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Background During the Covid-19 pandemic, a number of hotlines/helplines/call centers was implemented to provide remote services and support public health. The objective of this study was to investigate the characteristics, challenges and lessons learned of implementing Covid-19 hotlines/helplines/call centers during the pandemic. Methods PubMed, Web of Science, Scopus, the Cochrane Library, IEEE Xplore, and ProQuest databases as well as Google Scholar were searched between 1st January 2020 and 31st December 2023 to retrieve relevant articles published in English. The quality and risk of bias of the studies were assessed using the Appraisal tool for Cross-Sectional Studies (AXIS), the Mixed Methods Appraisal Tool (MMAT), and Critical Appraisal Skills Programme (CASP) Checklist. Results In total, 43 out of 1440 articles were included in this study. About half of the hotlines/helplines/call centers were launched in March 2020 ( n  = 19). Providing psychological support ( n  = 23), reliable information about Covid-19 ( n  = 10), healthcare advices about Covid-19 ( n  = 8), and triage ( n  = 7) were the most common purposes of implementing these services. The most common challenges included a lack of physical examination, unavailability of hotlines/helplines/call centers at the point of need, and delay in updating Covid-19 information. The most common lessons learned were employing qualified staff, providing proper training, and getting feedback from the callers and operators. Conclusion According to the results, most of the Covid-19 hotlines/helplines/call centers were launched in the early months of the pandemic, and about half of them were active seven days a week. Most of the operators were mental health providers and clinicians. The findings show the importance of continuous psychological support during crises, particularly when adequate information about the situation is not available. The challenges experienced by the callers and operators as well as the lessons learned by the service providers also need to be considered for future crises to increase the effectiveness of similar services.

The management of metastatic cancer is complicated by chemotherapy resistance. This manuscript provides a comprehensive academic review of strategies to overcome chemotherapy resistance in metastatic cancer. The manuscript presents background information on chemotherapy resistance in metastatic cancer cells, highlighting its clinical significance and the current challenges associated with using chemotherapy to treat metastatic cancer. The manuscript delves into the molecular mechanisms underlying chemotherapy resistance in subsequent sections. It discusses the genetic alterations, mutations, and epigenetic modifications that contribute to the development of resistance. Additionally, the role of altered drug metabolism and efflux mechanisms, as well as the activation of survival pathways and evasion of cell death, are explored in detail. The strategies to overcome chemotherapy resistance are thoroughly examined, covering various approaches that have shown promise. These include combination therapy approaches, targeted therapies, immunotherapeutic strategies, and the repurposing of existing drugs. Each strategy is discussed in terms of its rationale and potential effectiveness. Strategies for early detection and monitoring of chemotherapy drug resistance, rational drug design vis-a-vis personalized medicine approaches, the role of predictive biomarkers in guiding treatment decisions, and the importance of lifestyle modifications and supportive therapies in improving treatment outcomes are discussed. Lastly, the manuscript outlines the clinical implications of the discussed strategies. It provides insights into ongoing clinical trials and emerging therapies that address chemotherapy resistance in metastatic cancer cells. The manuscript also explores the challenges and opportunities in translating laboratory findings into clinical practice and identifies potential future directions and novel therapeutic avenues. This comprehensive review provides a detailed analysis of strategies to overcome chemotherapy resistance in metastatic cancer. It emphasizes the importance of understanding the molecular mechanisms underlying resistance and presents a range of approaches for addressing this critical issue in treating metastatic cancer.

