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Abstract Alzheimer's disease (AD) is a neurodegenerative disease that is characterized by amyloid plaques, neurofibrillary tangles, and neuronal loss. Early cerebral and body iron dysregulation and accumulation interact with AD pathology, particularly in the precuneus, a crucial functional hub in cognitive functions. Quantitative susceptibility mapping (QSM), a novel post‐processing approach, provides insights into tissue iron levels and cerebral oxygen metabolism and reveals abnormal iron accumulation early in AD. Increased iron deposition in the precuneus can lead to oxidative stress, neuroinflammation, and accelerated neurodegeneration. Metabolic disorders (diabetes, non‐alcoholic fatty liver disease (NAFLD), and obesity), genetic factors, and small vessel pathology contribute to abnormal iron accumulation in the precuneus. Therefore, in line with the growing body of literature in the precuneus region of patients with AD, QSM as a neuroimaging method could serve as a non‐invasive biomarker to track disease progression, complement other imaging modalities, and aid in early AD diagnosis and monitoring.

Abstract There are many pollutants in the air that can be harmful to human health. Their impact varies based on factors such as the kind of pollutant, duration of exposure, and concentration levels. Volatile organic compounds are particularly significant carcinogens among the various pollutants present in the air. Consequently, people who are exposed to these harmful airborne pollutants suffer permanent consequences. This study examines the properties of BTEX compounds—benzene, toluene, ethylbenzene, and xylene—as well as their sources and risk assessments throughout a one-year period from March 21, 2019, to March 20, 2020, in Karaj, Iran’s largest industrialized city. First, utilizing a geographical information system that covered the entire city, 17 locations within Karaj were chosen for this purpose. Then, samplings were carried out in the spring, summer, autumn, and winter months with the NIOSH 1501 method. During the research period, 68 samples of BTEX compounds were collected. The adsorption of these contaminants on the activated carbon adsorbents was performed using an environmental sampling pump with a flow rate of 0.2 L/min for 1 h. The samples were subsequently prepared using a carbon disulfide solution and injected into a GC-FID for analysis. In this research, the average annual concentration of BTEX compounds in the air of Karaj city was obtained at 33.01 µg/m3. Autumn and spring had the highest and lowest average concentrations of BTEX compounds, respectively. In addition, sites 5 and 8 had the highest average annual concentrations of these pollutants. The sourcing conducted in this study showed that transportation and fuel consumption, as well as industries, were the primary sources of pollution in the city. In addition, the excess lifetime cancer risk was higher than the guideline value in some sites and lower in others. Furthermore, the Hazard Quotients were lower than 1, but in general, the citizens of Karaj were at serious risk from exposure to this group of pollutants.

Abstract Amyotrophic lateral sclerosis (ALS) causes progressive motor neuron degeneration, but an in vivo understanding of its early pathology remains limited. A recent study used topographic layer imaging to investigate iron and calcium accumulation in the primary motor cortex (M1) of patients with ALS compared with controls. Despite the preserved cortical thickness, ALS patients showed increased iron in layer 6 and calcium accumulation in layer 5a and the superficial layer. Calcium accumulation was particularly prominent in the low‐myelin borders, potentially preceding the demyelination. This study reveals a novel in vivo pathology in ALS, suggesting that calcium dysregulation may precede iron accumulation and contribute to early M1 cell degeneration. Further investigation using quantitative susceptibility mapping and complementary techniques, such as diffusion kurtosis imaging, along with ultrahigh‐field magnetic resonance imaging, into the role of calcium and early intervention strategies is warranted.

Abstract Quantitative susceptibility mapping (QSM) is an advanced post‐processing technique in magnetic resonance imaging that offers precise measurements of tissue magnetic susceptibility with impressive spatial resolution and sensitivity. This review examines the potential of QSM as a biomarker for early detection and monitoring of amyotrophic lateral sclerosis (ALS). Since 2015, studies have consistently reported increased QSM values in the motor regions of individuals with ALS, indicating significant iron deposition. Iron accumulation is associated with dysfunction of the upper motor neurons and faster disease progression. Notably, increased QSM values were also observed in the critical subcortical areas responsible for motor function and cognitive control. However, standardizing optimized protocols, including background field removal algorithms, phase unwrapping approaches, and methods for final susceptibility map reconstruction, has the potential to enhance the consistency and reliability of QSM as an ALS biomarker. Overall, the current body of evidence strongly supports QSM in detecting iron dysregulation associated with neurodegeneration in both motor and extra‐motor regions in ALS. Furthermore, QSM's remarkable sensitivity to early pathological iron changes and its high specificity in distinguishing ALS positions make it a promising diagnostic and progression‐tracking biomarker.

Abstract Objective Several pathological conditions trigger the formation of microvesicles (MVs), including infectious diseases such as COVID-19. The shedding of MVs increases the levels of inflammatory factors (e.g., interleukin-6; IL-6) and ultimately leads to an inflammatory cascade response, while also increasing the procoagulant response. The current study aimed to evaluate the level of circulating MVs and their procoagulant activity as well as the serum level of IL-6 in patients with COVID-19 and healthy controls. In this case-control study, 65 patients with COVID-19 and 30 healthy individuals were sampled after obtaining written informed consent. MVs counting was measured using conjugated CD61, CD45, CD235a, and Annexin-V antibodies. Additionally, the procoagulant activity of MVs and the IL-6 level were estimated using enzyme-linked immunosorbent assay (ELISA). Results The majority of MVs were platelet-derived MVs (PMVs). Patients with COVID-19 had significantly higher levels of MVs, procoagulant MVs, and IL-6 compared to healthy controls (p

