Search

Abstract Hydraulic fracturing (HF) is a technique employed in the oil and gas industry to extract hydrocarbon resources from shale formations and low-permeability rocks. This process involves the creation of new fractures and the extension of existing ones within the rock by injecting a high-pressure fracturing fluid, which enhances the flow of hydrocarbons. To assess the efficiency and safety of HF, various factors such as fracture orientation, geometry, length, distribution, and stimulated reservoir volume are analyzed. In the complex field of HF, the accurate assessment of fracture parameters is crucial for optimizing operational efficiency and ensuring environmental safety. This study investigates the role of machine learning (ML) methodologies in enhancing the precision of these assessments, with a particular focus on fracture width a critical factor in the effectiveness of HF. By utilizing a comprehensive dataset from hydrocarbon fields, in this study, the application of several advanced ML models was investigated, including Artificial Neural Networks (ANNs), Random Forest (RF), and K-Nearest Neighbors (KNNs). These models were specifically employed to predict and assess fracture width based on a variety of geological and operational parameters: geometric factors (γ), Shear Modulus (G), Poisson’s ratio (ν), viscosity of the fracturing fluid (µ in centipoise), crack height (h), fluid efficiency (η), injection time (t), and crack length (x). This study evaluated the performance of ANN, RF, and KNN models, achieving accuracies of 0.978, 0.979, and 0.893, respectively, which underscores their strong predictive modeling capabilities. The results were meticulously documented for each methodology. The RMSE values for ANN, KNN, and RF were 7.552, 15.711, and 6.194, respectively. Notably, the RF approach demonstrated superior performance with an RMSE of 6.194, establishing it as the most accurate method. This study highlights the transformative potential of ML in the pre-stimulation planning phase of HF, enabling enhanced real-time decision-making and operational optimization, which ultimately results in more effective and efficient fracturing operations.

Abstract Prior studies examined Acidocin 4356’s antibacterial and antivirulence effects against Pseudomonas aeruginosa, including cell membrane penetration abilities. Building on prior research, an in-vitro co-culture of human cells was established to evaluate the selectivity of Acidocin (ACD) by concurrently cultivating human cells and bacterial pathogens. This study evaluated the antibacterial effectiveness of ACD against Acinetobacter baumannii and Pseudomonas aeruginosa. Laser scanning confocal microscopy (LSCM) and scanning electron microscopy (SEM) revealed significant biofilm dispersion at ACD concentrations as low as 1/2 MIC. The cytotoxicity of ACD was evaluated on two human cell lines, Calu-6 and THP-1, using the MTT assay. The IC50 values were 114 µg/mL and 24 µg/mL after a 12-hour treatment duration. In a co-culture model, the IC50 increased to 118 µg/mL, showing greater resilience of THP-1 cells under these settings, mimicking in-vivo conditions. Fluorescent microscopy and flow cytometry analysis confirmed the MTT results, showing ACD’s potent antimicrobial effects and minimal toxicity to human cells, even after 12 h of treatment. Transmission electron microscopy (TEM) study revealed that normal Calu-6 cells included papillary outgrowths and microvilli, while infected cells displayed secretory vesicles, indicating an active response to P. aeruginosa infection. The present study thus serves as a critical step toward the development of an innovative therapeutic strategy targeting biofilm-associated infections.

Wax deposition in oil and gas pipelines and equipment is a fundamental challenge that can lead to a decrease in the performance and useful life of these systems. To address this issue, various methods have been developed to reduce wax deposition. This article investigates two novel methods, namely microwave and ultrasonic, for wax deposition mitigation. The microwave method utilizes high-frequency electromagnetic waves and short wavelengths to transfer heat to the wax and separate it from the internal surface of the pipelines. In this method, microwave waves provide energy to the wax, increasing its temperature and causing it to melt and move. Due to its speed, efficiency, and applicability in industrial environments, the microwave method has been recognized as a leading approach in wax deposition reduction, requiring minimal modifications to the pipeline structure. The ultrasonic method employs high-frequency sound waves to disrupt and prevent wax deposition. Ultrasonic waves generate alternating pressure waves at the site of wax accumulation, breaking down the wax structure. This non-destructive and reliable method is capable of reducing wax deposition in hard-to-reach areas. Both microwave and ultrasonic methods have gained attention as innovative approaches for wax deposition reduction. However, further research is needed to optimize and enhance these methods, aiming to improve their implementation capabilities, increase efficiency, and reduce costs. The study also addressed conventional and common methods, such as insulators heat-proofing materials, heating techniques to prevent wax deposition, cold flow, wax inhibiting tools, wax removal techniques, chemicals, and bacterial treatment.

Abstract The increasing use of artificial intelligence (AI) systems in our daily lives through various applications, services, and products highlights the significance of trust and distrust in AI from a user perspective. AI-driven systems have significantly diffused into various aspects of our lives, serving as beneficial “tools” used by human agents. These systems are also evolving to act as co-assistants or semi-agents in specific domains, potentially influencing human thought, decision-making, and agency. Trust and distrust in AI serve as regulators and could significantly control the level of this diffusion, as trust can increase, and distrust may reduce the rate of adoption of AI. Recently, a variety of studies focused on the different dimensions of trust and distrust in AI and its relevant considerations. In this systematic literature review, after conceptualizing trust in the current AI literature, we will investigate trust in different types of human–machine interaction and its impact on technology acceptance in different domains. Additionally, we propose a taxonomy of technical (i.e., safety, accuracy, robustness) and non-technical axiological (i.e., ethical, legal, and mixed) trustworthiness metrics, along with some trustworthy measurements. Moreover, we examine major trust-breakers in AI (e.g., autonomy and dignity threats) and trustmakers; and propose some future directions and probable solutions for the transition to a trustworthy AI.

Objectives Microbial threats pose a growing concern worldwide. This paper reports the analysis of Iran’s policy process against microbial threats.Design This is a qualitative study.Participants We interviewed 16 purposefully identified key informants selected through snowball sampling.Setting Through the lens of stages heuristic framework, we analysed the interviews by using thematic content analysis. We used MAXQDA V.2020 software for data analysis, identified key themes and subthemes and discussed our findings to validate the results.Results We extracted four main categories in accordance with the stages heuristic domains. Through content analysis of the agenda-setting process, we identified three main themes: magnitude of the problem, actors’ power and priorities. Participants highlighted the significant impact of microbial threats, the influence of powerful stakeholders and the underprioritisation of infectious diseases based on perceived urgency and resources. In the process of policy formulation, we explored three main themes, related to governance, coherence and integration of policies and barriers to effective policy formulation. Governance issues included transparency, engagement with stakeholders, conflict of interest and use of evidence, while coherence and integration of policies focused on insufficient coherence and integration of plans as well as temporary and defensive policymaking. Barriers to effective policy formulation encompassed delay in policymaking, policy gap in response to public needs, weakness in policy feasibility, risk assessment and management. For policy implementation, we extracted governance and coordination, and health system capacity. Effective implementation of policies was hindered by fragmented governance, inadequate communication and accountability and systemic barriers, while health system capacity was limited in terms of infrastructure and human resources. Finally, content analysis of monitoring and evaluation (M&E) resulted in identification of two main themes: discrepancies in M&E and barriers to effective M&E. The discrepancies in M&E varied, with some programmes having regular evaluations and others lacking compliance with international standards. Barriers to effective M&E included inadequate data access, limited information-sharing and inefficiencies in the M&E system.Conclusions Iran needs to prioritise infectious diseases, invest in preventive measures, improve governance and coordination, strengthen health system capacity, enhance M&E and so on, to combat microbial threats effectively. Learning from successful experiences of other countries can help Iran develop more effective strategies to address microbial threats and strengthen global public health in the country.

Goal: This research aims to conduct a data mining analysis on the mental models of addicted women in Shiraz. Method: The logic of the research is of an applied type that utilizes a qualitative approach and employs a theoretical foundation. Through theoretical and purposive sampling, 17 participants were selected. Findings: Through the analysis of interviews, 65 codes were identified, which were transformed into 34 concepts and ultimately into 15 categories. Personal factors such as experience, self-awareness, ostracism, and disapproval of addictive behavior have led women towards the quitting process. They have chosen a strategy of rethinking to break free from addiction. However, for women, these concepts have a cyclical effect and have made the quitting process more challenging due to family, societal, and cultural pressures compared to men. The presence of these categories in women's lives has made the quitting experience more difficult, and they have experienced multiple unsuccessful attempts. Consequently, the core category of "failure in quitting" has been considered for women, which reflects their inability to quit. The categories of relapse triggers, fear, personality breakdown, marginalized lives, and depressed minds are the consequences of the quitting process among women. Therefore, the categories have shown that the quitting process is experienced differently by women, and breaking free from addiction is much more challenging for them than for men. Social, familial, and cultural conditions have made it difficult for women to be accepted as addicts, and they have less potential to break free from the addiction cycle.

