concern is that they may feel disconnected from their teachers, leading to feelings of loneliness and doubts about the quality of education they are receiving. To address this issue, a study was conducted to gather data on students' preferences for virtual education and to validate a tool for measuring students' preferences for virtual education. METHODS: The research was conducted in a mixed method with a quantitative-qualitative sequence. A virtual education preferences questionnaire (VEPQ) for students with a total of 17 items was created and validated as part of the qualitative component by looking at the theoretical underpinnings and experts' opinions in the focus group. The scale of the six-point Likert questionnaire was from very high to very low. To validate the tool and determine preferences, exploratory factor analysis was used. A total of 155 samples answered the questions and the data were analyzed using SPSS-24 software. RESULTS: A total of 155 complete questionnaires were returned; among them, 110 (71%) were filled out by women, 73 (47.1%) by respondents between the ages of 36 and 45, 107 (69%) were already employed in paramedical fields, and 48 (31%) were enrolled in a medical school. The opinions of ten experts were used to confirm the face validity of the questionnaire. With CVI = 0.924 and CVR = 0.805, content validity was verified. Using the internal consistency method of the questions with a Cronbach's alpha coefficient of R = 0.824, the validity of the entire questionnaire was confirmed. Exploratory factor analysis revealed that a total of five components-self-directed projects (29.58%), e-content (13.00%), online presentation (10.97%), face-to-face interactions (9.12%), and text interactions (7.11%) had the highest load, with a total of 69.77% of the structure explaining virtual education preferences. The factor analysis test and the suitability of the sample are both confirmed by the value of KMO = 0.721 and the significance of Pvalue < 0.001. CONCLUSION: It appears that the highly valid tool developed can be used to ascertain the educational preferences of students. Also, the high factor load of self-directed educational methods and e-content shows that independence and flexibility in time and place are more important for students.

Chitosan nanoparticles improve physiological and biochemical responses of Salvia abrotanoides (Kar.) under drought stress.

BACKGROUND: The use of organic nanoparticles to improve drought resistance and water demand characteristics in plants seems to be a promising eco-friendly strategy for water resource management in arid and semi-arid areas. This study aimed to investigate the effect of chitosan nanoparticles (CNPs) (0, 30, 60 and 90 ppm) on some physiological, biochemical, and anatomical responses of Salvia abrotanoides under multiple irrigation regimes (30% (severe), 50% (medium) and 100% (control) field capacity). RESULTS: The results showed that drought stress decreases almost all biochemical parameters. However, foliar application of CNPs mitigated the effects caused by drought stress. This elicitor decreased electrolyte conductivity (35%), but improved relative water content (12.65%), total chlorophyll (63%), carotenoids (68%), phenol (23.1%), flavonoid (36.4%), soluble sugar (58%), proline (49%), protein (45.2%) in S. abrotanoides plants compared to the control (CNPs = 0). Furthermore, the activity of antioxidant enzymes superoxide dismutase (86%), polyphenol oxidase (72.8%), and guaiacol peroxidase (75.7%) were enhanced after CNPs treatment to reduce the effects of water deficit. Also, the CNPs led to an increase in stomatal density (5.2 and 6.6%) while decreasing stomatal aperture size (50 and 25%) and semi-closed stomata (26 and 53%) in leaves. CONCLUSION: The findings show that CNPs not only can considerably reduce water requirement of S. abrotanoides but also are able to enhance the drought tolerance ability of this plant particularly in drought-prone areas.

The effect of video-based multimedia training on knowledge, attitude, and performance in breast self-examination.

BACKGROUND/OBJECTIVES: Breast neoplasm is one of the most common cancers in Iranian women due to the late diagnosis. Awareness of breast neoplasm and using Breast Self-Examination (BSE) assist in the early detection and treatment of cancer. This study examined the effectiveness of video-based multimedia training versus face-to-face training in awareness of breast neoplasm and BSE and possible factors affecting their effectiveness. METHODS: This research was a pre-test, a post-test experimental study comparing the knowledge, attitude, and performance of women about BSE across two training intervention groups (face-to-face versus video-based multimedia). The study was conducted at Shiraz University of Medical Sciences (SUMS), and 100 women between 20 to 60 years old were allocated to each intervention group via multi-stage cluster sampling (n:110). Three valid and reliable researcher-made questioners were used. Data were analyzed using SPSS 24 with independent t-test, paired t-test, and ANOVA. RESULTS: Both video-based multimedia and face-to-face training methods significantly increased the participant's knowledge, attitude, and skills about breast self-examination (P < 0.001). In the sub-categories, the results showed that the face-to-face training improved negligence and forgetfulness in applying BSE (P = 0.03) and correcting or modifying the previous knowledge around the issue (P = 0.02). The effect of the video-based method on participants with university education was more than on non-university (P = 0.04). CONCLUSION: Incorporating video-based multimedia training in awareness of breast neoplasm and breast self-examination provides an easy, flexible, and affordable way for detection, particularly considering crisis restrictions. This can be of particular attention in more populated, developing/low-income countries and rural and remote areas to enhance equitable access to training and facilitation diagnosis and treatment if applicable.

