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Background and Aim: Pharmaceuticals, especially antibiotics, are new contaminants that because of their cumulative nature, adverse effects and drug resistance; have created a major environmental concern. The aim of this study was to evaluate UV/peroxymonosulfate (UV/PMS) process efficiency in the removal of cefexime antibiotic from aqueous solution. Materials and Methods: This experimental laboratory study was conducted in batch mode. We assessed the effects of main operational parameters such as solution pH (3-9), reaction time (0-30 min), photocatalyst dosage (0.75-2.25 mmol/L), and initial concentration of cefexime (5-25 mg/L) on removal efficiency. Spectrophotometer (HACH DR-5000 UV–Vis) was used to measure the initial and final concentrations of cefexime. Results: Under optimal condition (pH=7.5, irradiation time=30 min, C0=5 mg/L, and PMS dosage=1.37 mmol/L), use of photocatalytic UV/peroxymonosulfate led to efficient removal of cefexime (93.18%). Conclusion: The results of this study showed the acceptable performance of peroxymonosulfate process in the removal of cefexime.

Background and Objective: Chemical dyes used in the textile wastewater besides having harmful effect on the environment, have carcinogenic and mutagenic effects. Methylene blue has harmful effect on living organisms in short period of exposure. The goal of this study was optimization of the catalytic ozonation process by pumice modified by magnesium nitrate in removal of methylene blue dye based on Taguchi statistical model. Materials and Methods: In this experimental study ozonation process was in a batch ozonation reactor. The prepared pumice was crushed and pulverized by standard ASTM (American Society for Testing and Materials) sieves at range of 70 mesh, then modified by magnesium nitrate. Effective factors such as reaction time, initial dye concentration, adsorbent dose, and initial pH at 4 different levels were considered using an L-16 Taguchi method. Residual concentration of contaminants was read using a spectrophotometer at a wavelength of 663 nm. Analysis of data was performed using one- way variance and calculation of S/N (signal- to- noise) rate. Results: The results showed best conditions for removal dye were at contact time of 15 min, pH of 10, dye concentration of 50 mg/l,and adsorbent dosage of 0.7 g/L and efficiency of dye removal was 98%. Analysis of variance results indicated that the reaction time was the most important variable influencing the dye removal percentage with the contribution value of 51.8% and pH was the least important variable influencing the dye removal with the contribution value of 3.8% Conclusion: The results showed that ozonation process can be a selective method to reduce the concentration of pollutants in textile wastewater effluent. [ABSTRACT FROM AUTHOR]

The diagnosis of abdominal pain in emergency departments is challenging, and appendicitis is a common concern. Atypical symptoms often delay diagnosis. Although the Alvarado score aids in decision-making, its low specificity can lead to unnecessary surgeries. By leveraging machine learning, we aim to enhance diagnostic accuracy by predicting appendicitis and distinguishing it from other causes of abdominal pain in the emergency department. Data were collected from 534 patients who presented with acute abdominal pain. Patient characteristics, laboratory results, and causes of pain were recorded. Machine learning algorithms (support vector classifier, random forest classifier, gradient boosting classifier, and Gaussian naive Bayes) were used to predict the cause of pain. Model calibration was assessed using the Brier score. The mean age was 46.89 (20.3) years, with an almost equal sex distribution (49% male, 51% female). Cholecystitis was the most prevalent outcome (37.07%), followed by appendicitis (25.84%). The Gaussian naive Bayes model exhibited superior performance in terms of accuracy (95.03% 95% CI 90.44-97.83%), sensitivity (87.18% 95% CI 72.57-95.70%), and specificity (97.54% 95% CI 92.98-99.49%), while the random forest model showed a sensitivity of 79.49%, specificity of 96.72%, and accuracy of 92.55%. The gradient boosting algorithm achieved a sensitivity, specificity, and accuracy of 89.74%, 95.90%, and 94.41%, respectively. The support vector classifier demonstrated a sensitivity of 89.74%, specificity of 92.62%, and accuracy of 91.93%. The use of modern machine learning methods aids in the accurate diagnosis of appendicitis., Competing Interests: Declarations. Conflicts of interest: The authors declare that there are no conflicts of interest relevant to this research. Ethics approval and consent to participate: According to the institutional review board, the data utilized in this study underwent a rigorous deidentification process prior to their usage. This study was submitted to the Hamadan University Medical Sciences Ethics Committee under the code IR.UMSHA.REC.1402.393. The study itself was conducted in strict adherence to the local ethical guidelines as well as the principles outlined in the Declaration of Helsinki. No approval was obtained from the international review boards (IRBs). Consent to participate: Informed consent was obtained from all individual participants included in the study., (© 2024. The Author(s), under exclusive licence to Società Italiana di Medicina Interna (SIMI).)

