Search

This paper presents a significant advancement in the understanding of tsunamigenic landslide hazard across the length of the Makassar Strait in Indonesia. We use statistical emulation across the length of the continental slope to conduct a probabilistic assessment of tsunami hazard on a regional scale, across 14 virtual coastal gauges. Focusing on the potential maximum wave amplitudes (distance between the wave crest and the still‐water level) from possible tsunamigenic landslide events, we generate predictions from Gaussian Process emulators fitted to input‐outputs from 50 training scenarios. We show that the most probable maximum wave amplitudes in the majority of gauges are between 1 and 5 m, with the maximum predicted amplitudes reaching values of up to 10 m on the eastern coast, and up to 50 m on the western coast. We also explore the potential use of Gaussian multivariate copulas to sample emulator prediction input values to create a more realistic distribution of volumes along the continental slope. The novel use of statistical emulation across a whole slope enables the probabilistic assessment of tsunami hazard due to landslides on a regional scale. This area is of key interest to Indonesia since the new capital will be established in the East Kalimantan region on the western side of the Makassar Strait. Plain Language Summary: This work is the first to use statistical models to conduct a landslide‐generated tsunami hazard assessment for the whole of the Makassar Strait in Indonesia. From 50 simulated landslide‐tsunami scenarios, we fit statistical models (known as emulators) to then predict the likelihood and maximum wave height of potential tsunami waves in 14 different locations along the Makassar continental slope. These predictions show that the most likely wave heights were between 1 and 5 m, with the highest predicted waves reaching up to 10 m on the eastern coast and up to 50 m on the western coast. The results of this study are particularly important because Indonesia has announced the relocation of its new capital city to the western side of the Makassar Strait, within the study area. Key Points: This is the first use of emulation for tsunamigenic landslide hazard assessment worldwide integrating both uncertain location and sizeThis is the first tsunamigenic landslide hazard assessment for the whole Makassar Strait regionProbable tsunami wave amplitudes reach up to 50 m on the West coast and around 14 m where the Indonesian capital will be relocated [ABSTRACT FROM AUTHOR]

The analyses of cores retrieved from three sites near Port Blair (South Andaman) revealed out-of-sequence deposits at various depths. They are identified as previous episodes of tsunami by their sediment characteristics and microfossil content, using the 2004 event deposition as a template. These deposits have median ages of 601 cal. yr BP, 837 cal. yr BP, 1440 cal. yr BP, 3018 cal. yr BP, 3591 cal. yr BP, 4712 cal. yr BP, 5607 cal. yr BP, and 6357 cal. yr BP and are chronologically equivalent of those from the far-field locations in the Indian Ocean region. The distant deposits that are correlated with the South Andaman sites most likely owe their origin to the 2004-type events, as indicated by tsunami simulations in the study region. The long-term record presented here is characterized by an early phase of a quasiperiodic recurrence regime that transitions into a distinct interval of temporally clustered events. The quasiperiodic regime that appears around the mid-Holocene with an inter-event interval of 980 ± 385 years is followed by a sizable quiescent period of 1605 ± 245 years, before being succeeded by a regime of temporally clustered events. The chronology of nine tsunami events in the last 6500 years from the Indian Ocean region, thus implies a nonlinear pattern for the causative earthquakes. As demonstrated in the subduction zones elsewhere, the temporal variability of tsunamigenic great earthquakes is supported by the theoretical models espousing the characteristics of long-term stress recycling processes active within the subduction zones and transfer processes between the lower viscoelastic layer and the upper seismogenic crust. • Provides a 6500-year sedimentary record from the South Andaman • The results are compared with the paleo-tsunamis records from elsewhere in the Indian Ocean coasts • Repeated tsunami patterns are categorized by clustered cycles separated by quiescence intervals • Non-linear temporal regimes of mega events can be used as a baseline inputs for theoretical models [ABSTRACT FROM AUTHOR]

Modeling typhoon-induced storm surges requires 10-m wind and sea level pressure fields as forcings, commonly obtained using parametric models or a fully dynamical simulation by numerical weather prediction (NWP) models. The parametric models are generally less accurate than the full-physics models of the NWP, but they are often preferred owing to their computational efficiency facilitating rapid uncertainty quantification. Here, we propose using a deep learning method based on generative adversarial networks (GAN) to translate the parametric model outputs into a more realistic atmospheric forcings structure resembling the NWP model results. Additionally, we introduce lead-lag parameters to incorporate a forecasting feature in our model. Thirty-four historical typhoon events from 1981 to 2012 are selected to train the GAN, followed by storm surge simulations for the four most recent events. The proposed method efficiently transforms the parametric model into realistic forcing fields by a standard desktop computer within a few seconds. The results show that the storm surge model accuracy with forcings generated by GAN is comparable to that of the NWP model and outperforms the parametric model. Our novel GAN model offers an alternative for rapid storm forecasting and can potentially combine varied data, such as those from satellite images, to improve the forecasts further. [ABSTRACT FROM AUTHOR]

