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Economic inequality is associated with preferences for smaller, immediate gains over larger, delayed ones. Such temporal discounting may feed into rising global inequality, yet it is unclear whether it is a function of choice preferences or norms, or rather the absence of sufficient resources for immediate needs. It is also not clear whether these reflect true differences in choice patterns between income groups. We tested temporal discounting and five intertemporal choice anomalies using local currencies and value standards in 61 countries (N = 13,629). Across a diverse sample, we found consistent, robust rates of choice anomalies. Lower-income groups were not significantly different, but economic inequality and broader financial circumstances were clearly correlated with population choice patterns. Ruggeri et al. find in a study of 61 countries that temporal discounting patterns are globally generalizable. Worse financial environments, greater inequality and high inflation are associated with extreme or inconsistent long-term decisions.

From long ago, orthopedists and physicians are trying to deal with bone diseases and disorders, while today, in the regenerative medicine field, bone scaffolds are being in attendance. Although there were common methods for fabricating bone scaffolds, such as foam casting and gas foaming, additive manufacturing (AM) techniques have been considered for producing bone scaffolds due to some appealing features such as creating a hierarchical structure, regular and controlled porosity, and designing of the complicated structures. AM techniques are divided into three categories, including extrusion-based, powder-based, and vat polymerization (light-based) techniques. Among the AM methods, the robocasting technique as an extrusion-based method is highly regarded for designing high-strength scaffolds for bone tissue regeneration owing to special features, for instance, a low-volume binder and the ability to print all types of ceramic materials as well as metals and polymers. This study discusses the robocasting method, as well as the essential parameters that are involved in 3D printing of the ideal scaffold with this method, such as the material, the structure of the robotic device, the printing parameters, the properties of the ideal paste or ink, the role of binder and its types in robocasting, and the rheological properties required in robocasting method. Also, future prospects and clinical applications of this technique were reviewed.

Background The present qualitative study was conducted to explain the experiences of secondary traumatic stress (STS) and its related factors in midwives working in maternity wards. Methods Data were collected using semi-structured interviews with 11 midwives working in the maternity wards of hospitals in Urmia, Iran, through in-depth interviews with open-ended questions. Data were analyzed using the conventional content analysis approach. Results The results of data analysis led to the extraction of three themes, seven main categories, and 18 subcategories. The first theme was “STS stimuli,” with the two categories of “Discriminatory approach to midwifery” and “The nature of the midwifery profession”. The second theme was “Traumatic outcomes”, which included the subcategories of “Psychological-emotional trauma”, “Physical trauma” and “Social trauma”. The third theme was “Risk management”, which had the two subcategories of “Reactive approach” and “Proactive approach”. Conclusions The results showed that, in addition to the traumatic nature of events that midwives experience during work as the secondhand victims, factors such as governance-organizational structure, unbalanced distribution of power, and poor supportive laws undermine their professional role and provide conditions conducive to STS. Therefore, avoiding traumatic situations and scientific and skill self-empowerment were the most important strategies adopted by the midwives in this study to prevent risky situations and cope with the consequences of STS. The participation of midwifery stakeholders in policy-making and adopting supportive legislation in redefining the position and role of midwives can play a major role in reducing STS and sustaining their role and position in maternal care.

Cardiac failure, such as myocardial infarction (MI), is one of the most serious causes of mortality worldwide. MI is the sign of cardiac cell damage as a result of decreased blood oxygen level, which causes some morphological changes in the form of 12‐lead electrocardiogram (ECG) waves including T‐wave, Q‐wave, and ST‐segment. The main goal of this study is to represent vectorcardiography (VCG) as a complementary diagnostic tool of the ECG method to discriminate the various type of MI from normal cases. The system proposed in this study was analysed on the Physikalisch‐Technische Bundesanstalt diagnostic ECG database and a recorded signal database for 80 MI and 52 healthy cases. Each record consists of 15 ECG and VCG signals. In this study, tridimensional morphological features were applied to the classification and regression tree (CART) and the feedforward neural network classifier. To classify MI cases from healthy control cases of our recorded database, classification and regression tree achieved the same results when VCG features or ECG features were applied with an accuracy of 99.4%, a sensitivity of 100%, and a specificity of 98.7%. Further, by using VCG Octant features with this current method, anterior‐MI and inferior‐MI were separated with an accuracy of 98.9%, a sensitivity of 98%, and a specificity of 100%. The outcomes prove that the VCG features performed more accurately than ECG features in MI localisation.

Background: Coronary sinus dimension is an important factor for diagnosing some types of cyanosis as well as congenital heart diseases and insertion of some devices into the coronary sinus if required. This study was designed to access the diameter and Z-score of the coronary sinus among children under 18 years of age. Methods: In this cross-sectional study on 95 individuals, the coronary sinus diameter was measured by transthoracic echocardiography in the four-chamber view at the connection to the right atrium, middle part, and distal end. The linear regression equation was utilized to determine age-adjust reference values, Z-scores, and the relationship between the individuals’ coronary sinus diameter age, height, and body surface area. The study was conducted from March to July 2020 in Namazi hospital clinic of Shiraz University of Medical Sciences, Shiraz, Iran. Results: The mean age of the persons who entered this study was 5.87±4.25 years. The mean coronary sinus diameter was 4.91±1.29 mm at the site of connection to the right atrium, 4.50±1.44 mm at the middle part, and 3.74±1.32 mm at the distal end. Coronary sinus diameter correlates positively with the participants’ age, weight, height, and body surface area (P