This study aimed to investigate the prevalence of insulin autoantibody (IAA), glutamic acid decarboxylase antibody (GADA), and insulinoma-associated antigen-2 antibody (IA-2A) in type 1 diabetes (T1D) children based on the presence of predisposing HLA-II alleles. Additionally, to assess the sequence homology between autoantigens of islet cells and selected proteins derived from gut bacteria in terms of their binding capacities to HLA risk alleles, HLA-DRB1/DQB1 alleles were determined by PCR-SSOP in 111 T1D children (probands) along with 222 parents and 133 siblings. Autoantibodies were measured by ELISA, and in silico analysis was run as follows: protein extraction, homology and epitope prediction, peptide alignment, and HLA-peptide docking. Higher significant frequencies of DRB1*03:01, DQB1*02:01, and DQB1*03:02 alleles and DRB1*03:01 ~ DQB1*02:01 haplotype and lower frequencies of DRB1*11:01, DRB1*14:01, and DQB1*03:01 alleles were found in probands compared to parents and siblings. DRB1*11:01 ~ DQB1*03:01, DRB1*14:01 ~ DQB1*05:03, and DRB1*15:01-DQB1*06:02 haplotypes were significantly less frequent in the probands compared to parents. Out of 111 probands, 21 were seronegative, 90 tested positive for one autoantibody, and 15 showed the concurrent presence of three autoantibodies. Logistic regression analysis revealed that DRB1*04 ~ DQB1*03:02 haplotype was associated with the induction of GADA and IA-2A, while DRB1*11:01 ~ DQB1*03:01 was associated with seronegativity. Epitopes derived from GAD and gut bacteria showed strong binding capacities to HLA risk alleles. Due to the sequence similarities between gut bacteria-derived proteins and islet cell autoantigens and their potential for binding to HLA risk alleles, dysbiosis of gut microbiota can be considered another risk factor for the development of T1D, especially in genetically susceptible individuals., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Underweight is a prevalent health issue in children. This study aimed to identify factors associated with underweight in children aged 1-2 years in Hamadan city. Unlike the studies conducted in this field, which are cross-sectional and do not provide information on the effect of age changes on underweight, our longitudinal approach provides insights into weight changes over time. On the other hand, this study focuses on the high-risk age group of 1 to 2 years, which has only been addressed in a few studies., Methods: In this longitudinal study, 414 mothers with 1 to 2 year-old children referred to the health centers of Hamadan city, whose information is in the SIB system, a comprehensive electronic system, were examined to identify factors related to underweight. The response variable was weight-for-age criteria classified into three categories: underweight, normal weight, and overweight. A two-level longitudinal ordinal model was used to determine the factors associated with underweight., Results: Of the children studied, 201 (48.6%) were girls and 213 (51.4%) were boys. Significant risk factors for underweight included low maternal education (AOR = 3.56, 95% CI: 1.10-11.47), maternal unemployment (AOR = 3.38, 95% CI: 1.05-10.91), maternal height (AOR = 0.85, 95% CI: 0.79-0.92), lack of health insurance (AOR = 2.85, 95% CI: 1.04-7.84), gestational age less than 24 years (AOR = 3.17, 95% CI: 16.28-0.97), child age 12-15 months (AOR = 2.27, 95% CI: 1.37-3.74), and child's birth weight (AOR = 0.63, 95% CI: 0.70-0.58)., Conclusion: Based on the results of the present study, it seems that the possibility of being underweight among children is more related to the characteristics of mothers; therefore, taking care of mothers can control some of the weight loss of children., (© 2024. The Author(s).)

Background: Smoking cessation is a dynamic process that often involves a series of unsuccessful quit attempts before long-term abstinence is achieved. To implement interventions that lead to long-term abstinence, it will be necessary to understand the determinants of smoking cessation. Therefore, the main objective of the present study was to determine the effect of factors influencing both smoking cessation attempts and successful smoking cessation in the general population of Iran., Methods: The data of 1293 participants whose information was obtained through a national cross-sectional study entitled "Survey of Risk Factors of Noncommunicable Diseases in 2016" were analyzed. There were three response levels: "quit attempt and successful quit", "quit attempt and unsuccessful quit", and "no quit attempt and unsuccessful quit". A multinomial logistic regression model was used to assess the effect of covariates on response., Results: The mean (sd) age of all participants was 47.21 (13.65) years. According to the results, 883 people (68.29%) did not attempt to quit smoking, and of those who attempted to quit smoking, only 64 (15.61%) men were successful. The factors of living in an urban area (OR = 1.71) and past smoking intensity (OR = 1.967) were associated with no quit attempt and unsuccessful quitting. In addition, physician recommendation to quit smoking was a protective factor for no quit attempt and unsuccessful quit (OR = 0.599). Alcohol consumption was also a protective factor against successful quitting for both attempters (OR = 0.351) and nonattempters (OR = 0.359)., Conclusions: Tobacco control programs should be implemented with a greater focus on heavy smokers and alcohol users. In addition, the role of health professionals in encouraging smokers to quit smoking should not be ignored., (© 2024. The Author(s).)