Tsunami hazard imposed by possible rupture of splay faults is important as it may significantly intensify tsunami heights locally. The Makran Subduction Zone (MSZ) in the northwestern Indian Ocean can generate large thrust earthquakes that could trigger significant tsunamis. In this paper, the effects of possible rupture of splay faults on the tsunami hazards of eastern MSZ are studied by developing a framework that uses stochastic earthquake rupture models and considers uncertainties related to rupture location, rupture geometry, seismic moment split ratio, earthquake slip asperity location within a fault plane, and earthquake slip heterogeneity. To quantify these uncertainties, 484 different parameter combinations of tsunami sources are considered systematically. The geometry of splay faults is developed using the most recent marine seismic surveys of the tectonic structure of the MSZ. A moment magnitude of 8.6 is considered as a scenario magnitude. The results of this study are generated in two parts, by considering average sources and stochastic sources. Results show significant local amplification of the maximum tsunami heights due to splay faults. For instance, the maximum wave height in Pasni, Pakistan can be amplified by a factor of four due to a single splay fault rupture scenario of average sources. [ABSTRACT FROM AUTHOR]

One-minute and five-minute Apgar scores are good measures to assess the health status of newborns. A five-minute Apgar score can predict the risk of some disorders such as asphyxia, encephalopathy, cerebral palsy and ADHD. The early prediction of Apgar score before or during birth and ranking the risk factors can be helpful to manage and reduce the probability of birth producing low Apgar scores. Therefore, the main aim of this study is the early prediction of the neonate 5-min Apgar score before or during birth and ranking the risk factors for a big national dataset using big data analytics methods. In this study, a big dataset including 60 features describing birth cases registered in Iranian maternal and neonatal (IMAN) registry from 1 April 2016 to 1 January 2017 is collected. A distributed big data analytics method for the early prediction of neonate Apgar score and a distributed big data feature ranking method for ranking the predictors of neonate Apgar score are proposed in this study. The main aim of this study is to provide the ability to predict birth cases with low Apgar scores by analyzing the features that describe prenatal properties before or during birth. The top 14 features were identified in this study and used for training the classifiers. Our proposed stack ensemble outperforms the compared classifiers with an accuracy of 99.37 ± 1.06, precision of 99.37 ± 1.06, recall of 99.50 ± 0.61 and F-score of 99.41 ± 0.70 (for confidence interval of 95%) to predict low, moderate and high 5-min Apgar scores. Among the top predictors, fetal height around the baby's head and fetal weight denote fetal growth status. Fetal growth restrictions can lead to low or moderate 5-min Apgar score. Moreover, hospital type and medical science university are healthcare system-related factors that can be managed via improving the quality of healthcare services all over the country. [ABSTRACT FROM AUTHOR]

Background: Neonatal mortality accounts for more than 47% of deaths among children under five globally but proper care at and around the time of birth could prevent about two-thirds of these deaths. The Every Newborn Action Plan (ENAP) offers a plan and vision to improve and achieve equitable and high-quality care for mothers and newborns. We applied the bottleneck analysis tool offered by ENAP to identify obstacles and bottlenecks hindering the scale-up of newborn care across seven health system building blocks.Methods: We applied the every newborn bottleneck analysis tool to identify obstacles hindering the scale-up of newborn care across seven health system building blocks. We used qualitative methods to collect data from five medical universities and their corresponding hospitals in three provinces. We also interviewed other national experts, key informants, and stakeholders in neonatal care. In addition, we reviewed and qualitatively analyzed the performance report of neonatal care and services from 16 medical universities around the country.Results: We identified many challenges and bottlenecks in the scale-up of newborn care in Iran. The major obstacles included but were not limited to the lack of a single leading and governing entity for newborn care, insufficient financial resources for neonatal care services, insufficient number of skilled health professionals, and inadequate patient transfer.Conclusions: To address identified bottlenecks in neonatal health care in Iran, some of our recommendations were as follows: establishing a single national authorizing and leading entity, allocating specific budget to newborn care, matching high-quality neonatal health care providers to the needs of all urban and rural areas, maintaining clear policies on the distribution of NICUs to minimize the need for patient transfer, and using the available and reliable private sector NICU ambulances for safe patient transfer. [ABSTRACT FROM AUTHOR]

The article discusses the implementation improvement of the cost-effective kangaroo mother care intervention for reducing mortality and morbidity in preterm infants in 2021. Topics covered include its skin-to-skin upright position infant care on a caregiver's chest, and practices of breastfeeding support and timely hospital discharge and follow-up. Also noted is the importance of a mother kangaroo care policy and its inclusion in a country's health system for it to be widely adopted.