Abstract Background Breast cancer remains a challenge for physicians. Metformin, an antidiabetic drug, show promising anticancer properties against cancers. An emerging quantum dot (QD) material improves therapeutic agents’ anticancer and imaging properties. QD are nano-sized particles with extreme application in nanotechnology captured by cells and accumulated inside cells, suggesting bioimaging and effective anticancer outcomes. In this study, a simple one-pot hydrothermal method was used to synthesize fluorescent metformin-derived carbon dots (M-CDs) and then investigated the cytotoxic effects and imaging features on two human breast cancer cell lines including, MCF-7 and MDA-MB-231 cells. Results Results showed that M-CDs profoundly decreased the viability of both cancer cells. IC50 values showed that M-CDs were more cytotoxic than metformin either 24–48 h post-treatment. Cancer cells uptake M-CDs successfully, which causes morphological changes in cells and increased levels of intracellular ROS. The number of Oil Red O-positive cells and the expression of caspase-3 protein were increased in M-CDs treated cells. Authophagic factors including, AMPK, mTOR, and P62 were down-regulated, while p-AMPK, Becline-1, LC3 I, and LC3 II were up-regulated in M-CDs treated cells. Finally, M-CDs caused a decrease in the wound healing rate of cells. Conclusions For the first, M-CDs were synthesized by simple one-pot hydrothermal treatment without further purification. M-CDs inhibited both breast cancer cells through modulating autophagy signalling. Graphical Abstract

The occurrence of the Marangoni phenomenon is due to the surface tension gradient within a system, resulting in the creation of a convective flow from low surface tension to high surface tension points. This phenomenon arises from changes in solvent concentration, temperature and electric charge. In the context of the enhanced oil recovery (EOR) process, changing solvent concentration at the interface of two fluids in matrix fracturing systems caused by gas injection (in immiscible, immiscible and near-miscible conditions) and surfactant flooding, can enhance oil recovery by increasing the Marangoni effect. This article presents a comprehensive overview of the Marangoni phenomenon in oil recovery and the first investigation of this effect in conjunction with other related phenomena. The findings demonstrate that the Marangoni flow is not only present but also significantly impacts bypass oil recovery. The magnitude of the Marangoni effect is directly proportional to the absolute value of the temperature and concentration gradient at the interface. Despite being less recognized in petroleum engineering, this phenomenon has the potential to recover bypassed oil in both the matrix and low permeability zones. Experimental data indicates that under favorable conditions, the Marangoni phenomenon can increase the amount of EOR by approximately 35 %.

Reducing the environmental impact caused by the production or use of carbon dioxide (CO2) and other greenhouse gases (GHG) has recently attracted the attention of scientific, research, and industrial communities. In this context, oil production and enhanced oil recovery (EOR) have also focused on using environmentally friendly methods. CO2 has been studied as a significant gas in reducing harmful environmental effects and preventing its release into the atmosphere. This gas, along with methane (CH4) and nitrogen (N2), is recognized as a ‘cushion gas’. Given that hydrogen (H2) is considered a green and environmentally friendly gas, its storage for altering wettability (contact angle (CA) and interfacial tension (IFT)) has recently become an intriguing topic. This study examines how H2 can be utilized as a novel cushion gas in EOR systems. In this research, the role of H2 and its storage in altering wettability in the presence of other cushion gases has been investigated. The performance of H2 in changing the CA and IFT with other gases has also been compared using machine learning (ML) models. During this process, ML and experimental data were used to predict and report the values of IFT and CA. The data used underwent statistical and quantitative preprocessing, processing, evaluation, and validation, with outliers and skewed data removed. Subsequently, ML models such as Random Forest (RF), Random Tree, and LSBoost were implemented on training and testing data. During this process of modeling and predicting IFT and CA, the hyperparameters were optimized using Bayesian algorithms and random search (RS) methods. Finally, the results and performance of the modeling were evaluated, with the LSBoost modeling method using Bayesian optimization reporting R2 values of 0.998614 for IFT and 0.986999 for CA.

Introduction Human immunodeficiency virus (HIV) and human T cell leukemia/lymphoma virus type 1 (HTLV-1) share similar routes of transmission and both target T cells. HTLV-1 may negatively affect the course of disease in people living with HIV, but previous evidence is conflicting. Therefore, we aimed to investigate the prevalence of HIV/HTLV-1 co-infection, routes of transmission, and patients’ CD4+ counts. Material and methods 184 HIV-positive individuals were recruited for this cross-sectional study from the Counseling Center for Behavioral Diseases of Imam Khomeini Hospital in Tehran. Serum samples were analyzed using enzyme-linked immunosorbent assay (ELISA) for anti-HTLV-1. Results The mean age of participants was 40.12 ± 11.6 years, and all cases were negative for HTLV-1 infection. Participants were diagnosed on average about 78 months (6 years) ago, and the mean CD4+ count of the participants was 669.22 cells/µl (SD = 284.2). Using ELISA screening, none of the participants from Tehran in various age groups showed concurrent HTLV-1 infection (0 percent). Conclusions Co-infection with HTLV-1 is negligible in HIV-infected patients in Tehran, Iran. Our data also showed that the most common route of HIV transmission among our study subjects was hetero­sexual contact (56.4%).

Background: Long COVID syndrome (LCS) is characterized by chronic symptoms of fatigue, cough, etc. after contracting COVID-19. This study aimed to identify the longevity of the symptoms of adults who reported suffering from LCS in our previous study which was conducted in 2021. The study population included patients who were referred to healthcare facilities (55 centers) in Fars province, Iran. Materials and Methods: This longitudinal retrospective and follow-up cohort study was conducted on adult patients who were hospitalized with COVID-19. We inquired about their current health status and obtained the information after they consented to participate and answer questions over the phone. Results: In total, 2383 people participated in the study, 543 of whom (27.3%) reported experiencing symptoms of LCS. Fatigue (12.2%) and exercise intolerance (10%) were the two most common symptoms of persistent LCS. On the other hand, 240 people (12.1%) who did not report any symptoms of LCS in phase 1 of the study reported experiencing problems that are compatible with the diagnosis of LCS. Patients with persistent LCS (long-LCS) had longer hospital stays during their initial illness (7 days vs. 5 days) and were more frequently admitted to ICUs (15.8% vs. 8.9%) compared with those without long-LCS. Conclusion: More than one-quarter of adults will continue to suffer from the symptoms of long-COVID for more than one year after their initial infection. The scientific community should develop validated measures and biomarkers to objectively diagnose and follow up this condition.

Background: Bipolar disorder is classified as one of the most debilitating mental diseases. Although patients receive medical treatment, cognitive deficits remain in the euthymic phase in many patients. It is hypothesized that brain electrical stimulation protocols that increase cognitive function may increase the quality of life. Therefore, this study aimed to evaluate the effectiveness of transcranial direct current stimulation in improving cognitive function in bipolar patients in the euthymic phase. Methods & Materials: In a double-blind, sham-controlled- clinical trial, 46 euthymic bipolar patients diagnosed based on DSM-V were randomly divided into the two intervention and control groups. tDCS was applied for the intervention group using an anode electrode at the left dorsolateral-peripheral cortex (F3) and the cathode at the right dorsolateral-frontal (F4) (based on the 10/20 system) at 2 mA for 20 min. The Strop Color and Word Test, The Rey Auditory Verbal Learning Test (RAVLT), and The Wechsler Adult Intelligence Scale (WAISR) were evaluated before, at the end of the third and the seventh weeks of the intervention. Statistical analysis was performed using SPSS v 16. Results: The scores of immediate and delayed auditory memory and visual memory in the intervention group, unlike the control group, improved significantly after treatment. Moreover, Wechsler's working memory score in the intervention group improved significantly after treatment. Consistent and inconsistent answers scores were also significantly improved in the intervention group compared with the controls. Conclusion: The present study indicated that tDCS might be an efficient and safe method for improving cognitive function in euthymic bipolar patients.

Background: Leishmania is a vector-borne protozoon, which causes visceral, cutaneous and mucocutaneous leishmaniosis in human and animals. Monocyte-derived exosome vaccines can be used as prophylaxis and immunotherapy strategies. The aim of this study was to design a multiple-epitope candidate vaccine using leishmaniolysin (GP63) and rK39 proteins against Leishmania major and L. infantum for monocyte-derived exosome preparation. Methods: This study was carried out in Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran, 2023–2024. Effective immunodominant epitopes were selected from two antigenic proteins of GP63 and rK39 using various immunoinformatics and bioinformatics approaches. Vibrio cholerae β-subunit was used as an adjuvant to stimulate immune responses. Then, appropriate linkers were selected for the fusion of epitopes. The 3D model of candidate vaccine was predicted and validated. Results: This designed candidate vaccine could effectively be used as a prophylaxis strategy against leishmaniosis. Conclusion: A candidate vaccine was designed using bioinformatic and immunoinformatic studies with virtual acceptable quality; however, effectiveness of this vaccine should be verified through further in-vitro and in-vivo studies.