One of the probable hypotheses for the onset of autoimmunity is molecular mimicry. This study aimed to determine the HLA-II risk alleles for developing Hashimoto's thyroiditis (HT) in order to analyze the molecular homology between candidate pathogen-derived epitopes and potentially self-antigens (thyroid peroxidase, TPO) based on the presence of HLA risk alleles. HLA-DRB1/-DQB1 genotyping was performed in 100 HT patients and 330 ethnically matched healthy controls to determine the predisposing/protective alleles for HT disease. Then, in silico analysis was conducted to examine the sequence homology between epitopes derived from autoantigens and four potentially relevant pathogens and their binding capacities to HLA risk alleles based on peptide docking analysis. We identified HLA-DRB1*03:01, *04:02, *04:05, and *11:04 as predisposing alleles and DRB1*13:01 as a potentially predictive allele for HT disease. Also, DRB1*11:04 ~ DQB1*03:01 (Pc = 0.002; OR, 3.97) and DRB1*03:01 ~ DQB1*02:01 (Pc = 0.004; OR, 2.24) haplotypes conferred a predisposing role for HT. Based on logistic regression analysis, carrying risk alleles increased the risk of HT development 4.5 times in our population (P = 7.09E-10). Also, ROC curve analysis revealed a high predictive power of those risk alleles for discrimination of the susceptible from healthy individuals (AUC, 0.70; P = 6.6E-10). Analysis of peptide sequence homology between epitopes of TPO and epitopes derived from four candidate microorganisms revealed a homology between envelop glycoprotein D of herpes virus and sequence 151-199 of TPO with remarkable binding capacity to HLA-DRB1*03:01 allele. Our findings indicate the increased risk of developing HT in those individuals carrying HLA risk alleles which can also be related to herpes virus infection., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Antineoplastic drugs (ADs) are widely used in cancer treatment. Nurses in chemotherapy centers are exposed to these drugs during preparation. They can affect healthy cells, leading to teratogenic and mutagenic effects, as well as oxidative stress. This study aimed to evaluate oxidative stress biomarkers in the nurses exposed to these drugs., Method: This study was conducted on 30 nurses exposed to ADs and 30 nurses with no exposure to these drugs as non-exposed group. Oxidative stress biomarkers were measured in the blood serum samples of both groups, including malondialdehyde (MDA), catalase (CAT), superoxide dismutase (SOD), glutathione peroxidase (GPx), total antioxidant capacity (TAC), and blood thiol groups., Results: Considering the possibility of confounding effect of nutritional supplement consumption, the effect of this factor was adjusted in the analysis. A significant difference was observed for CAT, SOD, thiol, and TAC biomarkers between two groups (P < 0.05). However, the difference in MDA and GPx biomarkers between two groups was not statistically significant., Conclusions: The findings of the present study showed that supplement consumption has a significant effect on the biomarker of total antioxidant capacity. Thus, total antioxidant capacity measurement is advised as the best biomarker for tracking oxidative status in nurses exposed to ADs due to its capacity to measure all antioxidants in the body, except the thiol group, and its lower cost when compared to other biomarkers. Furthermore, it can be claimed that the consumption of nutritional supplements has a greater effect on the non-enzymatic biomarkers of oxidative stress than on enzymatic antioxidant system., Competing Interests: Declaration of competing interest The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