ABSTRACT Background In this article, we review the most recent research on probiotics effects on diarrhea in both human and animal models of the condition along with the therapeutic potential of these compounds based on their findings. Recent Findings Nearly 50%–80% of cancer patients experience chemotherapy‐induced diarrhea (CID), serious gastrointestinal toxicity of chemotherapeutic and radiation regimens that leads to prolonged hospitalizations, cardiovascular problems, electrolyte imbalances, disruptions in cancer treatment, poor cancer prognosis, and death. CID is typically categorized as osmotic diarrhea. The depletion of colonic crypts and villi by radiotherapy and chemotherapy agents interferes with the absorptive function of the intestine, thereby decreasing the absorption of chloride and releasing water into the intestinal lumen. Probiotic supplements have been found to be able to reverse the intestinal damage caused by chemo‐radiation therapy by promoting the growth of crypt and villi and reducing inflammatory pathways. In addition, they support the modulation of immunological and angiogenesis responses in the gut as well as the metabolism of certain digestive enzymes by altering the gut microbiota. Conclusion Beyond the benefits of probiotics, additional clinical research is required to clarify the most effective strain combinations and dosages for preventing chemotherapy and radiotherapy diarrhea.

ABSTRACT Background/Objectives This systematic review and meta‐analysis aimed to investigate the role of magnetic susceptibility (χ) in deep gray matter (DGM) structures, including the putamen (PUT), globus pallidus (GP), caudate nucleus (CN), and thalamus, in the most common types of multiple sclerosis (MS) and relapsing‐remitting MS (RRMS), using quantitative susceptibility mapping (QSM). Methods The literature was systematically reviewed up to November 2023, adhering to PRISMA guidelines. This study was conducted using a random‐effects model to calculate the standardized mean difference (SMD) in QSM values between patients with RRMS and healthy controls (HCs). Publication bias and risk of bias were also assessed. Results Nine studies involving 1074 RRMS patients with RRMS and 640 HCs were included in the meta‐analysis. The results showed significantly higher QSM (χ) values in the PUT (SMD = 0.40, 95% confidence interval [CI] = 0.22–0.59, p = .000), GP (SMD = 0.60, 95% CI = 0.50–0.70, p = .00), and CN (SMD = 0.40, 95% CI = 0.15–0.66, p = .005) of RRMS patients compared to HCs. However, there were no significant differences in the QSM values in the thalamus between patients with RRMS and HCs (SMD = −0.33, 95% CI −0.67–0.01, p = .026). Age‐ and sex‐based subgroup analysis demonstrated that younger patients ( 25%) in the PUT and GP groups had more significant χ. Interestingly, thalamic QSM values were found to decrease in RRMS patients over 40 years of age and in higher male populations. Sex‐based subgroup analysis indicated higher iron levels in the PUT and GP of RRMS patients regardless of sex. QSM values were higher in certain brain regions (PUT, GP, and CN) during the early stages (disease duration 9.6 years) than HCs. Discussion/Conclusion QSM may serve as a biomarker for understanding χ value alterations such as iron dysregulation and its contribution to neurodegeneration in RRMS, especially in the basal ganglia nuclei including PUT, GP, and CN.

Abstract Coronavirus disease (COVID‐19) has been shown to impact the central nervous system, leading to various neurological complications. Arterial spin labeling (ASL), a non‐invasive magnetic resonance imaging technique, enables the measurement of cerebral blood flow and perfusion abnormalities. This systematic review aims to synthesize ASL findings in patients with COVID‐19 and assess the potential role of ASL in diagnosing and managing neurological complications. A comprehensive search was conducted on PubMed and Scopus for studies related to ASL in individuals with COVID‐19 or post‐COVID‐19 syndrome published between December 2019 and August 2024. Extracted data encompassed study characteristics, ASL protocols, cognitive assessments, and principal findings. The most consistent observation across studies was hypoperfusion detected in various brain regions, particularly within the frontal lobes, which may correlate with cognitive impairment and olfactory dysfunction. Additionally, some investigations reported hyperperfusion localized to the leptomeninges. These results may reflect underlying mechanisms such as hypoxic–ischemic injury, inflammation, vascular dysfunction, and neuronal damage attributable to COVID‐19. In conclusion, ASL has emerged as a valuable tool for evaluating brain perfusion among patients affected by or recovering from COVID‐19 since it offers critical insights into cerebral hemodynamics and metabolism. Further research is warranted to validate these ASL findings and elucidate whether post‐COVID‐19 syndrome contributes to persistent brain perfusion issues.

Kinetic inductance traveling-wave parametric amplifiers (KI-TWPAs) have a wide instantaneous bandwidth with a near quantum-limited noise performance and a relatively high dynamic range. Because of this, they are suitable readout devices for cryogenic detectors and superconducting qubits and have a variety of applications in quantum sensing. This work discusses the design, fabrication, and performance of a KI-TWPA based on four-wave mixing in a NbTiN microstrip transmission line. This device amplifies a signal band from 4 to 8 GHz without contamination from image tones, which are produced in a separate higher frequency band. The 4–8 GHz band is commonly used to read out cryogenic detectors, such as microwave kinetic inductance detectors and Josephson junction-based qubits. We report a measured maximum gain of over 20 dB using four-wave mixing with a 1 dB gain compression point of −58 dBm at 15 dB of gain over that band. The bandwidth and peak gain are tunable by adjusting the pump-tone frequency and power. Using a Y-factor method, we measure an amplifier-added noise of 0.5 ≤ Nadded ≤ 1.5 photons from 4.5 to 8 GHz.