Medical education and COVID-19 pandemic: a crisis management model towards an evolutionary pathway.

The COVID-19 crisis has had a profound effect on higher education, especially medical education due to its sensitive nature, dealing with people's life and wellbeing. This study presented a crisis management model of how to direct medical education during crises. A qualitative design was used via a focus group among 83 medical education administrators at Shiraz University of Medical Sciences. Four major challenges emerged regarding medical education during the COVID-19 pandemic including "The health and wellbeing of faculty members and students"; "Spatial constraints"; "Time constraints", and "Access to resources". A total of 13 strategies were suggested to tackle the challenges, including virtualization, technological support, empowerment, participation, sharing, helping, integration, compression, omission, flexibility and diversity, severance, protection; and monitoring. For a sustainable educational pathway in medical education, personalized approach to education via the incorporation of technology is essential. This provides opportunities to tackle the issues caused by the crisis, by provision of any time and anywhere approach to education via flexible technologies/platforms adjusted based on the audiences. The scope of crisis management expands not only on individual and academic levels but also on social and global relations.

The quality of reporting general safety parameters and immune-related adverse events in clinical trials of FDA-approved immune checkpoint inhibitors.

BACKGROUND: While immune-checkpoint inhibitors (ICIs) have transformed the field of oncology for advanced-stage cancers, they can lead to serious immune toxicities. Several systematic reviews have evaluated the risk of immune-related adverse events (irAEs); however, most have focused on published articles without evaluating trial registries. The objective of this methodological review was to compare the quality of reporting of safety information and in particular, serious irAEs (irSAEs), in both publications and ClinicalTrials.gov for all current FDA-approved ICIs. METHODS: PubMed was searched to retrieve all published phase III randomized controlled trials (RCTs) evaluating ICIs. For each eligible trial, we searched for corresponding registration on ClinicalTrials.gov and extracted relevant safety data from both the publication and results posted on registry. We then compared the quality of reporting and the value of safety data between both sources. RESULTS: Of 42 eligible published trials, 34 had results posted on ClinicalTrials.gov . Considerable variability was noted in the reporting of safety in both sources. SAEs were reported for all trial results in ClinicalTrials.gov compared to 23.5% of publications. An overall incidence for irAEs and irSAEs was reported in 58.8 and 8.8% of publications respectively, compared to 11.8 and 5.9% in registry results. Comparing the value of specific irSAEs was not possible between the two sources in 32/34 trials either due to different reporting formats (61.8%) or data not being reported in one or both sources (32.4%). From the 2 studies with compatible irSAE format, only 1 had matching data in both sources. CONCLUSIONS: The reporting of irAEs / irSAEs varies considerably in publications and registries, which outlines the importance of standardizing the terminologies and methodologies for reporting safety information relevant to ICIs.

ABCB1-C3435T polymorphism and breast cancer risk: a case-control study and a meta-analysis.

PURPOSE: To investigate the association of ABCB1-C3435T transition with breast cancer risk which was followed by a meta-analysis. METHODS: In a case-control study we collected blood samples from 290 women (including 150 breast cancer patients and 140 healthy controls). ABCB1-C3435T genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. A meta-analysis was performed for a total of 13 eligible studies involving 5,835 cases and 8,178 controls. RESULTS: The results of case-control study revealed a significant association between T allele (OR=1.770, 95%CI=1.236-2.535, p=0.002), CT genotype (OR=1.661, 95%CI=1.017-2.713, p=0.042), and TT genotype (OR=3.399, 95%CI=1.409-8.197, p=0.006) with breast cancer risk. Data from meta-analysis revealed a significant association between ABCB1-C3435T polymorphism and breast cancer risk in allelic (OR=1.243, 95%CI=1.079-1.432, p=0.003), co-dominant (OR=1.349, 95%CI=1.042-1.746, p=0.023), dominant (OR=1.204, 95%CI=1.019-1.422, p=0.029), and recessive (OR=1.226, 95%CI=1.011-1.488, p=0.039) models. CONCLUSIONS: The results suggest that the ABCB1-C3435T gene polymorphism might be a genetic risk factor and a potential biomarker for breast cancer.