This family-based study was conducted in a group of Iranians with Type 1 diabetes (T1D) to investigate the transmission from parents of risk and non-risk HLA alleles and haplotypes, and to estimate the genetic risk score for this disease within this population. A total of 240 T1D subjects including 111 parent-child trios (111 children with T1D, 133 siblings, and 222 parents) and 330 ethnically matched healthy individuals were recruited. High-resolution HLA typing for DRB1/DQB1 loci was performed for all study subjects (n = 925) using polymerase chain reaction-sequence-specific oligonucleotide probe method. The highest predisposing effect on developing T1D was conferred by the following haplotypes both in all subjects and in probands compared to controls: DRB1*04:05-DQB1*03:02 (Pc = 2.97e-06 and Pc = 6.04e-10, respectively), DRB1*04:02-DQB1*03:02 (Pc = 5.94e-17 and Pc = 3.86e-09, respectively), and DRB1*03:01-DQB1*02:01 (Pc = 8.26e-29 and Pc = 6.56e-16, respectively). Conversely, the major protective haplotypes included DRB1*13:01-DQB1*06:03 (Pc = 6.99e-08), DRB1*15:01-DQB1*06:02 (Pc = 2.97e-06) in the cases versus controls. Also, DRB1*03:01-DQB1*02:01/DRB1*04:02|05-DQB1*03:02 and DRB1*03:01-DQB1*02:01/DRB1*03:01-DQB1*02:01 diplotypes conferred the highest predisposing effect in the cases (Pc = 8.65e-17 and Pc = 6.26e-08, respectively) and in probands (Pc = 5.4e-15 and Pc = 0.001, respectively) compared to controls. Transmission disequilibrium test showed that the highest risk was conferred by DRB1*04:02-DQB1*03:02 (Pc = 3.26e-05) and DRB1*03:01-DQB1*02:01 (Pc = 1.78e-12) haplotypes and the highest protection by DRB1*14:01-DQB1*05:03 (Pc = 8.66e-05), DRB1*15:01-DQB1*06:02 (Pc = 0.002), and DRB1*11:01-DQB1*03:01 (Pc = 0.0003) haplotypes. Based on logistic regression analysis, carriage of risk haplotypes increased the risk of T1D development 24.5 times in the Iranian population (p = 5.61e-13). Also, receiver operating characteristic curve analysis revealed a high predictive power of those risk haplotypes in discrimination of susceptible from healthy individuals (area under curve: 0.88, p = 5.5e-32). Our study highlights the potential utility of genetic risk assessment based on HLA diplotypes for predicting T1D risk in individuals, particularly among family members of affected children in our population., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The short-term effects of air pollution on respiratory diseases have been reported in many countries. Urban areas are most affected because of the many sources of pollution and the large number of people living there. This study aims to investigate the effect of short-term exposure to air pollutants on respiratory hospital admissions in the city of Hamadan. In this ecological study, daily hospital admission data were collected from Shahid Beheshti Hospital in Hamadan. Daily information on air pollutants (CO, SO 2 , NO 2 , O 3 , PM 2.5 and PM 10 ) from Hamadan Department of Environment (DoE) organization and of climate factors from Hamadan Meteorological Office were collected. A negative binomial regression model was used to examine the effect of air pollution on daily respiratory hospitalizations. The effect of exposure to pollutants was measured whit different time lags (0-7 days). Furthermore, the effect of meteorological variables was controlled. Subgroup analyses were performed by sex and age group. A total of 12,454 hospitalizations for respiratory diseases were recorded. Results showed a strong and immediate effect of CO on respiratory hospital admissions with highest association at lag 7 (relative risk (RR) = 1.38, 95% CI: 1.33, 1.42). The effects of CO and SO 2 on respiratory hospitalizations are greater for men than women. Regarding the short-term effects of PM 2.5 , SO 2 and O 3 , adults (aged less than 65) were more prone to hospitalization for respiratory diseases. These results show that exposure to air pollution, particularly CO, may increase hospital admissions due to respiratory illness. So reducing the concentration of these pollutants can reduce the number of hospital admissions., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Systolic blood pressure (SBP) strongly indicates the prognosis of heart failure (HF) patients, as it is closely linked to the risk of death and readmission. Hence, maintaining control over blood pressure is a vital factor in the management of these patients. In order to determine significant variables associated with changes in SBP over time and assess the effectiveness of classical and machine learning models in predicting SBP, this study aimed to conduct a comparative analysis between the two., Methods: This retrospective cohort study involved the analysis of data from 483 patients with HF who were admitted to Farshchian Heart Center located in Hamadan in the west of Iran, and hospitalized at least two times between October 2015 and July 2019. To predict SBP, we utilized a linear mixed-effects model (LMM) and mixed-effects least-square support vector regression (MLS-SVR). The effectiveness of both models was evaluated based on the mean absolute error and root mean squared error., Results: The LMM analysis revealed that changes in SBP over time were significantly associated with sex, body mass index (BMI), sodium, time, and history of hypertension (P-value < 0.05). Furthermore, according to the MLS-SVR analysis, the four most important variables in predicting SBP were identified as history of hypertension, sodium, BMI, and triglyceride. In both the training and testing datasets, MLS-SVR outperformed LMM in terms of performance., Conclusions: Based on our results, it appears that MLS-SVR has the potential to serve as a viable alternative to classical longitudinal models for predicting SBP in patients with HF., Competing Interests: The authors declare that they have no conflicts of interest., (©2023 Pacini Editore SRL, Pisa, Italy.)

Introduction: Jaundice is one of the most common problems during infancy. It is believed that breast milk jaundice is one of the reasons for the persistence of jaundice after 14 days of prolonged jaundice. This study evaluates the effect of Clofibrate and phototherapy on prolonged jaundice originating from breast milk in term and healthy neonates., Materials and Methods: This double-blind clinical trial study was performed on 100 randomly divided neonates in the neonatal ward of Besat Hospital. In addition to phototherapy, the case group received a single dose of edible Clofibrate (50 mg/kg) dissolved in 2 CCs of distilled water. The control group received the same amount of distilled water as the phototherapy group. After treatment, bilirubin change rate, duration of hospitalization, and any association with gender, gestational age, hemoglobin, blood type, and Rh of neonates were determined and compared throughout the 2 groups., Results: Data analysis showed that the bilirubin reduction rate was statistically significantly higher in the case group than in the control group ( P  < .05). The mean duration of hospitalization and phototherapy in the case group was significantly lower than in the control group ( P  = .005). The bilirubin reduction rate was not affected significantly by gestational age, blood type, or Rh., Conclusion: This study's results demonstrated that Clofibrate effectively decreased bilirubin levels and shortened the duration of phototherapy and hospitalization in infants with probable breast milk jaundice., Registration: IRCT2012092910933N1., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: Adequate gestational weight gain (GWG) is an important factor for maternal and fetal health. This is especially important in low-income and slum areas due to limited access to health services and malnutrition. Thus, the purpose of this study is to evaluate the pattern of GWG changes in the slum areas of Hamadan in Iran., Methods: In this longitudinal study, the study sample consisted of 509 pregnant women who referred to nine health care clinics in the slum areas of Hamadan. Women's weight gain based on the recommended GWG by U.S. Institute of Medicine (IOM) was divided into three categories: Inadequate weight gain, Adequate weight gain, and Excessive weight gain. In order to evaluate the trend of GWG, a multi-level ordinal model was used., Results: According to pre-pregnancy BMI, a little more than half people (56.6%) were overweight or obese. 85.4% women in the first trimester and 49.1% in the second trimester did not have adequate GWG, but in the third trimester (38.9%) had adequate GWG. Based on multivariate analysis, pre- pregnancy BMI has a significant effect on the odds of inadequate GWG (P-value = 0.021); with one unit increase in pre-pregnancy BMI, the odds of inadequate GWG grows by 1.07 times compared to adequate and excessive GWG., Conclusions: In general, women did not have adequate weight gain in the first and second trimesters.Thus, designing appropriate interventions to achieve optimal GWG seems to be necessary in slums., (© 2023. The Author(s).)