Background Episiotomy is the most commonn surgical procedure in midwifery which as any other wounds can cause infection or delay in healing. The current study aimed to determine effect of Silybum marianum ointment on pain severity and healing of episiotomy wound in primiparous women referring to Shahid Nourani Hospital at 2019. Methods This research was done as a randomized, triple-blind clinical trial on 87 priiparous women (44 indivdiuals in Silybum marianum ointment group and 43 indivdiuals in placebo group) referred to Shahid Nourani Hospital in Talesh (Guilan Province), Iran at September 2019. After labor and performing episiotomy, twice a day for 10 days as a fingertip size of the ointment was prescribed to be topically used on the episiotomy incision for both groups (Silybum marianum ointment or placebo ointment). Data gathering was done using demographic and midwifery information questionnaire, Episiotomy healing assessment: Redness, Edema, Ecchymosis, Discharge, Approximation)REEDA Scale (REEDA Scale: Redness(R); Edema (E), Ecchymosis(E), Discharge from the wound(D); Approximation of the perineal tissues(A))(scale, and visual analogue scale of pain. Examination of healing status of the perinea incision was performed during first 12 h, fifth day and tenth day after labor.Kolmogrov-Smirnov test was used in order to investiagte nomrality of data distribution of quantitative data, and two- independent samples t test, Chi square, repeated measures two factorial analysis of variance and Fischer’s exact test were used. SPSS software version 23 was used to analyze data and 0.05 was considered as signifcance level. Results Both groups of Silybum marianum and placebo groups did not differ regarding demographic and midwifery characteristics, hygiene status prior to intervention (P > 0.05). Mean difference of pain severity and REEDA scale in Silybum marianum ointment group in 12 h after labor, at fifth day and tenth day after labor was significant comparing to control group which indicates decline in episiotomy pain severity and faster wound healing (P Conclusions Silybum marianum ointment ointment accelerates episiotomy wound healing rate due to its healing properties and decreases pain severity. Trial registration This study was registered in Iranian Registry of Clinical Trials in 10/08/2019 with the IRCT ID: IRCT201811100411603N1.

Background: Many patients with COVID-19 did not require hospitalisation, nor underwent COVID-19 testing. There is anecdotal evidence that patients with "mild" COVID-19 may complain about persistent symptoms, even weeks after the infection. This suggests that symptoms during the infection may not resolve spontaneously. The objective of this study was to assess whether multiple relevant symptoms recover following the onset of symptoms in hospitalised and nonhospitalised patients with COVID-19. Methods: A total of 2113 members of two Facebook groups for coronavirus patients with persistent complaints in the Netherlands and Belgium, and from a panel of people who registered on a website of the Lung Foundation Netherlands, were assessed for demographics, pre-existing comorbidities, health status, date of symptoms onset, COVID-19 diagnosis, healthcare utilisation, and the presence of 29 symptoms at the time of the onset of symptoms (retrospectively) and at follow-up (mean±SD 79±17 days after symptoms onset). Results: Overall, 112 hospitalised patients and 2001 nonhospitalised patients (confirmed COVID-19, n=345; symptom-based COVID-19, n=882; and suspected COVID-19, n=774) were analysed. The median number of symptoms during the infection reduced significantly over time (median (interquartile range) 14 (11-17) versus 6 (4-9); p

IntroductionAnxiety and depression are significant concerns in breast cancer patients, and it may remain for a long term after primary treatments. The hospital anxiety and depression scale (HADS) is widely used to measure depressive and anxiety symptoms in clinical practices. The purpose of this study was to assess the psychometric properties of the Persian version of this scale in Iranian breast cancer survivors.MethodsA total of 305 patients with breast cancer, refered to Cancer Hospital in northen Iran and completed the primary treatments were enrolled in. All patients responded to a 14-item HADS. We performed confirmatory factor analysis (CFA) to examine the factor structure of HADS and the item-scale analysis in order to estimate the item reliability and consider the Cronbach’s alpha as a measure of internal consistency.ResultsWith a threshold of ≥8, the prevalence of anxiety and depression symptoms (moderate/severe) was 78.9 and 66.9%, respectively. The Cronbach’s alpha coefficients for anxiety and depression were 0.81 and 0.78, respectively. The CFA confirmed the two-factor structure model for HADS, indicating a good fitting summary indexes (χ2/df = 2.83, NFI = 0.88, RFI = 0.82, IFI = 0.92, CFI = 0.92, and RMSEA = 0.078).ConclusionThe CFA and item reliability analysis have indicated an excellent psychometric property of the Persian version of HADS to measure depressive and anxiety symptoms in breast cancer survivors. Thus, HADS is a useful screening tool to identify post-breast cancer anxiety and depressive disorders.

Vehicular ad hoc Networks (VANETs) encompass the Internet of Vehicles, Vehicular Sensor Networks (VSNs), and electronic vehicles and tend to be an essential part of the world. In this network, communications are done through an open channel and are inevitably susceptible to a range of security issues. Their high mobility also adds to this concern. Roaming services are essential for global VANETs and mobility-based networks, which require a robust authentication mechanism to be maintained. Therefore, an effective and secure authentication and session key agreement mechanism in VANET is a challenge yet to be tackled. Recently, different three-party schemes were proposed to use in the handover authentication process, though they have their deficits. The present study showed that the three related schemes (Zhou et al., Patonico et al., and Eftekhari et al.) have security flaws such as insecurity against impersonation attack, key compromise impersonation attack, and man-in-the-middle attack. Also, a secure and robust handover authentication scheme is proposed for roaming service in VSNs, which stamps out the existing schemes' security problems. It considers the intra-network and inter-network roaming authentication models. Our proposed scheme, free from key escrow problems, is highly anonymous and provides forward/backward secrecy. Widely accepted random oracle model, AVISPA tool, and BAN logic used for security analysis. Our scheme outperforms the others in security metrics and improves communication overhead by up to 75%. Also, the simulation results show that our scheme is energy-efficient and imposes a lower end-to-end delay to the network.

The use of cyanoacrylate embolization has increased in interest as a safe, effective, and minimally invasive method to treat symptomatic saphenous reflux. The procedure is generally well tolerated by patients, and complications such as phlebitis are minor and usually self-limiting. Postprocedural infections have been described but occur infrequently and usually in the early postoperative course. In the present case report, we have described a late-onset infective thrombophlebitis of the great saphenous vein after cyanoacrylate embolization, requiring surgical excision of the treated vein.

