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Background and study aims Endoscopic ultrasound-directed transgastric ERCP (EDGE) is a safe and efficacious procedure to treat pancreaticobiliary diseases in Roux-en-Y gastric bypass (RYGB). This multicenter study aimed to determine the long-term outcomes of EDGE focusing on fistula persistence rates and post-procedure weight change.

Introduction and objectives: Industry 4.0 has brought significant changes to industries and businesses. This transformation, involving the interconnection of devices, processes, and systems through smart networks and the use of data-driven technologies and artificial intelligence, has created a comprehensive approach in businesses. This development is crucial and has substantial impacts on various areas, including production, services, supply chain, and marketing. Given the increasing stability and future competitiveness of the production sector, the new technologies of the fourth industrial revolution (Industry 4.0) have gained considerable attention from the academic and industrial communities in recent years. However, manufacturers face numerous factors in implementing Industry 4.0, which need to be identified and analyzed. The purpose of this research is to identify the organizational factors influencing the adoption of Industry 4.0 and to present a fuzzy cognitive model.Methods: This research is considered applied-developmental in terms of its purpose and hybrid (exploratory mixed) in terms of the research type. The statistical population of this research comprised small and medium-sized manufacturing companies, with 12 experts from small and medium-sized manufacturing companies active in the industrial town of Yazd province selected purposefully. Initially, to identify the organizational determinants of Industry 4.0, the meta-combination method was used, and then the relationships of these factors were determined using the fuzzy cognitive mapping method and the Fcmappear and Mental Modeler software.Findings: The findings of the meta-combination method indicate 36 primary codes and 11 determining factors affecting the acceptance of Industry 4.0 technologies in small and medium-sized manufacturing companies operating in Yazd Industrial Town. These factors include absorption capacity, commercial assets, technical competence in digitization, digitalization knowledge and expertise, participation in the implementation process, strategic management competence for Industry 4.0, organizational culture, organizational structure, availability of resources, social capital, and top management characteristics. Among these factors, participation in the implementation process, absorption capacity, and social capital have the highest influencing capacity, while top management characteristics, digitalization knowledge and expertise, technical competence in digitization, and strategic management competence have the highest impact. Ultimately, the factors of technical competence in digitization, digitalization knowledge and expertise, top management characteristics, and participation in the implementation process obtained the most central indicators.Conclusion: Industry 4.0 is a vital strategic option for small and medium-sized manufacturing companies, enabling them to keep pace with the digitization race. Small and medium-sized manufacturing companies are significantly behind large organizations in leveraging Industry 4.0 technologies. Additionally, these companies are still grappling with early adoption decisions regarding digital transformation under Industry 4.0, which is a concerning issue. The results identified various organizational determinants that may explain these conditions and provide efficient solutions for small and medium manufacturing companies. This study created an organizational digitalization roadmap that describes the necessary conditions to facilitate the digitalization of small and medium-sized manufacturing companies under Industry 4.0.

Aim and Background: The experience of childhood trauma is all the unpleasant and unpleasant experiences that a person has experienced during childhood either directly in relation to his caregivers and attachment figures, or as a result of the neglect and negligence of his attachment figures in relation to a stranger, he has experienced misbehavior. The present study was conducted with the aim of investigating the effectiveness of emotion-oriented intervention on attachment styles, hyperexcitability and fearful dreams in people with complex trauma symptoms. Methods and Materials: This semi-experimental research, including pre-test-post-test, control group, was conducted on all adults with symptoms of complex trauma referring to psychological clinics in Isfahan province in spring 2002. The sampling method in the first stage was based on the available sampling method and they were randomly divided into two experimental groups (15 people) and control (15 people) and using the questionnaire of consequences of childhood traumas in adulthood by Bernstein et al, Collins and Reed attachment style questionnaire, Mitmansgruber hyperexcitability questionnaire, Mitmansgruber et al. The data were analyzed using Levine's test, Shapiro-Wilko test, analysis of covariance test. Findings: The findings indicate that for secure attachment (F=44. 628 and df=1), avoidant attachment (F=28. 168 and df=1), anxious attachment (F=42. 228 and df=1), For the variable of negative over-excitement (F=74. 508 and df=1) and positive over-excitement (F=27. 197 and df=1) as well as for the variable of scary dreams (F=46. 446 and df=1), then From the pre-test control, in the post-test phase, the effect of the group is significant (P

