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Despite the recommendation for early diagnosis and rapid initiation of HIV treatment, more than half of patients are in an advanced stage of HIV disease in Iran. This study aimed to investigate the factors related to baseline CD4 cell count and advanced HIV disease (AHD) in Southern Iran. The study comprised all adults between 15 and 87 years of age who were newly diagnosed with HIV in Southern Iran. Linear and logistic regressions were used to identify baseline CD4 cell count predictors and AHD, respectively. A total of 820 (53.9%) HIV-infected individuals over 15 years of age were at the AHD stage. Based on the results of the multiple logistic regression, older age at diagnosis (OR≥40/<30 = 2.68, 95% CI = 1.38–5.19), gender (ORfemale/male = 0.62, 95% CI = 0.44–0.85), HIV/TB coinfection (ORyes/no = 1.98, 95% CI = 1.29–3.02), HIV/HBV coinfection (ORyes/no = 1.58, 95% CI = 1.07–2.38), and hemoglobin (OR = 0.89, 95% CI = 0.85–0.92) were directly associated with AHD in HIV/AIDS patients. As suggested by a linear regression model, factors including gender (B Female = 44.12, 95% CI:17.86, 70.38), older age (B ≥40 = −111.99, 95% CI:−174.70, −49.27), higher education level (B = 35.65, 95% CI:5.34, 65.97), WHO clinical stage (BIV = −254.53, 95% CI−298.82, −210.24), and hemoglobin (B = 5.23, 95% CI:0.25, 10.20) were significantly associated with CD4 count.The prevalence of AHD in patients was high in Iran. Our results suggested that several demographic and clinical factors are significantly associated with the baseline CD4 cell count and AHD. Targeted HIV testing, implementation of screening programs for early detection, and access to care services to assure early ART are recommended to improve the clinical status and quality of life of the patients. [ABSTRACT FROM AUTHOR]

Background: Unmeasured confounding is the primary obstacle to causal inference in observational research. We aimed to illuminate the association between exposure to influenza vaccination (IV) within six months before contracting the coronavirus disease (COVID-19) and COVID-19 hospitalization in relation to unmeasured confounding using the E-value method. Materials and Methods: Information about 367 patients, 103 of whom (28.07 %) had received IV, and confounders included sex, age, occupation, cigarette smoking, opium, and comorbidities were collected. We estimated the interest association using the inverse probability weighted (IPW) method. There was no information on some potential unmeasured confounders, such as socioeconomic status. Therefore, we computed E-value as a sensitivity analysis, which is the minimum strength of unmeasured confounding to explain away an exposure-outcome association beyond the measured confounders completely. Results: IPW denoted 1.12 (95% CI: 0.71 to 1.29) times greater risk of COVID-19 hospitalization in patients exposed to IV than in unexposed individuals. Sensitivity analysis demonstrated that an E-value (95% CI) of 1.49 (1.90 to 2.15) is required to shift the RR and the corresponding confidence Interval (CI) lower and upper limits toward the null. Moreover, if they had been omitted, the most computed E-values for measured confounders were relatively larger than for unmeasured confounders. Conclusion: According to the context of the measured confounders, if they had been omitted, an E-value of 1.16 to 1.76, a weaker confounding could fully explain away the reported association, suggesting that no relationship exists between IV and COVID-19 hospitalization. [ABSTRACT FROM AUTHOR]

Background and purpose: Lack of awareness of people about the future environmental risks posed by wastes is the most important problem of this sector. Awareness, and then cultural education in this area, can be a breakthrough to this significant environmental problem. This study aimed to assess the degree of awareness of the people of the cities of Gorgan, Gonbad, and Aliabad Katool (Iran) in relation to municipal solid waste management. Materials and methods: In this descriptive-periodic study in 2012, a questionnaire with a Cronbach's alpha of 0.78 was used. 550 questionnaires were completed: 200 in different areas of the city of Gorgan, 240 in different areas of the city of Gonbad, and 110 in different areas of the city of Aliabad Katool. Data were analyzed by SPSS software. Results: The awareness of the citizens in the studied cities in the area of waste-related diseases and the waste effect on the environment was