Background. Hemodynamic responses to laryngoscopy and endotracheal intubation are transient in most patients. However, in some patients with a history of heart disease, systemic hypertension, or cerebrovascular disease, these may lead to dangerous complications. This study is aimed at determining the effectiveness of intravenous nitroglycerin bolus doses in reducing hemodynamic responses to laryngoscopy and endotracheal intubation. Material and Method. In this double-blind randomized controlled trial, 78 patients aged 18 to 65 years were randomly divided into three groups: 1 μg/kg dose of nitroglycerin (first group), 2 μg/kg dose of nitroglycerin (second group), and normal saline or placebo (third group). 26 samples were allocated for each group. Patients’ hemodynamic responses to laryngoscopy and endotracheal intubation were measured at different times. Data were analyzed using SPSS V 16. Results. Patients in the three study groups were similar in terms of age, sex, and weight. There was no significant difference between the mean saturation of peripheral oxygen (SPO2) and the mean heart rate between the three groups before endotracheal intubation and 1 to 10 minutes after intubation ( P > 0.05 ). The difference of mean arterial blood pressure between study groups was only significant in the first and fifth minutes after intubation. Mean systolic and diastolic blood pressure in the first, third, and fifth minutes after intubation was significantly lower in the intervention groups than the control group ( P < 0.05 ). However, no significant difference was observed between the intervention groups. The frequency of systolic blood pressure decrease was significantly different in the first and fifth minutes after intubation in the three study groups ( P < 0.05 ). Conclusion. Bolus doses of 1 and 2 μg/kg nitroglycerin in noncardiac elective surgery prevents the increase of mean systolic, diastolic, and arterial blood pressure but has no significant effect on heart rate after intubation.

The proliferation of ridesourcing services has raised both hopes and concerns about their role in cities. The impacts of ridesourcing services are complex and multi-faceted. Through reviewing the literature, this study aims to identify the social, economic, and environmental impacts of these services and highlight opportunities and challenges that lay ahead of them for resolving issues related to urban transportation. According to the results, ridesourcing services offer safe modes of transport that provide convenient mobility options, improve transit availability in disadvantaged and remote areas, and respond to taxi demand fluctuations. They can create new job opportunities by employing new human resources that have not been used before, provide flexible working hours for drivers, and are more efficient than taxi cabs. These services provide other opportunities to extend or complement public transit, reduce car ownership and congestion, and minimize parking supply. However, they are criticized for unfair competition with traditional taxis, limited compliance with social legislation, and lack of affordability. They are not available in all places and exclude some vulnerable and socially disadvantaged groups. Labor rights are not secure in this industry, and driver income is not stable. Finally, there is also evidence showing that, in some cases, they contribute to the growth of VMT, energy use, greenhouse gas emissions, and congestion in cities.

Perovskite solar cells are efficient units in systems with modern renewable energy sources. Increasing the efficiency of solar cells is important in photovoltaic (PV) systems. In this paper, the effect of Zn–Cu–In–Se quantum dots on the performance of thin-film perovskite solar cells is analyzed. The effect of the specification of the perovskite layer, electrical connections and quantum dots has been discussed using modeling of solar cell open-circuit voltage, short-circuit current, spectral response, efficiency, and fill factor. Based on the simulation results, without using Zn–Cu–In–Se quantum dots, the optimal performance occurs in high and low electrode work function as 3.5 eV and 5.93 eV achieving 21.53% energy conversion efficiency. In the proposed perovskite solar cell including Zn–Cu–In–Se quantum dots, 33.56% efficiency can be obtained in the same conditions. More intensity of the electric field inside the perovskite layer and the quantum dots causes to increase the energy conversion efficiency compared to the case without quantum dots. The achievable power in case of Zn–Cu–In–Se quantum dots is 0.275 mW/cm2, which is 35% more than the case without these quantum dots in the solar cell. As shown in simulation results section, many improvements can be achieved via using Zn–Cu–In–Se quantum dots in the perovskite solar cell.

Since venous microthrombotic and thromboembolic events in end organs have been pathophysiologically confirmed as a component of thrombo-inflammatory cascade in COVID-19 syndrome, anticoagulant prescription with prophylactic or therapeutic goal is recommended. Different guidelines for the above are introduced; however, there is no general consensus on any neither the type of anticoagulant nor for the dosage and duration of prescription. In our medical center, adopted internal guideline was considered for patients COVID-19. We consulted patients with COVID-19 who suffered from concurrent hematoma. Appropriate surgical approach was considered. Finally autopsy study was performed for patients. In this article, we presented a series of seven SARS-CoV-2 confirmed cases faced with bleeding complication following initiation of anticoagulation protocol. The rectus sheath hematoma with extension to pelvic and/or retroperitoneal space, even involving bowel mesentery was seen most commonly. Despite receiving appropriate surgical care, all seven cases died. Finally, in all cases, autopsy studies revealed no evidence for confirmation of DIC/SIC or organ failure as the reason of death although pulmonary involvement with SARS-CoV-2 and bleeding phenomena were approved. The nature of the COVID-19 syndrome makes patients vulnerable to hemorrhagic events following anticoagulant administration which relatively causes or accelerates patient’s expiration.

One of the most challenging topics in analyzing multi-dimensional geo-spatial data such as geophysical data-sets is detecting outlier data. The issue mainly originates from the difficulty in describing “normality” or “abnormality” due to the complexity of the relationships between the data elements. Considerable number of methods have been proposed and applied for detecting outliers whether they are assumed to be noise, anomalies within the data-set or simply isolated events. A new outlier detection method reached from automatic training of Local Linear Model Tree (LOLIMOT) network, and based on the data selected by K-Nearest Neighborhood (KNN) search is proposed in this research. The procedure of selecting data pairs is through decile analysis using distances calculated during KNN data grouping. Experiment on a synthetic 12 cluster 3D data-set is indicative of the method’s robust performance where calculated Cumulative Error Percentage (CEP) is 13% for the method whereas the nearest value for the KNN is 19%. Also, by applying the method on a micro-gravimetric data and an earthquake catalogue related to the north Zagros- west Alborz, and based on the output of the analyses performed, the superiority of the method in outlier detection was confirmed.