Generative AI has rapidly entered college writing classrooms, raising practical questions about how student texts are changing and what that means for instruction. This study analyzes 255 final-draft analytical essays written in first-year writing classes across three instructional contexts—pre-Gen-AI (Winter/Spring 2022), AI-prohibited, and AI-permitted with specified uses (Winter/Spring 2024). We combined holistic quality ratings of essays with Coh-Metrix indices of writing volume, lexicality, referential cohesion, and syntax. Analytically, we estimated a regression of essay quality on class type and demographics, and MANCOVAs (with essay score and demographics as covariates) for the four linguistic constructs. Essay quality did not differ by AI policy. However, compared to 2022, essays of AI-permitted classes were organized into fewer but shorter paragraphs; displayed greater lexical diversity and used less frequent, less familiar vocabulary; showed lower local and global anaphor overlap (other cohesion indices were stable); and exhibited lower verb-phrase, passive, and negation densities but higher gerund density. We interpret these as selective redistributions of linguistic resources rather than uniform gains or losses. For instructors, the actionable implication is two-fold: leverage AI-era gains in lexical precision while explicitly teaching referential continuity and clause-level strategies that sustain argumentative coherence.

Schizophrenia is a severe chronic neuropsychiatric disorder with a wide-range of cognitive and mental deficits and different categories of symptoms including positive, negative, and cognitive symptoms. In rodents, sub-chronic ketamine administration is a common method to induce a schizophrenia-like state. Olanzapine, an atypical antipsychotic medication, is used for the treatment and management of schizophrenia symptoms. Here, we aimed to assess the effects of ketamine, olanzapine, and their combination on cognitive and behavioral functions, as well as on brain-derived neurotrophic factor (BDNF) expression in the prefrontal cortex of male and female rats. Ketamine hydrochloride (30 mg/kg, i.p.) was administered for 5 consecutive days to induce schizophrenia-like alterations, and olanzapine (6 mg/kg, i.p.) was administered immediately after the final ketamine dose. Behavioral tests for locomotion, anxiety-like behavior, nociception, compulsive-like behavior, depression-like behavior, and memory were conducted, and BDNF mRNA levels in the prefrontal cortex were measured by quantitative real-time PCR. The results showed that ketamine increased locomotor activity and climbing behavior, decreased rearing (exploration), impaired novel object recognition memory, and lowered BDNF levels in the prefrontal cortex in both sexes. Certain effects of ketamine were sex-specific: ketamine reduced pain threshold (indicating hyperalgesia) and decreased immobility in the forced swim test (suggesting an anti-depressant-like effect) only in females. Olanzapine co-treatment restored locomotor activity and climbing and attenuated memory impairment in both sexes. Olanzapine also increased rearing and normalized pain threshold and immobility in females, indicating a mitigation of ketamine’s female-specific effects. Olanzapine had no significant effect on BDNF levels. In conclusion, ketamine induced a schizophrenia-like phenotype with more pronounced effects in female rats, and olanzapine treatment reversed many of the ketamine-induced behavioral deficits in both sexes. Notably, the therapeutic actions of olanzapine in this model appear to be independent of BDNF upregulation in the prefrontal cortex.