satisfactory. The rate of citizens' awareness in the field of recycling and ways of reduction of household waste and the methods of waste disposal was above the average. The awareness in the area of existence of urban recycling organization and its duties was rated weak to average and in the area of compost, it was weak. The performance of citizens in the area of relation of people with urban materials recycling organization and regional municipality regarding solid waste materials was rated very weak to weak and in the area of source waste separation, the performance was rated average. Conclusion: Considering the results obtained, the information of people regarding compost production and existence of urban recycling organization and its duties was low and, it is necessary to provide certain educational programs for increasing public awareness. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Previous studies have estimated the risk of death associated with unemployment in the coronavirus disease 2019 (COVID-19) pandemic, but no studies have examined unemployment before COVID-19 infection as a risk factor for COVID-19-related mortality. Thus, this study aimed to investigate COVID-19 mortality among this population. METHODS: Data on 50,038 people aged 25-59 years were collected from 38 agencies in Fars Province, Iran, from February 2020 to July 2021. Follow-up lasted from participants' diagnosis with COVID-19 based on the results of a reverse transcription-polymerase chain reaction test to participants' death or the end of the study period. The association between unemployment and COVID-19-related mortality was estimated using the Poisson regression method, and a sensitivity analysis was conducted to calculate the E-value. RESULTS: Unemployment was associated with a 2.41-fold (95% confidence interval [CI], 2.01 to 2.90) higher age-adjusted and sex-adjusted risk of COVID-19-related mortality. The adjusted Poisson regression analysis showed 8.82 (95% CI, 6.42 to 12.11), 2.84 (95% CI, 1.90 to 4.24), and 1.58 (95% CI, 1.24 to 2.01) times higher risks of COVID-19-related mortality among unemployed people aged 25-39 years, 40-49 years, and 50-59 years, respectively, than among their employed counterparts. Unemployment increased the risk of COVID-19 mortality by 3.31 (95% CI, 2.31 to 4.74) and 2.30 (95% CI, 1.86 to 2.84) times in female and male, respectively. The E-value was 3.43, reflecting the minimum strength of confounding required to shift the association between unemployment and COVID-19-related mortality toward the null. CONCLUSIONS: Unemployment prior to COVID-19 infection increased the risk of COVID-19-related mortality. COVID-19-related mortality disproportionately impacted unemployed women and younger unemployed people. [ABSTRACT FROM AUTHOR]

In this paper, we introduce quasi-Bell states as a result of two-mode superposition of two "Near" coherent states, | α , δ θ ⟩ , shifted in phase by π and π 2 , where the latter introduced by Othman et al. as a new class of quantum states attached to the simple harmonic oscillator which generated via a Mach–Zehnder interferometer. To gain insight into useful attributes to quantum information theory, we present a general analysis of non-classical properties such as photon counting probability, photon statistics, squeezing effect and quantum polarization. We also derive the concurrence measure to quantify entanglement of these states and look for conditions that provide information on which these become maximally entangled. Comparing with some cases already discussed in the literature, we find that the phase angle δ θ plays an important role in non-classical effects. We also get a connection between entanglement and the polarization degree of the introduced states. [ABSTRACT FROM AUTHOR]

• Adding 1 percent of lignocellulosic fibers, as eco-friendly materials, can lead to high ultimate deviatoric stress (up to 67.25% increase) and low peak pore water pressure (up to 51.76% decrease) in one day-cured specimens. • Curing time improves soil strength, resilient modulus, secant modulus and energy absorption capacity of the reinforced specimens. • Effective cohesion is more influential in enhancing the soil strength than effective internal friction angle. • The improvement in soil strength of lignocellulosic fibers-reinforced sandy soil is the result of a physical process. Increasing environmental concerns and depleting non–renewable resources have prompted many researchers to evaluate the effectiveness of eco-friendly