Helicobacter pylori (H. pylori) infection can result in various complications, included micronutrient variations, nutritional impairment, gastric tissue damages and oxidative stress. The present study aimed to evaluate serum variations of Cu and Se in H. pylori infected individuals. A prospective case-control study was performed on 69 participants with abdominal pains (40 patients with H. pylori gastritis versus 29 control group). Serum levels of Cu and Se were measured using Atomic Absorption Spectrophotometer. Statistical analysis was performed using SPSS software. Comparisons of elements between included groups were done using independent sample t-test. Subgroup analysis between male and female (with or without H. pylori) was performed using one way analysis of variance. Correlation between serum Cu and Se was assessed using Pearson’s correlation test. The p-value levels less than 0.05 were considered as significant. There were no significant differences in serum levels of Cu and Se between H. pylori positive and negative persons. In male with H. pylori, Se levels were 38.4% higher than control male (p-value=0.03). A positive and significant correlation was observed between serum Cu and Se levels (r = 0.51, P-value = 0.024). Although no statistic difference was observed in serum Cu and Se levels, the significant correlation between measured elements represents as good evidence for some discrepancies. Given the importance of well controlled micronutrients in whole body health, especially in high-risk H. pylori patients, more studies are needed to clarify the exact relation of these and other trace elements with H. pylori outcomes.

Background Infertile women’s mental health problems, including depression, are key fertility health issues that affect infertile women more severely than infertile men. Depression may threaten the health of individuals and reduce the quality of their lives. Considering the role and impact of depression on responses to infertility treatments, a systematic review and meta-analysis were conducted to investigate the prevalence of depression symptoms among infertile women. Methods International databases (PubMed, Cochrane Library, Web of Sciences, Scopus, Embase, and PsycINFO), national databases (SID and Magiran), and Google Scholar were searched by two independent reviewers for articles published from 2000 to April 5, 2020. The search procedure was performed in both Persian and English using keywords such as “depression,” “disorders,” “infertility,” “prevalence,” and “epidemiology.” The articles were evaluated in terms of their titles, abstracts, and full texts. The reviewers evaluated the quality of the articles using the Newcastle–Ottawa Scale, after which they analyzed the findings using STATA version 14. The I2 and Egger’s tests were performed to examine heterogeneity and publication bias, respectively. Results Thirty-two articles were subjected to the meta-analysis, and a random effects model was used in the examination given the heterogeneity of the articles. The samples in the reviewed studies encompassed a total of 9679 infertile women. The lowest and highest pooled prevalence rates were 21.01% (95% confidence interval [CI]: 15.61–34.42), as determined using the Hospital Anxiety and Depression Scale, and 52.21% (95% CI: 43.51–60.91), as ascertained using the Beck Depression Inventory, respectively. The pooled prevalence values of depression among infertile women were 44.32% (95% CI: 35.65–52.99) in low- and middle-income countries and 28.03% (95% CI: 19.61–36.44) in high-income countries. Conclusion The prevalence of depression among infertile women was higher than that among the general population of a given country. Especially in low- and middle-income countries, appropriate measures, planning, and policy that target the negative effects of depression on infertile women’s lives should be established to reduce related problems.

Introduction: Bread is an unavoidable food ingredient in Iranian meals. Given the relationship between salt and baking soda and several diseases, this study aimed to investigate the role of bread and its effect on increasing additives (salt and baking soda) and comparing them to standards. Methods: In this cross-sectional study, all bakeries (95 bakeries) of Garmsar county were selected and sampled from consumed bread (Taftoon; 125, Barbari; 168, Lavash; 48 and, Sangak; 22 samples) and were sent to the Food and Drug Laboratory. The samples were tested according to the National Standards of Iran (No. 2628) method. Descriptive statistics and dispersion, Skewness and Kurtosis, and Spearman correlation were used to evaluate the results. The outcomes of the measures were analyzed using Excel and SPSS software version 22). Results: Comparison of the results of this study with Iranian standards showed that 16.3 and 66.7% of all bread samples, respectively, had the amount of salt and pH in the range of national standards. Barbari had the highest mean salt intake (1.47 ± 0.37), and Lavash had the highest mean pH (6.13 ± 0.36). Significant and reverse correlation was observed between salt intake and pH in Barbari (p = 0.041, r = -0.158) and lavash (p = 0.022, r = - 0.329) samples. The results also showed that the type of additive to increase yeast activity was different according to the type of bread. Conclusions: Bread can play a significant role in increasing the intake of salt and baking soda daily. As a result, bread is a potential source of these additives, and it is recommended that the amount of these substances be controlled to prevent a variety of diseases associated with salt and baking soda.

The main aim of the present paper is to investigate the inverse design of uniform distribution of heat transfer coefficient on the target plate by employing coaxial jet in the steady and pulsating state. The objective function is defined as the root-mean-square of the deviation of the local Nusselt number on the target plate in computational fluid dynamics simulation from the desired Nusselt number. The heat transfer search method minimizes the objective function. The geometric and fluid parameters are taken into account as design variables. Firstly, optimization in the steady state for the target Nusselt numbers 7, 10 and 13 is carried out and the values of the objective function in the optimal state are found to be 0.51, 0.18 and 0.314, respectively. The range of design variables in the steady and pulsating state is similar, while the heat transfer rate of the pulsating state is higher than that of the steady state. The variations of velocity in the inner and outer nozzles with time are considered to have a sine–sine, cosine–sine and constant–sine behavior. Optimization is carried out in the pulsating state for the Nusselt numbers 33, 44, 55 and 57. The objective function for these numbers in the optimal state is less than 0.02. By employing the conjugate gradient method with adjoint equation and the optimal value of design variables, the distribution of Nusselt number on the target plate in the steady and pulsating state for the constant–sine velocity case is experimentally estimated. The difference between experimental results and the value of the target Nusselt number is about 4–14%, indicating a good agreement between the two approaches.

