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Abstract Background Emergency personnel are the first line of emergency response systems to respond to emergencies; in essence, they are usually exposed to a wide range of physical and psychological problems. Accordingly, the current study aimed to clarify the lived experiences of paramedics when exposed to Patients’ Deaths during their missions in 2023. Methods This study was carried out using a qualitative approach and interpretative phenomenology from January 9, 2022, to September 21, 2023. The research was performed in Fars, Alborz, and Isfahan provinces in Iran. Data were gathered using semi-structured interviews with 17 male emergency personnel (both from the emergency medical service and Red Crescent). The obtained data were analyzed utilizing Smith’s approach to clarify the lived experiences of emergency responders when facing deaths in various incidents in Iran. Results Seventeen emergency personnel with the age range of 24–60 (average = 39) years and with a history of confronting patients’ deaths during their services were interviewed. Their lived experiences of being exposed to patients’ deaths during the emergency response in Iran were classified into three main themes: psychological and emotional status, personality, disposition, and behavior status, and mental and physical status. Sub-themes such as psychological and emotional problems, mental and physical problems, and sub-subthemes such as anxiety, stress, decreased appetite, irritability, insomnia, forgetfulness, and fatigue were also noted within the main themes. Conclusion While emergency personnel work diligently to save the lives of patients, the current study demonstrated that they were susceptible to multiple psychological, emotional, and physical problems, which potentially affect their lives outside of the workplace and make them more vulnerable to related physiological and psychological diseases. It is recommended that policymakers and clinical educators make ways to prevent these problems and provide emergency personnel with physical, psychological, and emotional support.

Abstract Background Emergency medical services preparedness in mass casualty incidents is one of the most important concerns in emergency systems. A mass casualty incident is a sudden event with several injured individuals that overwhelms the local health care system. This study aimed to identify and validate the components of emergency medical services readiness in mass casualty incidents which ultimately led to designing a conceptual model. Methods This research was an explanatory mixed-method study conducted in five consecutive stages in Iran between November 2021 and September 2023. First, a systematic review was carried out to extract the components of emergency medical services preparedness in mass casualty incidents based on the PRISMA guideline. Second, a qualitative study was designed to explore the preparedness components through in-depth semi-structured interviews and analyzed using the content analysis approach. Third, the integration of the components extracted from the two stages of the systematic review and qualitative study was done by an expert panel. Fourth, the obtained components were validated using the Delphi technique. Two rounds were done in the Delphi phase. Finally, the conceptual model of emergency medical services preparedness in mass casualty incidents was designed by a panel of experts. Results 10 articles were included in the systematic review stage and sixteen main components were extracted and classified into four categories. In the second stage, thirteen components were extracted from the qualitative study and classified into five categories. Then, the components of the previous two phases were integrated into the panel of experts and 23 components were identified. After validation with the Delphi technique, 22 components were extracted. Lastly, the final components were examined by the panel of experts, and the conceptual schematic of the model was drawn. Conclusions It is necessary to have an integrated framework and model of emergency medical service readiness in the planning and management of mass casualty incidents. The components and the final model of this research were obtained after the systematic scientific steps, which can be used as a scheme to improve emergency medical service preparedness in response to mass casualty incidents.

Abstract Introduction : This study aimed to investigate the work problems and challenges of male prehospital emergency technicians when faced with female medical emergencies. Given that qualitative research has not been done in this field, planning to find the weak points and improve the quality of prehospital emergency as the first line of treatment for female emergency patients, which is considered an important part of the health care system, is considered important and valuable. Therefore, this phenomenological study was conducted in 2023. Methods This study was conducted using a qualitative method of phenomenology in 2023. The environment of the research was urban and road prehospital emergency centers in Iran and the data were collected through interviews with EMS technicians. The collected data were analyzed using Smith’s approach to explain the lived experiences of EMS technicians facing female emergencies or women’s emergencies in Iran. Results All the 15 participants were men. Their mean age was 35 years, with a range of 25 to 45 years, and with a mean work experience of 10.54 years with a range of 4 to 20 years. The lived experiences of 115 emergency technicians in facing women’s emergencies in Iran were placed in four main themes cultural-social factors, organizational factors, human resources-related factors, and administrative-legal factors. Conclusion EMS personnel face various obstacles in carrying out missions related to women’s emergencies, Considering the critical nature of women’s emergencies, it is recommended that policymakers and clinical educators improve the level of community culture, communication skills, theoretical and practical training, respecting privacy, hiring female personnel, adding specialized equipment, amending and changing laws, removing road-traffic obstacles and to support personnel, patients and their families psychologically to optimize performance in women’s emergencies.

