Purpose: Although the etiology of Legg–Calvé–Perthes disease (LCPD) is not well understood, based on a new theory, it may be caused by a decrease in the supply of blood to the femoral head. The objective of this study was to examine the effects of a decrease in bone mineral density (BMD) and an increase in thickness of articular cartilage on the supply of blood to the femoral head in this group of patients. Materials and Methods: This case study was based on a simulation analysis. Computed tomography scan images of a subject with Perthes disease were used to create a three-dimensional model of the hip joint on both the normal and Perthes sides. In addition, modeling of the blood vessels of the femoral head, including the foveolar and retinacular arteries, was performed during this study. Results: Increased stress on all articular components (femoral head, acetabulum, articular cartilage, and blood vessels) was observed on the Perthes side compared to the normal side. On the Perthes side with normal articular cartilage thickness, stress on all components, particularly the femur, showed a significant increase compared to the normal side. Conclusion Increased deformation of the femoral head vessels was observed in patients with Perthes condition and when increased thickness of the articular cartilage was observed. A decrease in BMD can evidently increase the stress applied to the arteries of the femoral head, ultimately leading to death of the femoral head.

Purpose: Although the etiology of Legg–Calvé–Perthes disease (LCPD) is not well understood, based on a new theory, it may be caused by a decrease in the supply of blood to the femoral head. The objective of this study was to examine the effects of a decrease in bone mineral density (BMD) and an increase in thickness of articular cartilage on the supply of blood to the femoral head in this group of patients. Materials and Methods: This case study was based on a simulation analysis. Computed tomography scan images of a subject with Perthes disease were used to create a three-dimensional model of the hip joint on both the normal and Perthes sides. In addition, modeling of the blood vessels of the femoral head, including the foveolar and retinacular arteries, was performed during this study. Results: Increased stress on all articular components (femoral head, acetabulum, articular cartilage, and blood vessels) was observed on the Perthes side compared to the normal side. On the Perthes side with normal articular cartilage thickness, stress on all components, particularly the femur, showed a significant increase compared to the normal side. Conclusion Increased deformation of the femoral head vessels was observed in patients with Perthes condition and when increased thickness of the articular cartilage was observed. A decrease in BMD can evidently increase the stress applied to the arteries of the femoral head, ultimately leading to death of the femoral head.

Purpose: Although the etiology of Legg–Calvé–Perthes disease (LCPD) is not well understood, based on a new theory, it may be caused by a decrease in the supply of blood to the femoral head. The objective of this study was to examine the effects of a decrease in bone mineral density (BMD) and an increase in thickness of articular cartilage on the supply of blood to the femoral head in this group of patients. Materials and Methods: This case study was based on a simulation analysis. Computed tomography scan images of a subject with Perthes disease were used to create a three-dimensional model of the hip joint on both the normal and Perthes sides. In addition, modeling of the blood vessels of the femoral head, including the foveolar and retinacular arteries, was performed during this study. Results: Increased stress on all articular components (femoral head, acetabulum, articular cartilage, and blood vessels) was observed on the Perthes side compared to the normal side. On the Perthes side with normal articular cartilage thickness, stress on all components, particularly the femur, showed a significant increase compared to the normal side. Conclusion Increased deformation of the femoral head vessels was observed in patients with Perthes condition and when increased thickness of the articular cartilage was observed. A decrease in BMD can evidently increase the stress applied to the arteries of the femoral head, ultimately leading to death of the femoral head.

AIM: To compare the anterior and posterior corneal astigmatism and total refractive astigmatism before and after MyoRing implantation in keratoconus(KCN)patients.METHODS: In this historical cohort study, the preoperative and postoperative total refractive, anterior and posterior corneal astigmatism of KCN patients implanted with a 360-degree full-ring implant(MyoRing)were compared before and after four consecutive follow-up sessions at 3, 6, 9, and 12 mo after surgery.RESULTS: The study encompassed 79 KCN patients(85 eyes), comprising 43 males and 36 females. The mean age of the patients was 29±7.41 years, ranging from 17 to 48 years. Throughout the follow-up sessions, a gradual decrease was observed in the trend of changes for total refractive astigmatism, anterior corneal astigmatism, and posterior corneal astigmatism. Postoperatively, total refractive astigmatism measurements exhibited a significant decrease of 2.09 D at 12 mo after MyoRing implantation(4.27±3.15 vs 2.18±1.63 D, P<0.001). Additionally, post-operative measurements revealed an enhancement of approximately 3.20 D and 0.59 D for anterior and posterior corneal astigmatism, respectively [6.40±1.90 vs 3.20±1.75 D for anterior corneal astigmatism(P<0.001)and 1.30±0.55 vs 0.71±0.35 D for posterior corneal astigmatism(P<0.001)].CONCLUSION: MyoRing implantation demonstrates significant improvements in astigmatism parameters, encompassing total refractive astigmatism as well as anterior and posterior corneal astigmatism.