Background: Iran's fee-for-service (FFS) payment model in neonatal intensive care units (NICUs) is contentious due to the involvement of multiple stakeholders with differing interests, leading to increased costs, fragmentation, and reduced quality of care. This study explores the experiences and challenges of stakeholders with the NICU payment system and considers alternative payment methods., Method: A qualitative research approach was used, involving key informant interviews with stakeholders at various levels of the health system. Data were collected between March 2022 to September 2023 using a purposive sampling method with a snowball strategy. The transcribed data were analyzed using an inductive thematic approach in MAXQDA, with themes and sub-themes emerged and assessed by two independent coders. Four trustworthiness criteria were applied to ensure the quality of the results., Results: The study involved 23 participants with diverse NICU payment backgrounds, identifying issues related to service accessibility, rising costs, neonatologists' income, and service quality. Stakeholders held differing views on the best payment model: health insurance executives favored a prospective payment method, faculty members favored supported modified FFS or per diem, and neonatal specialists expressed concerns about low tariffs and delayed payments., Conclusion: Iran's NICU payment system is unsatisfactory and requires urgent reform. Although stakeholders disagree on the best approach, reforms must be evidence-based and collaborative, addressing structural and cultural issues within the health system. The identification of an optimal payment system is essential for supporting neonatal care, benefiting newborns, families, society, and the broader health system., (© 2024. The Author(s).)

Background: Maintaining and improving infant health and continuing care at home are very important for the health system. According to the coronavirus disease 2019 (COVID-19) pandemic and its effects on the health system capacity and medical staff's physical-mental health, this study investigated the health staff's attitude on the implementation of an infant home care plan., Materials and Methods: This descriptive-analytical cross-sectional study was conducted on 130 nurses, midwives, and doctors working in the newborn care department in Isfahan health-therapeutic centers, with at least 6 months of work experience. The samples were selected by random multistage method and completed the researcher-made 5-point Likert questionnaire with 25 items and two areas of education support and security safety. The total score of this questionnaire varied from 25 to 125, and obtaining a score equal to or greater than 91 meant that people had a favorable opinion about home care for babies. The reliability of the questionnaire was reported by Cronbach's α of 0.79, and content validity ratio (CVR) and content validity index (CVI) scores of 0.88-0.99 and 0.79-0.1, respectively. Data analysis was performed using the Statistical Package for the Social Sciences version 18.0 (SPSS) (Chicago, USA) and analysis of descriptive statistics, Chi-square, and Pearson correlation tests at a 0.05 significance level., Results: The mean score of medical staff's attitude was obtained at 77.59 ± 11.71 and the security-safety and education-support domains scores were 41.3 ± 6.34 and 36.29 ± 6.11, respectively. In addition, a significant inverted relationship was observed between the mean score of medical staffs"attitude with age and the number of shifts., Conclusion: According to the results, the medical staff's attitude about the infant home care program is neutral, and designing a professional educational period, considering economic preparations and responsibility assurance is essential for creating confidence and acceptance of the infant home care program by the medical staff., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Education and Health Promotion.)

Background: Neonatal mortality remains a critical global challenge, with preventable instances prevailing. The initial stride in mitigating neonatal mortality involves elucidating its underlying causes., Methods: This study utilized an umbrella review approach to discern factors associated with neonatal mortality. Five international databases, namely Pub Med, Web of Science, Scopus, CINAHL, and EMBASE, were meticulously searched to achieve this., Results: The initial search yielded 12,631 articles using a search strategy centered on keywords related to factors contributing to neonatal mortality. Ultimately, 95 articles met the criteria incorporated into this study., Conclusion: This study endeavors to identify the primary risk factors contributing to neonatal mortality. The discerned risk factors have been systematically categorized into four groups: maternal factors, neonatal factors, aspects linked to healthcare systems, and socio-economic factors. As such, it is imperative for policymakers to take heed of these identified risk factors and formulate comprehensive strategies encompassing both long-term and short-term initiatives. Effective interventions spanning various sectors are crucial for the prevention of neonatal mortality., (Copyright© 2024 Amini et al. Published by Tehran University of Medical Sciences.)