Background Fatigue is the most commonly reported symptom in patients with persistent complaints following COVID-19 (ie, long COVID). Longitudinal studies examining the intensity of fatigue and differentiating between physical and mental fatigue are lacking. Objective The objectives of this study were to (1) assess the severity of fatigue over time in members of online long COVID peer support groups, and (2) assess whether members of these groups experienced mental fatigue, physical fatigue, or both. Methods A 2-wave web-based follow-up study was conducted in members of online long COVID peer support groups with a confirmed diagnosis approximately 3 and 6 months after the onset of infectious symptoms. Demographics, COVID-19 diagnosis, received health care (from medical professionals or allied health care professionals), fatigue (Checklist Individual Strength–subscale subjective fatigue [CIS-Fatigue]; 8-56 points), and physical and mental fatigue (self-constructed questions; 3-21 points) were assessed. Higher scores indicated more severe fatigue. A CIS-Fatigue score ≥36 points was used to qualify patients as having severe fatigue. Results A total of 239 patients with polymerase chain reaction/computed tomography–confirmed COVID-19 completed the survey 10 weeks (SD 2) and 23 weeks (SD 2) after onset of infectious symptoms, respectively (T1 and T2). Of these 239 patients, 198 (82.8%) were women; 142 (59.4%) had no self-reported pre-existing comorbidities; 208 (87%) self-reported being in good health before contracting COVID-19; and 62 (25.9%) were hospitalized during acute infection. The median age was 50 years (IQR 39-56). The vast majority of patients had severe fatigue at T1 and T2 (n=204, 85.4%, and n=188, 78.7%, respectively). No significant differences were found in the prevalence of normal, mild, and severe fatigue between T1 and T2 (P=.12). The median CIS-Fatigue score was 48 points (IQR 42-53) at T1, and it decreased from T1 to T2 (median change: –2 points, IQR –7 to 3; P Conclusions Fatigue in members of online long COVID support groups with a confirmed COVID-19 diagnosis decreases from 10 to 23 weeks after onset of symptoms. Despite this, severe fatigue remains highly prevalent. Both physical and mental fatigue are present. It remains unclear whether and to what extent fatigue will resolve spontaneously in the longer term. Trial Registration Netherlands Trial Register NTR8705; https://www.trialregister.nl/trial/8705.

Obtaining functional devices with tunable features is beneficial to advance terahertz (THz) science and technology. Here, we propose multifunctional gradient metasurfaces that are composed of a periodic array of binary Si microcylinders integrated with V O 2 and graphene. The metasurfaces act as transmittive (reflective) beamsplitters for the dielectric (metallic) phase of V O 2 with a switchable characteristic. Moreover, by integrating the metasurfaces with graphene and modifying its chemical potential, one can tune the intensity of the split beam as well as obtain nearly perfect resonant absorptions. Consequently, the proposed metasurfaces can find potential applications in THz interferometers, multiplexers, and light absorbers.

Light-Matter Interactions at subwavelength-designed nanostructures have been the subject of intensive study in recent years. The realization of an ideal "blackbody" absorber is an emerging topic in nanophotonics and nanoplasmonics. An ideal black absorber is an object that harvests incoming light with near-unity efficiency. Based on their absorption spectral coverage, they are classified as narrow-band or broadband absorbers. This requirement can be achieved in bulky designs that have a thickness much larger than its light penetration depth as well as antireflective surface texturing.

Thinning the active layer’s thickness of the semiconductor down to a level comparable with the carriers’ diffusion length while keeping its absorption high is an ultimate goal to boost the performance of optoelectronic devices. Strong interference in multilayer structures is one of the promising and practical solutions owing to their simple and large-scale compatible fabrication route. These nanocavity designs not only provide near unity absorption, but they can also be designed in a way that a spectrally selective absorption response can be achieved. In this letter, we will demonstrate the functionality of a metal–insulator–semiconductor (MIS) cavity to obtain spectrally selective ultrathin photodetectors. To prove our theoretical and numerical findings, a 4-nm-thick amorphous silicon (a-Si)-based MIS cavity is designed, fabricated, and characterized. The experimental results show that the optimized cavity design can act as an efficient visible blind ultraviolet (UV) photodetector. The proposed design shows the responsivity values of 120 and 2.5 mA/W in the UV ( $\lambda =\textsf {350}$ nm) and visible ( $\lambda =\textsf {500}$ nm) regions, respectively.

In recent years, sub-wavelength metamaterials-based light perfect absorbers have been the subject of many studies. The most frequently utilized absorber configuration is based on nanostructured plasmonic metals. However, two main drawbacks were raised for this design architecture. One is the fabrication complexity and large scale incompatibility of these nano units. The other one is the inherent limitation of these common metals which mostly operate in the visible frequency range. Recently, strong interference effects in lithography-free planar multilayer designs have been proposed as a solution for tackling these drawbacks. In this paper, we reveal the extraordinary potential of bismuth (Bi) metal in achieving light perfect absorption in a planar design through a broad wavelength regime. For this aim, we adopted a modeling approach based on the transfer matrix method (TMM) to find the ideal conditions for light perfect absorption. According to the findings of our modeling and numerical simulations, it was demonstrated that the use of Bi in the metal-insulator-metal-insulator (MIMI) configuration can simultaneously provide two distinct functionalities; a narrow near unity reflection response and an ultra-broadband near perfect absorption. The reflection behavior can be employed to realize additive color filters in the visible range, while the ultra-broadband absorption response of the design can fully harvest solar irradiation in the visible and near infrared (NIR) ranges. The findings of this paper demonstrate the extraordinary potential of Bi metal for the design of deep sub-wavelength optical devices.

Objective Migration of healthcare workers could result in shortage of human resources and rising inequalities in service provision in resource poor countries. The aim of this review was to determine the factors influencing the migration decisions of medical and dental graduates migrating from low- and middle-income countries as well as introducing a practical model for health professional’s migration. Methods Google Scholar and PubMed were searched together with relevant journals for English studies from January 2005 to January 2020. The original studies which evaluated the motivational factors of dental and medical graduates migrating from low or middle income countries were included. The migration model was developed by investigating the factors and frameworks of selected studies. Results Twenty-five articles were met the inclusion criteria. Push and pull theory was the most popular way to describe the driving factors of migration. These factors were classified into three macro-, meso- and micro-level with eight key domains. Poor income, unfavorable socio-economic situation, political instability, lack of professional and educational opportunities together with family and personal concerns found as strong common reasons perpetuating migration. Conclusion Despite the fact that health workers migrate for different reasons, they follow a same route for decision to stay or leave their home countries. Un-fulfillment of expectations in mother land in addition to media reconstructed reality of life in foreign land can develop a positive attitude for better quality of life improvement after migration. Once individuals could overpass their national identity and barriers of migration, the final decision toward migration would be more feasible.