Background: Screening is a cost-effective method for prevention, early detection of the disease and reducing the burden of the third deadliest cancer in the world, i.e. colorectal cancer. This study aimed to analyze the cost-effectiveness of colonoscopy screening compared to sigmoidoscopy for colorectal cancer in high-risk individuals in Iran. Methods: This economic evaluation study was conducted using the cost-effectiveness method between July 2016 and February 2017. Evaluation of the effectiveness of screening methods was done using a systematic review. Cost evaluation was also done using the costs obtained from the tariff approved by the Iranian Ministry of Health in 2015 for colonoscopy and sigmoidoscopy. Finally, the combined model of decision tree and Markov was used to evaluate the cost effectiveness. Incremental Cost Effectiveness Ratio (ICER) formula was used for cost effectiveness analysis considering the final outcome of 5-year survival of high-risk individuals. Excel and TreeAge software were used for data analysis. Results: The effectiveness of sigmoidoscopy and colonoscopy in increasing 5-year survival is 11 and 15.7%, respectively, and colonoscopy screening is 4.7% more than sigmoidoscopy. The cost of colonoscopy and sigmoidoscopy screening was calculated as 1000 and 19920 billion Rials, respectively. Based on cost-effectiveness analysis, the cost of treating patients in the case of screening with colonoscopy and sigmoidoscopy is lower than without screening. The ICER ratio of colonoscopy and sigmoidoscopy compared to no screening was -4/441/389/160 and -4/757/954/940 Rials respectively, and colonoscopy compared to sigmoidoscopy was -3/699/785/880 Rials, respectively. Finally, the use of colonoscopy leads to spending 3/699/785/880 Rials less in exchange for obtaining 4722 additional survivals with the prevention of colorectal cancer compared to sigmoidoscopy. Conclusion: Screening by colonoscopy and sigmoidoscopy methods are effective in reducing the incidence and death of colorectal cancer compared to no screening. Screening by colonoscopy is a dominant option for the high-risk population in Iran. Colonoscopy screening is more cost effective compared to sigmoidoscopy. However, decisions about colorectal cancer screening and screening methods depend on local resources and personal preferences.

Objective(s): Polycystic ovary syndrome (PCOS), the primary cause of anovulatory infertility in women, may change the gene expression profile of cumulus cells. In human ART (assisted reproductive technology), gene expression profiling in cumulus cells, a non-invasive method, may be used to identify the most competent oocytes. We aim to identify key genes according to the network-based data and assess the suitability of these genes as markers to predict oocyte competence and PCOS diagnosis.Materials and Methods: The GSE34526 microarray dataset was obtained from the Gene Expression Omnibus (GEO) database. The function and pathway enrichment analysis for DEGs were analyzed. A protein-protein interaction (PPI) network analysis and candidate gene screening were conducted. A two-layer network consisting of mRNA and lncRNA was constructed. Expression levels of hub genes were verified using quantitative RT-PCR (qRT-PCR).Results: A total of 2721 DEGs were retained. The PPI network of selected genes associated with the biological process of “cell communication” was analyzed, and the first 10 key genes were determined by degree. Additionally, 2 hub genes and 2 hub lncRNAs, including STAT3, RHOA, GAS5, and LINC01116, were selected from the lncRNA-mRNA network. Finally, expression levels of STAT3, RHOA, GAS5, and LINC01116 were significantly increased in the cumulus cells of PCOS patients compared to the control group (P

Purpose: 360-degree evaluation is one of the evaluation methods that provides a complete and accurate evaluation of the skills, abilities, competencies, and performance of the evaluator due to the use of several sources to evaluate people. The aim of the study is to evaluate the performance of public library managers in Qom city by 360-degree feedback method. Method: The current research is an applied study which used a survey-analytical method to evaluate the performance of libraries managers in eight indicators (management skills, decision-making, encouragement and innovation, communication and interaction, leadership, professional skills, behavioral skills and teamwork) by 360-degree feedback method. The statistical population included all library managers (12 people), librarians (42 people) and superior officials (2 people) in the public libraries in Qom city. The tool for collecting data was the Brown questionnaire (with some modifications) in the five-point Likert scale with 64 items. The face validity of questionnaire was approved by experts, and its reliability was calculated by Cronbach’s alpha coefficient (0.97). Non-parametric tests of SPSS (version 26) software were used for data analysis. Findings: Findings revealed that the status of all indicators of the performance of the managers of public libraries in Qom city is in a favorable situation, and there was no significant difference between the managers’ self-evaluation with librarians and superior officials- except for the “leadership” indicator. “Management skills”, “Interaction and communication” and “Team work” are ranked first to third. According to its average rating, the “decision-making” indicator has the least importance from the respondents’ point of view and there was a high and significant correlation between performance indicators of managers. Furthermore, no significant difference was observed between the opinions of the respondents based on the demographic variables of age, gender, education degree, discipline and work experience. Originality/value: Thus far, there has been no study on evaluating the performance of public library managers with this method. 360-degree feedback method can be a suitable model for deciding on the performance of public libraries managers in a group and selecting them. The need to pay attention and delegation of authority is emphasized in indicators such as “encouragement and innovation”, “leadership” and “decision-making” according to the findings of the research in evaluating the performance of managers. Moreover, compiling and communicating performance evaluation indicators to librarians and managers of public libraries in order to gain a better understanding of these indicators and improve the quality of their performance can be useful.

Background: Hospitalized patients with COVID-19 may experience emotional problems and respiratory discomfort during mechanical ventilation. This study aimed to evaluate the effects of music therapy on respiratory comfort, anxiety, and depression among patients with COVID-19 under noninvasive mechanical ventilation. Methods: It was a randomized clinical trial. The study subjects were 64 patients requiring noninvasive mechanical ventilation (NIV) who were selected from the COVID-19 intensive care unit (ICU) of Ali ibn Abi Talib Hospital, Rafsanjan City, Iran. They were randomly allocated to the intervention (n=32) and control (n=32) groups. The intervention group received 30 minutes of daily light music by an MP3 player and a JBL headphone for 4 consecutive days, and the control group only used headphones. The data were collected by the hospital anxiety and depression scale and a visual analog scale before and 4 days after the intervention. The SPSS software, version 16 was employed for data analysis through the chi-square, independent sample, and paired-samples t-tests at a significance level P0.05). The mean scores of respiratory comfort, anxiety, and depression significantly changed in the intervention group (P0.05). Between-group differences respecting the post-test mean scores of these variables were also significant (P

Background: Given that COVID-19 spreads worldwide, it has become a public health priority. This study aims to investigate the correlation between social capital and the epidemiological indicators of COVID-19. Methods: This survey is an ecological study, so all studied variables are aggregated.‌ To collect the variables in the study, a data set was provided, which included the information of each country based on the cumulative deaths, case fatality rate, recovery rate, and the number of performed COVID-19 tests. We drew scatter plots of the social capital for the studied countries based on COVID-19 indices. Results: In all the studied countries, ‌the highest cumulative incidence rate of COVID-19 cases was in Montenegro (60310.56 per million), while the lowest cumulative incidence rate of cases was in Tanzania (8.42 per million).‌ The highest and lowest cumulative incidence rate of death due to COVID-19 was in Belgium (1425.15 per million) and Burundi (0.08 per million), respectively. ‌Also, social capital has a significant direct correlation with the cumulative incidence rate of cases (r=0.42, P

ABSTRACTThe emulsifying ability of SA01-OmpA (outer membrane protein A from Acinetobacter sp. SA01) was found to be constrained by challenges like low production efficiency and high costs associated with protein recovery from E. coli inclusion bodies, as described in our previous study. The present study sought to benefit from the advantages of the targeted truncating of SA01-OmpA protein, taking into account the reduced propensity of protein expression as inclusion bodies and cytotoxicity. Here, the structure and activity relationship of two truncated recombinant forms of SA01-OmpA protein was unraveled through a hybrid approach based on experimental data and computational methodologies, representing an innovative bioemulsifier with advantageous emulsifying activity. The recombinant truncated SA01-OmpA variants were cloned and heterologously expressed in E. coli host cells and subsequently purified. The results showed increased emulsifying activity of N-terminally truncated SA01-OmpA (NT-OmpA) compared to full-length SA01-OmpA. Molecular dynamics (MD) simulations analysis demonstrated a direct correlation between the C-terminally truncated SA01-OmpA (CT-OmpA) and its expression as inclusion bodies. Analysis of the structure-activity relationship of truncated variants of SA01-OmpA revealed that, compared to the full-length protein, deletion of the β-barrel portion from the N-terminal of SA01-OmpA increased the emulsifying activity of NT-OmpA while lowering its expression as inclusion bodies. Contrary to the full-length protein, the N-terminally truncated SA01-OmpA was not as cytotoxic, according to the MTT assay, FCM analysis, and AO/EB staining. The findings of this extensive study advance our knowledge of SA01-OmpA at the molecular level as well as the design and development of efficient bioemulsifiers.IMPORTANCEPrevious research (Shahryari et al. 2021, mSystems 6: e01175-20) introduced and characterized the SA01-OmpA protein as a multifaceted protein with a variety of functions, including maintaining cellular homeostasis under oxidative stress conditions, biofilm formation, outer membrane vesicles (OMV) biogenesis, and beneficial emulsifying capacity. By truncating the SA01-OmpA protein, the current study presents a unique method for developing protein-type bioemulsifiers. The findings indicate that the N-terminally truncated SA01-OmpA (NT-OmpA) has the potential to fully replace full-length SA01-OmpA as a novel bioemulsifier with significant emulsifying activity. This study opens up a new frontier in bioemulsifiers, shedding light on a possible relationship between the structure and activity of SA01-OmpA truncated forms.