Effect of mode of delivery on postpartum depression in Iranian women.

AIM: The aim of this study was to determine the relation between mode of delivery (cesarean section [CS] or unassisted vaginal delivery) and postpartum depression (PPD). MATERIAL AND METHODS: In a prospective study, 300 women who had experienced vaginal delivery (VD) or CS were recruited in Kashan, Iran. PPD was measured using the Edinburgh Postnatal Depression Scale (EPDS). A score of 13 or more was defined as PPD. Data collection was conducted at two assessment points: 2 months and 4 months postpartum. Mean scores of EPDS and PPD were compared between the VD and CS groups. RESULTS: Differences in mean scores of EPDS between CS (n = 150) and VD (n = 150) groups at the first and the second assessments were not significant. The depression mean scores differences from the first to the second assessment were compared between the two groups; VD group showed more decrease on EPDS score (P = 0.006). Comparing the two assessments, the VD group showed a more decreased EPDS from the first to the second one. PPD prevalence rates (score ≥ 13) among the VD and CS groups were 24% and 20.7% for the first and 14.7% and 16.7% for the second assessment, respectively, which were not significantly different. The logistic regression showed that an unwanted pregnancy and PPD 2 months after delivery were determinants for PPD 4 months after delivery. CONCLUSION: There was no relation between delivery mode and PPD at 2 and 4 months after delivery; however, the VD group showed greater decrease in EPDS score from 2 to 4 months after delivery.

Enhancing educational technology practical course: Designing and validating tools for evaluating knowledge, performance, and satisfaction of public health students.

Background: The present study was conducted with the aim of designing and validating questionnaires for evaluating the public health students' knowledge, performance, and satisfaction (KPS) in the course of educational technology. Methods: The present study was conducted with qualitative-quantitative approach. Qualitative stage was done based on experts' opinion and related articles and questionnaires for developing, designing, and validating the tools. For validating the tools, face validity and content validity was done based on the opinion of the 10 expert panel. In quantitative stage, all initial validated tools were implemented on 50 students of public health for determining the reliability. The reliability of the tools was calculated using the internal consistency method of the items with Cronbach's ⍺ coefficient, and Kuder-Richardson. All analyses were conducted using SPSS-19 software. Results: In the field of qualitative research, an assessment tool consisting of 20 four-option questions was designed. The content validity of this tool was confirmed based on the opinions of 10 educational experts, with CVI Total = 0.862 and CVR = 0.885. Additionally, the reliability of the tool was validated through testing on 50 public health students, resulting in a reliability coefficient of r = 0.780. Furthermore, for performance evaluation, four assessment tools each comprising 20 questions (totaling 80 questions) were designed. The validity values for these tools in the areas of PowerPoint (CVI = 0.981, CVR = 0.960), pamphlet (CVI = 0.866, CVR = 0.877), poster (CVI = 0.871, CVR = 0.906), role-playing (CVI = 0.871, CVR = 0.980), and the reliability of the tools with Cronbach's ⍺ r > 0.80 were confirmed. In the satisfaction assessment section, a researcher-made questionnaire consisting of 18 questions across seven domains was designed, with confirmed content validity (CVI = 0.949, CVR = 0.861) and reliability (r = 0.928). Conclusions: It seems that this tool can be used to measure the KPS of students from the educational technology course of the health field and similar fields.

Exploring the relationship between contextual factors and health-promoting lifestyle profile (HPLP) among medical students: A cross-sectional study.