Objective: The coronavirus disease 2019 (COVID-19) pandemic had a significant impact on pregnant women and neonates in Iran. This retrospective study describes the national experience among neonates having suspected and confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection following hospital admission to examine the epidemiology, demographic, and clinical features., Study Design: All nationwide cases of suspected and confirmed neonatal SARS-CoV-2 infection were drawn from the Iranian Maternal and Neonatal Network (IMaN) between February 2020 and February 2021. IMaN registers demographic, maternal, and neonatal health data throughout Iran. Statistical analysis of demographic, epidemiological, and clinical data were performed., Results: There were 4,015 liveborn neonates having suspected or confirmed SARS-CoV-2 infection that fulfilled the study inclusion criteria identified in the IMaN registry from 187 hospitals throughout Iran. There were 1,392 (34.6%) neonates that were preterm, including 304 (7.6%) less than 32 weeks' gestation. Among the 2,567 newborns admitted to the hospital immediately after birth, the most common clinical problems were respiratory distress (1,095 cases; 42.6%), sepsis-like syndrome (355; 13.8%), and cyanosis (300 cases; 11.6%). Of 683 neonates transferred from another hospital, the most frequent problems were respiratory distress (388; 56.8%), sepsis-like syndrome (152; 22.2%), and cyanosis (134; 19.6%). Among 765 neonates discharged home after birth and subsequently admitted to the hospital, sepsis-like syndrome (244 cases; 31.8%), fever (210; 27.4%), and respiratory distress (185; 24.1%) were most frequent. A total of 2,331 (58%) of neonates required respiratory care, with 2,044 surviving and 287 having a neonatal death. Approximately 55% of surviving neonates received respiratory support, compared with 97% of neonates who expired. Laboratory abnormalities included elevations of white blood cell count, creatine phosphokinase, liver enzymes, and C-reactive protein., Conclusion: This report adds the national experience of Iran to the list of reports from multiple countries describing their experience with COVID-19 in neonates, demonstrating that newborns are not exempt from COVID-19-morbidity and mortality., Key Points: · Most common clinical problem was respiratory distress.. · Sepsis-like syndrome was also frequently present.. · A total of 58% of all neonates required respiratory care.., Competing Interests: None declared., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: The neonatal mortality rate is a main indicator of the health and development of a country. Having insight into the cause of neonatal deaths may be the first step to reducing it. This paper depicts the cause of newborn deaths in Iran., Methods: This cross-sectional study was performed on data from the national Iranian Maternal And Neonatal network to investigate all neonatal deaths in the country during the year 2019. The cause of death data were reported according to categories of birth weight, gestational age (GA), death time and place., Results: The main causes of the 9959 neonatal deaths during the study period were respiratory distress syndrome (RDS) (37%), malformation (21%), prematurity of <26 weeks (20%), others (12%), asphyxia (7%) and infection (3%). The major causes of neonatal mortality in delivery rooms were prematurity of <26 weeks and in the inpatient wards the RDS. By increasing the GA and birth weight towards term babies, the rate of RDS gets lower, while that of malformation gets higher., Conclusions: RDS was the main cause of neonatal mortality in Iran which is seen mainly in preterm babies. Prematurity of <26 weeks was another main cause. Thus, suggestions include reducing prematurity by preconception and pregnancy care and, on the other hand, improving the care of preterm infants in delivery rooms and inpatient wards., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: For a long time, molding was one of the most important methods of producing metal, ceramic, and polymer materials. The two essential factors in this method were always cost and time. Technology advancements have made it possible to design in 3D using a computer and additive manufacturing. This article covers methods for using 3D printers to save time and money in the process of creating the final product. The "Prong" molds for premature neonatal respiratory aid were designed and produced based on neonatologists' considerations., Methods: The study was conducted on fifteen very low birth neonates at Alzahra Hospital in Tabriz University from September 2017 to September 2019. In the first section, we described dental plaster material for molding. When using this material, the printing material must be selected and the parameters, like melting temperature and printer speed, must be controlled to achieve acceptable quality for the final sample. CAD software can be used to print various objects if the final 3D design is appropriate., Results: We used additive manufacturing technology to create a new design and successfully resolved bubble issues at a low cost through a combination of creativity and experimentation. The new mold has cavities that allow the silicon to occupy the entire space and escape any bubbles., Conclusion: The use of 3D printers allows us to achieve the best design for the prong mold while reducing both production costs and time. The ultimate mold made of aluminum was finally produced by the CNC machine. The final product was tested at Al-Zahra Hospital in Tabriz, Iran, and the results were satisfactory, with no reports of necrosis on the babies' noses., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Aim: Neonatal mortality (NM) is a significant global challenge that has a profound impact on families, particularly mothers. To address this challenge, the first step is to identify its underlying causes. Accordingly, this study aimed to explore the phenomenon by consulting with stakeholders, including mothers and experts., Study Design: This study utilized a qualitative design, conducting in-depth interviews with 16 mothers and 15 healthcare experts to gather information. A conventional content analysis approach was employed to analyze the data., Results: NM is influenced by personal, systemic, and socioeconomic factors. Personal factors can be further divided into those related to the neonate and those related to the mother. Systemic factors are primarily related to the healthcare system, while socioeconomic factors include low literacy, low income, lack of access to healthcare, and consanguineous marriage., Conclusion: NM is influenced by a wide range of factors that require separate and targeted interventions to reduce its incidence. In the short term, priority should be given to preventable factors that can be addressed through simple interventions, such as screening mothers for urinary tract infections, educating mothers, and preparing them for pregnancy with necessary lab tests and supplements. In the long term, preventing premature birth, addressing maternal addiction, family poverty, and shortages in healthcare equipment and personnel must be thoroughly addressed., (© 2023 John Wiley & Sons Ltd.)

