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Abstract We demonstrate two general classes of magnetophoretic transistors, called the “trap” and the “repel-and-collect” transistors, capable of switching single magnetically labeled cells and magnetic particles between different paths in a microfluidic chamber. Compared with prior work on magnetophoretic transistors operating in a two-dimensional in-plane rotating field, the use of a tri-axial magnetic field has the fundamental advantages of preventing particle cluster formation and better syncing of single particles with the general operating clock. We use finite element methods to investigate the energy distribution on the chip surface and to predict the particle behavior at various device geometries. We then fabricate the proposed transistors and compare the experimental results with the simulation predictions. We found that with gate electrical currents of ~ 40 mA for a transistor with proper geometry, complete switching of magnetic particles with diameters in the range of 8–15 μm is achieved. We show that the device is reliable and works well at different magnetic field strengths (50–100 Oe) and frequencies (0.05–0.5 Hz). We also employed an image processing code with a trained convolutional neural network to automate the proposed transistors for identifying and sorting particles with various sizes and magnetic susceptibilities with accuracies higher than 98%. The proposed transistors can be used in designing novel magnetophoretic circuits for important applications in biomedical microdevices and single-cell biology.

Background: Incivility in nursing education is a complex concept that is not exactly defined in nursing. The purpose of this study was to clarify the concept of incivility in nursing education in the Iranian cultural context. Materials and Methods: Concept analysis was performed based on hybrid model in three steps. In the theoretical phase, a review of studies was conducted from 2000 to 2020. During the fieldwork, 7 nursing faculty members and 9 nursing students were interviewed. The third phase included the comparison of the themes that were extracted from the two previous phases. Results: From the 1250 titles, 45 articles were analyzed. Review of literature showed that incivility has several attributes: unconventional communication, irresponsible and disrespectful behavior. The fieldwork phase added unmanaged behavior and being contrary to academic goal. Conclusions: Defining the concept of incivility in nursing education refers to an unconventional, disrespectful, unmanaged behavior that is contrary to the academic goal of nursing education and results from individual differences, stress, improper application of technology, and inappropriate role models which, by creating an unsafe learning condition leads to harming the individual, organization and profession. Here, this study provides a comprehensive understanding of the incivility in nursing education that can be used in instrumentation, model building, and development of theory.

Objective: Inflammatory bowel diseases (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), have been associated with sleep disturbances as extra-intestinal manifestations. We aimed to evaluate sleep quality in a group of Middle Eastern IBD patients while assessing the links between disease characteristics, sleep disturbances, and related comorbidities. Materials and Methods: Outpatient IBD cases who attended our hospital clinic from 2019 to 2021 were recruited in this prospective study. The patients filled in verified translations of the insomnia severity index, Epworth sleepiness scale, Pittsburgh sleep quality index, Berlin questionnaire for obstructive sleep apnea (OSA), and restless legs syndrome (RLS) questionnaire by means of online or phone surveys. The chi-squared test and Student’s t-test were used for binary and continuous variables, respectively. The Mann-Whitney U test was used for non-normally distributed data. Results: The sleep quality of 82 IBD patients (13 CD and 69 UC) was assessed. Low sleep quality was observed in 52 cases (63.4%), and UC patients with pancolitis were significantly more likely to have sleep disturbances compared to patients with partial colitis (p=0.015). Moreover, patients with elevated C-reactive protein (CRP) displayed significantly higher frequencies of OSA and RLS (p=0.038 and p=0.040, respectively). Conclusion: Sleep impairment was identified in more than half of our IBD patient pool. Therefore, we suggest screening for sleep disturbances (particularly in UC patients with pancolitis) and related comorbidities, such as OSA and RLS (especially in patients with elevated CRP levels), in IBD patients to enhance their quality of sleep.

Abstract Background Secreted frizzled-related proteins (SFRPs) comprise a family of WNT signaling antagonists whose roles in the ovary are poorly understood. Sfrp4-null mice were previously found to be hyperfertile due to an enhanced granulosa cell response to gonadotropins, leading to decreased antral follicle atresia and enhanced ovulation rates. The present study aimed to elucidate the mechanisms whereby SFRP4 antagonizes FSH action. Methods Primary cultures of granulosa cells from wild-type mice were treated with FSH and/or SFRP4, and effects of treatment on gene expression were evaluated by RT-qPCR and RNAseq. Bioinformatic analyses were conducted to analyse the effects of SFRP4 on the transcriptome, and compare them to those of FSH or a constitutively active mutant of FOXO1. Additional granulosa cell cultures from wild-type or Sfrp4-null mice, some pretreated with pharmacologic inhibitors of specific signaling effectors, were used to examine the effects of FSH and/or SFRP4 on signaling pathways, autophagy and apoptosis by western blotting and TUNEL. Results Treatment of cultured granulosa cells with recombinant SFRP4 was found to decrease basal and FSH-stimulated mRNA levels of FSH target genes. Unexpectedly, this effect was found to occur neither via a canonical (CTNNB1-dependent) nor non-canonical WNT signaling mechanism, but was found to be GSK3β-dependent. Rather, SFRP4 was found to antognize AKT activity via a mechanism involving AMPK. This lead to the hypophosphorylation of FOXO1 and a decrease in the expression of a portion of the FSH and FOXO1 transcriptomes. Conversely, FSH-stimulated AMPK, AKT and FOXO1 phosphorylation levels were found to be increased in the granulosa cells of Sfrp4-null mice relative to wild-type controls. SFRP4 treatement of granulosa cells also induced autophagy by signaling via AKT-mTORC1-ULK1, as well as apoptosis. Conclusions This study identifies a novel GSK3β-AMPK-AKT signaling mechanism through which SFPR4 antagonizes FSH action, and further identifies SFRP4 as a novel regulator of granulosa cell autophagy. These findings provide a mechanistic basis for the phenotypic changes previously observed in Sfrp4-null mice, and broaden our understanding of the physiological roles of WNT signaling processes in the ovary.