Introduction: Nowadays, the use of androgenic-anabolic steroids (AAS) by competitive and non-competitive bodybuilders and its side effects have become a major public health problem. Many studies have focused on determining the role and severity of various factors in AAS use, but the existence of collinearity between the factors leads to the non-significance of important factors. The study aimed to determine factors affecting the androgenic-anabolic steroids use in Iranian bodybuilders., Method: This descriptive-analytical study was performed on 280 male bodybuilders (142 non-competitive and 138 competitive bodybuilders) in Hamadan, west of Iran, in 2016. The participations were recruited a multistage sampling method. A self-administrated questionnaire was used, which included parts such as intrapersonal, interpersonal, and behavioral factors affecting on AAS use. To solve the consequences of collinearity was used ridge logistic regression model (RLRM) in R.3.5.1 software., Results: The mean age of bodybuilders was 25.21 years (SD = 6.31). The prevalence rate of AAS use among non-competitive and competitive bodybuilders was 27.5% and 34.1%, respectively. Factors such as age, time of starting bodybuilding, attitude, physical self-concept, behavioral intention, coach and friend use AAS, alcohol consumption, and supplement use were associated with AAS use among non-competitive and competitive bodybuilders., Conclusion: The results of the study indicated that a combination of intrapersonal, interpersonal and behavioral factors was effective on the androgenic-anabolic steroids use among Iranian bodybuilders. Adequate education about the side effects of AAS and improvement of individual skills seem to be helpful in reducing AAS use., (© 2023. The Author(s).)

Background: Office workers are at high risk of developing musculoskeletal symptoms (MSS) due to improper workstations. Open-plan bank office employees must communicate with bank clerks properly and perform financial activity precisely, but noise is a factor that disrupts their communication. Therefore, MSS and annoying noise are two of the main problems in open-plan offices., Objective: This study evaluated the effects of a multi-component intervention involving individual (employee ergonomics training) and physical (improvements in workstation design and work environment) ergonomic factors on musculoskeletal outcomes and speech communication in open-plan environments., Methods: A preliminary survey was carried out to investigate the overall ergonomics problems, the tasks and time analysis, workstations setup, the prevalence of MSS (Nordic Musculoskeletal Questionnaire), physical discomfort (Visual Analogue Scale [VAS]), and posture (assessed by Rapid Upper Limb Assessment [RULA] method), environmental status (measurement of noise), and speech intelligibility (assessed by Speech Interference Level [SIL] method based on ISO 9921). The multi-component interventions were performed afterward based on the data collected. A baseline assessment and a 9-month follow-up assessment were conducted., Results: The results showed a significant decrease in the prevalence of musculoskeletal complaints (shoulders, elbows, and low back), physical discomfort, and awkward working postures after the intervention. A considerable improvement was also found in speech intelligibility post-intervention. The post-intervention questionnaire survey also indicated that employees generally favored the redesigned workstations., Conclusion: The results support the effectiveness of implementing multi-component interventions in open-plan bank offices to improve musculoskeletal complaints and speech communication.

Background: Acoustic comfort is one of the most critical challenges in the open-plan workspace., Objective: This study was aimed to assess the effect of irrelevant background speech (IBS) and mental workload (MWL) on staffs' physiological parameters in open-plan bank office workspaces., Methods: In this study, 109 male cashier staff of the banks were randomly selected. The 30-minute equivalent noise level (LAeq) of the participants was measured in three intervals at the beginning (section A), middle (section B), and end of working hours (section C). The heart rate (HR) and heart rate variability (HRV): low frequency (LF), high frequency (HF), and LF/HF of the staff were also recorded in sections A, B, and C. Moreover, staff was asked to rate the MWL using the NASA-Task load., Results: The dominant frequency of the LAeq was 500 Hz, and the LAeq in the frequency range of 250 to 2000 was higher than other frequencies. The LAeq (500 Hz) was 55.82, 69.35, and 69.64 dB(A) in sections A, B, and C, respectively. The results show that the IBS affects staffs' physiological responses so that with increasing in IBS, the HF power decreases. Moreover, with higher MWL, increasing noise exposure, especially IBS, causes more increases in LF power and LF/HF ratio., Conclusion: It seems that the IBS can affect physiological responses and increase staff stress in open-plan bank office workspaces. Moreover, the mental workload can intensify these consequences in these working settings.

