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OBJECTIVE:  The aim of Placental Assessment in Response to Environmental Pollution Study (PARENTs) was to determine whether imaging of the placenta by novel multiparametric magnetic resonance imaging (MRI) techniques in early pregnancy could help predict adverse pregnancy outcomes (APOs) due to ischemic placental disease (IPD). Additionally, we sought to determine maternal characteristics and environmental risk factors that contribute to IPD and secondary APOs. STUDY DESIGN:  Potential patients in their first trimester of pregnancy, who agreed to MRI of the placenta and measures of assessment of environmental pollution, were recruited into PARENTs, a prospective population-based cohort study. Participants were seen at three study visits during pregnancy and again at their delivery from 2015 to 2019. We collected data from interviews, chart abstractions, and imaging. Maternal biospecimens (serum, plasma, and urine) at antepartum study visits and delivery specimens (placenta, cord, and maternal blood) were collected, processed, and stored. The primary outcome was a composite of IPD, which included any of the following: placental abruption, hypertensive disease of pregnancy, fetal growth restriction, or a newborn of small for gestational age. RESULTS:  In this pilot cohort, of the 190 patients who completed pregnancy to viable delivery, 50 (26%) developed IPD. Among demographic characteristics, having a history of prior IPD in multiparous women was associated with the development of IPD. In the multiple novel perfusion measurements taken of the in vivo placenta using MRI, decreased high placental blood flow (mL/100 g/min) in early pregnancy (between 14 and 16 weeks) was found to be significantly associated with the later development of IPD. CONCLUSION:  Successful recruitment of the PARENTs prospective cohort demonstrated the feasibility and acceptability of the use of MRI in human pregnancy to study the placenta in vivo and at the same time collect environmental exposure data. Analysis is ongoing and we hope these methods will assist researchers in the design of prospective imaging studies of pregnancy. KEY POINTS: · MRI was acceptable and feasible for the study of the human placenta in vivo.. · Functional imaging of the placenta by MRI showed a significant decrease in high placental blood flow.. · Measures of environmental exposures are further being analyzed to predict IPD..

Background and purpose: The occurrence of medical errors in healthcare centers is highly significant due to the sensitive nature of providing care and saving patients' lives. Failure to report such errors can result in both financial and moral harm to patients and have adverse effects on the healthcare system. Medical errors have significant clinical and economic consequences and can influence mortality rates. Despite the wide range of medical errors in healthcare delivery, the errors committed by medical staff—due to the close care relationship between them and the patient—are among the most complex issues in the management of treatment systems. Therefore, the purpose of this study was to explore the causes of non-reporting of medical errors in hospitals and methods of encouraging the reporting of such errors. Materials and methods: This qualitative study was conducted using semi-structured, in-depth individual interviews with a conventional content analysis approach. The goal was to identify the factors contributing to the non-reporting of medical errors in 1402 (Iranian calendar year). The study population included doctors, specialists, and providers actively involved in patient safety in the hospital. In other words, individuals with knowledge and valuable experience in this area were interviewed. Data collection was conducted using a semi-structured questionnaire, designed by reviewing the literature and with the assistance of expert professors for the interviews. Sampling was performed purposefully until data saturation was reached. Data saturation was achieved after interviewing 22 experts. After the interviews, items and sub-items were identified through content analysis. Results: Key factors contributing to the failure to report medical errors were identified in two themes, six categories, and 45 items. The extracted themes included organizational and management factors, as well as legal issues. Organizational and management factors encompassed organizational culture, communication, reporting, and monitoring, while legal factors involved the consequences of reporting and control mechanisms. In total, 38 solutions were proposed to encourage the reporting of medical errors. The experts' suggestions for strategies to promote error reporting were identified under two themes, six categories, and 38 items. The themes included organizational and management factors and legal issues. Organizational and management factors covered organizational culture, the reporting process, monitoring, and communication, while legal factors involved the consequences of reporting and control. Conclusion: Errors in medical procedures may occur due to the inherent nature and sensitivity of these procedures. However, it is essential that medical staff consider themselves obligated to minimize errors and reduce harm to patients. Studying the causes of non-reporting of medical errors and understanding the underlying reasons are critical for improving patient safety and the quality of healthcare services. This knowledge can assist policymakers and healthcare practitioners in making informed decisions about error reporting and in delivering higher-quality services to the public. Additionally, it is important to train medical teams on the various types of errors and how to appropriately address them.