Abstract Background Congenital myasthenic syndrome (CMS) is a group of neuromuscular disorders caused by abnormal signal transmission at the motor endplate. Mutations in the collagen-like tail subunit gene (COLQ) of acetylcholinesterase are responsible for recessive forms of synaptic congenital myasthenic syndromes with end plate acetylcholinesterase deficiency. Clinical presentation includes ptosis, ophthalmoparesis, and progressive weakness with onset at birth or early infancy. Methods We followed 26 patients with COLQ-CMS over a mean period of 9 years (ranging from 3 to 213 months) and reported their clinical features, electrophysiologic findings, genetic characteristics, and therapeutic management. Results In our population, the onset of symptoms ranged from birth to 15 years. Delayed developmental motor milestones were detected in 13 patients ( $$\sim$$ 52%), and the most common presenting signs were ptosis, ophthalmoparesis, and limb weakness. Sluggish pupils were seen in 8 ( $$\sim$$ 30%) patients. All patients who underwent electrophysiologic study showed a significant decremental response (> 10%) following low-frequency repetitive nerve stimulation. Moreover, double compound muscle action potential was evident in 18 patients ( $$\sim$$ 75%). We detected 14 variants (eight novel variants), including six missense, three frameshift, three nonsense, one synonymous and one copy number variation (CNV), in the COLQ gene. There was no benefit from esterase inhibitor treatment, while treatment with ephedrine and salbutamol was objectively efficient in all cases. Conclusion Despite the rarity of the disease, our findings provide valuable information for understanding the clinical and electrophysiological features as well as the genetic characterization and response to the treatment of COLQ-CMS.

Energy resilience is a vital consideration for ensuring the survivability of modern infrastructure systems. Achieving 100% resilience, however, is often impractical and economically burdensome. In this paper, we propose a smart investment framework that enables decision-makers to determine optimal investments in energy resilience based on available resources and desired levels of resilience. To illustrate the effectiveness of this framework, we present a case study of a campus microgrid research and testing facility. Using a real-time simulation approach conducted with Typhoon Hardware In Loop (HIL), we evaluate the performance of the microgrid system over 24 hours following 4 historically significant hurricanes that have affected Louisiana in the past few years. The microgrid is designed to power local loads during outages, providing an effective solution for enhancing energy resilience. Real solar data collected from our 1.1 Megawatt (MW) solar facility on the University of Louisiana at Lafayette campus is integrated into the simulation, enabling a realistic evaluation of the system’s performance under hurricane-induced disruptions. By employing the proposed smart investment framework, decision-makers can better identify and address resilience challenges. The framework facilitates informed investment decisions by considering available resources and aligning them with the desired level of resilience. This approach avoids over-investment in unnecessary redundancy while ensuring critical systems are adequately protected. Our research contributes to the field by demonstrating the practicality and benefits of a smart investment framework for energy resilience in a real-world scenario. The case study of the campus microgrid research facility provides valuable insights for decision-makers in similar contexts, highlighting the potential of this framework to guide resilient energy infrastructure planning and investment strategies.

Key Clinical Message Advanced MRI techniques, including SWI, MinIP, and QSM, are instrumental in detecting the “motor band sign” in ALS, aiding in the early diagnosis and assessment of upper motor neuron involvement, which is critical for therapeutic interventions.

Introduction: This study examined the anti-inflammatory and antioxidant properties of Capparis spinosa L. (caper) in order to determine its medicinal potential in the treatment of acute colitis. Method: Sixty male rats were divided into six groups. After the experimental period, distal colonic extension was collected for determination of colonic damage, oxidative stress markers, along with antioxidant markers. The impact of altered levels of inflammatory cytokines in colon tissues on the underlying mechanisms examined. Results: The results showed that administering different doses of caper led to significant decreases in TNF-α and IL-6 levels when compared to the control colitis group (p

Abstract Introduction Given the importance of promoting self-care and quality of life for discharged elderly patients after acute Myocardial Infarction(MI), It is necessitated we conduct interventions to promote these items. This study was conducted to determine the effect of mHealth-Cardiac rehabilitation (CR) on the inner Strength and resilience of elderly patients with MI after discharge from the hospital. Methods The present study was a randomized controlled trial that was conducted on 56 Elderly patients with myocardial infarction were discharged from the heart departments. In the intervention group after the patient’s discharge, the patients were contacted twice a week for one month and the necessary training and support were given online. To gather data, the Mini-Mental State Examination (MMSE), the demographic and clinical characteristics questionnaire, the inner strength scale (ISS), and the Connor-Davidson Resilience Scale (CD-RISC) were completed pre- and post-intervention. The data analysis was done by SPSS16. Results This study showed the mean resilience and inner strength scores before and after the intervention in the control group had no statistically significant difference(P˃0.05). There was a significant increase in the mean resilience and inner strength scores in the intervention group after the intervention (P ≤ 0.001). Conclusion The results of this study showed that mHealth as a kind of telenursing nursing has a significant effect on both variables of inner strength and resilience of post-discharge elderly patients after acute myocardial infarction. This means that using mHealth for these patients could increase the inner strength and resilience of the elderly discharged after myocardial infarction. Therefore, through using this method, elderly patients’ self-care ability and quality of life could be increased.