Abstract Background Considering the challenges of the referral system in the family physician program and the impact of COVID-19 pandemic on the performance of the relevant ministry’s programs, it is necessary to assess the performance of the referral system. This study was conducted with the aim of investigating the performance of the family physician referral system before and during COVID-19 in Golestan province. Methods The present repeated cross-sectional study was conducted on secondary data Recorded of 786,603 cases referred and cared by family physicians (including information on physicians’ and midwives’ visits, percentage of prescriptions and other information) in Golestan province from 2017 to 2022 in a census and retrospective manner. Data were collected using the reference ratio checklist and analyzed with SPSS 23 software at a significance level of less than 0.05. Results Referral to 10 types of medical specialties and 10 indicators of family physicians referral before and during COVID-19 were investigated. The highest and lowest percentages of referrals by family physicians were belonged to the surgical (17.6%) and infectious (2%) specialists before COVID-19, and internal medicine (15.07%) and urology (3%) specialists during COVID-19, respectively. Referral due to physician’s diagnosis increased by 19.3% compared to before Covid-19, target group increased by 0.86%, care decreased by 2.69% and reverse referral decreased by 36.1%. The amount of population covered by rural insurance, the amount of visits to midwives, the percentage of electronic appointments in the post-Covid-19 years have changed significantly compared to before.it (P-Value

Ultrasonic Metal Welding (UMW) employs high-power ultrasonic vibrations to join thin metal sheets of different materials, effectively addressing the thermal damage issues associated with traditional welding methods. This study aimed to optimize the joining of thin aluminum (Al) and pure copper (Cu) metal sheets using high-power ultrasonic vibration. The investigation focused on the effect of input parameters, including time, static pressure, and welding power, on the output parameter of joint strength. The results indicated that the welding time had the most significant effect on the load obtained from the Tensile-shear test. The optimal condition was determined to be a welding time of 0.98 s, a pressure of 2 bar, and a power of 85%, resulting in a maximum predicted tensile-shear test load of 753.3 N, with an error value of 11.4% obtained from the software. Microscopic images reveal that the welding mechanism in ultrasonic welding involves continuous plastic deformation, dispersion of oxide layers, and the formation and extension of micro-bonds along the weld line.

Background & Aim: Electrocardiography (ECG) is the most widely utilized diagnostic tool in medicine. However, nursing students often have problems with interpreting ECGs, highlighting the need for revised training methods. This study aimed to assess the effect of ECG drawing assignments on nursing students' learning and their perspectives on this teaching method in the context of a critical care nursing course. Methods & Materials: This quasi-experimental study involved 52 fifth-semester BSc nursing students enrolled in the fall and spring terms at Qom University of Medical Sciences. For the fall group, traditional lectures and Q&A sessions were conducted during the first half of the semester, followed by an assignment requiring students to draw common ECGs in the second half. In contrast, for the spring group, students drew ECGs during the first half of the semester. Learning outcomes were assessed through a written test, while students’ perspectives on the drawing assignments were evaluated using a questionnaire. Data were analyzed using SPSS software version 22, employing Mann-Whitney and Wilcoxon tests to compare groups. Results: The mean score from the perspective questionnaire regarding ECG drawing was 14.86±3.34 (maximum score of 18). In most cases, students had positive or relatively positive views towards this teaching method. A significant difference was observed between the course exam scores of students when they engaged in drawing ECGs compared to when they did not (P