Background: T cells and regulatory T cells (Tregs) play a critical role in viral infectious immunity. Exhaustion of T cells during infection and decreased Tregs both contribute to the exacerbation of the disease. In the present study, we assessed T cells and regulatory T cells of COVID-19 patients and a control group according to the expression of the PD-1 molecule. Methods: Forty-two COVID-19 patients and 40 controls were enrolled in the study. In COVID-19 patients, blood samples were collected on the first day of their hospitalization. Regulatory T cells (CD4+, CD25+, FOXP3+), CD4+PD-1+, and PD-1+ regulatory T cells were assessed by flow cytometry. Results: The percentage of CD4+PD-1 + T cells in COVID-19 patients was significantly higher compared to the control group (P < 0.0001). The percentage of PD-1+ regulatory T cells was significantly increased in the patient group compared to the control group (P < 0.0001). However, the Treg percentage was significantly decreased in the patient group compared to the control group (P < 0.0001). The frequency of CD4+PD-1 + T cells, Tregs, and PD-1+ Tregs had acceptable sensitivity and specificity for assisting in the diagnosis of severe/critical COVID-19. The declined Tregs and enhanced CD4+CD25+, CD4+PD-1+, and PD-1 + T cells were associated with disease severity. Conclusion: The decrease in Tregs and the increase in exhaustion of these cells and T cells play an important role in COVID-19 pathogenesis. These immune parameters could be used as meaningful indicators for assisting in the diagnosis of severe/critical COVID-19.

Background and Objectives:Yazd province is located in the central desert part of Iran in which water scarcity was one of the most important problems. This has been recently solved to some extent, due to the approved channel project of water transferring from Isfahan to Yazd. Chlorination is usually used in the last stage of water treatment for disinfection in the networks, treatment plants, storages and channel stations. The possibility of carcinogen lateral composites formation is expected by tri-halo-methanes (THMs) due to the reactions occurs between the natural organic materials and free chlorine available in water. Based on the established standard by the country, the permissible limit of THMs in water is 200 mg/L. In this research, in addition to the amount of THMs and their distribution in Yazd water transferring channel and the city water network system, the important parameters and their correlations with THMs formation were discussed.Materials and Methods: In a year of sampling period, the concentrations of THMs including the four major components of chloroform, bromoform, bromo di-chloro methane and di-bromo chloro methane during all seasons were measured using gas chromatograph and analyzed. This was done for 11 stations including Zayande-rood Basin River and Isfahan water treatment plant up to Yazd Shehneh storage, stations and inline equalization tanks and also five regions of Yazd city network.Results: According to the results, the maximum rate of THMs (51.14 mg/L) during the sampling period in summer for Yazd city network and in ancient context of Jamea Mosque district was found. In addition, the minimum concentration of THMs was 1.60 mg/L in winter for the domestic network of the city which was related to Azad Shahr district. The Average total amount of THMs during sampling periods in all stations was 12.26 mg/L. Conclusion: SPSS and Excel softwares were used to analyze the research data in the descriptive and inferential manner. Both statistical methods (Simple correlation coefficient, Pearson and Spearman correlation test)) with 5% significant level were considered for data analysis. The results indicated that no significant difference existed between these parameters and national and international standard scales. These rates were generally desirable and lower than standard limit which indicates acceptable operation in the treatment system and storages in the channel line of Isfahan to Yazd. Furthermore, it was obtained that there is a correlation between THMs rates and effective parameters in producing confidential values such as 95%and 99%for the residue chlorine and heat respectively. Finally the distribution and diffusion plan of THMs in transferring line and civic network of Yazd were drawn.