Background: The present study was conducted to investigate the potential protective effect of cerium oxide nanoparticles (CeNPs) against lead acetate-induced toxicity. Materials and Methods: In this study, 30 adult male Wistar rats were randomly divided into three groups and treated simultaneously, except for the normal control, for 5 weeks with lead acetate in drinking water (1000 mg/L). Control rats and negative control rats received saline intraperitoneally. At the same time, the third group was treated with intraperitoneal injections of CeNPs at the dose of 0.5 mg/kg 1 week before lead administration, and continued with its administration. Finally, serum was obtained by the conventional methods and rats were sacrificed to obtain liver, heart, testis, and kidney tissue for histopathological examinations. Results: The lead-treated group showed significant increases in blood urea nitrogen (BUN), serum creatinine, serum aspartate aminotransferase (AST), serum alanine aminotransferase (ALT), and malondialdehyde (MDA) levels (P

Grouping of earthquakes into distinct clusters is applied to improve mechanism identification and pattern recognition for active seismicity in a region. One of the important issues concerning earthquake data clustering is determining the optimum number of clusters (ONC) at the early stages of algorithms. In this paper a robust method based on K-nearest neighbor search (KNNS) is presented to achieve three goals: improving output accuracy, improving output stability, and adding the ability to weight the features used in ONC determination. By introducing a new formula, the proposed method utilizes the error calculated for clustered data based on the similarity between the members in each cluster. An outlier attenuation algorithm is also used to improve the performance of the method. Both the Krzanowski–Lai Index (KLI) and the silhouette coefficient (SC), as two conventional methods, were used to compare the results and evaluate the performance. Experiments on synthetic data sets verified the effectiveness of the method, with considerable differences found. The clustering of a real earthquake catalogue related to the seismogenic province of Zagros in Persia using our proposed methodology suggests using 13-cluster analysis for clustering based on the spatiotemporal features with the same weights, and seven-cluster analysis for a case where priority is given only to the spatial parameters of the epicenters. Under the same circumstances, the KLI and SC methods suggest three and 18 clusters, respectively. The results of the experiments on synthetic data sets indicate that the proposed method is quantitatively more stable and more accurate than the other two methods.

Data aggregation is an effective mechanism to prolong lifetime in the wireless sensor networks by preventing extra data transmission. However, it may have some adverse effects on accuracy, confidentiality, delay, and privacy preserving. Sensing nodes tends to trade-off between energy demand and security issue. Data can be filtered by temporal correlation of sensory data, and thus, network traffic is controlled. Furthermore, data transmission via unnecessary nodes can be controlled by spatial correlation of sensing devices. This, in turn, prolongs network lifetime. CBDA algorithm was proposed by Hu et al. as a technique based on tree and chain formation and slice-mixing. However, we showed the proposed scheme was vulnerable to stolen key set attack and failed to provide forward secrecy. This has been fixed in proposed key distribution and agreement scheme. In this paper, we propose a continuous hybrid and energy-efficient secure data aggregation (CHESDA) algorithm that trades off between privacy preserving, data integrity, communication overload, delay and accuracy and then chooses the best scenario based on application and importance of the parameters. Here, privacy preserving is maintained by slice-mixing technique. Fuzzy logic is applied to choose optimal slicing in each subtree, and GNY logic is utilized to verify key authentication scheme. Results of analysis and simulations indicate that CHESDA, compared to PECDA and SMART, is more energy-efficient and highly secure with lower communication overhead.

Aim Interventions based on adopting a healthy lifestyle have been less successful. The aim of this study was to investigate the effectiveness of healthy lifestyle interventions on weight gain in overweight pregnant women. Design A cluster randomized controlled trial. Methods Health centres were selected by simple random sampling; then, 66 overweight pregnant women were enrolled by convenience sampling and divided into intervention and comparison groups. Intervention group received individual nutritional counselling and physical activity training. The data were collected in several stages with the demographic and obstetric questionnaire, maternal weight record, food frequency and international physical activity questionnaire. Results Pregnancy weight gain‐4.75(CI 95%: −4.02, −5.48) was significantly lower in the intervention group (p

Objectives: Breast cancer is the most common malignancy in women. In addition, it is the most mentally powerful cancer in women due to affecting the most important female sexual part. Patients with breast cancer experience problems in their marital relationship because of their disrupted mental image and sexual relations. In this regard, this study was conducted to investigate the relationship between sexual self-concept and mental body image in women with breast cancer. Materials and Methods: This descriptive cross-sectional study was conducted on a sample of 120 women with breast cancer. Using a convenience sampling technique, patients were selected from among those hospitalized in the selected hospitals of Tehran in 2018. Data were collected using demographic details, the Multidimensional Sexual Self-Concept Questionnaire (MSSCQ), and the Fisher’s Body Focus questionnaire. Finally, the data were statistically analyzed in SPSS-21. Results: According to the descriptive and analytical statistics, women with breast cancer obtained the highest scores in avoiding risky sex and sexual problem prevention while the lowest scores in terms of sexual preoccupation. Based on the results, there was no disruption in the body image of any of the examined women. Eventually, a significant correlation was observed between sexual self-concept and body image (PConclusions: In general, body image has a positive relationship with sexual self-concept in women with breast cancer and is considered an important predictor of sexual health and behaviors of this group. Accordingly, psychological interventions, along with midwifery and sexual consultations offered by trained personnel can help empower these patients.

Using a radiomics framework to quantitatively analyze tumor shape and texture features in three dimensions, we tested its ability to objectively and robustly distinguish between benign and malignant renal masses. We assessed the relative contributions of shape and texture metrics separately and together in the prediction model. Computed tomography (CT) images of 735 patients with 539 malignant and 196 benign masses were segmented in this retrospective study. Thirty-three shape and 760 texture metrics were calculated per tumor. Tumor classification models using shape, texture, and both metrics were built using random forest and AdaBoost with tenfold cross-validation. Sensitivity analyses on five sub-cohorts with respect to the acquisition phase were conducted. Additional sensitivity analyses after multiple imputation were also conducted. Model performance was assessed using AUC. Random forest classifier showed shape metrics featuring within the top 10% performing metrics regardless of phase, attaining the highest variable importance in the corticomedullary phase. Convex hull perimeter ratio is a consistently high-performing shape feature. Shape metrics alone achieved an AUC ranging 0.64–0.68 across multiple classifiers, compared with 0.67–0.75 and 0.68–0.75 achieved by texture-only and combined models, respectively. Shape metrics alone attain high prediction performance and high variable importance in the combined model, while being independent of the acquisition phase (unlike texture). Shape analysis therefore should not be overlooked in its potential to distinguish benign from malignant tumors, and future radiomics platforms powered by machine learning should harness both shape and texture metrics. • Current radiomics research is heavily weighted towards texture analysis, but quantitative shape metrics should not be ignored in their potential to distinguish benign from malignant renal tumors. • Shape metrics alone can attain high prediction performance and demonstrate high variable importance in the combined shape and texture radiomics model. • Any future radiomics platform powered by machine learning should harness both shape and texture metrics, especially since tumor shape (unlike texture) is independent of the acquisition phase and more robust from the imaging variations.