Introduction: Despite the burden of ischemic heart disease (IHD), there remains a paucity of research on the incidence, mortality, and burden of this condition in the Middle East and North Africa (MENA) regions. This study aimed to evaluate the epidemiology and the risk factors associated with IHD in the MENA region. Methods: This study was performed based on the GBD study 2019 data. We retrieved the data related to the epidemiology and burden of IHD, including prevalence, incidence, years of life lost due to premature death (YLLs), years lived with disability (YLDs), and mortality at the global level and in MENA countries across years and sexes. Results: IHD accounted for approximately 2.55 million (95 % UI 2.29–2.83) incident cases in MENA in 2019, with an age-standardized incidence rate of 613.87 (95 % UI 555.84–675.16) per 100 000 people, which has decreased by 9 % between 1990 and 2019. IHD accounted for 11.01 % of DALYs causes in MENA in 2019, an increase of 68 % compared to 1990. The DALYs rate from IHD increased with age in both men and women and was higher in men than in women in all age groups, except 85–89 years age-group, in 2019. Conclusion: The age-standardized prevalence and incidence of IHD are decreasing in MENA. However, this reduction is lower than the global level, which can be due to a weaker performance of the countries in the region in reducing the prevalence and incidence of the disease compared to the global average.

Musculoskeletal biomechanical models have wide applications in ergonomics, rehabilitation, and injury estimation. Their use can be extended to enable quantitatively explaining and estimating ride comfort for a vehicle's passenger. A biomechanical model of the upper body in the sagittal plane is constructed, which allows for curved motion to simulate the propagation of disturbance energy within a seated passenger aboard a moving vehicle. The dynamic predictions of the model are validated against experimental results within the literature. Frequency responses show that within the vehicular frequency range, the L4L5 and the L5S1 discs in the lower lumbar region are susceptible to the highest vibration transmission. It was also found that vibration transmission is maximized at around 4.5 Hz. The model provides analytical and geometric intuition into the motion of the various segments of the upper body using a few simple geometric assumptions and can be employed to develop a quantitative ride-comfort metric, such that the most comfortable ride would be that which would induce the least internal motion within the passenger model.

The steady progress in genome editing, especially genome editing based on the use of clustered regularly interspaced short palindromic repeats (CRISPR) and programmable nucleases to make precise modifications to genetic material, has provided enormous opportunities to advance biomedical research and promote human health. However, limited transfection efficiency of CRISPR-Cas9 poses a substantial challenge, hindering its wide adoption for genetic modification. Recent advancements in nanoparticle technology, specifically lipid nanoparticles (LNPs), offer promising opportunities for targeted drug delivery. LNPs are becoming popular as a means of delivering therapeutics, including those based on nucleic acids and mRNA. Notably, certain LNPs, such as Polyethylene glycol-phospholipid-modified cationic lipid nanoparticles and solid lipid nanoparticles, exhibit remarkable potential for efficient CRISPR-Cas9 delivery as a gene editing instrument. This review will introduce the molecular mechanisms and diverse applications of the CRISPR/Cas9 gene editing system, current strategies for delivering CRISPR/Cas9-based tools, the advantage of LNPs for CRISPR-Cas9 delivery, an overview of strategies for overcoming off-target genome editing, and approaches for improving genome targeting and tissue targeting. We will also highlight current developments and recent clinical trials for the delivery of CRISPR/Cas9. Finally, future directions for overcoming the limitations and adaptation of this technology for clinical trials will be discussed.

Introduction: Considering changes in the structure of Iran’s population, the prevalence of cancer is increasing. Increasing social awareness about cancer and screening for common cancers are the most cost-effective approaches for breast cancer prevention and control. Studies show a significantly low rate of regular breast cancer screening behaviors. Given the importance of breast cancer and the decreasing effect of screening methods on the financial burden and disease complications, awareness about their attitude can provide appropriate information for decision- and policy-making about breast cancer screening methods in Iran. This study aimed to investigate the attitude of women over 40 years-old visiting health centers affiliated toward breast cancer screening methods. Methods: This is a descriptive/analytical study performed cross-sectionally in the health centers affiliated with TUMS. 255 women from Imam Khomeini Hospital Complex and some health centers that were subsidiaries of the south health centers of TUMS, were enrolled. To collect the required data, we developed a questionnaire based on tools used in similar studies. We used the Chi-square test to investigate the relationship of the attitude score with demographic and socioeconomic variables. The statistical analyses in this study were performed in STATA. Results: 14.5% of the participants had a history of breast cancer, and 18.8% of the participants had a first-degree relative with breast cancer history. About 64.7% of participants underestimated their risk for breast cancer, and 43.1% expressed their concern about breast cancer. About 77.6% of the participants agreed that breast cancers detected earlier are almost treatable. About 18.9% of the participants believed that (agree and highly agree) they will not develop breast cancer in the future, and 47.8% had no idea; 68.2% of the participants disagreed with the item “breast cancer is almost incurable even if detected in early stages;” about 22.0% of them believed that they are at higher risks for breast cancer compared to other women, and 61.3% of the participants agreed to visit a physician in case of feeling pain or a mass in the breast Conclusion: The attitude of the women’s society toward breast cancer screening is high; this finding can be used in plans aiming to raise awareness and conduct screening in Iran.

BackgroundDifferent populations and areas of the world experienced diverse COVID-19 hospitalization and mortality rates. Claims data is a systematically recorded source of hospitalized patients' information that could be used to evaluate the disease management course and outcomes. We aimed to investigate the hospitalization and mortality patterns and associated factors in a huge sample of hospitalized patients.MethodsIn this retrospective registry-based study, we utilized claim data from the Iran Health Insurance Organization (IHIO) consisting of approximately one million hospitalized patients across various hospitals in Iran over a 26-month period. All records in the hospitalization dataset with ICD-10 codes U07.1/U07.2 for clinically/laboratory confirmed COVID-19 were included. In this study, a case referred to one instance of a patient being hospitalized. If a patient experienced multiple hospitalizations within 30 days, those were aggregated into a single case. However, if hospitalizations had longer intervals, they were considered independent cases. The primary outcomes of study were general and intensive care unit (ICU) hospitalization periods and case fatality rate (CFR) at the hospital. Besides, various demographic and hospitalization-associated factors were analyzed to derive the associations with study outcomes using accelerated failure time (AFT) and logistic regression models.ResultsA total number of 1 113 678 admissions with COVID-19 diagnosis were recorded by IHIO during the study period, defined as 917 198 cases, including 51.9% females and 48.1% males. The 61-70 age group had the highest number of cases for both sexes. Among defined cases, CFR was 10.36% (95% CI: 10.29-10.42). The >80 age group had the highest CFR (26.01% [95% CI: 25.75-26.27]). The median of overall hospitalization and ICU days were 4 (IQR: 3-7) and 5 (IQR: 2-8), respectively. Male patients had a significantly higher risk for mortality both generally (odds ratio (OR) = 1.36 [1.34-1.37]) and among ICU admitted patients (1.12 [1.09-1.12]). Among various insurance funds, Foreign Citizens had the highest risk of death both generally (adjusted OR = 2.06 [1.91-2.22]) and in ICU (aOR = 1.71 [1.51-1.92]). Increasing age groups was a risk of longer hospitalization, and the >80 age group had the highest risk for overall hospitalization period (median ratio = 1.52 [1.51-1.54]) and at ICU (median ratio = 1.17 [1.16-1.18]). Considering Tehran as the reference province, Sistan and Balcuchestan (aOR = 1.4 [1.32-1.48]), Alborz (aOR = 1.28 [1.22-1.35]), and Khorasan Razavi (aOR = 1.24 [1.20-1.28]) were the provinces with the highest risk of mortality in hospitalized patients.ConclusionHospitalization data unveiled mortality and duration associations with variables, highlighting provincial outcome disparities in Iran. Using enhanced registry systems in conjunction with other studies, empowers policymakers with evidence for optimizing resource allocation and fortifying healthcare system resilience against future health challenges.

