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The mother is traditionally the primary caregiver for the child, and uncertainty is a major source of psychological distress for parents of sick children. As a result, the current study sought to investigate the impact of an educational program on illness uncertainty in mothers of children with insulin-dependent diabetes mellitus (IDDM). This is a quasi-experimental study with a pretest-posttest design, involving 40 mothers of children with IDDM. After visiting the research site and recruiting eligible mothers, the researcher used the purposive sampling method to randomly assign them to one of two intervention and control groups. Taking into account their needs and conditions, mothers were scheduled for at least three sessions, with a 30-minute interval every other day. The data analysis revealed no significant differences between the two groups in terms of child age and gender, mother age and education level, number of children, and duration of diabetes. There was a significant difference in the total score of uncertainty, total score of ambiguity, lack of clarity, lack of information, unpredictability, and their dimensions between mothers of diabetic children before and after the intervention (P=0.02). Based on the findings, it is recommended that the educational needs of children and their mothers be assessed upon admission and that educational content be prepared and taught accordingly, thereby helping to reduce illness uncertainty in mothers. [ABSTRACT FROM AUTHOR]

Background High-grade gliomas (HGGs) are the most prevalent primary malignancy of the central nervous system. The tumor results in vasogenic and infiltrative edema. Exact anatomical differentiation of these edemas is so important for surgical planning. Multimodal imaging could be used to differentiate the edema type. Purpose The aim of this study was to investigate the role of multimodal imaging in the differentiation of vasogenic edema from infiltrative edema in patients with HGG (grade III and grade IV). Data Sources A search on PubMed, EMBASE, Scopus, and ISI Web of Science Core Collection up to June 2022 using terms related to (a) multimodal imaging AND (b) HGG AND (c) edema. (PROSPERO registration number: CRD42022336131) Study Selection Two reviewers screened the articles and independently extracted the data. We included original articles assessing the role of multimodal imaging in differentiating vasogenic from infiltrative edema in patients with HGG. Six high-quality articles remained for the narrative synthesis. Data Synthesis Dynamic susceptibility contrast imaging showed that relative cerebral blood volume and relative cerebral blood flow were higher in the infiltrative edema component than in the vasogenic edema component. Diffusion tensor imaging revealed a dispute on fractional anisotropy. The apparent diffusion coefficient was comparable between the two edematous components. Magnetic resonance spectroscopy exhibited an increment in choline/creatinine ratio and choline/N-acetyl aspartate ratio in the infiltrative edema component. Limitations Strict study selection, low sample size of relevant published studies, and heterogeneity in endpoint variables were the major drawbacks. Conclusions Multimodal imaging, including dynamic susceptibility contrast and magnetic resonance spectroscopy, might help differentiate between vasogenic and infiltrative edema. [ABSTRACT FROM AUTHOR]

Smart tourism destinations can be considered as a system consisting of a complex set of variables. Developing sustainable destinations through smart technologies requires effective policies to be identified prior to any investment decision making. So, System Dynamics is a good method to see how a set of complex and dynamic variables influence eachother and shape the behaviour of the system and its components over time. In this research a dynamic model is devised to simulate developing smart tourism destinations via smart technologies. The results suggest that about 10 million tourists would be expected to come by 2025 if existing situation persists. The results of this study help to make strategic decisions by policymakers by predicting the behaviour of variables of different subsystems. This study provides a reilable tool to evaluate different policies for realizing tourism sustainability. [ABSTRACT FROM AUTHOR]

Objective: Saffron is a spice derived from the Crocus sativus L. with antioxidant, anti-inflammatory, and neuroprotective effects. This study aims to systematically review the systematic reviews (SRs) investigating the clinical neuropsychotropic effects of saffron. Materials and Methods: The protocol of this SR was registered in PROSPERO (CRD42021268446). Scopus, ISI Web of Science, Embase, MEDLINE, PubMed, CINAHL, Cochrane Library, Google Scholar, and PROSPERO were searched up to June 6, 2021, to find SRs investigating the neuropsychotropic effects of saffron. The primary outcome was a report on whether or not saffron was effective in each study. AMSTAR was checked for the included reviews. Results: Twenty-three studies were reviewed with a mean AMSTAR score of 6.08 (ranging from 1 to 10). Thirteen SRs investigated the effects of saffron on depression. Six of the SRs studied its impact on sexual dysfunction. Each of the anxiety and cognitive disorders was discussed in three distinct reviews. Furthermore, possible effects of saffron on some other disorders, like premenstrual syndrome, postpartum depression, sleep disorders, and snacking behavior, have been reported. Conclusion: Saffron is beneficial, safe, and tolerable in treating the mentioned neurological and psychiatric disorders. Further high-quality, large-scale studies are recommended to rectify the shortcomings. [ABSTRACT FROM AUTHOR]