Herein, a non-boiling two-phase flow containing air and water through a downward flow in a vertical tube with helical corrugations has been investigated. In this simulation, various flow rates for air and water are considered, and three corrugation pitches 1, 1.5, and 2 cm are included. It can be seen in the results that the pressure drop values decrease with an increase in volume fraction. It should be noted that the reduction of pressure drop values with the reduction of volume fraction (VF) is based on the reduction of the water flow rate, which is visible. By comparing the pressure drop values for each corrugation pitch, it can be seen that as the pitch decreases, the pressure drop values increase significantly. The results for Nusselt number show that Nusselt number decreased with an increase in the volume fraction. By reducing the water flow rate, the intensity of the main flow is reduced the intensity of turbulence is also reduced and the heat transfer coefficient is reduced. Ultimately, the cost-benefit ratio has been utilized to show real results for each studied case.

Abstract Introducing suitable alternatives to the existing fossil fuels can provide insightful aspects of the expected benefits. In the energy sector, the transportation system is one of the key contributors to fossil fuel consumption and greenhouse gas productions. To elaborate on the performance of each introduced alternative, two perspectives are considered; short-term and long-term evaluations. In the short outlook, the PROMETHEE method is used for evaluation. Six scenarios are introduced based on the technical, economic, social, and policy criteria and each scenario benefits from different weights. In this scheme, the impacts of evolutions in the battery applications in the vehicles are investigated. Based on the short-term study, CNG and gasoline are considered the best options for the fuels of vehicles in Iran by taking into consideration the current situation. By viewing the technical and economic criteria, it was concluded that the Li-Ion battery provides better performance in comparison with gasoline in the long run. By 2040, the number of EVs will reach 10% of the overall vehicle production. It is obtained that the benefits of the electrical vehicles’ presence as the alternative to the internal combustion vehicles can provide growing interest in this outlook from 2.02 × 106 US$ in 2025 to 17.55 × 108 US$ in 2040.

Abstract Background To the best of our knowledge, no population-based studies have provided insights into the prevalence of hysterectomy and its risk factors among northern Iranian females. Thus, the present study aimed to investigate the prevalence and sociodemographic determinants of hysterectomy in a large cohort of northern Iranian females. Methods This cross-sectional study included data from the enrollment phase of the Tabari cohort study (TCS). The TCS consists of 10,255 adults (4,149 males and 6,106 females) aged 35–70 years who reside in Sari, Mazandaran, Iran, of which 6103 females were included in the study. Multiple logistic regression analysis was used to search for hysterectomy determinants. Results Our results revealed that the prevalence of hysterectomy among northern Iranian females was 9.7% (595/6103). Additionally, 50–59 (OR: 4.63, 95% CI: 3.57–6.01) and 60–70 (OR: 5.83, 95% CI: 4.28–7.95) age groups, higher socioeconomic levels (OR: 1.66, 95% CI: 1.13–2.42), a history of tubectomy (OR: 1.27, 95% CI: 1.05–1.53), and more gravida (OR: 5.35, 95% CI: 1.62–17.63) were found to increase the odds of hysterectomy, whereas living in mountainous areas (OR: 0.57, 95% CI: 0.43–2.75) and having a job (OR: 0.62, 95% CI: 0.45–0.86) were found to decrease the odds of hysterectomy. Conclusion Older age groups, living in urban areas, higher socioeconomic levels, not having a job, a history of tubectomy, and more gravida were found to increase the odds of hysterectomy.