PURPOSE: Boarding is a common problem in the emergency department (ED) and is associated with poor health care and outcome. Imam Khomeini Hospital is the main healthcare center in Urmia, a metropolis in the northwest of Iran. Due to the overcrowding and high patient load, we aim to characterize the rate, cause and consequence of boarding in the ED of this center. METHODS: All medical records of patients who presented to the ED of Imam Khomeini Hospital from August 1, 2017 to August 1, 2018 were retrospectively analyzed. Patients with uncompleted records were excluded. Boarding was defined as the inability to transfer the admitted ED patients to a downstream ward in ≥2 h after the admission order. Demographic data, boarding rate, mortality and triage levels (1-5) assessed by emergency severity index were collected and analyzed. The first present time of patients was classified into 4 ranges as 0:00-5:59, 6:00-11:59, 12:00-17:59 and 18:00-23:59. Descriptive, parametric and non-parametric statistical tests were performed and the risk of boarding was determined by Pearson Chi-square test. RESULTS: Demographic data analysis showed that 941 (58.5%) male and 667 (41.5%) female, altogether 1608 patients were included in this study. Five patients (0.3%) died. The distribution of patients with the triage levels 1-5 was respectively 79 (4.9%), 1150 (71.5%), 374 (23.3%), 4 (0.2%) and 0 (0%). Most patients were of level 2. Only 75 (4.7%) patients required intensive care. The majority of patients (84.2%) were presented at weekdays. The maximum patient load was observed between 12:00-17:59. Of the 1608 patients, 340 (21.1%) experienced boarding within a mean admission time of 13.70 h. Among the 340-boarded patients, 20.1% belonged to surgery, 12.1% to orthopedics, 10.9% to neurosurgery and 10.3% to neurology. The boarding rate was higher in females, patients requiring intensive care and those with low triage levels. Compared with the non-boarded, the boarded patients had a higher mean age. CONCLUSION The boarding rate is higher in the older and female patients. Moreover, boarding is dependent on the downstream ward sections: patients requiring surgical management experience the maximum boarding rate.
Age Factors ; Chi-Square Distribution ; Cross-Sectional Studies ; Crowding ; Emergency Service, Hospital ; Female ; Hospital Mortality ; Hospitalization/statistics & numerical data* ; Humans ; Iran ; Length of Stay ; Male ; Patient Admission ; Retrospective Studies ; Risk Assessment/methods* ; Risk Factors ; Sex Factors ; Time Factors ; Triage

Students’ engagement in academic-related learning activities is one of the important determinants of students’ success. Identifying the best teaching strategies to sustain and promote nursing students’ engagement in academic and clinical settings has always been a challenge for nurse educators. Hence, it is essential to provide a set of strategies for maintaining and enhancing the academic engagement of nursing students. The purpose of this review was to explore and summarize the strategies that nurse educators use to sustain and promote nursing students’ engagement in academic and clinical settings. A narrative literature review was conducted. CINAHL (nursing content), ProQuest, Medline, the Cochrane, Google Scholar, and Scopus were searched. Of 1,185 retrieved articles, 32 teaching strategies were identified and extracted from the nursing literature. We used thematic analysis approach to organize these strategies into five main categories as follows: technology-based strategies (15 articles), collaborative strategies (10 articles), simulation-based strategies (two articles), research-based strategies (two articles), and miscellanea learning strategies (three articles). As a general comment, these strategies have the potential to promote nursing students’ engagement. Among the strategies discussed in this review, the use of technology, particularly the response system and online learning, was more common among nursing educators, which is in line with today’s advances in smart technologies. The collection presented in this review can be used as a starting point for future research to evaluate the effectiveness of an educational intervention on the academic engagement of nursing students. Nevertheless, due to the lack of experimental studies, the optimal strategies remain to be elucidated through future high-quality experimental study.

OBJECTIVES: In recent decades, due to the high prevalence of divorce in numerous countries and the detrimental aftermath thereof, it has become increasingly important to study the components of marital stability. The current study explored fundamental protective factors in long-term marriage through a systematic review. METHODS: Searches for relevant publications were conducted in Embase, Web of Science, PubMed, Scopus, Science Direct, Magiran, and Scientific Information Database from their inception through January 30, 2019. Through the keyword search, 1,706 articles were found, of which 25 articles remained after screening based on the eligibility criteria. RESULTS: The extracted protective factors associated with marital stability in long-term marriage were classified as interpersonal and intrapersonal. Notable extracted factors included spirituality and religion, commitment, sexual relationship, communication, children, love and attachment, intimacy, and conflict resolution approach. These findings show that some aspects of relationships, such as commitment, act to preserve the pillars of marriage in critical situations, while other aspects, such as intimacy, help to construct marital identity and satisfaction. CONCLUSIONS: The identified components of marital stability are structures that enhance a couple’s identity and sense of togetherness. Identifying the specific aspects of marital relationships that contribute to marital stability may help specialists and researchers to target specific types of marital interaction that may enhance the happiness and longevity of relationships, thereby preventing avoidable divorces.
Child ; Divorce ; Happiness ; Humans ; Longevity ; Love ; Marriage ; Mass Screening ; Negotiating ; Prevalence ; Protective Factors ; Specialization ; Spirituality