Encapsulation is a viable strategy to improve the stability and survival of probiotics during processing, storage, and consumption. Cruciferin, a major canola protein with high denaturation temperature and resistance to gastric degradation, has potential for encapsulation and protection of probiotics against harsh conditions in processing and gastrointestinal tract. Cruciferin/alginate capsules were fabricated to encapsulate probiotics, and were characterized using confocal and scanning electron microscopy (SEM). The bacterial viability was studied during storage, processing, and gastro-intestinal transit. Limosilactobacillus reuteri TMW 1.656 was encapsulated in spherical cruciferin/alginate capsules (2.2 ± 0.1 mm) prepared using an extrusion method. SEM images of the capsules showed that the bacteria were entrapped within the porous structure which was formed by the complexation of cruciferin and alginate. The confocal microscopy images confirmed that cruciferin and alginate were homogeneously distributed throughout the capsules. The shelf life of the bacteria in the presence of cruciferin and alginate increased up to 8 weeks at 4 °C, while unencapsulated (free) bacteria lost their viability after 2 weeks storage. The heat resistance of encapsulated bacteria exposed to 65 °C and 70 °C was improved by up to ∼ 4 and 2 log cycles, respectively, compared to unencapsulated bacteria. Encapsulation also protected L. reuteri against gastric low pH and enzymes; the viability was 3 logs higher when compared to unencapsulated bacteria. The capsules were degraded in simulated intestinal fluid, leading to the release of the encapsulated bacteria, whereas the wall materials increased the resistance of released bacteria to bile salts. Comparison between the viability of unencapsulated bacteria in presence of cruciferin/alginate mixtures and bacteria encapsulated in the capsules revealed that capsule formation provided physical barriers to the harsh conditions and played a key role in the protection of bacteria. This study showed that cruciferin/alginate capsules are capable to improve stability and shelf life of Limosilactobacillus reuteri.

This study was undertaken to design a stable easy-recoverable nanoadsorbent (Fe3O4@CM-β-CDP@Tet-Cu(II)) hybrid with rich catalytic sites via wet-chemical method for the catalytic reduction of toxic dyes in wastewater. β-cyclodextrin (β-CD) with a hydrophilic character outside and hydrophobic inside cavity play an important role in catalytic reduction process by interacting with organic molecules and also prepared more sites for further surface modifications. Several characterization techniques including FT-IR, TGA analysis, FE-SEM/EDX, TEM, X-Ray diffraction patterns (XRD) measurements were employed to investigate the structural properties of the synthesized material. The catalytic ability of the obtained material was examined in the presence of different dyes including p-nitrophenol, Eosin Y, Rhodamine B, Congo red, and Methyl orange by UV–Vis spectroscopy as a simple and available method. Moreover, the parameters which effect on reduction process, such as dye and reducing agent (NaBH4) concentrations, mass of adsorbent and time were optimized at room temperature. The obtained data demonstrate the considerable catalytic ability of Fe3O4@CM-β-CDP@Tet-Cu (II) besides a remarkable reduction rate and high yield over a short reaction time, in particular for Methyl orange dye. Recycling experiments revealed that Fe3O4@CM-β-CDP@Tet-Cu (II) has an excellent stability wherein the catalyst was recycled five times with a slight decrease in the reduction ability without any remarkable change in morphological properties which confirm by FE-SEM analysis. The high catalytic activity, the magnetic recoverability, along with the excellent stability of Fe3O4@CM-β-CDP@Tet-Cu (II) make it a potential candidate for the reduction of multiple dyes in real wastewater samples.

BackgroundDifferent medication prescription patterns have been associated with varying course of disease and outcomes in COVID-19. Health claims data is a rich source of information on disease treatment and outcomes. We aimed to investigate drug prescription patterns and their association with mortality and hospitalization via insurance data for a relatively long period of the pandemic in Iran.MethodsWe retrieved hospitalized patients’ data from Iran Health Insurance Organization (IHIO) spanning 26 months (2020–2022) nationwide. Included were patients with ICD-10 codes U07.1/U07.2 for confirmed/suspected COVID-19. A case was defined as a single hospitalization event for an individual patient. Multiple hospitalizations of a patient within a 30-day interval were aggregated into a single case, while hospitalizations with intervals exceeding 30 days were treated as independent cases. The Anatomical Therapeutic Chemical (ATC) was used for medications classification. The two main study outcomes were general and intensive care unit (ICU) hospitalization periods and mortality. Besides, various demographic and clinical associate factors were analyzed to derive the associations with medication prescription patterns and study outcomes using accelerated failure time (AFT) and logistic regression models.ResultsDuring the 26 months of the study period, 1,113,678 admissions with COVID-19 diagnosis at hospitals working in company with IHIO were recorded. 917,198 cases were detected from the database, among which 51.91% were females and 48.09% were males. Among the main groups of medications, antithrombotics (55.84% [95% CI: 55.74–55.94]), corticosteroids (54.14% [54.04–54.24]), and antibiotics (42.22% [42.12–42.32]) were the top used medications among cases with COVID-19. Investigation of the duration of hospitalization based on main medication groups showed antithrombotics (adjusted median ratio = 0.94 [0.94–0.95]) were significantly associated with shorter periods of overall hospitalization. Also, antithrombotics (adjusted odds ratio = 0.74 [95%CI, 0.73–0.76]), corticosteroids (0.97 [0.95–0.99]), antivirals (0.82 [0.80–0.83]), and ACE inhibitor/ARB (0.79 [0.77–0.80]) were significantly associated with lower mortality.ConclusionOver 2 years of investigation, antithrombotics, corticosteroids, and antibiotics were the top medications for hospitalized patients with COVID-19. Trends in medication prescription varied based on various factors across the country. Medication prescriptions could potentially significantly impact the trends of mortality and hospitalization during epidemics, thereby affecting both health and economic burdens.

Abstract Background Medical staff migration is one of the challenges for both developed and developing countries affecting society’s health and welfare, which limits access to equity. Therefore, this study was designed and conducted to investigate the tendency to migrate and the factors affecting it among medical students of the Tehran University of medical sciences, Tehran, Iran, in 2019. Methods This cross-sectional study was performed among 472 medical students using a valid questionnaire which was designed after reviewing the literature and using the opinions of experts. The tendency to migrate and its associated factors were analyzed and reported using the Pearson correlation test, independent t-test, one-way ANOVA test, Tukey post-hock test, and Kruskal–Wallis non-parametric test. Results According to this study, the tendency to migrate was 6.13 ± 2.82 out of 10. While there was no significant relationship between age, marital status, medical educational phase and the tendency to migrate (p > 0.05); There was a significant relationship between willingness to migrate with variables of gender (p = 0.027), pre-university study region (p

Nurse prescription is a relatively new and developing subject, with many critics and advocates worldwide. However, it is expanding rapidly and is being implemented in many countries. In Iran, nurses are not allowed to prescribe. No significant action has been taken in this regard. In Iran, nurse prescribing requires preparing the ground and providing the necessary conditions. The current study aimed to examine nurse prescribing worldwide and its possible challenges in Iran.This study is a narrative review of the English and Persian articles published in 2022 on nurse prescription in Iran and worldwide. We collected data by searching the international databases of PubMed, Science Direct, and Scopus, and the local databases of SID, Magiran, and Iran Medex for the keywords "nurse prescribing", "nurse prescription", "prescribing factors", "prescribing effect", "prescribing facilitation", "prescribing barriers", "prescribing benefits", "prescriptions", "medication and nursing", "independent nurse prescribing", "supplementary nurse prescribing", "independent prescribing", "nurse prescriber", "prescribing", and the possible combinations. We retrieved all related articles published between 2010 and the end of 2022.A total of 32 case studies were reviewed in this study. The results showed that nurse prescribing occurs globally in one of three forms: independent, supplementary, and patient group protocols. In Iran, nurse prescribing is prohibited, necessitating social support and assistance in policy-making, planning, and nursing education.Due to the unprepared environment in Iran, it is vital to provide assistance for prescribing. Numerous factors play a role in implementing nurse prescribing in Iran, so it is necessary to use the successful experience of countries that have been pioneers in this domain. It is suggested that health officials and those engaged take steps to teach prescribing nurses at the postgraduate and doctoral levels, or create a new discipline of nurse prescription.

Abstract Background End stage renal disease (ESRD) is a major health concern and a large drain on healthcare resources. A wide range of payment methods are used for management of ESRD. The main aim of this study is to identify current payment methods for dialysis and their effects. Method In this scoping review Pubmed, Scopus, and Google Scholar were searched from 2000 until 2021 using appropriate search strategies. Retrieved articles were screened according to predefined inclusion criteria. Data about the study characteristics and study results were extracted by a pre-structured data extraction form; and were analyzed by a thematic analysis approach. Results Fifty-nine articles were included, the majority of them were published after 2011 (66%); all of them were from high and upper middle-income countries, especially USA (64% of papers). Fee for services, global budget, capitation (bundled) payments, and pay for performance (P4P) were the main reimbursement methods for dialysis centers; and FFS, salary, and capitation were the main methods to reimburse the nephrologists. Countries have usually used a combination of methods depending on their situations; and their methods have been further developed over time specially from the retrospective payment systems (RPS) towards the prospective payment systems (PPS) and pay for performance methods. The main effects of the RPS were undertreatment of unpaid and inexpensive services, and over treatment of payable services. The main effects of the PPS were cost saving, shifting the service cost outside the bundle, change in quality of care, risk of provider, and modality choice. Conclusion This study provides useful insights about the current payment systems for dialysis and the effects of each payment system; that might be helpful for improving the quality and efficiency of healthcare.