The urgent need for appropriate treatment for suicide, the tenth leading cause of death, has led to numerous studies. This study aims to systematically identify and appraise systematic reviews with or without meta‐analyses investigating ketamine in suicidal ideation and behaviours. Scopus, ISI, Embase, PubMed, CINAHL, PsycINFO, Cochrane Library, Google Scholar and two registries were searched without any restrictions for systematic reviews investigating the efficacy of ketamine on suicidal ideation and behaviours. The primary outcome was the final inference of ketamine effectiveness. A formal narrative synthesis was conducted, and the AMSTAR‐2 tool was used to evaluate the quality of the studies. Of 27 studies that addressed ketamine for suicidal ideation, only four reported mixed or negative results, and out of nine reviews, esketamine was significantly beneficial only in five. A transient rise in pulse rate and blood pressure, dissociation, confusion, blurred vision, nausea and vertigo were the most common adverse effects; however, most were mild. More than two‐thirds of the included studies qualified as of low or critically low quality. Preliminary evidence for the short‐term efficacy of ketamine in suicidality was noted by the majority of reviews; however, long‐term effects remained unknown. Due to the low quality of many studies and the limitations of core studies, further research is required. [ABSTRACT FROM AUTHOR]

Objective: Available treatments of depression have limited efficacy and unsatisfactory remission rates. This study aims to review randomized controlled trials (RCTs) investigating effects of glutamate receptor modulators in treating patients with resistant depression. Method: The study protocol was registered in PROSPERO (CRD42021225516). Scopus, ISI Web of Science, Embase, Cochrane Library, Google Scholar, and three trial registries were searched up to September 2020 to find RCTs evaluating glutamate receptor modulators for resistant depression. The difference between intervention and control groups in changing depression scores from baseline to endpoint was considered the primary outcome. Version 2 of the Cochrane risk-of-bias tool for randomized trials was used to assess the quality of the RCTs. No funding was received. Results: Thirty-eight RCTs were included. Based on the included studies, compelling evidence was found for ketamine (with or without electroconvulsive therapy, intravenous or other forms), nitrous oxide, amantadine, and rislenemdaz (MK-0657); the results for MK-0657, amantadine, and nitrous oxide were only based on one study for each. Lithium, lanicemine, D-cycloserine, and decoglurant showed mixed results for efficacy, and, riluzole, and 7-chlorokynurenic acid were mostly comparable to placebo. A limited number of studies were available that addressed drugs other than ketamine. Conclusion: The study cannot determine the difference between statistical and clinical significance between the agents and placebo due to high heterogeneity among the RCTs. Nevertheless, ketamine could be used as an efficacious drug in TRD; still, additional studies are needed to delineate the optimum dosage, duration of efficacy, and intervals. Further studies are also recommended on the effectiveness of glutamatergic system modulators other than ketamine on treatment-resistant depression. [ABSTRACT FROM AUTHOR]

Given the fact that tourism is an important sector of many national economies, it is very essential to examine the factors which can help develop successful and smart tourism experiences. The importance of developing tourism destinations through smart technologies as a strategic tool to develop tourism has persuaded many countries to explore the implementation of these destinations, their models, components, and policies. The present study proposed a model for developing online tourism services in smart tourism destinations. The model was analyzed via structural equation modeling using SPSS (version 20) and Lisrel (version 8.8). The data analysis identified 21 components in six major dimensions which can affect smart tourism development: online content quality, access to interactive online services, end-user internet service, demand for online services, the utilization rate of location-based services, and level of online services. The identified factors can help researchers gain a better understanding of the factors affecting the development of smart destinations and recognize their importance and their degree of influence and power. It is recommended that more attention be paid to improving the quality of services provided to tourists for developing smart destinations. [ABSTRACT FROM AUTHOR]