Over the past years, the benefits of stem cell therapy approach for treatment of the cardiovascular diseases have been shown through the rebuilding of new cardiomyocytes and blood vessels. while a successful regeneration of the myocardium has been proven on the animal models of acute myocardial injuries resulted from the stem cells transplantation, no significant long-term regenerative with autologous stem cell therapy in patients with acute myocardial infarction have been reported based on recent meta-analyses. It seems that the inflammatory microenvironment of acute myocardial infarction has an inhibitory effect on the stem cells potential for regenerating the injured myocardium. Secretion of critical cytokines with pro-inflammatory properties including tumor necrosis factor-α, interleukin-1β, and interleukin-6 as well as induction of hypoxic condition and finally formation of cytotoxic elements cause the cellular death and hinder the stem cells proliferation and differentiation. Based on the evidence, application of some approaches like co-delivery of mesenchymal stem cells with the other useful cells, using the stem cells derived productions, administration of preconditioned and modified cells, and also using the anti-inflammatory agents besides the cell therapy are hypothesized as the primary developed safe and practical approaches for decreasing destructive effects of the inflammation on the implanted stem/progenitor cells. In this review, we critically discuss the quiddity of the inflammatory microenvironment and its promoted mechanisms as the main elements to hinder the efficacy of stem cell therapy in the cases of acute myocardial infarction. Also, we finally propose some applied solutions to the problem of cardiac regeneration with stem cells therapy.Over the past years, the benefits of stem cell therapy approach for treatment of the cardiovascular diseases have been shown through the rebuilding of new cardiomyocytes and blood vessels. while a successful regeneration of the myocardium has been proven on the animal models of acute myocardial injuries resulted from the stem cells transplantation, no significant long-term regenerative with autologous stem cell therapy in patients with acute myocardial infarction have been reported based on recent meta-analyses. It seems that the inflammatory microenvironment of acute myocardial infarction has an inhibitory effect on the stem cells potential for regenerating the injured myocardium. Secretion of critical cytokines with pro-inflammatory properties including tumor necrosis factor-α, interleukin-1β, and interleukin-6 as well as induction of hypoxic condition and finally formation of cytotoxic elements cause the cellular death and hinder the stem cells proliferation and differentiation. Based on the evidence, application of some approaches like co-delivery of mesenchymal stem cells with the other useful cells, using the stem cells derived productions, administration of preconditioned and modified cells, and also using the anti-inflammatory agents besides the cell therapy are hypothesized as the primary developed safe and practical approaches for decreasing destructive effects of the inflammation on the implanted stem/progenitor cells. In this review, we critically discuss the quiddity of the inflammatory microenvironment and its promoted mechanisms as the main elements to hinder the efficacy of stem cell therapy in the cases of acute myocardial infarction. Also, we finally propose some applied solutions to the problem of cardiac regeneration with stem cells therapy.

Background Recently, an increase in the older adult population, their chronic diseases, and functional disabilities have led to an increase in the need for more healthcare services. Telecare is one of the solutions for caring these people and can improve their quality of life. Aim The objective of this study was to investigate impact of telecare interventions on quality of life in older adults. Methods This was a systematic review conducted in 2021. PubMed, Web of Science, Scopus, the Cochrane Library, Embase, IEEE Xplore, and ProQuest databases as well as Google Scholar were searched until the end of 2020 to retrieve relevant articles published in English. The quality of the studies was assessed using the National Institutes of Health (NIH) quality assessment checklists and the mixed-methods appraisal tool (MMAT). The risk of bias in the studies was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) and the risk of bias in non-randomized studies—of interventions (ROBINS-I). Results In total, ten out of 1245 articles identified in the initial search, were included in this study. Telemonitoring ( n  = 7) and telerehabilitation ( n  = 3) were the most common methods of telecare interventions. Overall, the findings showed that in most studies, different dimensions of quality of life were improved after using these interventions ( p  < 0.05). Conclusion Evaluating impact of telecare interventions on quality of life, especially in older adults can help system developers to improve current and future telecare technologies to meet users’ requirements. Future studies can focus on evaluating the impact of specific telecare systems for a particular target group using different research methodologies.

Fostering equity in undergraduate science, technology, engineering, and mathematics (STEM) programs can be accomplished by incorporating learner-centered pedagogies, resulting in the closing of opportunity gaps (defined here as the difference in grades earned by minoritized and non-minoritized students). We assessed STEM courses that exhibit small and large opportunity gaps at a minority-serving, research-intensive university, and evaluated the degree to which their syllabi are learner-centered, according to a previously validated rubric. We specifically chose syllabi as they are often the first interaction students have with a course, establish expectations for course policies and practices, and serve as a proxy for the course environment. We found STEM courses with more learner-centered syllabi had smaller opportunity gaps. The syllabus rubric factor that most correlated with smaller gaps was Power and Control , which reflects Student’s Role, Outside Resources, and Syllabus Focus. This work highlights the importance of course syllabi as a tool for instructors to create more inclusive classroom environments.