materials, such as lignocellulosic fibers, on the geotechnical properties of soils. In this research, the effects of fiber content (0.5, 1 and 2 percent by dry weight of soil), fiber length (0.5, 1 and 1.5 mm) and curing time (one and seven days) on the strength behavior of sandy soil reinforced with three types of randomly distributed lignocellulosic fiber pulps, namely soft woods bleached kraft pulp (S.B.), old corrugated containers (OCC) and high yield wheat straw soda pulp (W.S.) were investigated. To this end, a series of consolidated undrained (CU) triaxial compression tests were conducted. Furthermore, the environmental and microstructure characteristics of the lignocellulosic fibers-treated soil were evaluated using pH test, X-ray fluorescence (XRF), X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses. At identical conditions, those specimens reinforced with 1 percent of fibers demonstrated the highest ultimate deviatoric stress and lowest pore water pressure. Furthermore, longer fibers led to more strength and pore water pressure while S.B. fibers (pure cellulose) were more effective to enhance the shear strength of the investigated soil. Curing time also led to the higher strength but lower pore water pressure. Besides, the increased shear strength of the reinforced specimens was mainly resulted from the effective cohesion rather than the effective internal friction angle. The effective cohesion of seven day-cured specimens reinforced with 1 percent of 1.5 mm-long S.B., OCC and W.S. fibers increased up to 36.6, 31.1 and 29.6 kPa, respectively. Moreover, no considerable pH change or trace of heavy metals was observed in the treated soil specimens. The results of SEM and XRD analyses also demonstrated that the change in the soil strength behavior was merely the result of a physical process. [ABSTRACT FROM AUTHOR]

Introduction: Obesity is a major health concern in postmenopausal women, and chronic low-grade inflammation contributes to the development of obesity. Cellular studies and high-fat-diet-induced obese mouse model mimicking obesity show the antiobesity effect of annatto-extracted tocotrienols (TT) with antioxidant capability. We aim to assess the safety and efficacy of TT consumption for lipid-related parameters in obese postmenopausal women., Methods and Analysis: Eligible obese postmenopausal women will be randomly assigned to placebo group (430 mg olive oil) and TT group (DeltaGold Tocotrienol 70%) for 24 weeks. In the present study, the primary outcome is total/regional fat mass and visceral adipose tissue. The secondary outcomes include lipid profile in serum, mRNA expression of fatty acid synthase and carnitine palmitoyltransferase 1A in fat tissue, oxylipins and endocannabinoids in plasma and adipose tissue, abundance and composition of intestinal microbiome in faeces, high-sensitivity C-reactive protein (hs-CRP) in serum and leptin in serum. Every participant will be evaluated at 0 (prior to starting intervention) and 24 weeks of intervention, except for serum lipid profile and hs-CRP at 0, 12 and 24 weeks. ' Intent-to-treat ' principle is employed for data analysis. Hierarchical linear modelling is used to estimate the effects of dietary TT supplementation while properly accounting for dependency of data and identified covariates. To our knowledge, this is the first randomised, placebo-controlled, double-blinded study to determine dietary TT supplementation on an obese population. If successful, this study will guide the future efficacy TT interventions and TT can be implemented as an alternative for obese population in antiobesity management., Ethics and Dissemination: This study has been approved by the Bioethics Committee of the Texas Tech University Health Sciences Center, Lubbock. An informed consent form will be signed by a participant before enrolling in the study. The results from this trial will be actively disseminated through academic conference presentation and peer-reviewed journals., Trial Registration Number: NCT03705845., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Sleeve gastrectomy (SG) is one of the most common procedures performed for weight loss. Many seek the "perfect sleeve" with the notion that the type of calibrating device affects sleeve shape, and this in turn will affect outcomes and complications. Two major concerns after SG are amount of weight loss and acid reflux. Our aim was to determine if the various calibration methods could impact sleeve shape and thereby allow for better