Bed occupancy rate (BOR) is important for healthcare policymakers. Studies showed the necessity of using simulation approach when encountering complex real-world problems to plan the optimal use of resources and improve the quality of services. So, the aim of the present study is to estimate average length of stay (LOS), BOR, bed blocking probability (BBP), and throughput of patients in a cardiac surgery department (CSD) using simulation models. We studied the behavior of a CSD as a complex queueing system at the Farshchian Hospital. In the queueing model, customers were patients and servers were beds in intensive care unit (ICU) and post-operative ward (POW). A computer program based on the Monte Carlo simulation, using Python software, was developed to evaluate the behavior of the system under different number of beds in ICU and POW. The queueing simulation study showed that, for a fixed number of beds in ICU, BOR in POW decreases as the number of beds in POW increases and LOS in ICU increases as the number of beds in POW decreases. Also, based on the available data, the throughput of patients in the CSD during 800 days was 1999 patients. Whereas, the simulation results showed that, 2839 patients can be operated in the same period. The results of the simulation study clearly demonstrated the behavior of the CSD; so, it must be mentioned, hospital administrators should design an efficient plan to increase BOR and throughput of patients in the future., (© 2022. The Author(s).)

Because the age at which a person first starts smoking has such a strong correlation with future smoking behaviours, it's crucial to examine its relationship with smoking intensity. However, it is still challenging to accurately prove this relationship due to limitations in the methodology of the performed studies. Therefore the main purpose of this study is to evaluate the potential risk factors affecting the intensity of smoking, especially the age of smoking onset among Iranian adult male smokers over 18 years of age using a generalized additive model (GAM). In GAM a latent variable with logistic distribution and identity link function was considered. Data from 913 Iranian male current smokers over the age of 18 was evaluated from a national cross-sectional survey of non-communicable disease (NCD) risk factors in 2016. Individuals were classified into: light, moderate, and heavy smokers. A GAM was used to assess the relationship. The results showed that 246 (26.9%) subjects were light smokers, 190 (20.8%) subjects were moderate smokers and 477 (52.2%) subjects were heavy smokers. According to the GAM results, the relationship was nonlinear and smokers who started smoking at a younger age were more likely to become heavy smokers. The factors of unemployment (OR = 1.364, 95% CI 0.725-2.563), retirement (OR = 1.217, 95% CI 0.667-2.223), and exposure to secondhand smoke at home (OR = 1.364, 95% CI 1.055-1.763) increased the risk of heavy smoking. but, smokers with high-income (OR = 0.742, 95% CI 0.552-0.998) had a low tendency to heavy smoking. GAM identified the nonlinear relationship between the age of onset of smoking and smoking intensity. Tobacco control programs should be focused on young and adolescent groups and poorer socio-economic communities., (© 2022. The Author(s).)

Purpose: Since cancer patients are at higher risk of COVID-19, the present study was conducted to investigate the epidemiology of these patients and identify the affecting risk factors on their mortality., Methods: The present retrospective cohort study was conducted on 66 hospitalized patients with cancer and COVID-19 in Hamadan in 2020. In the present study, demographic, clinical, and laboratory information and patients' outcome were collected through a checklist and its impact on death was assessed. Data were analyzed in SPSS-24 software and the significance level of the tests was considered at 5%., Results: The mean (standard deviation (SD)) age of patients was 61.6 (13.5) years. Forty patients (60.6%) were male. Twenty and five patients (37.9%) died at the end of study. The results of logistic regression model revealed that the nausea, mechanical ventilation, admission to ICU, and length of hospital stay in the ward had a significant impact on the odds of death among cancer patients with COVID-19 (p < 0.05)., Conclusion: Owing to high mortality rate in cancer patients with COVID-19 and due to underlying diseases and more severe clinical symptoms than other patients with coronavirus, these patients need intensive care and specific treatments. However, screening these patients and early identifying and vaccinating of them can reduce the mortality rate in these patients., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Muscle fatigue (MF) can lead to musculoskeletal disorders (MSDs) in the long term; however, it can be managed if the causes are well known. This study aimed to examine the grip force (GF) and grip fatigue (GFa) of employees with light, moderate and heavy manual tasks using a dynamometer and find their possible relationship with other factors. The nature of heavy manual tasks led to more experience of GFa and GF of the right hand. Moreover, the equal need for both hands in occupations with light and moderate manual tasks is the reason for more GFa in the left hand. In this primary study, the height, weight and age of subjects and their exposure to vibration had a decisive effect on GF. In order to determine the accurate effects of the aforementioned risk factors on MF, it is recommended for future studies to be performed on larger populations.

Objectives: Breast cancer (BC) is the most common cause of cancer death in Iranian women. Sometimes death from other causes precludes the event of interest and makes the analysis complicated. The purpose of this study was to identify important prognostic factors associated with survival duration among patients with BC using random survival forests (RSF) model in presence of competing risks. Also, its performance was compared with cause-specific hazard model., Methods: This retrospective cohort study assessed 222 patients with BC who were admitted to Ayatollah Khansari hospital in Arak, a major industrial city and the capital of Markazi province in Iran. The cause-specific Cox proportional hazards and RSF models were employed to determine the important risk factors for survival of the patients., Results: The mean and median survival duration of the patients were 90.71 (95%CI: 83.8-97.6) and 100.73 (95%CI: 89.2-121.5) months, respectively. The cause-specific model indicated that type of surgery and HER2 had statistically significant effects on the risk of death of BC. Moreover, the RSF model identified that HER2 was the most important variable for the event of interest., Conclusion: According to the results of this study, the performance of the RSF model was better than the cause-specific hazard model. Moreover, HER2 was the most important variable for death of BC in both of the models., Competing Interests: Conflict of interest statement The authors declare that they have no conflicts of interest., (©2022 Pacini Editore SRL, Pisa, Italy.)