Today, despite the advantages of the PACS system, its implementation in some healthcare organizations faces many challenges. One of the important factors in the successful implementation of a PACS system is identifying and prioritizing the challenges from the perspectives of involved staff and user of this system. Therefore, the aim of this study was to determine and compare the challenges of implementing PACS from perspectives these users in educational hospitals. This study was conducted on all IT and medical equipment staff, and radiology residents (n = 140) in Kerman University of Medical Sciences (KUMS) and Shiraz University of Medical Sciences (SUMS) in 2016. The data were collected through two researcher-made questionnaires. Their validity was approved by radiologists, IT staff, and medical informatics specialists and their reliability through calculation of Cronbach’s Alpha (0.969 and 0.795). We used Multivariate Analysis of Variance (MANOVA) to compare the scores given by three groups of participants in the challenges and Univariate Analysis of Variance (ANOVA) to compare the scores in two universities. The participants believed that technical challenges were more important than other challenges (x̄=3.74, SD = 0.7). IT experts (x̄=3.87, SD = 1) and radiology residents (x̄=3.95, SD = 0.9) gave the higher scores to the “shortage of high quality monitors” factor and medical equipment experts (x̄=4.26, SD = 0.87) to the “low speed of communication networks” factor among all technical challenges. The mean scores given to technical (x̄=76.1, SD = 13.5) and managerial (x̄=16, SD = 5.9) challenges in SUMS were more than the scores of the same challenges in KUMS (x̄=69.9, SD = 15.7) and (x̄=11.9, SD = 6.4) (p < 0.05). The technical challenges are the most common challenges to PACS implementation, and different universities experience different levels of technical challenges. Eliminating implementation challenges can reduce the risk of failure in the utilization process. Based on the results of this study, providing necessary infrastructures such as appropriate monitors and upgraded IT equipment can prevent many of the PACS implementation challenges.

Background Investigating experiences of staff and callers of call centers/hotlines during the Covid-19 pandemic is essential to identify perceived strengths, challenges, and opportunities for improving service delivery. This study aimed to explore experiences and perspectives of staff and callers of the 4030 call center during the Covid-19 pandemic. Methods This was a qualitative study in which data were collected via conducting semi-structured interviews with the call center’s staff ( n  = 5), consultants ( n  = 24), and callers ( n  = 35). The data were analyzed using the framework analysis approach. Result The results included four main themes emerged from interviewing the staff and consultants of the call center: the rationale behind establishing the 4030 call center, its operational processes, strengths, and challenges. Interviews with the callers included three key main themes: reasons for contacting the call center, its strengths, and challenges. Conclusion During the Covid-19 pandemic, the 4030 call Center played an important role in reducing the burden of in-person visits to healthcare centers as well as providing psychological support to the public. Despite advantages such as preventing disease spread and alleviating public concerns, challenges including the large number of calls, long waiting times, and limitations of telephone counseling were reported. Therefore, healthcare policymakers need to pay more attention to the strengths and challenges of the call centers during health crises to improve service delivery and use past experiences for future planning.

We propose a concept system termed distributed base station (DBS) which enables distributed transmit beamforming at large carrier wavelengths to achieve significant range extension and/or increased downlink data rate, providing a low-cost infrastructure for applications such as rural broadband. We consider a frequency division duplexed (FDD) system using feedback from the receiver to achieve the required phase coherence. At a given range, N cooperating transmitters can achieve N2-fold increase in received power compared to that for a single transmitters, and feedback-based algorithms with near-ideal performance have been prototyped. In this paper, however, we identify and address key technical issues in translating such power gains into range extension via a DBS. First, to combat the drop in per-node SNR with extended range, we design a feedback-based adaptation strategy that is suitably robust to noise. Second, to utilize available system bandwidth, we extend narrowband adaptation algorithms to wideband channels through interpolation over OFDM subcarriers. Third, we observe that the feedback channel may become a bottleneck unless sophisticated distributed reception strategies are employed, but show that acceptable performance can still be obtained with standard uplink reception if channel time variations are slow enough. We quantify system performance compactly via outage capacity analyses.