outcomes of weight loss and reflux., Methods: A retrospective chart review was performed of 210 patients who underwent SG and had postoperative upper gastrointestinal (UGI) study from 2011 to 2015 in a single center by a single (fellowship-trained) bariatric surgeon. Data regarding demographics, calibrating devices and clinical outcomes at 1 year (weight loss and de novo acid reflux) were collected. UGIs were reviewed by two radiologists blinded to the clinical outcomes. Sleeve shape was classified according to a previously described classification as tubular, dumbbell, upper pouch, or lower pouch. The types of calibrating devices used to guide the sleeve size intraoperatively were endoscopy, large-bore orogastric tube, and fenestrated suction tube., Results: One hundred ninety-nine patients met inclusion criteria (11 had no esophagram). Demographics revealed age 45.76 ± 10.6 years, BMI 47 ± 8.6 kg/m 2 , and 82% female. Calibration devices used were endoscopic guidance (7.6%), large bore orogastric tube (41.4%), and fenestrated suction tube (50.5%). Sleeve shape was reported as 32.6% tubular, 20.6% dumbbell, 39.2% lower pouch, and 7.5% upper pouch (100% interrater reliability). No correlation was seen with type of calibration used. Of patients, 62.0% had > 50% excess weight loss at 1 year. Twenty-three percent of patients remained on PPI at 1 year (of which 43.3% did not have reflux preoperatively). The lower pouch shape showed a trend toward less reflux and more weight loss., Conclusion: This study showed no clear association between uniformity of sleeve shape and the type of calibration device used. The study showed a trend toward decreased reflux and improved weight loss with the lower pouch shape, regardless of calibration device.

Background: Ligation and division of the saphenofemoral junction (L/D SFJ) can protect against the danger of venous thromboembolism (VTE) associated with greater saphenous vein (GSV) radiofrequency ablation (RFA). Although this procedure is regarded as clean from an infection standpoint, surgical site infection (SSI) can offset its thromboembolic benefit. We questioned whether SSI associated with L/D SFJ could be minimized by a single preoperative dose of antibiotic., Methods: A retrospective cohort study was performed on 902 ambulatory surgery patients who underwent 953 consecutive RFAs of the GSV in combination with L/D SFJ. A single dose of preoperative antibiotic was administered 1 hour before incision to some patients (n = 449 extremities), with all other patients receiving no antibiotic (n = 504). Primary outcome measure was SSI categorized based on type of therapy required (1: oral antibiotic, 2: hospitalization for intravenous antibiotic and/or wound debridement), with a secondary outcome measure of VTE., Results: VTE occurred in 10 patients (1%) and included three pulmonary emboli. The majority of VTE were calf deep vein thromboses (n = 7). SSI developed in 78 patients (8.2%) with groin, thigh, and calf distributions of 47%, 8%, and 45%, respectively. All category 2 infections (n = 8, 10%) occurred in control subjects, and the majority were located in the groin. Body mass index significantly increased risk for both overall (odds ratio [OR]: 1.09, 95% confidence interval [CI]: 1.05-1.14, P < 0.0001) and groin (OR: 1.08, 95% CI: 1.02-1.14, P = 0.01) SSI as well as VTE (OR: 1.17, 95% CI: 1.08-1.30, P = 0.003). Diabetes was a significant risk for groin SSI (OR: 5.13, 95% CI: 1.44-18.26, P = 0.01). Antibiotic was associated with a significantly reduced risk for both overall (OR: 0.54, 95% CI: 0.37-0.89, P = 0.02) and groin (OR: 0.34, 95% CI: 0.16-0.73, P = 0.01) SSI. Furthermore, prophylaxis eliminated category 2 infections (P = 0.008) and was associated with a significantly lower risk of VTE (OR: 0.11, 95% CI: 0.01-0.85, P = 0.01). Although SSI was noted more commonly in extremities with thromboembolic complications (20% [n = 2] vs. 8.1% [n = 76] in those without), this trend was not significant and could not account for the antibiotic effect on VTE., Conclusions: L/D SFJ combined with RFA of the GSV, when treated as a clean procedure and not prophylaxed with antibiotic, carries a significant risk of SSI. While diabetes and high body mass index are patient-associated SSI risk factors, a single dose of preoperative antibiotic significantly reduces the rate of all infection, eliminates the danger of serious infection, and is associated with minimal VTE., (Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.)