Background: The main role of nurses is not only to inform about the disease and treatment of the patient but also to establish an effective therapeutic relationship to address concerns and provide empathy, comfort, and support. This issue is very prominent in neonatal intensive care units (NICUs) and doubles the importance of empathetic communication between nurses and parents and promoting empathy skills in nurses working in neonatal intensive care units., Aim: This study aimed to evaluate the effect of a support program on the empathy of neonatal intensive care nurses across the Iran., Methods: This study was conducted in 2021 as a semi-experimental intervention in a group of 166 nurses working in the neonatal department all over Iran who met the inclusion criteria. Jefferson's empathy questionnaire was completed electronically by the participants before and after the online education program start. Data were analyzed using SPSS software (V 24.0)., Results: The empathy score of nurses was 60.31 ± 5.76 before and 66.47 ±6.60 after the intervention. The empathy scores of nurses after the intervention increased statistically significantly., Conclusion: Nurses can communicate empathically with parents by training their verbal and nonverbal communication skills and gaining a common understanding of the feelings of parents of premature infants., (© 2023 Mohammad H., et al.)

Objective: To examine the prevalence of novel newborn types among 165 million live births in 23 countries from 2000 to 2021., Design: Population-based, multi-country analysis., Setting: National data systems in 23 middle- and high-income countries., Population: Liveborn infants., Methods: Country teams with high-quality data were invited to be part of the Vulnerable Newborn Measurement Collaboration. We classified live births by six newborn types based on gestational age information (preterm <37 weeks versus term ≥37 weeks) and size for gestational age defined as small (SGA, <10th centile), appropriate (10th-90th centiles), or large (LGA, >90th centile) for gestational age, according to INTERGROWTH-21st standards. We considered small newborn types of any combination of preterm or SGA, and term + LGA was considered large. Time trends were analysed using 3-year moving averages for small and large types., Main Outcome Measures: Prevalence of six newborn types., Results: We analysed 165 017 419 live births and the median prevalence of small types was 11.7% - highest in Malaysia (26%) and Qatar (15.7%). Overall, 18.1% of newborns were large (term + LGA) and was highest in Estonia 28.8% and Denmark 25.9%. Time trends of small and large infants were relatively stable in most countries., Conclusions: The distribution of newborn types varies across the 23 middle- and high-income countries. Small newborn types were highest in west Asian countries and large types were highest in Europe. To better understand the global patterns of these novel newborn types, more information is needed, especially from low- and middle-income countries., (© 2023 The Authors. BJOG: An International Journal of Obstetrics and Gynaecology published by John Wiley & Sons Ltd.)

Background: More attention is paid to the survival and treatment of the sick infant in the neonatal intensive care unit (NICU) and parental stress is not considered. The purpose of this study was to determine samples of the level of parental stress in the NICU., Method: This study is a descriptive-analytical study in which Parental Stress and General Health were used in an analytical national survey in Iran. The research sample consists of 2456 parents of infants admitted to NICU. The sampling method was multi-stage random. We used 11- item parental stress questionnaire and 28-item general health questionnaire for the data collection., Result: Baloch ethnicity with an average of 11.52 had the highest level of stress. The mean stress score of mothers was higher than fathers. The mean score of all dimensions of physical symptoms, anxiety, social functioning, depression, and total mental health score in mothers was higher than fathers. There was a statistically significant difference in the length of hospitalization in terms of different levels of parental stress scores (p < 0.002). Lack of decisive response to parents was one of the most stressful issues (8.1%)., Conclusion: Our result shows mothers' stress was higher than fathers. So that health policymakers should pay attention to stress risk factors to provide appropriate interventions according stress risk factors Future studies should design appropriate interventions to reduce parental stress, especially in high-risk mothers., (© 2023. The Author(s).)