Background and purpose: The process by which family physicians refer patients to specialized levels of the healthcare system is presented. In other words, the referral system can assure us that the clients of health care services are optimally allocated at the specialized level of services. In addition to providing proper time and providing proper health care for health benefits. The referral process is a specialized outpatient consulting process that determines the course and communication of the individual in three levels of the health system to provide the integrity and continuity of services this study aimed to determine the quality of referral and feedback forms in the medical family physician of Mazandaran province in 2019. Materials and methods: This descriptive cross-sectional study was conducted to examine the form of insurance referral of social security insurance by physicians of urban families and feedback from experts. After receiving the code of ethics and obtaining permission from the relevant organization the researcher paid the social security organization 1397 issued by the physicians in the province. The statistical population consisted of all forms of reference and the feedback from experts to the social security insurance organization to get the right According the report of the department of medical record department of the social security insurance organization of Mazandaran province in1397 has been handed over to that organization in a total of 151075 reference sheets completed to obtain the right of the specialists. the collected data were entered into Excel software for statistical analysis was performed in descriptive statistics using central dices (mean, median, mode) and dispersion index(variance, standard deviation, range of changes, coefficients of variation ) for quantitative variables, and index, percentage, and prevalence for qualitative data. The data were analyzed by using spss-25 software. Results: The study of 3200 cases of referral and referral forms of family physicians and specialists showed that among the Physicians 2321(72.5) were male and 879(27.5) were female. The patient's records in 586(%18.3) were incomplete. Clinical findings Were found in 98(2.7%) cases and paraclinical findings were incomplete in 22 cases (0.7%) and complete in 171 cases (5.3%). in 884 cases (27.6%) the papers were illegible the cause of referral was written in 560(17.5%). the reason for further referral in 187 cases (5.8%) was written by experts. In addition, 1454 cases (45.4%) of the return sheets completed by specialists were illegible. Conclusion: The results obtained in this study show that the status of the quality of completion of the referral form by the family doctors and also the status of providing feedback by the specialist doctors are not suitable. to improve this situation the implementation of face-to-face and non-face-to-face training programs for both groups and using electronic referral forms can be put on the agenda.

Abstract Background Cleft in the mitral valve leaflet is a primary cause of congenital mitral regurgitation, stemming from developmental anomalies in the mitral valve and frequently associated with other congenital heart defects. Concurrent presence of cleft in mitral valve leaflet with atrial septal defect and ventricular septal defect is relatively rare. Echocardiography, especially transesophageal echocardiography, is essential in diagnosing cleft mitral valve leaflet and related congenital heart defects, providing critical, detailed imagery for accurate assessment. This study presents a young female patient whose anterior mitral cleft, along with atrial septal defect and ventricular septal defect, was revealed through three-dimensional transesophageal echocardiography. Case presentation A 25-year-old Iranian female, experiencing progressive dyspnea and diminished physical capacity over 3 months, was referred to our hospital. Initial examination and transthoracic echocardiography indicated severe mitral regurgitation. Further evaluation with transesophageal echocardiography corroborated these findings and identified a cleft in the anterior mitral valve leaflet, coupled with mild left ventricular enlargement and significant left atrial enlargement. The complexity of the patient’s condition was heightened by the diagnosis of cleft mitral valve leaflet in conjunction with atrial septal defect and ventricular septal defect, showing the complex nature of congenital defects. Conclusion This case emphasizes the critical role of transthoracic echocardiography in diagnosing cleft of mitral valve leaflet and associated cardiac anomalies, showcasing its superiority over transthoracic echocardiography for detailed visualization of cardiac structures. The identification of multiple congenital defects highlights the necessity for a comprehensive diagnostic approach to manage and treat patients with complex congenital heart diseases effectively. Future research should aim to refine diagnostic methodologies to enhance patient outcomes for cleft of mitral valve leaflets and related congenital conditions.

This study aimed to investigate the interaction between exploratory behaviours and entrepreneurial opportunity recognition among agriculture students mediated by strategic learning and mindfulness. The study was conducted on agriculture students of Bu-Ali Sina University in Hamadan, Iran (N = 420). The sample was 200 people taken by the simple randomisation technique. The assessment tool was a standard questionnaire whose face and content validity was confirmed by entrepreneurship experts and its reliability was estimated by conducting a pilot study. The findings showed that exploratory behaviours had a positive and significant effect on entrepreneurial opportunity recognition, mindfulness, and students' strategic learning. Also, mindfulness influenced entrepreneurial opportunity recognition positively and significantly. However, the effect of strategic learning on entrepreneurial opportunity recognition was insignificant. It can be concluded that exploratory behaviours can influence students' mindfulness and strategic learning and students' exploratory behaviours and mindfulness lead to discovering entrepreneurial opportunities.