Background and Aim: This research aimed to study the status of providing health information services in public libraries in Tehran, which was conducted based on the views of librarians working in these libraries. Materials and Methods: The research method was applied in terms of its purpose and descriptive in terms of data collection, which was conducted as a survey. The statistical population was 150 librarians of public libraries in Tehran. The tool for collecting information was a researcher-made questionnaire. Data analysis was done using SPSS statistical software.. Results: The status of health information resources available in public libraries of Tehran is low and very low in most sources. The level of familiarity of librarians with health and public health issues is %20. The level of familiarity of librarians with selective dissemination of health information services is low and very low with %77.4. The participation rate of librarians in medical information workshops is faced with the non-participation of %70 of librarians. The familiarity of librarians with the services of selective distribution of health information is low and very low. %60 of librarians are not familiar with medical information systems. The percentage of familiarity of librarians with internal medical websites is %60-78 weak. The percentage of familiarity of librarians with foreign international websites in the field of health is average. Librarians consider the main reason for providing selective health information services to improve the level of health literacy in the society. Also, the main obstacle to providing health information dissemination services is the librarian not having enough time to provide services. Conclusion: The country’s public libraries should consider measures to familiarize librarians with the field of health information and implement policies in this field. Considering the appropriate technical facilities of public libraries in Tehran, it is possible to create and access internal and external health systems and websites. and expanded the sources and documents of librarians’ health information.

The purpose of this research is to identify and investigate the relationship between the barriers to the implementation of the circular economy and Industry 4.0 in the supply chain in one of the polluting industries of the country (Yazd Glass Complex). In order to identify the barriers and categorize the barriers, the Meta-Synthesis approach was used, and in the quantitative part, in order to present the pattern of relationships between these barriers and their prioritization, the combined method of Fuzzy DEMATEL- ANP (FDANP) was used. The findings of the qualitative section included the identification of 24 obstacles in 5 dimensions. In the quantitative part, the findings showed that economic, infrastructural and technical-legal barriers are considered as causal dimensions that affect human resources and organizational-management (Effect) dimensions. Also, the obstacles of lack of expertise and knowledge of employees regarding the circular economy and Industry 4.0; Fear of unemployment and resistance to organizational and process changes and lack of funds and financial tools for training and research and development and operations are the most important obstacles in the implementation of the circular economy and Industry 4.0 in the supply chain of polluting industries such as the glass industry.

BACKGROUND: Caring for COVID-19 patients has caused high stress and burnses. Therefore, the current research aims to develop and validate an educational-therapeutic package based on psychological flexibility for COVID-19 nurses. MATERIALS AND METHODS: The approach of this research was Exploratory Sequential Mixed Method, which was carried out in 2019 to 2021. In the qualitative phase, to identify the paradigm model of the research, the grounded theory of the Strauss and Corbin model, purposeful sampling, and in-depth semi-structured interviews with 12 nurses were used. Goba and Lincoln’s criteria were used to ensure the accuracy and reliability of the data. In the quantitative phase, based on the Paradarim model, a training package according to psychological flexibility was developed with the approval of 10 experts from the fields of medical, psychology and nursing education. RESULTS: The qualitative analysis of the data obtained from the interviews led to the identification of 29 primary concept codes, 8 subcategories, and 3 categories in the conceptual format of context, process, and consequence. The categories included “psychological insecurity in the workplace,” “strategic immunization in facing special conditions,” and “safe communication.” “Psychologically safe exposure” was identified as the central category. In several stages, based on the findings of the qualitative stage, the educational-therapeutic package was compiled. The validity of the package was confirmed by calculating two relative coefficients of content validity ratio (CVR) and content validity index (CVI) equal to 0.91 and 0.85, respectively. CONCLUSION: This research led to the development of an educational-therapeutic package of safe psychological exposure for nurses, which can be used by managers and nurse educators through in-service training courses. Therefore, it is suggested to use training and safe coping strategies to improve the quality of life in nurses.

We discovered a giant magnetoelasticity in soft matter with up to 5-fold enhancement of magnetomechanical coupling factors compared to that of rigid metal alloys without an externally applied magnetic field. A wavy chain analytical model based on the magnetic dipole-dipole interaction and demagnetizing field was established, fitting well to the experimental observation. To explore its potentials in electronic textiles, we coupled it with magnetic induction to invent a textile magnetoelastic generator (MEG), a new working mechanism for biomechanical energy conversion, featuring an intrinsic waterproofness, an ultralow internal impedance of approximately 20 Ω, and a high short-circuit current density of 1.37 mA/cm2, which is about four orders of magnitude higher than that of other textile generator counterparts. Meanwhile, assisted by machine learning, the textile MEG could continuously monitor the respiratory activities on heavily perspiring skin without any encapsulation, allowing a timely diagnosis of the respiration abnormalities in a self-powered manner. We foresee that this discovery can be extended to wide-range soft-matter systems, emerging as a compelling approach to develop electronic textiles for energy, sensing, and therapeutic applications.