Abstract Background One of the most significant advantages of Helicopter Emergency Medical Service (HEMS) in disaster relief efforts is their ability to reach inaccessible or remote areas quickly. This is especially important in the aftermath of natural disasters such as earthquakes, floods, or hurricanes, where roads may be blocked or damaged, and conventional ground transportation may not be available. There are many factors can affect the performance of Helicopter Emergency Medical Service (HEMS) in disasters. This study aims to investigate the factors affecting the Helicopter Emergency Medical Service (HEMS) in disasters. Methods The systematic search in Cochran Library, PubMed, Scopus, Science Direct, Web of Science, ProQuest, and Google Scholar databases between the first of January in 1975 and the thirty-first of May in 2023. The articles were selected based on the keywords of the authors. At last, the criteria were extracted from the selected ones. Results The primary search included 839 articles. After studying their title, abstract, and full context, only nine articles, including two qualitative and seven quantitative ones, were chosen for analysis. After analysis and extracting data from the final studies, the preparation factors were categorized into 6 general classes of human resources: training and practicing, management, instructions and standards, equipment, and structure. Among these, the role of training is highlighted by holding practice and maneuvers to improve and prepare the personnel and manage disasters and incidents. Conclusion The results obtained from this systematic review provide a total view of the factors affecting the preparation of the air ambulance during disasters and incidents. It is recommended that senior managers and policy makers use the findings of the present study to identify the factors which affect preparedness of HEMS in disasters and take the necessary measures to eliminate to obstacles.

Abstract In this work, we obtain exact thick brane models in $$4+1$$ 4 + 1 dimensions generated by higher order field theory kinks, inspired by specific potentials for $$\phi ^{10}$$ ϕ 10 and $$\phi ^{18}$$ ϕ 18 models. We verify that the geodesic equation along the fifth dimension confirms the confining effects of the scalar field on the brane for all of these models. These models provide new solutions with exponential and power-law tails which live in different topological sectors. We show that the resulting branes of specific exponential law models do not possess $$Z_2$$ Z 2 -symmetry. Furthermore, we examine the stability of the thick branes, by determining the sign of the $$w^2$$ w 2 term in the expansion of the potential for the resulting Schrödinger-like equation. It turns out that two of the three models of the $$\phi ^{10}$$ ϕ 10 brane are stable, while another contains unstable modes for certain ranges of the model parameters. We also show that the brane solution from the specific $$\phi ^{18}$$ ϕ 18 models are stable, while the others involve neutral equilibrium. The asymptotic behaviour of the brane solutions are also discussed.

Abstract Background Epidemics caused by emerging respiratory viruses are challenging for the health system of most societies, and preparedness of the health system in responding to such epidemics is important. Therefore, the aim of this study was identifying different fields and key issues of the senior managers’ experiences preparedness to respond to the COVID-19 epidemic from the Iranian senior managers’ point of view. Methods This is a qualitative descriptive study. Eighteen in-depth and semi-structured individual interviews were conducted for data collection. For this purpose, 18 senior managers with work experience in managing the COVID-19 crisis were enrolled in the study using purposive sampling. The collected data were analyzed according to Graneheim and Lundman’s approach. Results Analysis of the data resulted in the emergence of five themes and twelve sub-themes. The main themes and sub-themes included: (1) capacity improvement consisting of performance improvement and logistic improvement; (2) resource and infrastructure management including supply and support of human resources, infrastructure improvement, and supply of equipment; (3) an increase in epidemiology capacity including epidemiology improvement and emerging disease surveillance; (4) application of the principles of disaster and emergency management including intra- and extra-organizational interaction management, disaster risk management, and data management; and (5) society resilience increase including improving adaptation skill and maintaining health and social participation. Conclusion The results of this study present the key issues for the management of future emergency situations. Health system managers and policymakers in Iran and other countries should be aware of these key issues and apply them in practice to prepare the health systems to respond to next outbreaks. Indeed, the study results can help policymakers and health system managers to plan to achieve acceptable preparedness for the management of such outbreaks.