Abstract Next-generation sequencing (NGS) has been proven to be one of the most powerful diagnostic tools for rare Mendelian disorders. Several studies on the clinical application of NGS in unselected cohorts of Middle Eastern patients have reported a high diagnostic yield of up to 48%, correlated with a high level of consanguinity in these populations. We evaluated the diagnostic utility of NGS-based testing across different clinical indications in 1436 patients from Iran, representing the first study of its kind in this highly consanguineous population. A total of 1075 exome sequencing and 361 targeted gene panel sequencing were performed over 8 years at a single clinical genetics laboratory, with the majority of cases tested as proband-only (91.6%). The overall diagnostic rate was 46.7%, ranging from 24% in patients with an abnormality of prenatal development to over 67% in patients with an abnormality of the skin. We identified 660 pathogenic or likely pathogenic variants, including 241 novel variants, associated with over 342 known genetic conditions. The highly consanguineous nature of this cohort led to the diagnosis of autosomal recessive disorders in the majority of patients (79.1%) and allowed us to determine the shared carrier status of couples for suspected recessive phenotypes in their deceased child(ren) when direct testing was not possible. We also highlight the observations of recessive inheritance of genes previously associated only with dominant disorders and provide an expanded genotype–phenotype spectrum for multiple less-characterized genes. We present the largest mutational spectrum of known Mendelian disease, including possible founder variants, throughout the Iranian population, which can serve as a unique resource for clinical genomic studies locally and beyond.

Abstract Background Type 2 Diabetes Mellitus (T2DM) has become a major health concern with an increasing prevalence and is now one of the leading attributable causes of death globally. T2DM and cardiovascular disease are strongly associated and T2DM is an important independent risk factor for ischemic heart disease. T-wave abnormalities (TWA) on electrocardiogram (ECG) can indicate several pathologies including ischemia. In this study, we aimed to investigate the association between T2DM and T-wave changes using the Minnesota coding system. Methods A cross-sectional study was conducted on the MASHAD cohort study population. All participants of the cohort population were enrolled in the study. 12-lead ECG and Minnesota coding system (codes 5–1 to 5–4) were utilized for T-wave observation and interpretation. Regression models were used for the final evaluation with a level of significance being considered at p 0.05). Hypertension, age, and body mass index were significantly associated with T2DM (p

Background and purpose: The organ transplant network is among the most complex and challenging systems in the healthcare sector. This study presents a three-objective hierarchical location model for kidney transplants, aiming to simultaneously minimize total time and costs while maximizing geographic equity in the supply and demand network for donated kidneys. Various transportation modes within the network are also analyzed. Materials and Methods: This applied research was conducted over a one-year period in 2022 (1401 in the Iranian calendar) in the province of Sistan and Baluchistan. The proposed mathematical model was implemented in GAMS software and solved using the Torabi-Hosseini method and epsilon constraint technique. Results: The model recommended establishing candidate locations for organ collection units and transplant centers without the need for air transport equipment. It suggested that only the candidate location number 2 at Zabol Hospital Transplant Center should be equipped with air transport facilities, while the other proposed locations do not require the establishment or use of air emergency services. Conclusion: The results indicate that the designed kidney transplant network is practical and feasible. Efficient network management ensures that all organ recipients, even those far from the provincial center and in remote areas, have timely access to the necessary facilities and equipment for transplant operations.

Background and Aim: The tourism industry plays a very important role in the economic cycle of society. Medical tourism, as one of the types of tourism industries, has a direct result in globalizing health care. Therefore, by strengthening the supply chain in this area, a very high added value can be achieved. For this reason, the present study provides a conceptual framework for predicting the demand for medical tourism supply chain by determining the relationship between medical tourism demand and economic, medical, and welfare-service components of Zahedan city. Materials and Methods: The present study is a descriptive-analytical and applied research. Data were collected using a questionnaire and field and library methods. The statistical population of interest was specialist doctors in Zahedan city, and 97 people were selected using simple random sampling with Morgan’s table. The validity of the questionnaire was confirmed by experts and its reliability was obtained using Cronbach’s alpha coefficient with SPSS software more than 0.7. Data analysis was performed using the tangent sigmoid neural network algorithm, linear regression criteria, and mean square error. For this purpose, SPSS software was used to examine the correlation between the data, and MATLAB software was used to design the neural network. Results: There was anerrore in The basis for the optimality of the answers, linear regression criteria and mean square error. The results showed that the values related to regression, education, and health were more than 0.8 and were 0.9033, 0.8818, and 0.9985, respectively. The highest priorities of the respondents related to medical equipment, education, and health were 0.5657, 0.5558, and 0.20726, respectively. Conclusion: According to the results obtained from the proposed model, the neural network has a high accuracy in predicting the demand for medical tourism supply chain in terms of education, health, and welfare. It is also predicted that the demand for medical tourism has been constant during the one-year period of research and it is expected that medical tourism in Zahedan city will decrease in future. Therefore, it is recommended that officials pay attention to the development and improvement of medical tourism to promote it.

The application of nanocatalysts for the removal of dyes from industries' wastewater and effluents has attracted great attention these days. In this paper, CdTe/CdS/ZnS core/multi-shell quantum dots were used as a nanocatalyst for the degradation and removal of methylene blue, methylene orange, and rhodamine b dyes from water. The obtained results showed that CdTe/CdS/ZnS nanocatalyst had excellent ability for removal of methylene blue dye from water and after 60 min reaction time, methylene blue dye was completely degraded (100%). Also, the degradation percentage of rhodamine b and methylene orange dyes was obtained at about 80.2% and 55.2%, respectively. The radical scavenger experiment was used to study which active radicals play a key role in the photocatalyst process of CdTe/CdS/ZnS nanocatalyst with methylene blue dye and results showed that electrons play a key role in the degradation process. The successful formation of CdTe/CdS/ZnS core/multi-shell QDs was studied by XRD, EDS, PL, absorbance, and TEM analysis.