Abstract Background Non- communicable diseases (NCDs) are the main cause of death, which lead to over 73% of death and 62% of DALYs globally. As an unhealthy diet is the leading behavioral risk factor of NCDs, in line with the national action plan for the prevention and control of NCD, this study explored the nutrition-related stewardship problems to reduce the burden of NCDs in Iran. Methods This is a qualitative study. We interviewed 30 purposefully identified key informants, i.e., stakeholders, policymakers, and academics, from December 2018 to August 2019. All interviews were recorded and transcribed verbatim. We analyzed data using qualitative content analysis facilitated by MAXQDA 11 software. Results Ample policies and laws were identified, most of which were not or partially implemented. Despite some plausible efforts, NCDs do not seem to be a top priority for high-level managers and decision-makers. Besides, the role of non-state actors, i.e., the private sector, is marginal in NCD’s planning and management. Whereas the government, e.g., the Food and Drug Organization (FDO), is the biggest player. Worse still, many harmful products are advertised and easily distributed across the country. Conclusion Iran’s government has created a noticeable roadmap to battle NCDs despite imposing many sanctions and related socioeconomic problems. Nevertheless, more interventions are needed to strengthen the stewardship of NCDs by various stakeholders. We recommend the government to monitor the implementation of policies and advertisement of harmful products to prioritize prevention and control of NCDs. In addition, we advocate employing the capacity of non-state actors to reduce the consumption of unhealthy food and the burden of NCDs across the country, ultimately.

Abstract Background Non-communicable diseases (NCDs), also known as chronic diseases, specifically cardiovascular diseases (CVD), cancers, respiratory diseases, and diabetes are the main reason for more than two-thirds of global deaths, in which the unhealthy diet is one of the primary risk factors. The golden solution to reducing obesity and CVD linked to an unhealthy diet is to reduce calories, salt, sugar, and fat intake. Besides, activities highlighting lifestyles that contain healthy diets usually focus on reducing salt, sugar, and saturated fat consumption. As a result, the researchers aimed to study the gaps and economic barriers to recommended consumption of salt, sugar, and fat in Iran, based on WHO recommendations. Methods This is a qualitative study. We conducted semi-structured and in-depth interviews with 30 stakeholders, including academics, experts, and key informants in different sectors from December 2018 until August 2019 in Tehran, Iran. We used a purposeful and snowball sampling method to select participants. All interviews were transcribed verbatim and thematically analyzed using MAXQDA 11. Results Economic problems and inflation in Iran caused people to eat more unhealthy foods, while a healthy diet consumption was reduced due to higher prices. Unfair political sanctions imposed on the country caused economic pressure and adversely affected family nutrition. Worse still, despite legal bans, advertising unhealthy foods via media, mainly to generate revenue, encouraged more consumption of unhealthy food. The lack of targeted subsidies and failure in tax legislation and implementation related to the unhealthy products deteriorated the conditions. Conclusion Some economic barriers have hampered plans to reduce salt, fat, and sugar consumption in Iran. Fundamental reforms in the tax and subsidy system are required to improve people’s eating habits. In particular, citizens’ income that has been continuously shrinking due to economic conditions, imposed sanctions, and the inevitably high inflation needs to be addressed urgently. Unless the government of Iran deals with the economic barriers to healthy nutrition, the pathway for implementing the national action plan for prevention and control of NCDs toward a 30% mortality reduction due to NCDs by 2030 looks unlikely to reach.

Background: Pre-hospital emergency medical services are one of the vital parts of the health system, which was created to timely diagnose and treat patients injured in life-threatening conditions. The use of motorcycles has increased in recent years to reach the golden time standard and overcome traffic in some countries, especially Iran. This study was conducted to investigate the effectiveness of a motor ambulance compared to an ambulance in Tehran City, Iran. Materials and Methods: The present study is a cross-sectional descriptive-analytical type. The time to reach the patient’s bedside, death at the scene, and physiological parameters of the patient at the time of delivery to the hospital were studied as effectiveness indicators in this model. Since the primary data on the effectiveness of these two interventions is mortality, according to previous studies, the mortality data should be converted into the form of prevented mortality and enter the analysis phase. In this study, since the mortality index is expressed as a percentage, the difference in the mortality index from 100 was estimated as the prevented mortality index and entered into the analysis. Results: The results showed that the chance of death in the motor ambulance group with an ambulance in severe level patients is 44.8% and 66.9% in the ambulance group. In the motorcycle and ambulance group, the probability of death for patients with mild and moderate injuries was estimated at 0.02% in ambulance missions and 0.7% in motorcycle and ambulance missions (P=0.05). Conclusion: According to the desired outcome (reduction of death), the use of motor ambulance with ambulance was effective in severe group patients. Of course, this outcome alone cannot be an accurate basis for judgment, and outcomes such as survival, disability-adjusted life years, and quality-adjusted life years seem necessary for a more accurate evaluation.

Mobile games are getting a lot of attention as a content-based sector of the digital economy. Especially considering "Free with In-App Purchase" as the mainstream business model of these games, designing the right economic structure to monetize the content of mobile games is crucial. However, there is limited knowledge about the mechanisms of persuading users to pay for in-game content and most of the studies are merely focused on the revenue models. Due to this knowledge gap, this study attempts to aggregate the game monetization methods into a multi-level classification and focus on identifying the main content monetization mechanics of five genres: Arcade, Sport, Puzzle, Racing, and Platformer/ Runner. For this purpose, interviews were conducted by game design and economics experts about successful mobile games. As a result, a new multi-level classification for mobile games revenue models is proposed which includes monetization via selling core items, selling performance items, and providing supplementary services in addition to retailing and in-game advertising. It also became clear that monetization mechanics for each of these methods vary in different genres and change depending on the type of game. The results of this study can be useful for digital game researchers, designers, and marketeers to structure a better revenue stream.

مقدمه: فرسودگی تحصیلی در دانش آموزان می تواند به دلایل مختلفی از جمله دوری خانواده، ناتوانی در برقراری ارتباط صحیح با سایر همسالان و حجم زیاد دروس ایجاد شود که به عملکرد و موفقیت تحصیلی آسیب می زند . این مطالعه با هدف بررسی رابطه بین اعتیاد به تلفن همراه و اعتیاد به اینترنت با فرسودگی تحصیلی در دانشجویان پزشکی دانشگاه علوم پزشکی مشهد انجام شد.روش‌ کار: این مطالعه مقطعی (توصیفی- تحلیلی) بر روی دانشجویان پزشکی دانشگاه علوم پزشکی مشهد در سال 1399 انجام شد. تعداد یکصد و نود و نه دانشجو در رشته‌های علوم پایه، فیزیوپاتولوژی، کارآموزی و کارورزی به صورت تصادفی ساده انتخاب شدند. ابزار تحقیق شامل تست اعتیاد به اینترنت کیمبرلی یانگ (IAT)، شاخص اعتیاد به تلفن همراه کوهی (MPAI) و پرسشنامه فرسودگی شغلی مازلاک (MBI) بود. داده ها با استفاده از آزمون های آمار توصیفی، تی مستقل، تحلیل واریانس یک طرفه، آزمون تعقیبی بونفرونی، رگرسیون خطی چندگانه و نرم افزار SPSS-25 تحلیل شدند.یافته ها: میانگین نمره اعتیاد به اینترنت در دانشجویان دوره کارورزی کمتر از سایر دوره ها است (001/0 P). همچنین نتایج رگرسیون خطی نشان داد که استفاده از اینترنت می‌تواند فرسودگی تحصیلی را در دانش‌آموزان افزایش دهد (001/0 P).نتیجه گیری: اعتیاد به اینترنت می تواند خطر فرسودگی تحصیلی را در دانشجویان افزایش دهد. با این حال، استفاده از تلفن همراه این خطر را افزایش نمی دهد.