Background: According to the cholinergic hypothesis for Alzheimer’s disease, potentiation of cholinergic neurotransmission is one of the best strategies for combating dementia. Methods: A new series of benzamide derivatives bearing 1,3,4-thiadiazole nucleus were synthesized and subsequently, their anticholinesterase activity was evaluated. Molecular docking was carried out to explore the likely binding mode and interactions. Results: Fortunately, some of the tested compounds exhibited more activity than donepezil as a reference drug (IC50 = 0.6 ± 0.05 µM). Some of the evaluated derivatives displayed potency in the nanomolar range. Compound 7e with fluorine atom on the meta position of the phenyl ring was the most active compound in this series (IC50 = 1.82 ± 0.6 nM). Conclusion: The 1,3,4-thiadiazole derivatives that were synthesized and tested in the current manuscript demonstrated remarkable anticholinesterase activity. Therefore, these compounds could be suggested as potential anti-Alzheimer agents.

IntroductionTo characterize early-gestation changes in placental structure, perfusion, and oxygenation in the context of ischemic placental disease (IPD) as a composite outcome and in individual sub-groups.MethodsIn a single-center prospective cohort study, 199 women were recruited from antenatal clinics between February 2017 and February 2019. Maternal magnetic resonance imaging (MRI) studies of the placenta were temporally conducted at two timepoints: 14-16 weeks gestational age (GA) and 19-24 weeks GA. The pregnancy was monitored via four additional study visits, including at delivery. Placental volume, perfusion, and oxygenation were assessed at both MRI timepoints. The primary outcome was defined as pregnancy complicated by IPD, with group assignment confirmed after delivery.ResultsIn early gestation, mothers with IPD who subsequently developed fetal growth restriction (FGR) and/or delivered small-for gestational age (SGA) infants showed significantly decreased MRI indices of placental volume, perfusion, and oxygenation compared to controls. The prediction of FGR or SGA by multiple logistic regression using placental volume, perfusion, and oxygenation revealed receiver operator characteristic curves with areas under the curve of 0.81 (Positive predictive value (PPV) = 0.84, negative predictive value (NPV) = 0.75) at 14-16 weeks GA and 0.66 (PPV = 0.78, NPV = 0.60) at 19-24 weeks GA.DiscussionMRI indices showing decreased placental volume, perfusion and oxygenation in early pregnancy were associated with subsequent onset of IPD, with the greatest deviation evident in subjects with FGR and/or SGA. These early-gestation MRI changes may be predictive of the subsequent development of FGR and/or SGA.

OBJECTIVE: The aim of this work was to report the prevalence of computed tomography (CT)-detected intra-articular mineralization. DESIGN: We included participants from the Multicenter Osteoarthritis (MOST) Study. At the 12th year visit of the MOST study, bilateral knee CTs were first obtained. All participants also had posteroanterior and lateral radiographs of bilateral knees and completed standard questionnaires. Knee radiographs were assessed for Kellgren & Lawrence grade (KLG) and radiographic evidence of intra-articular mineralization. CT images were scored using the Boston University Calcium Knee Score (BUCKS) for cartilage, menisci, ligaments, capsule, and vasculature. Prevalence of intra-articular mineralization was computed for the total sample, and stratified by age, sex, race, Body Mass Index (BMI), presence of frequent knee pain, and KLG. We also determined distribution of mineralization in the cartilage and meniscus, and co-localization. RESULTS: 4140 bilateral knees from 2070 participants were included (56.7% female, mean age 61.1 years, mean BMI: 28.8 kg/m2). On radiographs 240 knees (5.8%) had intraarticular mineralization, while CT-detected mineralization was present in 9.8% of knees. Prevalence of hyaline articular and meniscus mineralization increased with age and KL grade, and was similar by sex, BMI categories, and comparable in subjects with and without frequent knee pain. Mineralization tended to be ubiquitous in the joint, most commonly involving all three (medial/lateral tibiofemoral and patellofemoral) compartments (3.1%), while the patellofemoral compartment was the most involved compartment in isolation (1.4%). CONCLUSIONS: CT of the knee provides greater visualization of intra-articular mineralization than radiographs and allows better localization of the crystal deposition within the joint. Further studies should focus on the co-localization of intra-articular crystal deposition and corresponding magnetic resonance imaging (MRI)-features of knee osteoarthritis (OA).