Objectives: Neonatal jaundice or hyperbilirubinemia is one of the common findings in neonatal medicine. Severe disease can cause neurological damage and even Kernicterus. Magnesium ion is the most important N-methyl-D-aspartate receptor antagonist. The most commonly used treatment for jaundice is phototherapy, but the effect of phototherapy on serum magnesium is less investigated. In this study, we aim to investigate the effects of phototherapy on total serum magnesium levels in icteric neonates., Methods: This prospective cohort study was carried out on 160 neonates with jaundice referring to the Besat Hospital of Hamadan. Based on the bilirubin level, newborns were divided into three subgroups of mild, moderate, and severe disease which were subjected to single, double, and intensive phototherapy, respectively. Serum bilirubin and magnesium levels were measured before and after phototherapy and compared using parametric tests., Results: Subjects have a mean intrauterine age of 38.8 weeks and a jaundice onset age of 3.8 days. In all groups, serum magnesium levels were within the normal range before phototherapy. After phototherapy, on the other hand, the most reduction of total serum magnesium was in the double phototherapy group, which was -0.13 ± 0.42 mg/dl ( P = 0.018). The change in serum magnesium level was not significant in the single phototherapy (-0.02 ± 0.25) and intensive phototherapy (-13.55 ± 2.73) groups ( P > 0.05)., Conclusion: In the present study, serum magnesium did not increase significantly before the treatment in three groups. After treatment, a significant reduction was seen in the double phototherapy group., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2022 Fatemeh Eghbalian et al.)

Purpose: Colorectal cancer is one of the most common cancers and the leading cause of cancer death in Iran. This study aimed to develop and validate a random survival forest (RSF) to identify important risk factors on mortality in colorectal patients based on their demographic and clinical-related variables., Methods: In this retrospective cohort study, the information of 317 patients with colorectal cancer who were referred to Imam Khomeini Clinic of Hamadan during the years of 2002 to 2017 were examined. Patient survival was calculated from the time of diagnosis to death. In the present study, the RSF model was used to identify factors affecting patient survival. Also, the results of the RSF model were compared with the Cox model. The data were analyzed using R software (version 3.6.1) and survival packages., Results: One-, 2-, 3-, 4-, 5-, and 10-year survival rates of included patients were 81.4%, 63%, 57%, 52%, 45%, and 34%, respectively, and the median survival was obtained to be 53 months. The number of 150 patients was died at this time period. The four most important predictors of survival included metastasis to other organs, WBC count, disease stage, and number of lymphomas involved. RSF method predicted survival better than the conventional Cox proportional hazard model., Conclusion: We found that metastasis to other organs, WBC count, disease stage, and number of lymphomas involved were the most four most important predictors of low survival for colorectal cancer patients., (© 2020. Springer Science+Business Media, LLC, part of Springer Nature.)

There is a recent trend to place more emphasis on noise non-auditory effects. Despite its implications on health, there is a lack of recommendations for noise in occupational settings. This study aimed to present occupational exposure limits for noise-induced non-auditory effects in healthy males using empirical exposure-response regression models based on the data of laboratory and field considering the effective variables. To this end, the equivalent noise level was measured and recorded in four working settings including closed offices, open-plan offices, control rooms, and industrial workplaces during a normal working day. They were 65, 68, 73, and 80dB(A), respectively. In the laboratory, 31 healthy males were exposed to five noise conditions (four noisy conditions and one quiet) during 8 h and they were asked to perform the cognitive tests. In the field phase, 124 healthy males were also examined from four working settings in their workstations for 8 h. The psychophysiological parameters of the participants were recorded in both lab and field. The results indicated variations in mental responses at levels above 55dBA, and psychophysiological variations at levels above 70dB(A) in both phases. The findings also showed that the developed regression models could plausibly predict the noise-induced psychophysiological responses during exposure to noise levels; thus, they can be presented the likely exposure limits. Based on the results of the models, the levels <55dB(A) are likelihood of the acoustic comfort limit, and the levels ranged from 55 to 65dB(A) are the acoustic safe limits. The acoustic caution limit is the likelihood of the levels ranged from 65 to 75dB(A). The levels ranged from 75 to 80dB(A) are likely the action levels or control limits, and the occupational exposure limit are the probability of levels> 80dB(A)., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Introduction: the Er,Cr:YSGG laser has a suitable wavelength for the ablation of both hard and soft tissues of the periodontium and can be considered as a potential tool in periodontal surgeries. The current study aimed at evaluating the application of this laser versus conventional instruments in periodontal pocket reduction flap surgery. Methods: Eight patients (16 dental arches) requiring periodontal surgery were included (Trial registration number: IRCT201711129014N199). Using a split-mouth study design, two posterior sextants of a dental arch were randomly allocated into either a test group, open flap debridement periodontal surgery using the Er,Cr:YSGG laser or a control group using the conventional method. Laser parameter settings of a 2780 nm wavelength, H mode (60 µs pulse duration), 25-50 Hz, 2-3.5 W output powers and Air-20%, Water-60-80% were applied and adjusted individually for each step of the flap surgery procedure. Baseline, 1 and 3-month measurements of plaque index (PI), Gingival Index (GI), gingival recession (GR), probing depth (PD) and clinical attachment level (CAL) were recorded for comparisons. Data were analyzed by a linear model for correlated data using the generalized estimating equations (GEE) method and the least significant difference (LSD). Results: In both treatment groups, reductions in PI and GI were observed in the 3-month follow-up period. These indices were significantly lower in the laser-treated sides compared to the conventional group ( P <0.05). The Mean PD and CAL were lower at 1 month and 3 months compared to the baseline in both groups ( P <0.05). However, these parameters were not statistically different in the treatment groups during these follow-up timelines. An increase in GR was observed from the baseline to 1 month and 3 months with less recession in the laser-treated sides ( P =0.016). Conclusion: Based on the results of the present study, the Er,Cr:YSGG laser assisted periodontal flap surgery resulted in similar treatment outcomes to the conventional method and may be considered as a safe and effective treatment modality., (Copyright © 2022 J Lasers Med Sci.)