Background To determine whether routine administration of calcium supplementation is useful in postmenopausal women, while it is associated with an increased risk of cardiovascular complications. Methods A literature search was performed using Medline/PubMed, Scopus and Google Scholar by using relevant keywords. Results Calcium supplement exerts a small protective effect against bone loss which disappears after cessation. Antifracture effect of supplemental calcium is limited to older frail women or community-dwelling residents who are vitamin D deficient and have inadequate dietary calcium intake. The results of studies on the association between calcium supplementation and cardiovascular complications are contradictory and do not lead to a decisive conclusion Conclusion Current data do not support routine calcium supplementation to all postmenopausal women for prevention of bone loss or bone fracture.

BackgroundA major part of midwifery care involves the empowerment of women and their families for the control of factors affecting their health. To this end, midwives should experience their own empowerment first. The present study was conducted to translate and determine the psychometric properties of the Perception of Empowerment in Midwifery Scale among Iranian midwives.MethodsA total of 380 people participated in this cross-sectional study. A demographic questionnaire and the 22-item Perception of Empowerment in Midwifery Scale were sent to the participants online. The validity of the scale and the analysis of its main components were carried out through exploratory factor analysis with Varimax rotation and confirmatory factor analysis. The reliability of the scale was assessed using the internal consistency method with Cronbach’s alpha coefficient, average inter-item correlation (AIC) and McDonald’s omega.ResultsSeventeen scale items were retained after the exploratory factor analysis, and five factors were extracted, including “effective management”, “professional practice”, “authority”, “advocacy”, and “professional informant”, with factor loadings ranging from 0.489 to 0.899. The five latent factors explained 53.07% of the overall variance of the scale. The confirmatory factor analysis showed an acceptable goodness of fit. The internal consistency of the scale was confirmed with a Cronbach’s alpha above 0.7.ConclusionThe Persian version of the Perception of Empowerment in Midwifery Scale with 17 items has adequate reliability for midwives working in Iran. Given its appropriate psychometric properties, this scale is fit to be used among midwives in future studies.

While there is a growing body of scholarship on regional competitiveness, little attention has been paid to the planning methods that can pursue this objective. Public planners are mainly relying o...

BackgroundFertility, in addition to the biomedical aspect, is phenomena of social, economic and demographic changes. Social network were considered for understanding fertility behaviors and changes in the levels of fertility. This study was conducted to investigate the relationship between social capital and childbirth behaviors in Iranian women employees.MethodsThis cross-sectional study was conducted in 2017 on 536 women health care workers who randomly selected from health care setting Babol/Iran. Data were collected using demographic, childbearing behavior and social capital questionnaires. The SPSS-21 software was employed to analysis the data at a significant level of 0.05.ResultsThe results of the study showed that, there was significant relationship between number of pregnancy and social capital (P = 0.039). Furthermore, social capital has a significant relationship with the time of pregnancy (P = 0.043), the time of pregnancy in women with high social capital was observed to be relatively 30% shorter compare the women with low social capital.ConclusionSocial capital, as one of the important factors influencing childbirth behaviors, should be considered in population planning and policy making.

Introduction: One of the concerns of painless deliveries is the safety of neonates. This clinical trial study aimed to compare the effects of epidural and spinal anesthesia on the mortality rate of neonates. Methods: This clinical trial was conducted in Hamadan Hospital in Iran. Ninety women, ages 18 to 45, were randomly assigned to receive epidural or subdural anesthesia. Using a checklist, the following were collected: demographic information, midwifery, hemodynamic status, mothers' pain intensity, and analyses of the baby's umbilical cord blood. The data were analyzed by SPSS version 16 for statistical analysis. Twenty-two of the patients with spinal anesthesia and epidural anesthesia were excluded from the study. Results: There was no significant difference between the two groups in terms of age, gestational age, parity, and severity of pain before or after anesthesia. The hemodynamic status of the mothers before and during the first postoperative period was in the normal range, except that in the spinal group, a decrease in systolic blood pressure was observed in normal range compared with the epidural anesthesia group. In blood gas analysis, the mean pH, partial pressure of carbon dioxide (PCO2), and bicarbonate (HCO3) did not show significant differences between the two groups (p > 0.05). The only complications were acidosis and epidural anesthesia. Conclusion: Based on the findings of the present study, both spinal and epidural opioids have no adverse effects on the health of neonates. However, both spinal and epidural opioid are preferred due to fewer changes in the hemodynamic changes in mothers and in umbilical cord blood gas.

Objective Gestational diabetes mellitus (GDM) is the most prevalent medical complication in pregnancy. Early diagnosis of GDM can influence maternal/neonatal outcomes. To assess the association between platelet and blood inflammatory indices and the risk of GDM occurrence using the complete blood count (CBC) test. We also aimed to determine the sensitivity of each parameter for an early screening of this disorder during pregnancy. Methods This case-control study included 2 groups of 110 pregnant women with and without GDM. The women in each group were compared after the routine screening for GDM and after the CBC test at 24-28 weeks’ gestation after being matched according to the inclusion criteria. Data were analyzed using SPSS version 16 and Medcalc version 14.8.1 software. Results There were statistically significant intergroup differences in white blood cell (WBC) count, platelet count, mean platelet volume (MPV), plateletcrit (PCT), MPV to platelet ratio, platelet to lymphocyte ratio, and Rh values. The values of lymphocyte count, neutrophil count, neutrophil to lymphocyte ratio, and blood group were not significantly different between groups. The logistic regression analysis showed the predictive values of WBC, platelet, MPV, and PCT in GDM. According to the receiver operating characteristic curve for all 3 variables, the level below the PCT chart was more than that of the others. Conclusion Increasing platelet and inflammatory indices on the CBC test in the second trimester of pregnancy seemed to be associated with the probability of GDM occurrence.