Background: Major β-Thalassemia is the most prevalent singlegene disorder in Iran. Over 2 million beta-thalassemia carriersand more than 25,000 patients have been identified nationwide. This study aimed to evaluate the Major β-Thalassemia (MBT) screening surveillance system in the Jiroft district, southeast Iran.Methods: This descriptive study was conducted using the census method and was based on the information recorded in the files of all major thalassemia births (born between 2011 and 2021) in the health centers of Jiroft University of Medical Sciences. A formula was used to calculate the program’s incidence, expected incidence, and success rate. Stata version 14 and Excel software were utilized to analyze the data, and the qualitative data are presented as numerical values and percentages.Results: During the study periods, 91 patients with betathalassemia Major were born in the population covered by Jiroft University of Medical Sciences. By performing prenatal diagnosis tests in the first weeks of pregnancy and obtaining parental consent for legal abortion, the birth of 422 sick children was prevented. The 11-year incidence of beta-thalassemia major was 5.32 per 10,000, and the expected incidence (if no prevention program was implemented) was 30 per 10,000 live births. The mean success rate of the Major β-Thalassemia surveillance system during the study period was 82.26%, which reached 95.45% in 2021.Conclusion: The i mplementation of efficient, e ffective h ealth policies influenced by the native culture of the region has resulted in the thalassemia prevention program in Jiroft City being completely effective. The implementation success rate of this program has exceeded 95%. Modeling and adapting these preventive policies can assist in implementing thalassemia prevention programs in other parts of the country and developing countries.

This research evaluates two types of vertical axis turbines from both an aerodynamic and economic perspective. The turbines used in this study have straight (H-shaped) and angled (V-shaped) blades, with equivalent dimensional characteristics that are suitable for the climatic conditions and average wind speed distribution in Zahedan city. The aerodynamic evaluation of the turbines was conducted using the semi-analytical DMST method. The results indicate that the V-shaped turbine generates significantly less power than the H-shaped turbine due to the reduction of the effective area of the turbine and the torque produced by its rotor. However, during startup, the V-shaped turbine exhibits about seven times less negative power than the H-shaped turbine, which improves the overall startup process. Economically, the cost of energy production per kWh for a V-shaped turbine is approximately 20% lower than that of an H-shaped one. This makes the V-shaped turbine a more suitable option for urban and small-scale applications.