Substance use is a social harm. Promoting substance users readiness for treatment of substance use with a non-medical approach is important besides the medical approach. The current study aimed to determine the relationship between readiness for treatment of substance use and self-efficacy based on life skills. In this descriptive-analytical study, a number of 118 substance users in Hamadan city (Iran) were participated. The data collection tools were Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) and Drug Avoidance Self-Efficacy Scale (DASES). Analytical and descriptive tests were used for data analysis, at 95% significant level, using Statistical Package for the Social Sciences 16. The results of this study showed that the readiness for treatment of substance use had a significant relationship with the self-efficacy includes assertiveness and communication (Df:1; P value <0.05). Self-efficacy based on life skills can be used to promote substance users readiness for treatment of substance use in educational interventions.

Background: Long-term use of computer in a static mode may cause musculoskeletal disorders (MSDs) in bank staff. Considering the high number of bank employees in different countries, such as Iran, the risk factors of these disorders should be investigated in order to implement interventions required to reduce the risk factors. This study aimed to examine the risk factors of MSDs using the Rapid Office Strain Assessment (ROSA) method and to perform an ergonomic intervention program with banking staff in Iran., Methods: This interventional study was conducted on 277 bank employees in Iran. Subjects were randomly divided into three groups, including a control group (without any intervention), an educational intervention (EI) group, and a group receiving both educational and physical intervention (EPI). Before and after the intervention, the ROSA method and Nordic questionnaire were used to assess the risk factors of MSDs in office jobs and to investigate the prevalence of MSDs. Data were collected 2 weeks before and 9 months following the intervention., Results: Before the intervention, the mean score of ROSA at workstations of all groups was above five with high risk. Nine months after the start of the intervention, there was a significant decrease in the mean ROSA score and its components in the two groups that received the intervention, which was statistically significant (P < 0.001). The results of the study of the prevalence of MSDs in the employees-before the intervention-indicate that the highest prevalence of MSDs in the control group was in areas of the neck (67.1%), back (64.4%), and lower back (63%). In the EI group, the highest prevalence of MSDs was in the neck (65.2%), lower back (61.6%), and back (60.7%) areas. In the EPI group, the discomfort areas were the neck (68.5%), shoulders (66.3%), and lower back (60.9%). Nine months after the intervention, there was a significant decrease in the prevalence of MSDs in the neck, shoulders, and lumbar regions of staff who received the intervention (P < 0.05)., Conclusion: Nine months after performing the interventions, there was a relative improvement in workstations and prevalence of MSDs in various areas within the bodies of the bank staff. This study showed that using the ROSA method is appropriate for assessing the risk factors of office work and that it can identify deficiencies in workstations. These defects can be addressed by designing and implementing an EI program together with physical interventions according to the components of the ROSA method., (© 2021. The Author(s).)

Objectives: Heart failure (HF) is a common disease with a high hospital readmission rate. This study considered class imbalance and missing data, which are two common issues in medical data. The current study's main goal was to compare the performance of six machine learning (ML) methods for predicting hospital readmission in HF patients., Methods: In this retrospective cohort study, information of 1,856 HF patients was analyzed. These patients were hospitalized in Farshchian Heart Center in Hamadan Province in Western Iran, from October 2015 to July 2019. The support vector machine (SVM), least-square SVM (LS-SVM), bagging, random forest (RF), AdaBoost, and naïve Bayes (NB) methods were used to predict hospital readmission. These methods' performance was evaluated using sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Two imputation methods were also used to deal with missing data., Results: Of the 1,856 HF patients, 29.9% had at least one hospital readmission. Among the ML methods, LS-SVM performed the worst, with accuracy in the range of 0.57-0.60, while RF performed the best, with the highest accuracy (range, 0.90-0.91). Other ML methods showed relatively good performance, with accuracy exceeding 0.84 in the test datasets. Furthermore, the performance of the SVM and LS-SVM methods in terms of accuracy was higher with the multiple imputation method than with the median imputation method., Conclusions: This study showed that RF performed better, in terms of accuracy, than other methods for predicting hospital readmission in HF patients.