Background: Pregnant women are one of the most vulnerable groups in the Covid-19 pandemic. Due to the lack of knowledge about fetal and perinatal complications following Covid-19 infection, the association of Covid-19 pandemic and congenital anomalies in babies conceived and born during this pandemic is unclear. Current study aimed to investigate the association between the Covid-19 pandemic and congenital birth anomalies in Iran. The population of newborns whose embryonic period coincided with the Covid-19 crises were compared with a similar group born during the pre-Covid-19 period., Methods: This is a retrospective comparative analysis of congenital birth anomalies in Iran; desired data was extracted from national birth registry database. All registered congenital anomalies in hospital births were compared between two time periods: During Covid-19 (1st November 2020- 28th February 2021) and Before Covid-19 (1st November 2019-29th February 2020). Incidence of congenital anomalies at birth were compared and analyzed between these two time periods., Results: The incidence of congenital birth anomalies are significantly increased during Covid-19 pandemic compared with before Covid-19 (P value < 0.00001). The number of all types of anomalies has increased in the current pandemic, but the congenital anomalies of the central nervous system (P value = 0.04) and Genitourinary (P value = 0.03) have a larger contribution than before., Conclusion: Covid-19 pandemic are associated with congenital anomalies at birth. There are several factors in the Covid-19 pandemic which can affect fetal development in the first trimester of pregnancy. Possible reasons include vertical transmission of Covid-19 infection; maternal fever, stress and anxiety; insufficient preconception and prenatal care; neglect of fetal screening; and poverty imposed by this pandemic., (© 2022. The Author(s).)

Objective: The aim of this study was to examine parents' and healthcare professionals' experiences and perceptions of parental readiness for resuscitation of their child in a paediatric hospital., Design: This exploratory descriptive qualitative study used content analysis. Participants shared their experiences and perceptions about parental readiness for cardiopulmonary resuscitation through semi-structured and in-depth interviews. MAXQDA 2020 software was also used for data analysis., Setting: The setting was two large teaching paediatric hospitals in Iran (Este Azerbaijan and Mashhad)., Participants: Participants were 10 parents and 13 paediatric healthcare professionals (8 nurses and 5 physicians). Selection criteria were: (a) parents who experienced their child's resuscitation crisis at least 3 months prior and (b) nurses and physicians who were working in emergency rooms or intensive care wards with at least 2 years of experience on the resuscitation team., Results: Participants shared their experiences about parental readiness for resuscitation of their child in four categories: awareness (acceptance of resuscitation and its consequences; providing information about the child's current condition and prognosis), chaos in providing information (defect of responsibility in informing; provide selective protection of information; hardness in obtaining information), providing situational information (honest information on the border of hope and hopeless; providing information with apathy; providing information as individual; dualism in blaming; assurance to parents; presence of parents to better understand the child's situation) and psychological and spiritual requirements (reliance on supernatural power; need for access to a psychologist; sharing emotions; collecting mementos)., Conclusion: The results of this study provide insight on the needs of parents and strategies to use to prepare them for their child's resuscitation crisis, which can be used to enhance family centred care practices in paediatric acute care settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: CNS injury in preterm infants is still one of the leading causes of mortality and morbidity. Routine care events might affect the perfusion and cerebral oxygenation of preterm infants. Although positioning the infant's head in a particular condition to improve brain oxygenation is included in many institutions, there is no robust clinical evidence to support this intervention's effectiveness., Objective: The present study aimed to determine the effect of head positioning on brain tissue oxygenation in preterm infants., Methods: This study is a randomized clinical trial. In the first 48 h after birth, 39 infants who met the study inclusion criteria underwent head positioning intervention. In this case, the infants were placed in the supine position, and every 2 h, the head position was changed continuously to one of six randomized modes [using random modes generated by SPSS]. During each head positioning, brain tissue oxygenation was recorded by NIRS., Results: The findings showed a significant difference in brain tissue oxygen saturation among these positions (P < 0.001). Dunn's test showed that the brain tissue oxygen saturation in the third position (head rotates 45-60 degrees from the midline to the right and the head of the bed is zero degrees) was significantly lower than the baseline (P = 0.029; Mean difference = 2.3). Also, in the third position, compared to the first position (P = 0.002; Mean difference = 1.9) and compared to the fourth position (P = 0.003; Mean difference = -2.1), and in the second position compared to the first position (P = 0.046; Mean difference = 1.3), the brain tissue oxygen saturation of the infants was lower., Conclusion: Based on the results of the present study, head positioning was effective on brain tissue oxygenation in preterm infants in the first 48 h after birth; Therefore, it is recommended when possible, not to rotate the infant's head during the first 48 h after birth while the head of the bed is at 0°., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background: The rise of Cesarean Sections (CS) is a global concern. In Iran, the rate of CS increased from 40.7% in 2005 to 53% in 2014. This figure is even higher in the private sector., Objective: To analyze the CS rates in the last 2 years using the Robson Classification System in Iran., Methods: A retrospective analysis of all in-hospital electronically recorded deliveries in Iran was conducted using the Robson classification. Comparisons were made in terms of the type of hospital, CS rate, and obstetric population, and contributions of each group to the overall cesarean deliveries were reported., Results: Two million three hundred twenty-two thousand five hundred women gave birth, 53.6% delivered through CS. Robson group 5 was the largest contributing group to the overall number of cesarean deliveries (47.1%) at a CS rate of 98.4%. Group 2 and 1 ranked the second and third largest contributing groups to overall CSs (20.6 and 10.8%, respectively). The latter groups had CS rates much higher than the WHO recommendation of 67.2 and 33.1%, respectively. "Fetal Distress" and "Undefined Indications" were the most common reasons for cesarean deliveries at CS rates of 13.6 and 13.4%, respectively. There was a significant variation in CS rate among the three types of hospitals for Robson groups 1, 2, 3, 4, and 10., Conclusion: The study revealed significant variations in CS rate by hospital peer-group, especially for the private maternity units, suggesting the need for further attention and audit of the Robson groups that significantly influence the overall CS rate. The study results will help policymakers identify effective strategies to reduce the CS rate in Iran, providing appropriate benchmarking to compare obstetric care with other countries that have better maternal and perinatal outcomes., (© 2022. The Author(s).)