Besides concerns about the increasing prevalence of psychiatric disorders and the significant burdens and costs, there are concerns about its validity. The dilemma of validity went so far that studies described the diagnoses in psychiatry as scientifically worthless. We suggest integrating psychiatry and medical biotechnology and using biotechnological products in psychiatric aspects help psychiatry become more precise, strengthen its position among other sciences, and increase its scientific credibility by giving examples. For this matter, we need different inputs to choose between the vast outputs. The most common inputs are clinical symptoms, cognitive function, individual and environmental risk factors, molecular markers, genetic markers, neuroimaging signs, and big data. Some molecular markers have been shown to have a relationship with psychiatric disorders such as Interleukin-6 (IL-6) and Tumor Necrosis Factor-α (TNF-α). Genetic studies might evolve the most accurate part of precision psychiatry. Currently, and through the developments in technology, genome-wide association studies have become available. In neuroimaging signs, psychiatric disorders are associated with generalized rather than focal brain network dysfunction, and functional magnetic resonance imaging could be performed to study them. It would exhibit different aberrancies in various psychiatric disorders. In big data, the constitution of predictive models and movement toward precision psychiatry can be led by using artificial intelligence and machine learning. [ABSTRACT FROM AUTHOR]

In recent years, technological advances have motivated industries, companies and even governments to look for an improved alignment between strategic objectives and technology management, preferably through the application of structured and flexible approaches that use techniques such as technology roadmapping. There are a lot of studies that have presented various models, processes and frameworks to develop technology roadmap and more studies have developed roadmaps based on these contributions. Most of these studies have mentioned that the roadmapping process must be customized in every case. Accordingly, having a model or a framework that represents the most prominent findings of these studies in one view is so helpful for customizing the process. But there is no research that accumulates previous studies and achieving this purpose. This paper presents the outcomes of a Meta-synthesis review of technology roadmapping literature that was published between 1997 and 2016 (73 papers) and develops a framework from important roadmapping components which affected the roadmapping process and roadmaps. Finally, the components of the proposed framework have been evaluated by survey benefiting from experts' opinion and Shannon's entropy technique. [ABSTRACT FROM AUTHOR]

Purpose -- Software-as-a-Service (SaaS) has the potential to provide substantial opportunities for organizations to improve their information technology without cost and management concerns. However, organizations have not utilized it to the desired level because it is very challenging for them to completely transform their basic conventional methods of running software into SaaS as a high-tech method. On the other hand, organizations have doubt which factors should be mostly considered if they want to move to SaaS. Therefore, investigating the adoption of SaaS can contribute organizations to benefit from this technology. The purpose of this paper is to provide a good insight into SaaS technology adoption. Design/methodology/approach -- Considering Technology, Organization and Environment (TOE) framework and diffusion of innovation (DOI) theory as the basis, 22 university experts expressed their idea about the proposed model of SaaS adoption. Then, 30 IT professional in 15 IT enterprises that had adopted SaaS were asked to fill the questionnaire related to fuzzy Analytic Hierarchy Process (AHP) based on linguistic preference relations (LinPreRa) in order to rank the submitted criteria. Findings -- The findings demonstrate that all attributes of Technology (relative advantage, compatibility, complexity, trialability, observability and security and privacy), Organization (IT resource, sharing and collaboration culture) and environment (competitive pressure, social influence) are influential in the adoption of SaaS. Moreover, the top five influential factors are relative advantage, competitive pressure, security and privacy, sharing and collaboration culture and social influence based on adopter's opinions. Research limitations/implications -- For researchers, this study provides a useful literature, which can help them in related subject. In addition, it applies IT adoption theories in SaaS context that can be extended in future studies. For organizations, this study derives priority of factors by which they can make strong decisions about adoption of SaaS. Originality/value -- This study contributes to the adoption of SaaS technology using well-known IT adoption theories. A version of Fuzzy AHP based on LinPreRa was used in order to cover the limitations of previous methodologies of ranking the criteria. [ABSTRACT FROM AUTHOR]

This paper contributes to identify systematic problems in NIS using Thinking Process (TOC-TP) and to eliminate the bottlenecks, which results in improving the innovation process and efficiency of NIS. The Case study in this research is the NIS of Iran. The national documents of the innovation system were studied and all problems of NIS mentioned in documents were gathered. The causal relationships between the systematic problems were identified by the survey and grouped into 6 components by Exploratory Factor Analysis: weakness in technology diffusion mechanisms, the lack of centralized governance on science and technology policy, the government's pivotal role as an executor in education and research, weak laws and regulations in the field of research and technology, the lack of adequate financial resources in R&D and the lack of any perspective on the creation of wealth and entrepreneurship among the actors of research and technology. Finally the bottleneck of Iran's NIS was recognized by Thinking Process tools: the small participation of private sector in research and education system as the result of government's pivotal role as an executor of Iran's national innovation system. So the researchers could diagnose the policy gaps related to the identified bottlenecks. [ABSTRACT FROM AUTHOR]