Objectives Since older people make up a great percent of the population is Iran, and they experienced higher mental, physical, and emotional pressures due to quarantine and lockdown during the COVID-19 pandemic, the present study aims to investigate the lived experiences of older adults during the COVID-19 pandemic in Iran. Methods & Materials This qualitative phenomenological study was conducted in Fars, Kermanshah, and Tehran provinces of Iran from October 1, 2021 to January 30, 2022. The data were collected through interviewing 16 older adults. Data analysis was done by Smith’s interpretative phenomenology analysis. Results Of 16 older adults, 9 were male and 7 were female, with a mean age of 73 years. Their lived experiences were classified into three main categories: Psychological tensions, resilience (healing) measures, and economic tensions. Conclusion Iranian older people experienced various types of tensions during the COVID-19 pandemic. Social distancing and quarantine increased the concerns about their mental health. Therefore, it is very important to identify and analyze the psychological concepts and protective factors along with preparing practical guidelines to protect their mental health during the COVID-19 pandemic.

Abstract Background and Aims The reasons for the unfavorable performance of hospitals in providing care to Coronavirus Disease 2019 (COVID‐19) patients include the lack of preparation, knowledge, and relevant skills, making it necessary to evaluate the preparedness of nurses to respond to COVID‐19. Therefore, the present study aimed to investigate the preparedness of hospitals affiliated with Shahrekord University of Medical Sciences during the COVID‐19 pandemic in 2022. Methods In this analytical study, data were collected from 350 randomly selected nurses who worked in three hospitals affiliated with Shahrekord University of Medical Sciences; demographic information tools and the preparation of nurses for COVID‐19 patients were used to collect the data. We analyzed the data using SPSS software version 26. Results The mean and standard deviation of the total preparation score was 118.85 ± 0.98. The lowest (6.80 ± 0.18) and highest (23.35 ± 0.19) average values belonged to risk assessment and management and COVID‐19, respectively. The score of nurses' preparedness to deal with COVID‐19 was not statistically correlated with age, work experience, and so on. The average preparation score was significantly different in different treatment departments (operating room and COVID‐19). Conclusion The preparation of nurses was low in dealing with COVID‐19. Thus, managers of nursing services should design and implement educational programs to strengthen the nurses' weaknesses and ultimately increase their awareness and skills in dealing with disasters.

Leachate production and management is a challenging environmental issue in municipal landfills and depots in Iran. Leachate contains toxic materials, heavy metals, and organic and microbial pollutants on a significant scale. Its uncontrolled entrance into the surface, groundwater, and soils can also substantially inverse impacts on human health and natural habitats. In Mazandaran province, during the last decades, depots and landfilling of municipal and industrial waste have led to environmental degradation in its eco-sensitive natural zones and brought a series of health, social, and security challenges to the region. Due to the region's high precipitation rate and landfills with no cover, these places practically convert into an extensive resource for leachate production. To diminish the environmental impacts, a lot of work has been done in recent years to develop a sort of leakage gathering system and treatment plants in these landfills, based primarily on an overall estimation. In this study, a calculating computer model has been developed for leakage production based on regional climate conditions and the characteristics of municipal waste. This model is different from the HELP model, which is commonly used for sanitary landfills and is specifically developed for the waste depots of the Mazandaran province. In this model, hydrological methods, which are based on the water balance in the landfill sites, were used for the calculation. The developed model was uploaded as an online service for public use. By referring to the internet address provided, the developed model in the landfill part and the leachate section, the amount of produced leachate for the landfill site of Mazandaran province can be calculated. Also, the leachate volume of the Babol Anjilsi landfill has been calculated as a case study. As a result of this study, the lowest and highest amount of the production leachate for hot and dry months of the year (June and July) and for wet and rainy months (October) was about 63.39 and 260.07 cubic meters per day, respectively.