Background. Employees are critical assets of an organization, and it is necessary to investigate and identify factors affecting their performance and productivity. This study aimed to determine the relationship between job stress and job productivity in university settings. Methods. This cross-sectional study included 124 employees of Ahvaz Jundishapur University of Medical Sciences (AJUMS) based on Cochran's formula. Data collection instruments included the standard occupational stress questionnaire of the England Institute (HSE) and Echio’s productivity questionnaire. The validity and reliability of the instruments have been confirmed. Statistical analyses were performed using SPSS 22 software. Results. The mean score of job stress and job performance was 119.75 (±17.49) and 103.3 (±21.47), respectively, and their level was estimated as average. Findings indicated a significant negative correlation between job stress and performance. In addition, three variables, including employee position, management support, and change were identified as the main predictors of employee productivity based on linear regression. There was a significant relationship between some demographic variables (age, gender, and education level) and occupational stress. Conclusion. According to our results, there was a significant negative correlation between occupational stress and staff productivity. These findings can be generalized to university administrative personnel. Three occupational stress components, including management support, change, and employee position, were identified as main predictors of productivity. Therefore, in order to improve productivity, managers need to consider more independence and support for personnel, as well as reduce the changes’ rate.

This research study presents a resilient control scheme for an islanded DC microgrid (DC MG) integrating solar photovoltaic (PV), battery storage (BESS), and piezoelectric (PE) energy harvesting modules. The microgrid (MG) case study represents an energy hub designed to provide electricity for lighting systems in transportation, roads, and other infrastructure. To enhance practicality, the PE is modeled using the real data captured from a traffic simulator. The proposed reinforcement learning (RL) method was tested against four severe and unexpected failure scenarios, including short circuit at the load side, sudden and severe change of load, open circuit, and converter failure. The performance of the controller was quantitatively compared with a conventional PI controller. The results show marginal improvement in one scenario and significant improvement in the other three, suggesting that the proposed scheme is a robust candidate for microgrids with high levels of uncertainty, such as those involving solar and PE harvesters.

Abstract Background The coronavirus disease 2019, also known as COVID-19, imposed various challenges to healthcare and became a pandemic accompanied by a high rate of mortality. This infection has many manifestations and affects nearly all body systems. The circulatory and coagulation systems also seem to be affected. Studies show elevated rates of thrombotic events within COVID-19 patients such as disseminated intravascular coagulation (DIC), deep vein thrombosis (DVT), and pulmonary embolism (PE). Incidences of such coagulopathies were correlated to poor patient prognosis and mortality. Given the importance, complication, and mortality caused by thrombotic events (TEs) in COVID-19 patients, the goals of this study are to collect and analyze data on coagulopathy in COVID-19 patients and the pathophysiology and molecular events behind it. We also aim to bring attention to the role of d-dimer in COVID-19 infection by presenting the most recent information available from research studies evaluating d-dimer as a potential biomarker for disease severity, as well as mortality in COVID-19 patients. Main body Various mechanisms are described for COVID-19 coagulopathies such as endothelial cell dysfunction, fibrinolysis inhibitor overexpression, immuno-thrombosis, and imbalance between pro- and anticoagulants, to name a few. d-dimer which is a degradation product of fibrin is a helpful diagnostic tool for the assessment of clots and thrombosis. Given the pro-thrombotic nature of COVID-19 infection, within the current narrative review, we studied the diagnostic value of d-dimer for PE prediction. Several studies utilized d-dimer as a predictive tool for detecting PE, and the results were varied. Different cutoff points are proposed ranging from 0.5 up to over 4 mg/L with varying sensitivity and specificity. Although CT pulmonary angiography (CTPA) is the standard model for the prediction of PE, radiation exposure, contrast nephropathy, higher cost, and lack of adequate access can shift our diagnosis into models based on d-dimer. Short conclusion In summary, various coagulopathies have been associated with COVID-19 infection, and a safe and early diagnosis is needed. d-dimer showed various successes in PE prediction and can be a good candidate for further research and diagnostic model and algorithm development.

Abstract Background and purpose The lack of timely foot care among individuals with diabetics often lead to ulceration followed by infection and amputation. This study aimed to evaluate the foot self-care status and foot screening practices among patients with type 2 diabetes in various cities across Iran. Methods The cross-sectional descriptive study was performed on patients with type 2 diabetes in 10 main cities of Iran. The information about demographic and lifestyle factors, diabetes history, and diabetic foot self-care (DFSQ) was assessed. Additionally, the neurological and vascular condition of the foot were screened by Inlow’s 60-Second Screen. Results The study included 1094 diabetic patients with, with a majority being female (64.8%) and married (92.5%). The average age of the participants was 57.6 ± 10.21 (mean ± SD), and the mean duration of diabetes was 11.56 ± 7.41 years. Based on Inlow’s 60-Second Screen criteria, 58% of the patients should undergo yearly foot ulcer screening, 47% exhibited peripheral neuropathy, and 37% were found to have inappropriate footwear. Conclusion The high prevalence of peripheral neuropathy observed in approximately half of the participants across different regions of Iran underscores the importance of continuous patient education regarding foot care and appropriate footwear. Furthermore, regular foot ulcer screenings, following the recommended intervals outlined in Inlow’s screening protocol, should be implemented to effectively manage diabetic foot complications.