Antidiabetic medications have shown efficacy in alleviating autism symptoms. However, there is a lack of clinical research on the impact of metformin on irritability associated with autism. This study aimed to assess the efficacy and safety of metformin as an adjuvant therapy with risperidone for managing irritability in children diagnosed with Autism Spectrum Disorder (ASD).This is a randomized, 10-week, double-blind, placebo-controlled trial conducted at the children’s autism clinic of Roozbeh Hospital (Tehran, Iran) from March 2024 to May 2024. Participants were divided into two groups of risperidone plus metformin (500 mg per day) and risperidone plus placebo and were assessed at baseline, weeks 5 and 10 with the aberrant behavior checklist-community scale (ABC-C).A total of 55 patients were included in the final analysis. Irritability (primary outcome measure) sharply decreased in the metformin compared to the placebo group (p = 0.008). Among the other four subscales of ABC-C, the hyperactivity/noncompliance score showed a significant drop during the baseline-to-week-5 period (p = 0.021). In addition, inappropriate speech subscales decreased significantly from baseline-to-week 5 in the metformin compared to the placebo group (p = 0.045). No other significant finding was observed among ABC-C scores for lethargy/social withdrawal or stereotypic behavior subscales.Metformin demonstrated promising results in reducing irritability in ASD patients, which is in concordance with previous studies. However, further studies are required before any broad clinical recommendation. [ABSTRACT FROM AUTHOR]

Background: Given the inherent nature of their job, law enforcement staff regularly confront major stressors. Objectives: The prevalence of post-traumatic stress disorder (PTSD) among law enforcement staff is about twice that of the general population. We conducted this study to assess PTSD risk factors among this population. Methods: This prospective case-control study was conducted on patients with PTSD working as law enforcement staff as the case group, and their comrades with no PTSD as the control group. We used a questionnaire, including possible factors contributing to the development of PTSD, to gather the data. Binomial logistic regression was used to calculate the odds ratio (OR) and 95% confidence intervals. Results: A total of 84 participants were included in the study. We found that some factors could be protective against PTSD, including marriage (OR: 0.270, 95% CI: 0.087 - 0.839, P-value: 0.024), having an academic degree (OR: 0.333, 95% CI: 0.114 - 0.978, Pvalue: 0.045), higher income (R2: 0.081; OR: 0.849, 95% CI: 0.721 - 1.000, P-value: 0.050), and receiving satisfactory family support (OR: 0.413, 95% CI: 0.171 - 0.999, P-value: 0.050). Furthermore, logistic regression showed that a positive psychological history (OR: 2.562, 95% CI: 1.025 - 6.406, P-value: 0.044), a positive familial psychological history (OR: 2.667, 95% CI: 1.099 - 6.406, P-value: 0.030), and encountering trauma (aside from the current trauma) after 18 years of age (OR: 2.643, 95% CI: 1.038 - 6.731, P-value: 0.041) are risk factors for PTSD. Conclusions: Our results showed that marriage, having an academic degree, higher income, and receiving satisfactory family support are protective factors. In addition, the risk factors for PTSD include a positive psychological history, a positive familial psychological history, and encountering trauma (aside from the current trauma) after 18 years of age. However, given our limitations, further studies should be conducted before drawing solid conclusions. [ABSTRACT FROM AUTHOR]

The mother is traditionally the primary caregiver for the child, and uncertainty is a major source of psychological distress for parents of sick children. As a result, the current study sought to investigate the impact of an educational program on illness uncertainty in mothers of children with insulin-dependent diabetes mellitus (IDDM). This is a quasi-experimental study with a pretest-posttest design, involving 40 mothers of children with IDDM. After visiting the research site and recruiting eligible mothers, the researcher used the purposive sampling method to randomly assign them to one of two intervention and control groups. Taking into account their needs and conditions, mothers were scheduled for at least three sessions, with a 30-minute interval every other day. The data analysis revealed no significant differences between the two groups in terms of child age and gender, mother age and education level, number of children, and duration of diabetes. There was a significant difference in the total score of uncertainty, total score of ambiguity, lack of clarity, lack of information, unpredictability, and their dimensions between mothers of diabetic children before and after the intervention (P=0.02). Based on the findings, it is recommended that the educational needs of children and their mothers be assessed upon admission and that educational content be prepared and taught accordingly, thereby helping to reduce illness uncertainty in mothers.