In this paper, we analyze the eighth grade students performance in Fars province in cognitive and content domains in mathematics by TIMSS 2019 assessment results. Due to the cultural, social and economic proximity of Fars and Isfahan provinces, corresponding results have been obtained for students of Isfahan province and comparisons have been made in each domain by using appropriate tests. Also, gender analysis has been derived in both cognitive and content dimensions and in all of their domains in mathematics for students of both provinces

Due to the high concentration of various contaminants in the paper mill effluent, it must undergo an efficient treatment process before being discharged to the environment or being reused in the production cycle. In the present study, the submerged membrane adsorption bioreactor (SMABR) system was used for the treatment of the paper mill effluent. The modified polyethersulfone PES/MoS2 membrane was fabricated by incorporating exfoliated MoS2 nanosheets prepared in the laboratory, into the PES matrix. This membrane along with the powdered activated carbon (PAC) were utilized in the SMABR system for the paper mill effluent treatment. After the acclimation of the sludge with the target effluent, the optimum values of food to microorganism (F/M), hydraulic retention time (HRT), and adsorbent dosage were determined separately to be 0.451, 18 h, and 3 g/L by considering the maximum values of chemical oxygen demand (COD) removal and mixed liquor suspended solid MLSS concentration in each stage. In the final stage, the MBR and SMABR systems (using the pristine and modified membranes, separately) were prepared to separately investigate the effect of the presence of the PAC adsorbent and modified membrane, on the output parameters. In all systems, the values of pH and dissolved oxygen (DO) were maintained in the normal range (pH: 6.2–6.7, DO>2) to provide favorable conditions for the growth of microorganisms. Most importantly, best performance in this study was related to the SMABR system consisting the PES/MoS2 membrane and PAC adsorbent, with the highest values of COD removal (96%), MLSS concentration (15620 mg/L), and membrane permeation flux (110 L/m2.h). It is worth mentioning that the functionalized membrane exhibited better hydrophilicity compared with the pristine membrane, resulting in high water permeation flux, which is in accordance with the performance results.

Abstract Background and Aims The effective response of emergency medical services in mass casualty incidents (MCIs) calls for sufficient preparation. The components of preparation must be determined first to achieve this goal. This study aimed to describe the elements of preparedness of emergency medical services for MCIs. Methods A qualitative study was carried out on emergency medical service systems in Iran (from April 2022 to mid‐March 2023), using in‐depth semistructured interviews with participants who were managers and members of the incident command team, experts, technicians, paramedics, and telecommunicators of emergency medical services. Interviews were carried out face‐to‐face and via telephone. The data were collected using voice recorder and transcript and analyzed by content analysis method. This study was conducted using the consolidated criteria for reporting qualitative research. Results Thirty‐six participants were included in the study. A total of 834 codes were analyzed. Thirteen components were extracted from the study and classified as five categories including “Strengthening management and organization,” “individual and group empowerment,” “capacity expansion,” “technology and infrastructure development,” and “operational response measures.” Conclusion Emergency medical service preparedness in response to MCIs is a critical issue. For improving preparedness, the main components must be identified. The study results described the elements of emergency medical service preparedness, which could be used as a framework for developing the national model of emergency medical service preparedness in MCIs.

Abstract Background & Objective Continuity of midwifery-led care during labour and birth is considered optimal. To ensure its sustainability in practice where limited evidence is available, the aim of the present study was to explore midwives’ lived experiences of delivering continuous midwife-led intrapartum care. Methods This study took a qualitative approach in meeting its aim. Participants were midwives working in the labour wards of private and public hospitals in Iran. The data were purposefully collected in 2019 through in-depth, semi-structured, and face-to-face interviews with midwives (n = 10) aged between 26 and 55 years. A thematic analysis based on descriptive phenomenology was undertaken to make sense of the data collected. Results “Wanting to lead continuous woman-centered care but being unable to” was identified as an overarching theme. Three other themes “emphasis on the non-interventional care”, “midwifery-specific focus” and “barriers and challenges of midwifery care” were also identified. Ultimately, midwives described knowing how to and wanting to lead continuous ‘woman’-centered care but being unable to. Perceived barriers included lack of familiarity with and knowledge in relation to childbirth, the insignificant role of midwives in decision making, obstetrician utilitarianism, high workloads along with work-related stress argument-driven communication between midwives and obstetricians and an absence of a ‘triangle of trust’ in care. Conclusion Future research strategies could usefully include obstetricians and focus on the upscaling of midwifery in Iran using continuity of care models, highlight the value of midwives, identify why uptake of antenatal education in Iran is poor and develop user friendly, evidence based, midwife-led programs. Initiatives aiming to promote mutual professional respect, trust and collegiality and increased remuneration for midwifery work would be also welcomed in pursuit of reducing maternal and infant mortality in Iran.