Introduction: Pulmonary rehabilitation (PR) is one of the core components in the management of patients with chronic obstructive pulmonary disease (COPD). In order to achieve the maximal level of independence, autonomy, and functioning of the patient, targeted therapies and interventions based on the identification of physical, emotional and social traits need to be provided by a dedicated, interdisciplinary PR team. Areas covered: The review discusses cardiopulmonary exercise testing in the selection of different modes of training modalities. Neuromuscular electrical stimulation as well as gait assessment and training are discussed as well as add-on therapies as oxygen, noninvasive ventilator support or endoscopic lung volume reduction in selected patients. The potentials of pulsed inhaled nitric oxide in patients with underlying pulmonary hypertension is explored as well as nutritional support. The impact of sleep quality on outcomes of PR is reviewed. Expert opinion: Individualized, comprehensive intervention based on thorough assessment of physical, emotional, and social traits in COPD patients forms a continuous challenge for health-care professionals and PR organizations in order to dynamically implement and adapt these strategies based on dynamic, more optimal understanding of underlying pathophysiological mechanisms.

Background To explore and characterize the inter-relationship between psychological well-being, spirituality, social support, comorbidity, demographic and lifestyle factors and quality of life (QoL). Methods This cross-sectional study was conducted with 305 breast cancer survivors in northern Iran in 2017. The demographic and socio-economic data and physical activity were measured with a standard questionnaire. The standard European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 QoL scale, a system-of-belief inventory questionnaire, the social support scale, the short form of the Hospital Anxiety and Depression Scale and the fatigue severity scale (FSS) were used in data collection. In structural equation modelling analysis, we used the maximum likelihood procedure to estimate the direct and indirect effects of relevant factors on QoL. Results The median age (quartile 1 [Q1], quartile 3 [Q3]) of patients was 50 y (43, 55). The psychological factors designated by anxiety, depression and FSS had a negative significant direct effect on QoL (β=−0.62). Spirituality has a positive direct effect (β=0.089) but a negligible indirect effect (β=0.020) on QoL, while the direct association of social support was almost negligible. Conclusions The findings emphasized the unifying structure of the determinants of QoL and the mediating negative association of psychological factors with QoL. Thus the supportive education efforts should focus on improving psychological well-being along with standard treatment in breast cancer survivors.

Introduction Postoperative peritoneal adhesions (PPAs) is a common complication of abdominal surgeries causing significant morbidity and mortality. The inflammatory response to damaged peritoneal tissue is a speculated culprit. The aim of this study is to investigate the protective effect of pimecrolimus, an anti-inflammatory and immunomodulator agent, in formation of PPAs in rats. Methods Complied with the Animal Research Reporting In Vivo Experiments (ARRIVE) Guidelines Checklist, 50 Albino rats underwent laparotomy and were allocated into 5 groups. In groups 1 to 3, topical pimecrolimus (25, 50 and 100% concentration, respectively) was applies on a scratched area of peritoneum. In group 4, only topical Eucerin was used and group 5, was the control group. On postoperative days 7 and 28, five rats from each group were randomly selected and the tensile strength and adhesiveness of intraabdominal fibrotic bundles were assessed. Results There was no significant difference in tensile strength and adhesiveness, between the groups on postoperative day 7. On postoperative day 28, however, the tensile strength was significantly lower in pimecrolimus groups than in Eucerin ( Conclusion Administration of topical pimecrolimus decrease adhesions and their tensile strength on postoperative day 28 in rats.

Objectives To assess the incidence of ocular manifestations of Kawasaki disease (KD) in children and to evaluate the relationship between ocular manifestations and the other clinical manifestations, laboratory findings, and echocardiographic findings. Methods Complete ophthalmologic examination and echocardiography were performed in 36 patients with KD during the acute phase before starting the treatment. Clinical manifestations and laboratory data including white blood cell (WBC) count, neutrophil-to-lymphocyte ratio, platelet count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were obtained from all the patients. All the clinical and laboratory findings were compared between the group with ocular involvement and the one without ocular involvement. Results The incidence of bilateral non-exudative conjunctivitis was 63.9%. It was significantly higher in patients with skin rashes (P 0.05). Conclusion In children with Kawasaki disease, uveitis is associated with coronary artery dilatation, higher neutrophil count, and higher CRP level.

Metamaterial perfect absorbers (MPAs) with dynamic thermal tuning features are able to control the absorption performance of the resonances, providing diverse applications spanning from optical switches and filters to modulators. In this paper, we propose an MPA with diverse functionalities enabled by vanadium dioxide (VO2) embedded in a metal-dielectric plasmonic structure. For the initial design purpose, a silicon (Si) nanograting on a silver (Ag) mirror is proposed to have multiple resonant responses in the near infrared (NIR) region. Then, the insertion of a thin VO2 layer at the right position enables the design to act as an on/off switch and resonance tuner. In the insulator phase of VO2, in which the permittivity data of VO2 is similar to that of Si, a double strong resonant behavior is achieved within the NIR region. By increasing the temperature, the state of VO2 transforms from insulator to metallic so that the absorption bands turn into three distinct resonant peaks with close spectral positions. Upon this transformation, a new resonance emerges and the existing resonance features experience blue/red shifts in the spectral domain. The superposition of these peaks makes the overall absorption bandwidth broad. Although Si has a small thermo-optic coefficient, owing to strong light confinement in the ultrasmall gaps, a substantial tuning can be achieved within the Si nanogratings. Therefore, the proposed hybrid design can provide multi-resonance tunable features to cover a broad range and can be a promising strategy for the design of linearly thermal-tunable and broadband MPAs. Owing to the proposed double tuning feature, the resonance wavelengths exhibits great sensitivity to temperature, covering a broad wavelength range $$.$$ Overall, the proposed design strategy demonstrates diverse functionalities enabled by the integration of a thin VO2 layer with plasmonic absorbers.