Objectives: Access to maternal and neonatal care services (MNCS) is an important goal of health policy in developing countries. In this study, we proposed a 3-level hierarchical location-allocation model to maximize the coverage of MNCS providers in Iran., Methods: First, the necessary criteria for designing an MNCS network were explored. Birth data, including gestational age and birth weight, were collected from the data bank of the Iranian Maternal and Neonatal Network national registry based on 3 service levels (I, II, and III). Vehicular travel times between the points of demand and MNCS providers were considered. Alternative MNCS were mapped in some cities to reduce access difficulties., Results: It was found that 130, 121, and 86 MNCS providers were needed to respond to level I, II, and III demands, respectively, in 373 cities. Service level III was not available in 39 cities within the determined travel time, which led to an increased average travel time of 173 minutes to the nearest MNCS provider., Conclusions: This study revealed inequalities in the distribution of MNCS providers. Management of the distribution of MNCS providers can be used to enhance spatial access to health services and reduce the risk of neonatal mortality and morbidity. This method may provide a sustainable healthcare solution at the policy and decision-making level for regional, or even universal, healthcare networks.

In this paper, statistical emulation is shown to be an essential tool for the end-to-end physical and numerical modelling of local tsunami impact, i.e. from the earthquake source to tsunami velocities and heights. In order to surmount the prohibitive computational cost of running a large number of simulations, the emulator, constructed using 300 training simulations from a validated tsunami code, yields 1 million predictions. This constitutes a record for any realistic tsunami code to date, and is a leap in tsunami science since high risk but low probability hazard thresholds can be quantified. For illustrating the efficacy of emulation, we map probabilistic representations of maximum tsunami velocities and heights at around 200 locations about Karachi port. The 1 million predictions comprehensively sweep through a range of possible future tsunamis originating from the Makran Subduction Zone (MSZ). We rigorously model each step in the tsunami life cycle: first use of the three-dimensional subduction geometry Slab2 in MSZ, most refined fault segmentation in MSZ, first sediment enhancements of seabed deformation (up to 60% locally) and bespoke unstructured meshing algorithm. Owing to the synthesis of emulation and meticulous numerical modelling, we also discover substantial local variations of currents and heights., (© 2021 The Authors.)

A lack of understanding about the effect of microorganism inoculation on compost production and relatively expensive downstream processing are the main obstacles towards an economic compost production. Our work tries to fill this gap. For this, influence of inoculation on the composting of organic fraction of municipal solid waste (OFMSW) to produce compost with higher agronomic value was evaluated. Three similar aerated bioreactors (A, B and C) with the same size and shape in laboratory scale designed. Reactor A was inoculated with the Aspergillus niger IBRC-M 30095, reactor B was inoculated with old compost and reactor C was used as a control. During the composting process temperature, moisture, pH, and electrical conductivity (EC) were evaluated. Also, the ratio of carbon to nitrogen (C/N) and germination index (GI) were measured in during process to evaluate compost maturity. The results of this study showed that the C/Ns decreased to about 63.37%, 59.6% and 46% for bioreactors B, A and control, respectively. Also maximum GI and temperature reached to about 138% and 59 °C in reactor B. Furthermore, our results showed that inoculation with this microorganism reduces process time to 18 days that is better than the results of other researchers and thus results in cost savings. However, we think, Aspergillus niger is appropriate candidate for compost production as a model. Graphical abstractSchematic diagram of experimental reactors: Reactor A was inoculated with the Aspergillus Niger IBRC-M 30095, reactor B was inoculated with old compost and reactor C used as a control without inoculation; (1) composting tank; (2) air compressor; (3) gas flow meter; (4) air regulator; (5) thermal probe; (6) exhausted gas; (7) mixer; (8) effluent; (9) moisture content probe; (10) sampling; (11) electric motor; (12) pump., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest.