Abstract Background Various investigations have specified the role of each RBC indices separately [including hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red blood cell distribution width (RDW)] to predict the prognosis of acute heart failure (AHF) patients. However, in the current study, these variables were compared based on accuracy, sensitivity, and specificity to determine the best prognostic factor. Methods Of 734 heart failure patients referred to the emergency department, 400 cases were enrolled based on the inclusion and exclusion criteria. Data of them were documented, and patients were followed for one year. Eventually, the association of clinical variables and RBC indices with one-year mortality was explored. Results The study included 226 (56%) men and 174 (44%) women with a median age of 66 years. Body Mass Index (HR 1.098, p = 0.016), Hb (HR 0.728, p = 0.024), HTC (HR 0.875, p = 0.066), MCHC (HR 0.795, p = 0.037), and RDW-CV (HR 1.174, p = 0.006) were confirmed as predictors of long-term mortality. Despite confirming the predictive role of these variables by ROC curves, their sensitivity and specificity were reported as follows: [72% and 50% for Hb], [75% and 52% for HCT], [88% and 27% for MCHC], and [49% and 81% for RDW]. In addition, stratified groups of patients, based on normal cut-off values obtained from scientific literature, had significantly different survival in Kaplan–Meier analyses. Conclusion Whilst proving the predictive role of Hb, HCT, MCHC, and RDW in AHF patients, the most sensitive measurement was MCHC and the most specific one was RDW; therefore, these variables should be considered for risk stratification purposes of AHF patients in daily clinical practice.

Key Clinical Message Biliopleural fistula is a rare but serious complication after liver transplantation that should be managed nonoperatively with antibiotics, pleural drainage, decompression of high‐pressure biliary tract, or ultimately surgery in unresponsive cases. Abstract Bilious pleural effusion is a rare entity often iatrogenic, following hepatobiliary surgeries and biliary interventions, and has been reported only in a limited number of patients after liver transplantation. A 5‐year‐old girl underwent living donor liver transplantation due to progressive familial intrahepatic cholestasis. At the 7th day of the postoperative course, due to increased liver enzymes and bilirubin levels and intrahepatic bile duct dilatation on sonography, Magnetic Resonance Cholangiopancreaticography followed by a liver biopsy were performed; the findings demonstrated moderate intrahepatic bile duct dilatation and moderate cellular rejection associated with mild cholestasis, respectively. The patient was therefore administered a pulse of methylprednisolone; however, due to fever, peritonitis and also sonographic evidence of infected biloma collection adjacent to the transplanted liver, the patient underwent surgery. Laparotomy and peritoneal washout were performed and a Jackson‐Pratt drain was inserted adjacent to the liver cut surface. Succeeding tachypnea on 28th post day, led to detection of right side massive pleural effusion on chest Xray and hence thoracostomy tube was inserted. A diagnosis of biliopleural fistula was established and broad‐spectrum intravenous antibiotic therapy was started, followed by cholangiography, fistula closure, and bile duct stricture ballooning and internal‐external biliary catheter insertion. The patient was discharged in generally good condition on the 50th posttransplant day. The diagnosis of biliopleural fistula is facilitated with the utilization of chest imaging and pleural fluid analysis, however, a high index of suspicion is required.

Introduction: Undesirable working conditions, insufficient professional development and other labour market pressures have significantly impacted the status of general practitioners (GPs). This study aimed to conduct a situational analysis of GPs in Iran using a forecasting approach until 2025. Methods: Data were collected concurrently through direct contact, data matching among databases and tracking among graduates from four clusters of medical science universities over the past decade. This retrospective longitudinal study determined the status of GPs over consecutive years. Multi-state Markov and binary logistic regression analyses were performed using R and Stata 14. Results: Of 430 graduates over the past decade, 94% were successfully identified. Only 20% of the graduates remained active as GPs. The greatest fluctuations in transfer occurred in the third year after graduation, with the remaining proportion of GPs dropping to less than 50%. The probability of remaining as GPs was 0.76 per year, while the highest transition was observed towards specialisation (0.12). Additionally, 2% of the GPs chose not to work, and less than 1% transitioned to a different specialty. Based on the transfer matrix for 2025, only 19% of the GPs were projected to remain, with the majority (59%) transitioning to specialisation. Conclusion: The transfer probability varies across different years, indicating higher flow rates among GPs. However, only a limited number of GPs are projected to remain until 2025. A comprehensive set of interventions should be considered, spanning the pre-medical stage, during education and after graduation, to mitigate the factors contributing to GPs leaving their profession.

Abstract Fabrication of well-ordered and bio-mimetic scaffolds is one of the most important research lines in tissue engineering. Different techniques have been utilized to achieve this goal, however, each method has its own disadvantages. Recently, melt electrowriting (MEW) as a technique for fabrication of well-organized scaffolds has attracted the researchers’ attention due to simultaneous use of principles of additive manufacturing and electrohydrodynamic phenomena. In previous research studies, polycaprolactone (PCL) has been mostly used in MEW process. PCL is a biocompatible polymer with characteristics that make it easy to fabricate well-arranged structures using MEW device. However, the mechanical properties of PCL are not favorable for applications like bone tissue engineering. Furthermore, it is of vital importance to demonstrate the capability of MEW technique for processing a broad range of polymers. To address aforementioned problems, in this study, three ten-layered box-structured well-ordered scaffolds, including neat PLA, neat PCL, and PLA/PCL composite are fabricated using an MEW device. Printing of the composite PLA/PCL scaffold using the MEW device is conducted in this study for the first time. The MEW device used in this study is a commercial fused deposition modeling (FDM) 3D printer which with some changes in its setup and configuration becomes prepared for being used as an MEW device. Since in most of previous studies, a setup has been designed and built for MEW process, the use of the FDM device can be considered as one of the novelties of this research. The printing parameters are adjusted in a way that scaffolds with nearly equal pore sizes in the range of 140 µm to 150 µm are fabricated. However, PCL fibers are mostly narrower (diameters in the range of 5 µm to 15 µm) than PLA fibers with diameters between 15 and 25 µm. Unlike the MEW process of PCL, accurate positioning of PLA fibers is difficult which can be due to higher viscosity of PLA melt compared to PCL melt. The printed composite PLA/PCL scaffold possesses a well-ordered box structure with improved mechanical properties and cell-scaffold interactions compared to both neat PLA and PCL scaffolds. Besides, the composite scaffold exhibits a higher swelling ratio than the neat PCL scaffold which can be related to the presence of less hydrophobic PLA fibers. This scaffold demonstrates an anisotropic behavior during uniaxial tensile test in which its Young’s modulus, ultimate tensile stress, and strain to failure all depend on the direction of the applied tensile force. This anisotropy makes the composite PLA/PCL scaffold an exciting candidate for applications in heart tissue engineering. The results of in-vitro cell viability test using L929 mouse murine fibroblast and human umbilical vein endothelial (HUVEC) cells demonstrate that all of the printed scaffolds are biocompatible. In particular, the composite scaffold presents the highest cell viability value among the fabricated scaffolds. All in all, the composite PLA/PCL scaffold shows that it can be a promising substitution for neat PCL scaffold used in previous MEW studies.

Abstract Objectives Priority setting in health directly impacts the general public as payers and final consumers, so the public preferences must be considered. The present study aimed to provide public preferences about health intervention allocation criteria for the optimal allocation of public health budget in Iran. Methods A choice-based survey method was used to assess the general public’s preferences regarding 8 critical criteria with a societal aspect. One thousand sixty-four adult citizens of Tehran, Iran, participated in the study. Participants were asked to allocate a hypothetical budget between the two groups with differences in allocation criteria. Public preferences were inferred from absolute majority responses i.e., more than 50% of participants’ allocation for a criterion. The Logistic Regression Model was used to investigate the factors affecting the preferences regarding the importance of allocation criteria. Results Based on expressed participants’ preferences, criteria of disease severity, age, daily care needs, Number of alternative interventions, individual’s economic status, and diseases with absence from work were important. Thus, 77, 69, 61, 57, 54, and 51% of participants preferred to allocate the hypothetical budget to the treatment of patients with poor economic status, treatment of patients with diseases leading to absence from work, treating patients with severe diseases, treatment of diseases in need of daily care and treatment of children’s diseases, respectively. Findings from the factors affecting participants’ preferences regarding allocation criteria also showed that people with different characteristics had different preferences. Conclusions Iranian general public pays special attention to the criteria of equitable allocation, including patients’ economic status, criteria with societal aspects such as absenteeism from work and the need for daily care, as well as criteria with medical aspects such as disease severity and access to alternative interventions which may sometimes be less considered in decision making.

The severe acute respiratory syndrome coronavirus 2 (known as COVID-19), initially appeared in the Wuhan city of China in December 2019, has become a current medical issue around the world. Due to its highly contagious nature, COVID-19 has spread widely to all countries. As no effective treatment or vaccine is developed for this infectious disease, preventive measures are the only mandatory strategy to stop its human-to-human transmission. In the present spread of COVID-19, the discovery of antiviral drugs is crucially important as the development of these drugs often takes time. However, no specific drug has yet been approved for COVID-19. In this review, we focus on the available drug candidates used for the treatment of infections caused by COVID-19 to identify potential inhibitors through molecular docking.