Abstract Purpose Global warming has led to an increase in the number and intensity of extreme heat events, posing a significant threat to the health and safety of workers, especially those working outdoors, as they often have limited access to cooling strategies. The present systematic literature review (a) summarizes the current knowledge on the impacts of climate change on outdoor workers, (b) provides historical background on this issue, (c) explores factors that reduce and increase thermal stress resilience, (d) discusses the heat mitigation strategies, and (e) provides an overview of existing policy and legal frameworks on occupational heat exposure among outdoor workers. Materials and methods In this systematic review, we searched scientific databases including Scopus (N = 855), Web of Science (N = 828), and PubMed (N = 202). Additionally, we identified relevant studies on climate change and heat-stress control measures through Google Scholar (N = 116) using specific search terms. In total, we monitored 2001 articles pertaining to worker populations (men = 2921; women = 627) in various outdoor climate conditions across 14 countries. After full-text assessment, 55 studies were selected for inclusion, and finally, 29 eligible papers were included for data extraction. Results Failure to implement effective control strategies for outdoor workers will result in decreased resilience to thermal stress. The findings underscore a lack of awareness regarding certain adaptation strategies and interventions aimed at preventing and enhancing resilience to the impact of climate change on heat stress prevalence among workers in outdoor tropical and subtropical environments. However, attractive alternative solutions from the aspects of economic and ecological sustainability in the overall assessment of heat stress resilience can be referred to acclimatization, shading, optimized clothing properties and planned breaks. Conclusion The integration of climate change adaptation strategies into occupational health programs can enhance occupational heat resilience among outdoor workers. Conducting cost-benefit evaluations of health and safety measures for thermal stress adaptation strategies among outdoor workers is crucial for professionals and policymakers in low- and middle-income tropical and subtropical countries. In this respect, complementary measures targeting hydration, work-rest regimes, ventilated garments, self-pacing, and mechanization can be adopted to protect outdoor workers. Risk management strategies, adaptive measures, heat risk awareness, practical interventions, training programs, and protective policies should be implemented in hot-dry and hot-humid climates to boost the tolerance and resilience of outdoor workers.

Abstract Background This study was conceived to assess the postoperative stability of condylar position following fixation with miniplates and lag screws after bilateral sagittal split osteotomy (BSSO). Methods This retrospective study included a cohort of 20 patients undergoing BSSO using the Obwegeser-Dal Pont modification. The bony segments were stabilized using either miniplates with two 2.0-mm monocortical screws per segment or three 2.0-mm bicortical lag screws along the mandible’s superior border. Pre- and postoperative (7-day interval) spiral computed tomography scans were conducted to assess skeletal changes across both groups. Data analysis employed Wilcoxon signed-rank and Wilcoxon rank-sum tests (α = 0.05). Results No statistically significant difference was observed between the pre-and postoperative condylar position parameters (P>0.05). However, the lag screw group showed a marginal significant increase in the left condyle’s angulation (preoperative: 24.83 ± 6.37 vs. postoperative: 32.5 ± 4.93; P = 0.04). Changes in condylar height, length, and width were not statistically significant before and after BSSO in either groups (P>0.05). Nor was any statistically significant difference found between the miniplates and lag screws groups regarding condylar position parameters (P>0.05). Conclusion The results indicated that both lag screw and miniplate fixation methods can be effectively employed in BSSO procedures without impacting condylar position parameters. Thus, either fixation method can be chosen depending on factors such as the surgeon’s preference and clinical outcomes.

Abstract Background Policymakers are tasked with both driving the rapid expansion of renewable energy technologies and, additionally channelling the limited national potential of biomass into areas where it can provide the greatest benefit to the energy system. But do current policy instruments promote the use of biomass in these areas? As biomass is limited, its use must be sustainable without leading to further biodiversity loss or depleting forest or soil resources. In this study, short-term energy scenarios are generated using the BenOpt model, which take into account both current and alternative policy instruments under limited biomass utilisation. The results are compared with long-term, cost-optimal energy scenarios for the use of biomass. Results The analysis reveals that the instrument of a GHG quota does not promote the use of biofuels in hard-to-electrify areas of the transport sector, where they should be cost-optimally allocated according to long-term energy scenarios. Biofuels are promoted for use in passenger road transport and not in the shipping or aviation sector. In contrast, alternative policy scenarios indicate that the sole instrument of a high CO2 price is more conducive to direct electrification and could displace more fossil fuels by 2030 than the GHG quota alone. This instrument also promotes the optimal use of biogas plants in the power sector in accordance with long-term cost-optimal developments. Conclusions The instrument of a GHG quota might lead to counterproductive developments in passenger road transport, but it also helps to ramp up the biofuel capacities required in shipping and aviation in the long term. However, it does not provide the necessary incentives for the ramp-up of battery electric vehicles, which would be the cost optimal solution in passenger road transport according to the long-term scenarios. Even though alternative policy scenarios show that the sole instrument of a high CO2-price is more conducive to direct electrification, a high CO2 price alone is not enough (e.g. in the heat sector) to promote the efficient use of biomass instead of simply covering the base load demand.