Background and Aims: The present study was conducted with the aim of investigating the relationship between health-promoting lifestyle profile (HPLP) among medical students and contextual factors such as gender, age, field of study, academic level, marital status, history of physical and mental illnesses, and smoking. Methods: The present research was conducted in a cross-sectional method in 2021 on 500 students of Shiraz University of Medical Students. An e-questionnaire link was sent to them via email. The research tool was the HPLP questionnaire consisting of 52 questions in six domains in a 4-point Likert scale. Data were analyzed using SPSS software version 24 with one-sample t-test, independent t-test, analysis of variance, and Tukey's post hoc test. Results: A total of 500 students fully answered the questions completely. All components of a healthy lifestyle-except for exercise-obtained a score higher than the cut-off point. The component of Self-Actualization (spiritual growth) (3.035 ± 0.68) had the highest score, while the lowest score was related to exercise and physical activity (2.126 ± 0.60). Married individuals had a better average health score compared to singles (p = 0.047). The average health score did not have a significant relationship with gender, but significantly related to age, field of study (p < 0.001), history of mental illnesses (p < 0.001) and Smoking (p < 0.001). Conclusion: It seems that university officials should pay more attention to the health domain of students' lifestyles, such as nutrition, the development of exercise and physical activities, and the management of stress and mental health. Additionally, providing necessary awareness and considering training courses, as well as developing sports and recreational facilities, can be effective in creating a better environment for the growth and development of students and ensuring their well-being.

Dental students in an orthodontic course flipped classroom: A semi-experimental study on knowledge, practice, attitude, and satisfaction.

OBJECTIVE: The purpose of this study was to determine the students' attitudes before and after the flipped classroom, and the effectiveness of this method to promote the students' lateral cephalograms tracing abilities, students' satisfaction and their final exam scores. MATERIALS AND METHODS: This is a single-group quasi-experimental research conducted on dental students of Shiraz University of Medical Sciences (SUMS), Iran in 2019. The intervention was carried out in a blended learning approach with the flipped classroom model. Thirty-five fourth-year dental students participated in a flipped classroom held during a semester for the lateral cephalograms tracing course. The students were provided with the educational materials before the class time through multimedia learning tools and the class time was devoted to discussions. The students were asked to fill out four questionnaires (pretest/posttest attitudes, pretest/posttest self-assessments of theoretical knowledge and practical skills in cephalograms, posttest of satisfaction from quality of the course, and posttest of students' views about effectiveness of blended learning tools) and final exam scores of students. RESULTS: Students' attitudes toward e-Learning were improved after the flipped classroom and the quality of this method was acceptable to the students (p < .001). Their self-assessment of theoretical knowledge and practical skills were promoted (p < .001). While all blended learning tools averaged more than the cut-off-point, short lecture (5.11 ± 0.98) and live feedback (4.98 ± 1.07) were considered to be the most efficient interactive tools. CONCLUSION: It seems that the flipped classroom has a positive effect on increasing students' knowledge, attitude, and satisfaction. In general, this method of learning seems to be favored by dental students. CLINICAL SIGNIFICANCE: The findings showed that blended learning had a positive effect on increasing knowledge, performance, and satisfaction among dental students. Therefore, blended learning as a reliable method might be used in training dental students.

Integrated approaches for heavy metal-contaminated soil remediation: harnessing the potential of Paulownia elongata S. Y. Hu, Oscillatoria sp., arbuscular mycorrhizal fungi (Glomus mosseae and Glomus intraradices), and iron nanoparticles.

In recent years, researchers have extensively investigated the remediation of heavy metal-contaminated soil using plants, microorganisms, and iron nanoparticles. The objective of this study was to investigate and compare the individual and simultaneous effects of Paulownia elongata S. Y. Hu, cyanobacteria (Oscillatoria sp.), arbuscular mycorrhizal fungi (AMF) including Glomus mosseae and Glomus intraradices, and zero-valent iron nanoparticles (nZVI) on the remediation of heavy metal-contaminated soil containing chromium (Cr VI and Cr III) and nickel (Ni). The study found significant variations in parameters such as pH (acidity), electrical conductivity (EC), nitrogen (N), phosphorus (P), potassium (K), and organic carbon (OC) among different treatments. The addition of cyanobacteria, AMF, and nZVI influenced these properties, resulting in both increases and decreases compared to the control treatment. The treatment involving a combination of cyanobacteria, AMF, and nZVI (CCAN25) exhibited the highest increase in growth parameters, such as total dry mass, root length, stem diameter, and leaf area, while other treatments showed varied effects on plant growth. Moreover, the CCAN25 treatment demonstrated the highest increase in chlorophyll a, chlorophyll b, and carotenoid levels, whereas other treatments displayed reductions in these pigments compared to the control. Moderate phytoaccumulation of Cr and Ni in P. elongata samples across all treatments was observed, as indicated by the bioconcentration factor and bioaccumulation coefficient values being less than 1.0 for both metals. The findings provide insights into the potential application of these treatments for soil remediation and plant growth enhancement in contaminated environments.