This study investigated the allowability of materials in the laser powder melting process, with a focus on powder mixing as a means of adjusting the material composition quickly and cost-effectively. By mixing different powders, a desired alloy can be created during additive processing without the need to produce new powder, which can be expensive. However, one of the main challenges in this process is the segregation of powders, which can lead to non-homogeneous alloys. To address this challenge, the study examined the use of a single component 316L mixed with 1% and 5% copper powder in the additive processing. The results showed that homogeneous components with a uniform and targeted copper content could be produced. However, the mechanical-technological properties of both alloys were lower than those of 316L in situ. To optimize and extend this study, further investigation could be conducted to improve the homogeneity of the powder mixture and to enhance the mechanical-technological properties of the alloys produced. This could involve exploring different alloy designs, optimizing the laser powder melting process parameters, and using advanced characterization techniques to gain a deeper understanding of the microstructure and properties of the alloys. By addressing these challenges, the laser powder melting process could become an even more promising method for producing customized alloys with tailored properties.

Background. Cancers are showing a rising trend in developing countries. In Iran, cancer is the third leading cause of death after cardiovascular diseases and accidents. The cost of cancer diagnosis and treatment places heavy financial burden on health systems, requiring accurate financial assessments and evaluations. Therefore, this study aimed to determine the direct medical expenses of cancer patients undergoing surgery in Ahvaz, Iran, teaching hospitals. Methods. This descriptive-analytical cross-sectional study was conducted in 2021. The research population included cancer patients undergoing surgery in Ahvaz teaching hospitals. Data collection was done using clinical records of the hospital. Quantitative statistical indicators such as frequency, mean, standard deviation, and tables were used for data analysis. In addition, analytical statistical indicators such as independent samples t-test, one-way analysis of variance (ANOVA), Pearson correlation coefficient, and regression were used with SPSS22 software. Results. The overall mean costs for cancer surgery were calculated at 77,994,903 (SD= 111,224,332) Iranian Rials (IRR). The most expensive cancer surgery was colorectal cancer with an average of 193,558,434 (SD= 266,162,757) IRR, and the lowest cost was pancreatic cancer surgery with an average of 29,284,226 (SD= 23,057,425) IRR. There was a significant positive relationship between the type of cancer (p= 0.000) and the length of hospital stay (p= 0.041) and the cost of hospitalized patients. Conclusion. The economic costs of treating all types of cancer are very high. Any therapeutic and administrative measure that can reduce the cost of cancer treatment or the duration of treatment will contribute significantly to reducing patients' sufferings, improving their quality of life, and reducing the imposed costs.

Abstract Introduction Hypertensive patients' failure to refer to health centers for the management of their disease is the most fundamental public health challenge in most societies. The aim of this study was to identify the utilization obstacles to hypertension services provided at comprehensive health centers (CHCs) from the perspective of patients and the staff of health centers. Methods This was a qualitative study using conventional content analysis which was conducted in 2022. Participants included 15 hypertensive patients referring to CHCs and 10 staff (including personnel of CHCs and expert staff) of Ahvaz Jundishapur University of Medical Sciences, Ahvaz, southwest of Iran. Data were collected using semi-structured interviews. Interviews were analyzed using content analysis method, and coding was done manually. Results In total, 15 codes and 8 categories were extracted from the interviews which were organized in two main themes of "individual problems" and "systemic problems". More particularly, the main theme of “individual problems” involved attitudinal obstacles, occupational obstacles, and economic obstacles. The main theme of "systemic problems" included educational obstacles, motivational obstacles, procedural obstacles, structural obstacles, and managerial obstacles. Conclusion In order to address individual problems associated with the patients' failure to refer to CHCs, we need to take appropriate measures. These include using motivational interviewing techniques and utilizing the effective activity of healthcare liaisons and volunteers in CHCs to increase patients' awareness and change their negative attitudes and misconceptions. To solve systemic problems, it is imperative that effective training courses be held for health center staff.

Background: Aggressive behaviors are the most critical and common challenges shown by children with autism spectrum disorders (ASD) through their life. Children- scale for hostility and aggression: reactive and proactive (C-SHARP) is a comprehensive instrument for measuring aggressive behaviors. No instruments have been developed for measuring aggression in children with ASD or other developmental disabilities in the Persian language; therefore, this study aimed to assess the reliability, validity and responsiveness to change of Persian version of C-SHARP in children with ASD.Methods: This is a psychometric study with three phases including translation process, assessment of the validity and reliability, and responsiveness to change. World health organization (WHO) guidelines for translation and adaptation process were used to translate the C-SHARP. To evaluate the psychometric properties of the instrument, we performed across-sectional study on 162 children with ASD and dimensionality and convergent validity, internal consistency, and composite reliability were used. In order to measure responsiveness, we performed a comparative study in the form of a free-gluten dietary intervention, and gamma correlation coefficient was used to correlate change the scores with GRS.Results: Cronbach’s alpha coefficients were reported greater than 0.85 for all subscales and the composite reliability coefficient for C-SHARP was 0.94. Root mean square error of approximation (RMSEA) was 0.052 which confirmed robust construct of C-SHARP Persian version. Average variance extracted (AVE) for total C-SHARP was >0.50. Gamma correlation coefficient was 0.77, indicating excellent responsiveness to change of the instrument.Conclusion: The current study approved the reliability, validity, and responsiveness to change of the Persian C-SHARP in children with ASDs. Persian C-SHARP can be used in clinical and research settings to assess aggression.