OBJECTIVES: In recent decades, due to the high prevalence of divorce in numerous countries and the detrimental aftermath thereof, it has become increasingly important to study the components of marital stability. The current study explored fundamental protective factors in long-term marriage through a systematic review.METHODS: Searches for relevant publications were conducted in Embase, Web of Science, PubMed, Scopus, Science Direct, Magiran, and Scientific Information Database from their inception through January 30, 2019. Through the keyword search, 1,706 articles were found, of which 25 articles remained after screening based on the eligibility criteria.RESULTS: The extracted protective factors associated with marital stability in long-term marriage were classified as interpersonal and intrapersonal. Notable extracted factors included spirituality and religion, commitment, sexual relationship, communication, children, love and attachment, intimacy, and conflict resolution approach. These findings show that some aspects of relationships, such as commitment, act to preserve the pillars of marriage in critical situations, while other aspects, such as intimacy, help to construct marital identity and satisfaction.CONCLUSIONS: The identified components of marital stability are structures that enhance a couple's identity and sense of togetherness. Identifying the specific aspects of marital relationships that contribute to marital stability may help specialists and researchers to target specific types of marital interaction that may enhance the happiness and longevity of relationships, thereby preventing avoidable divorces.
Child ; Divorce ; Happiness ; Humans ; Longevity ; Love ; Marriage ; Mass Screening ; Negotiating ; Prevalence ; Protective Factors ; Specialization ; Spirituality

OBJECTIVES: In recent decades, due to the high prevalence of divorce in numerous countries and the detrimental aftermath thereof, it has become increasingly important to study the components of marital stability. The current study explored fundamental protective factors in long-term marriage through a systematic review. METHODS: Searches for relevant publications were conducted in Embase, Web of Science, PubMed, Scopus, Science Direct, Magiran, and Scientific Information Database from their inception through January 30, 2019. Through the keyword search, 1,706 articles were found, of which 25 articles remained after screening based on the eligibility criteria. RESULTS: The extracted protective factors associated with marital stability in long-term marriage were classified as interpersonal and intrapersonal. Notable extracted factors included spirituality and religion, commitment, sexual relationship, communication, children, love and attachment, intimacy, and conflict resolution approach. These findings show that some aspects of relationships, such as commitment, act to preserve the pillars of marriage in critical situations, while other aspects, such as intimacy, help to construct marital identity and satisfaction. CONCLUSIONS The identified components of marital stability are structures that enhance a couple's identity and sense of togetherness. Identifying the specific aspects of marital relationships that contribute to marital stability may help specialists and researchers to target specific types of marital interaction that may enhance the happiness and longevity of relationships, thereby preventing avoidable divorces.

PURPOSEThere are some studies which showed neurofeedback therapy (NFT) can be effective in clients with traumatic brain injury (TBI) history. However, randomized controlled clinical trials are still needed for evaluation of this treatment as a standard option. This preliminary study was aimed to evaluate the effect of NFT on continuous attention (CA) and short-term memory (STM) of clients with moderate TBI using a randomized controlled clinical trial (RCT).

METHODSIn this preliminary RCT, seventeen eligible patients with moderate TBI were randomly allocated in two intervention and control groups. All the patients were evaluated for CA and STM using the visual continuous attention test and Wechsler memory scale-4th edition (WMS-IV) test, respectively, both at the time of inclusion to the project and four weeks later. The intervention group participated in 20 sessions of NFT through the first four weeks. Conversely, the control group participated in the same NF sessions from the fifth week to eighth week of the project.

RESULTSEight subjects in the intervention group and five subjects in the control group completed the study. The mean and standard deviation of participants' age were (26.75 ± 15.16) years and (27.60 ± 8.17) years in experiment and control groups, respectively. All of the subjects were male. No significant improvement was observed in any variables of the visual continuous attention test and WMS-IV test between two groups (p ≥ 0.05).

CONCLUSIONBased on our literature review, it seems that our study is the only study performed on the effect of NFT on TBI patients with control group. NFT has no effect on CA and STM in patients with moderate TBI. More RCTs with large sample sizes, more sessions of treatment, longer time of follow-up and different protocols are recommended.