The increasing prevalence and burden of suicide have led to numerous studies to identify its risk factors. Cannabis is the most common illicit substance detected in suicide victims' toxicology tests. This study aims to identify and appraise systematic reviews investigating suicidality after using cannabis and cannabinoids. Seven databases and two registries were searched without restrictions for systematic reviews investigating cannabis effects on suicidality. AMSTAR-2 was used for quality assessment and corrected covered area and citation matrix were used to determine overlap. Twenty-five studies were included, of which 24 were on recreational use and one was on therapeutic use. Only three of the studies on recreational use reported no effect or inconsistent results. Evidence generally showed a positive association between cannabis use and suicidal ideation and attempt among the general population, military veterans, and bipolar or major depression patients. A bidirectional causal association between cannabis and suicidal ideation was also mentioned. Moreover, a younger age of initiation, long-term use, and heavy consumption were reported to be associated with even worse suicidal outcomes. On the contrary, current evidence indicates that the therapeutic cannabis is safe. In conclusion, the literature supports the cannabis-suicidality association in recreational use but considers cannabidiol safe for treatment. Further studies with quantitative and interventional approaches are recommended.

Background: There is little data on physical activity (PA), organized PA (OPA), and sedentary behaviors in autism spectrum disorders (ASD) and other neurodevelopmental disorders in developing countries., Aim: To examine OPA, non-OPA, and sedentary behaviors and their associated factors in children and adolescents with ASD, cerebral palsy (CP), and intellectual disability (ID)., Methods: A total of 1020 children and adolescents with ASD, CP, and ID were assessed regarding the child and family information as well as the Children's Leisure Activities Study Survey., Results: The results showed that the OPA level was significantly lower than non-OPA in all groups. Furthermore, the OPA level was significantly lower in the CP group compared to ASD and ID groups ( P < 0.001). Also, moderate ( P < 0.001), vigorous ( P < 0.05), and total ( P < 0.001) physical activity levels were significantly different between all three groups, with the values being higher in the ASD group compared to the other two. The mean of the total sedentary behavior duration in the ASD group (1819.4 min/week, SD: 1680) was significantly lower than in the CP group (2687 min/week, SD: 2673) ( P = 0.007) but not ID group (2176 min/week, SD: 2168.9) ( P = 0.525)., Conclusion: Our findings remark on the participation rate of PA, OPA, and sedentary behaviors of children and adolescents with ASD, CP, and ID in a developing country. In contrast, the need for developing standards of PA/OPA participation in neurodevelopmental disorders is discussed., Competing Interests: Conflict-of-interest statement: Authors have no conflict of interest to declare., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: To investigate managerial barriers and challenges facing East Azerbaijan Province health system., Methods: This qualitative study was conducted in Tabriz, Iran, from August 2014 to August 2015, and comprised professionals, experts and informants working at the East Azerbaijan Health Centre. Data was collected through focus group discussions and semi-structured, face-to-face, individual and group interviews were conducted. Interviews and focus group discussions were taped, transcribed and analysed using content analysis method.., Results: Of the 46 participants, 29(63%) were male and 17(37%) were female. Moreover, 15(33%) participants were head of their respective units and 8(17%) were district health managers. Managerial barriers witnessed during the study period differed between the three managerial levels of interest, i.e., district health centres, provincial health centre departments and top levels of provincial health centre and macro-management systems outside the health centre. Lack of management training, inadequate resources, unclear duties and responsibilities were considered to be the most common barriers facing district health centres. Unclear budgeting mechanisms, instability of management positions and shortage of trained staff on provincial and district levels were reported to be managerial barriers in provincial health centre departments. Political interference in technical decisions, treatment-based approaches, lack of clear career paths on all levels of health system management, unnecessary bureaucracy lying within inter-organisational relationships and ineffective employment legislation were identified as managerial barriers on top levels of the provincial health system and in macro-management systems independent of the health system., Conclusions: Diverse challenges influenced the performance of health managers.