COVID-19 Vaccine Effectiveness Studies against Symptomatic and Severe Outcomes during the Omicron Period in Four Countries in the Eastern Mediterranean Region.

Vaccine effectiveness (VE) studies provide real-world evidence to monitor vaccine performance and inform policy. The WHO Regional Office for the Eastern Mediterranean supported a regional study to assess the VE of COVID-19 vaccines against different clinical outcomes in four countries between June 2021 and August 2023. Health worker cohort studies were conducted in 2707 health workers in Egypt and Pakistan, of whom 171 experienced symptomatic laboratory-confirmed SARS-CoV-2 infection. Test-negative design case-control studies were conducted in Iran and Jordan in 4017 severe acute respiratory infection (SARI) patients (2347 controls and 1670 cases) during the Omicron variant dominant period. VE estimates were calculated for each study and pooled by study design for several vaccine types (BBIBP-CorV, AZD1222, BNT162b2, and mRNA-1273, among others). Among health workers, VE against symptomatic infection of a complete primary series could only be computed compared to partial vaccination, suggesting a benefit of providing an additional dose of mRNA vaccines (VE: 88.9%, 95%CI: 15.3-98.6%), while results were inconclusive for other vaccine products. Among SARI patients, VE against hospitalization of a complete primary series with any vaccine compared to non-vaccinated was 20.9% (95%CI: 4.5-34.5%). Effectiveness estimates for individual vaccines, booster doses, and secondary outcomes (intensive care unit admission and death) were inconclusive. Future VE studies will need to address challenges in both design and analysis when conducted late during a pandemic and will be able to utilize the strengthened capacities in countries.

ZnO nanoparticles efficiently enhance drought tolerance in Dracocephalum kotschyi through altering physiological, biochemical and elemental contents.

Using nanofertilizers in certain concentrations can be a novel method to alleviate drought stress effects in plants as a global climate problem. We aimed to determine the impacts of zinc nanoparticles (ZnO-N) and zinc sulfate (ZnSO4) fertilizers on the improvement of drought tolerance in Dracocephalum kotschyi as a medicinal-ornamental plant. Plants were treated with three doses of ZnO-N and ZnSO4 (0, 10, and 20 mg/l) under two levels of drought stress [50% and 100% field capacity (FC)]. Relative water content (RWC), electrolyte conductivity (EC), chlorophyll, sugar, proline, protein, superoxide dismutase (SOD), polyphenol oxidase (PPO) and, guaiacol peroxidase (GPO) were measured. Moreover, the concentration of some elements interacting with Zn was reported using the SEM-EDX method. Results indicated that foliar fertilization of D. kotschyi under drought stress with ZnO-N decreased EC, while ZnSO4 application was less effective. Moreover, sugar and proline content as well as activity of SOD and GPO (and to some extent PPO) in treated plants by 50% FC, increased under the influence of ZnO-N. ZnSO4 application could increase chlorophyll and protein content and PPO activity in this plant under drought stress. Based on the results, ZnO-N and then ZnSO4 improved the drought tolerance of D. kotschyi through their positive effects on physiological and biochemical attributes changing the concentration of Zn, P, Cu, and Fe. Accordingly, due to the increased sugar and proline content and also antioxidant enzyme activity (SOD, GPO, and to some extent PPO) on enhancing drought tolerance in this plant, ZnO-N fertilization is advisable.

Surviving surgery; succumbing to pharmacotherapy: A case report underscoring the importance of PRN order clarification for patient safety.

"Pro re nata" (PRN) or "as needed" medicine administration and usage is a relatively neglected area in medication management (pharmacotherapy/pharmaceutical care) which contributes to error-prone use of medications and is unsafe for patients. In this case, we report the incident of diclofenac toxicity in a 51-year-old woman due to a prescription of 100 mg diclofenac suppositories PRN, or as needed, for postoperative pain control without explanation of the maximum daily dose (150 mg daily), which led to arbitrary consumption of 3 g of diclofenac over 5 days (600 mg daily) by the patient, and subsequent development of metabolic acidosis, acute kidney injury, and sudden cardiac arrest. The implementation of practical guidelines and training programs for health care workers to appropriately prescribe, dispense, and administer PRN medicines are necessary, and should at least include providing clarification for their indication, dose and frequency, as well as any cautionary instructions to ensure safe and effective use of such medicines.