∴ Introduction ∴ In the wake of the Coronavirus pandemic, the global legal framework has been put to the test, revealing the vulnerabilities of ongoing contracts, such as leases, to sudden and unforeseeable emergencies. These emergencies can disrupt the economic equilibrium of contracts, making the fulfillment of contractual obligations challenging, if not impossible, without necessarily leading to their annulment or dissolution. This paper outlines the potential for adjusting lease agreements under extraordinary circumstances induced by global health crises. ∴ Research Question ∴ The core research question addresses whether the economic balance of lease contracts, which has been disrupted by the outbreak of pandemics like Covid-19, can be readjusted. It seeks to explore the legal avenues available for such adjustment, particularly in the context of Islamic jurisprudence. This question is pertinent in understanding the extent to which legal frameworks can provide flexibility and fairness in the execution of contracts amidst unforeseen global health emergencies. ∴ Research Hypothesis ∴ The hypothesis posits that, contrary to traditional enforcement mechanisms like contract dissolution or termination due to force majeure or other changing circumstances, the legal and jurisprudential foundations of Islamic law, including no harm principle [La-Za'rar], hardship [Osr va Haraj], implied condition, and unjust enrichment, support the adjustment of lease contracts. This approach aims at maintaining the contract while preventing harm to any party involved, thus offering a balanced solution that prioritizes the contract's survival over its termination. The novel concept of "Segmentation of Benefits" introduced in this research underscores the divisibility and interconnection of benefits derived from leased property, providing a foundational basis for adjusting lease contracts in the face of pandemics. ∴ Methodology & Framework, if Applicable ∴ The research employs a doctrinal methodology combined with a descriptive-analytical approach to explore the feasibility of adjusting rent in epidemic conditions. By scrutinizing the works of Islamic jurists and analyzing existing legal precedents and theories, the study aims to uncover jurisprudential and legal bases for contract adjustment in the context of lease agreements affected by pandemics. This investigation is structured around a three-part framework: firstly, examining the change in circumstances of lease contracts during pandemics; secondly, exploring the Islamic jurisprudential bases for lease contract adjustment; and finally, clarifying the legal bases for such enforcement. This comprehensive framework allows for a detailed exploration of the subject matter, facilitating a nuanced understanding of the potential for contract adjustment in unprecedented times. ∴ Results & Discussion ∴ The study meticulously examined the impact of the coronavirus pandemic on the economic balance of lease contracts, recognizing the necessity of adapting legal practices to address unforeseen disruptions. The key findings highlight the importance of a dynamic approach to contract law, one that acknowledges the unpredictable nature of such global crises and their potential to render existing contractual agreements inequitable or unfeasible. The investigation revealed that the principles of "no harm," "hardship," "unjust enrichment and abuse of rights," "implied condition," and "segmenting the benefits of the lease contract" provide robust jurisprudential and legal bases for the adjustment of lease agreements in response to the pandemic. These principles collectively advocate for a balance between the contractual obligations and the unforeseen circumstances that may disadvantage one party disproportionately. Specifically, the study found that: No harm principle necessitates avoiding any contractual adjustments that would unfairly disadvantage one party, advocating for equitable solutions in the face of adversity. Hardship and implied condition principles support the notion that contracts can and should be adapted when fundamental assumptions underpinning the agreement change unexpectedly. Unjust enrichment and abuse of rights principles warn against leveraging the pandemic for disproportionate gain at the expense of the other party. Segmenting the benefits of the lease contract emerges as a novel approach, suggesting that the divisibility of the leased property's benefits can guide the proportional adjustment of rent, aligning with the actual utility received by the lessee during the pandemic. This study underscores the critical role of social solidarity in contract law, especially during crises that affect the fundamental conditions of lease contracts. It proposes a paradigm shift towards viewing contracts not merely as static agreements but as dynamic instruments that must adapt to ensure fairness and equity between the parties. The emphasis on adjusting rent according to new conditions reflects a commitment to preserving the contractual relationship and ensuring its sustainability over termination or dissolution. ∴ Conclusion ∴ The research conclusively demonstrates that the adjustment of lease contracts in response to pandemics like the coronavirus is not only feasible but necessary to uphold the principles of fairness, equity, and social solidarity in the face of unforeseen events. It argues against the outright termination of contracts due to the hardships imposed by the pandemic, advocating instead for a more nuanced approach that seeks to maintain the contractual bond through equitable adjustments. This study's conclusions contribute significantly to the field of contract law, offering a blueprint for navigating the legal challenges posed by pandemics and other similar crises. It lays the groundwork for future legislative and jurisprudential developments that could incorporate these principles into the legal fabric, ensuring that lease contracts remain viable and equitable under the most challenging conditions. Ultimately, this research highlights the importance of flexibility, fairness, and foresight in contract law, calling for a legal framework that is responsive to the needs of both parties and the broader community during times of crisis. The proposed model of rent adjustment, grounded in Islamic jurisprudence and supported by legal principles, provides a viable path forward that honors the spirit of contractual agreements while adapting to the realities of an ever-changing world. In sum, the findings and conclusions of this study not only address the immediate concerns posed by the pandemic but also offer a timeless consideration for contract law: the need for adaptability, empathy, and a deep commitment to justice and equity in the face of unforeseeable challenges.