Outsourcing of the services, as one of the key interventions, has been always given a particular attention by policymakers seeking to improve the performance and reform the financial system of the health sector. This study aimed to identify the factors affecting the decision-making, challenges and obstacles, and evaluation criteria of the hospital services outsourcing. In this study, a scoping review method based on the Arksey and O'Malley protocol was adopted. All articles published in four databases, namely SID, Magiran, Emerald, PubMed, and Google Scholar search engine were searched and collected using appropriate keywords. The inclusion criteria of this study were English and Persian original/review articles as well as case studies. Using qualitative analysis and coding approach, finally, the content of the entered studies was analyzed and summarized in the designed tables based on three main areas of criteria and factors affecting the decision-making, evaluation criteria, as well as outsourcing challenges and obstacles.A total of 44 studies were included in the present study. According to our study results, the criteria and factors effective in decision-making process of outsourcing hospital services included four components of the activity nature, internal and external stimuli, and supplier characteristics; and those effective in evaluation criteria included four financial components of beneficiaries, process internal and growth, learning, and innovation. Challenges and obstacles of outsourcing were also divided into four components including legal, structural, organizational, financial, and administrative components.To achieve a successful outsourcing in the organization, especially in the hospital, it was necessary that a scientific approach should be adopted in this field in order to formulate executive instructions and principles, implement strong laws, and strengthen the supervision.

Abstract Background Various vaccines have been developed and distributed worldwide to control and cope with COVID-19 disease. To ensure vaccines benefit the global community, the ethical principles of beneficence, justice, non-maleficence, and autonomy should be examined and adhered to in the process of development, distribution, and implementation. This study, therefore, aimed to examine ethical considerations of vaccine development and vaccination processes. Methods A scoping review of the literature was conducted based on the Arkesy and O’Malley protocol to identify eligible studies published until November 2021. We searched Web of Science, PubMed, Scopus, and SciELO databases. The search was conducted using combinations of Medical Subject Heading (MeSH) search terms and keywords for Ethics, COVID-19, and vaccines in abstract, keywords, and title fields to retrieve potentially relevant publications. We included any study that reported one of the four principles of medical ethics: autonomy, justice, non-maleficence, and beneficence in the COVID-19 vaccine development and distribution and implementation of vaccinations. Letters, notes, protocols, and brief communications were excluded. In addition, we searched gray literature to include relevant studies (ProQuest database, conferences, and reports). Data were analyzed using framework analysis. Results In total, 43 studies were included. Ethical considerations concluded two themes: (1) production and (2) distribution and vaccination. The production process consisted of 16 codes and 4 main Categories, distribution and vaccination process consisted of 12 codes and 4 main Categories. Moreover, the ethical considerations of special groups were divided into four main groups: health care workers (HCWs) (five codes), children and adolescents (five codes), the elderly (one code), and ethnic and racial minorities (three codes). Conclusion Due to the externalities of pandemics and the public and social benefits and harms of vaccination, it is not feasible to adhere to all four principles of medical ethics simultaneously and perfectly. This issue confronts individuals and policymakers with several moral dilemmas. It seems that decision-making based on the balance between social benefit and social harm is a better criterion in this regard, and the final decision should be made based on maximizing the public benefit and minimizing the public harm.

Quantum dot (QD)-based solar cells have been the focus of extensive research. One of the critical challenges in this field is optimizing the size and placement of QDs within the cells to enhance light absorption and overall efficiency. This paper theoretically investigates InAs/GaAs QD intermediate band solar cells (QD-IBSC) employing cylindrical QDs. The goal is to explore factors affecting light absorption and efficiency in QD-IBSC, such as the positioning of QDs, their dimensions, and the spacing (pitch) between the centers of adjacent dots. Achieving optimal values to enhance cell efficiency involves modifying and optimizing these QD parameters. This study involves an analysis of more than 500 frequency points to optimize parameters and evaluate efficiency under three distinct conditions: output power optimization, short-circuit current optimization, and generation rate optimization. The results indicate that optimizing the short-circuit current leads to the highest efficiency compared to the other conditions. Under optimized conditions, the efficiency and current density increase to 34.3% and 38.42 mA/cm2, respectively, representing a remarkable improvement of 15% and 22% compared to the reference cell.

We herein report an unusual case of a 58-year-old man with polycythemia presented with sudden right leg and right arm weakness. He was treated for a stroke but continued to worsen, leading to quadriparesis. He was referred to the emergency department after experiencing progressive weakness in all four limbs for five days. No prior history of fever, cough, chest pain, diarrhea, backache, or trauma was found. The patient had normal neurological examination, MRC scores, and bilateral weak hand grips. Sensory examination was normal. The patient had normal blood tests, electrolytes and brain MRI. CSF examination revealed protein an albumin-cytological dissociation pattern. An electrodiagnostic study showed evidence of acute motor axonal polyneuropathy. The patient received IVIg for five days, and symptoms improved significantly.