Background and Aims: Newborn death is an unexpected outcome for parents. Parents face with several needs in infant end-of-life. The health care team is responsible for meet these needs. This qualitative study aim was to explore of parental needs in infant end-of-life and bereavement., Materials and Methods: For this qualitative study, 24 single semi-structure interviews were done. A qualitative content analysis method was used. Sampling conducted on purposeful with maximum variation in five Neonatal Intensive Care Unit (NICU) environments in Isfahan city. Inclusion criteria for nurses and doctors were having at least one experience of caring for an infant and their family at end-of-life. Inclusion criteria for parents and their families were having at least one infant at end-of-life or had lost their infant for 6 months before in NICU., Results: Data analysis uncovered two main themes. Family's support needs with two subthemes (family's support needs before infant's death and family's support needs after infant's death) and family's preparatory needs upon infant's death with two subthemes (management of the bad news of infant's death by treatment team and management of the bad news of infant's death by family)., Discussion: Mourning mother's need for her husband's presence by her side, getting hospitalized in a separate room, and management of infant's death news by father and family were among items rarely pointed out in other studies. Exploration of these needs cab be helpful for the health care team for providing care.

Background: Early childhood development is one of the most social determinants of health that must be notified in order to reducing social gap and inequity. In spite of increasingly developing intensive neonatal care wards and decreasing neonatal mortality rate, there is no follow-up surveillance system to identify high-risk infants (HRI) and their health problems for timely intervention after discharge. This study was carried out to design and pilot high-risk infant follow-ups (HRIFs) surveillance system, in Alzahra Hospital, a tertiary level center of Tabriz University of Medical Sciences (TUOMS), in 2012-2013., Methods: In this qualitative research after studying international documents, consensus about criteria of HRIs accomplished by focus group discussion. Then, Delphi agreement technique was used to finalizing assessment timetable. In the second phase, we piloted the designed surveillance system in Alzahra Hospital, a tertiary level center of TUOMS. Pilot study was implemented by follow-up team organized in designed model at the first phase of the study. Then, the findings of the pilot study were being assessed by an expert panel. If the members agreed on made decisions, they were being placed on the agenda of the national committee of development care of newborns for final approval., Results: High-risk infants follow-up surveillance system was designed in following steps: Defining of evidence-based criteria of HRIs, organizing the follow-up team, regulating the organs and neurodevelopment assessment timetable, publishing a health certificate notebook for HRIs, and designing Access database software for data collection, report and evaluation., Conclusions: We designed and piloted HRIFs surveillance system, so this system was institutionalized in Alzahra Hospital, finally. It can be prepared to apply in the whole country, after detecting the quantitative outcomes and developing the program in East Azarbijan.

Introduction: This study was aimed to reach expert's expectations of neonatal transport system for developing neonatal transport system in Iran., Materials and Methods: This is a qualitative study conducted by using focus group discussion (FGD) to present expert's perspectives and expectancy about neonatal transport system. Participants was selected from all experts and specialist about neonatal transport in Iran countryside. Finally 48 experts, participate in this study. To data collection 4 FGD were conducted, data were analyzed by content analyses. All subthemes were categorized in main themes according to conceptual relationship as an expert panels opinions. In order to comply with the ethical issues involved in the study was voluntary, also permission for the recording session were taken and confidentiality was also ensured., Result: According to FGD results, 11 themes and 90 subthemes were founded related to neonatal transport system, the main identified themes included: Aims, necessity and models of neonatal transport system, organizing the transport system, management and quality of instruments in the transport system, Neonatal transport system staff, Human resource management and issue related to human resources, conditions and requirements of neonatal transport system, facilitating factors in neonatal transport system, information management and communication system and weakness of neonatal transport system., Conclusion: Neonatal transport systems in different countries must adapted according to situation and component of each country have different strength and weakness and in implementing a system must attend to geographical conditions, financial ability and access to professionals, health system structure, facilities related to neonatal health care, antenatal services in regain, health care related, health care program about neonates and pregnant women and epidemiological status and mortality and morbidity in deferent locals and regains in countryside.