Background: A variety of clinical and administrative employees form a complicated communication network which makes various conflicts and contradictions possible in hospitals. This highlights the significant impact of internal communication in directing healthcare centers as one of the manager’s duties. Although improving hospital management is key to improvement of the healthcare delivery, few studies have been conducted to address internal communication as one of the main management tasks in hospitals. The current study aimed to determine the contributing factors influencing internal communication based on hospital managers and healthcare personnel’s points of view. Methods: A qualitative study utilizing a content analysis approach was performed. A purposive sampling method was recruited and twenty hospital managers and healthcare staff in Shiraz University of Medical Sciences participated in the study. Semi-structured interviews with open-ended questions were conducted. Data were analyzed using thematic analysis by MAXQDA version 10. Results: Eight managers and twelve healthcare staff including eleven male and nine female subjects participated in the study. Three main themes were discerned: namely “personal factors”, “technical factors”, and “organizational and structural factors”. The participants placed the most emphasis on leadership and new technologies as the influential subthemes. Conclusion: Many factors can affect internal communication, some of which depend mostly on managers to be applied effectively in the hospitals and some on healthcare staff. The identified factors help the managers and staff to recognize how their internal communication can be impressed by these factors and how they can create effective internal communications.

Abstract Background The accuracy of health care−associated infections (HAIs) statistics in many countries is questionable and the main reasons of this inaccuracy are not well-known. The study aim was to explore inhibitors of and corrective recommendations for HAIs case findings and reporting in some of Iran hospitals. Methods Sixteen face-to-face interviews and an expert panel were performed with expertise of infection prevention and control (IPC) programs in hospitals, and Deputies of Health and Treatment in medical university and Ministry of Health from Feb 2018 to May 2019. Using conventional content analysis, code, subcategories and categories were developed. Result Three categories emerged including improper structure preparation, conflict of interest, and inadequate motivation. Allocating distinct budget and adequate staff to IPC programs, developing a user-friendly surveillance system and engaging physicians and nurses for HAIs reporting are the main corrective recommendations accepted by the expert panel. Conclusion Despite the improvement in growing case-findings and reporting of HAIs in Iran, there are many challenges which inhibit accurate case finding and reporting of HAIs. So it is necessary to update the structure, system and rules to reach accurate HAIs data in Iran.

Background and Objectives: Nurses are at higher risk of insomnia due to changes in their work shifts. This study aims to investigate the effect of extremely low-frequency magnetic field (ELF-MF) exposure on the sleepiness of night-shift nurses during rest time. Methods: This is a randomized crossover clinical trial that was conducted on 28 night-shift nurses, randomly divided into two groups of exposure (n=14) and sham (n=14). The central areas of the brain of nurses in the exposure group was exposed to a magnetic field with 200-μT intensity at a frequency of 10Hz for 10 minutes after each night shift for eight night shifts and four weeks. The executive protocol for the sham group was the same, except that the nurses were not exposed to a magnetic field. After exposure, there was no intervention for two weeks to wash out the effects. Then, the groups exchanged their roles and the protocol was repeated. Stanford sleepiness scale (SSS) was used to measure the sleepiness of nurses. Findings were analyzed in SPSS software. Results: No significant difference was observed in the mean SSS score in the first and second periods between the two groups (P=0.30). No significant difference was observed in the mean SSS score between the periods and the order of placement in each period, either (carryover effect=0.97, period effect=0.96). Conclusion: The local ELF-MF exposure has no significant effect on the sleepiness of night-shift nurses during rest time. It may be due to their disturbed circadian rhythm or the disturbance by the noise and light (not by work-related anxiety). Further investigation is needed.

Abstract Background Social determinants have a significant impact on children’s development and their abilities and capacities, especially in early childhood. They can bring about inequity in living conditions of children and, as a result, lead to differences in various dimensions of development including the social, psychological, cognitive and emotional aspects. We aimed to identify and analyze the social determinants of Early Childhood Development (ECD) in Iran and provide policy implications to improve this social context. Methods In a qualitative study, data were collected through semi-structured interviews with 40 experts from October 2017 to June 2018. Based on Leichter’s (1979) framework and using the deductive approach, two independent researchers conducted the data analysis. We used MAXQDA.11 software for data management. Results We identified challenges related to ECD context in the form of 8 themes and 22 subthemes in 4 analytical categories relevant to the social determinants of ECD including: Structural factors (economic factors: 6 subthemes, political factors: 2 subthemes), Socio-cultural factors (the socio-cultural setting of society: 6 subthemes, the socio-cultural setting of family: 4 subthemes), Environmental or International factors (the role of international organizations: 1 subtheme, political sanctions: 1 subtheme), and Situational factors (genetic factors: 1 subtheme, the phenomenon of air pollution: 1 subtheme). We could identify 24 policy recommendations to improve the existing ECD context from the interviews and literature. Conclusion With regard to the challenges related to the social determinants of ECD, such as increasing social harms, decreasing social capital, lack of public awareness, increasing socio-economic inequities, economic instability, which can lead to the abuse and neglect of children or unfair differences in their growth and development, the following policy-making options are proposed: focusing on equity from early years in policies and programs, creating integration between policies and programs from different sectors, prioritizing children in the welfare umbrella, empowering families, raising community awareness, and expanding services and support for families, specially the deprived families subject to special subsidies.

Background: Streptococcus beta group (GBS: Group B Streptococcus) is a gram-positive coccus that colonizes in the rectovaginal area. About 4.6% to 31.3% of women of childbearing age carry GBS infection. GBS colonization is a risk factor for subsequent infections in pregnant women that can be transmitted to the fetus through vertical transfer and aspiration of infected amniotic fluid. 2% of cases lead to an invasive infection in the baby. In most countries, treatment is done according to the CDC (Centers for Disease Control and Prevention) protocol which is based on culture results. According to studies conducted in our country, treatment is based on risk factors. Therefore, during this study, we decided to compare the results of treatment based on risk factors and treatment based on culture results and other maternal and neonatal complications in these two groups. Methods: This case-control study was performed on 98 pregnant women aged 35 to 37 weeks who were referred to the perinatal clinic of Arash Hospital from April 2018 to the end of March 2020 and also 200 pregnant women with a GBS risk factor. Samples of rectovaginal discharge of 98 pregnant women were sent to a selected laboratory for culturing. In this group, treatment was performed based on the culture result. The control samples included 200 pregnant mothers who were treated based on risk factors without culture. Then the two groups were compared in terms of pregnancy outcomes. Results: Out of 98 subjects, 24 (24.5%) had positive rectovaginal culture. Individuals treated with antibiotics based on positive culture results did not show a significant difference in terms of observed pregnancy outcomes compared with the control group. Conclusion: The prevalence of GBS colonization was significantly higher in patients with a history of vaginal discharge than in those without a history. Due to the small number of studies conducted in Iran, it is recommended to conduct studies with a larger sample size in order to explain a more appropriate protocol in terms of effectiveness and economics.

Abstract Background Esophageal cancer causes considerable costs for health systems. Appropriate treatment options for patients with esophageal squamous cell carcinoma (ESCC) can reduce medical costs and provide more improved outcomes for health systems and patients. This study evaluates the cost-effectiveness of treatment interventions for patients with ESCC according to the Iranian health system. Material and methods A five-state Markov model with a 15-year time horizon was performed to evaluate the cost-effectiveness of treatment interventions based on stage for ESCC patients. Costs ($US 2021) and outcomes were calculated from the Iranian health system, with a discount rate of 3%. One-way sensitivity analyses were performed to assess the potential effects of uncertain variables on the model results. Results In stage I, the Endoscopic Mucosal Resection (EMR) treatment yielded the lowest total costs and highest total QALY for a total of $1473 per QALY, making it the dominant strategy compared with esophagectomy and EMR followed by ablation. In stages II and III, chemoradiotherapy (CRT) followed by surgery dominated esophagectomy. CRT followed by surgery was also cost-effective with an incremental cost-effectiveness ratio (ICER) of $2172.8 per QALY compared to CRT. Conclusion From the Iranian health system’s perspective, EMR was the dominant strategy versus esophagectomy and EMR followed by ablation for ESCC patients in stage I. The CRT followed by surgery was a cost-effective intervention compared to CRT and esophagectomy in stages II and III.

Background: Patients undergoing coronary artery bypass graft (CABG) surgery face a serious psychological problem called death anxiety, which can harm the patient physically, socially, and emotionally. White noise and Benson’s relaxation technique are among the complementary and effective treatments which help mitigate death anxiety in these patients.Aim: This study aimed to investigate the impact of white noise and Benson’s relaxation technique on death anxiety among patients undergoing CABG.Method: This randomized clinical trial study was performed on 60 hospitalized patients in Iran in 2020. The permutated block method was used to randomly divide the eligible participants into intervention and control groups. In the intervention group, participants accomplished Benson’s technique with white noise music on three consecutive occasions in the morning, afternoon, and before night sleep. The control group did not receive any intervention. The demographic and clinical characteristics form and Templer scale were used to collect data. Data were analyzed using SPSS software (Version 25).Results: The mean±SD age of the participants was 61.97±8.80 and 64.81±6.53 years in the intervention and control groups, respectively. The results showed a significant decrease in the mean score of death anxiety in the intervention group (P