BackgroundQuantitative susceptibility mapping (QSM) is a magnetic resonance imaging (MRI) technique that can measure the magnetic susceptibility of tissues, which can reflect their iron content. QSM has been used to detect iron accumulation in cortical and subcortical brain regions. However, its application in subcortical regions such as the basal ganglia, particularly the putamen, is rare in patients with amyotrophic lateral sclerosis (ALS).Case presentation and literature reviewWe present the case of a 40-year-old male patient with ALS who underwent an MRI for QSM. We compared his QSM images with those of a control subject and performed a quantitative analysis of the magnetic susceptibility values in the putamen regions. We also reviewed the literature on previous QSM studies in ALS and summarized their methods and findings. Our QSM analysis revealed increased magnetic susceptibility values in the bilateral putamen of the ALS patient compared to controls, indicating iron overload. This finding is consistent with previous studies reporting iron dysregulation in subcortical nuclei in ALS. We also discussed the QSM processing techniques used in our study and in the literature, highlighting their advantages and limitations.ConclusionThis case report demonstrates the potential of QSM as a sensitive MRI biomarker for evaluating iron levels in subcortical regions of ALS patients. QSM can provide quantitative information on iron deposition patterns in both motor and extra-motor areas of ALS patients, which may help understand the pathophysiology of ALS and monitor disease progression. Further studies with larger samples are needed to validate these results and explore the clinical implications of QSM in ALS.

We conducted the present study on seven important medicinal species of Achillea (in a total of 28 populations) in their natural habitats. The results indicated that the populations had a base number (x= 9) and the diploid, tetraploid, and hexaploidy levels were observed. In addition to the inter-species diversity, there was the intra-species genetic diversity as A. millefolium (4x, 6x), A. vermicularis (2x, 4x), A. tenuifolia (2x, 4x), A. Aleppica (2x), A. talagonica (2x), A. biebersteinii, and A. wilhelmsii (4x). Furthermore, studies also indicated that 11 out of 28 populations had 1A symmetry, 15 populations had 2B symmetry, a population had 2A, and another population had 2B. Cluster analysis of cytogenetic variables could differentiate only the species of A. aleppica, A. talagonica and A. wilhelmsii but others could not separate differences between species appropriately, probably due to the superiority of intra-species diversity of populations to inter-species diversity. Furthermore, we found %TF and DRL are useful parameters for differentiating intrachromosomal variation of species.

This study aims to improve the performance of sustainable electric vehicle chargers in the face of unpblackictable/unpreventable disturbances. Over the past few years, Dual Active Bridge (DAB) DC-DC Converters are procuring substantial recognition for electric vehicle charging applications due to their superior characteristics such as higher power density, bidirectional mode of operation, and higher efficiency. Unexpected disturbances and fault scenarios at both source and load sides can deteriorate DAB converters’ performance. In this study, the performance of a single-phase shifted DAB converter is enhanced to achieve desiblack output current under several disturbance conditions for electric vehicle (EV) charging applications. A Reinforcement Learning (RL) based Deep Deterministic Policy Gradient (DDPG) algorithm is deployed to proactively tune control parameters when the DAB undergoes certain unexpected disturbances including short circuit faults at the source and battery sides. Results show that the RL-tuned PI controller improves the rate of current overshoot significantly compablack with the manually-tuned PI controller. The method and results are validated through simulations in MATLAB/Simulink environment.

Abstract Background Electronic Health Records (EHRs) were introduced to all Iranian medical universities in 2015 with the launch of Integrated Electronic Health System (which is known as SIB: a Persian backronym in Persian meaning apple), and a number of studies were conducted on SIB. However, most of these studies did not consider the benefits and challenges of adopting SIB in Iran. Therefore, the present study aimed to identify the benefits and challenges of SIB in health centers of Khuzestan Province, Iran. Methods This was a qualitative study using qualitative conventional content analysis conducted on 6 experts and 24 users of SIB in six health centers of three cities in Khuzestan province, Iran. The participants were selected using a purposeful sampling method. Maximum variation was considered in selecting the group of users, and snowball sampling was used in the group of experts. Data collection tool was semi-structured interview. Data analysis was performed using thematic analysis. Results Overall, 42 components (24 for benefits and 18 for challenges) were extracted from the interviews. Common sub-themes and themes were identified for challenges and benefits. The components formed 12 sub-themes, and they were placed in 3 main themes, namely structure, process and outcome. 1) Structure included four sub-themes of Financial resources, Human resources, Facilities, and Access to the Internet; 2) Process involved three sub-themes of Training, Providing services, and Time and workload; and 3) Outcome incorporated five sub-themes of Quality of health services, Access, Safety and personal distance, Screening and evaluation, and Research. Conclusions In the present study, the benefits and challenges of adopting SIB were examined in three themes: structure, process, and outcome. Most of the identified benefits were related to the theme of outcome, and most of the identified challenges were related to the theme of structure. Based on the identified factors, by strengthening the benefits of SIB and also trying to eliminate or reduce its challenges, it is possible to institutionalize and use it more effectively in order to solve health problems.

Mass flow inequality in the initial stage of tube processing can lead to eccentricity and micro- and nano-structural changes that affect residual stress and texture development. In this study, the macro- and micro-texture development of copper tubes drawn with a tilted die was investigated using three methods: synchrotron, neutron diffraction, and electron backscatter diffraction, in the positions of maximum and minimum wall thickness of the tubes. Understanding how a tilted die can affect the texture development in copper tubes is the main aim of this study. The micro-texture results of EBSD examinations showed the same behavior at the maximum and minimum sides of the as-received tube, as observed using the synchrotron diffraction method as well as macro-texture measurements. The cube texture component was found to be the predominant orientation in the as-received tube. However, it almost disappeared after drawing with −5° tilting. By contrast, the Cu texture component increased significantly. Before drawing, the cube component varied strongly across the wall thickness. After drawing, however, there was no noticeable texture gradient across the wall thickness. The analyses showed that tilting is not creating an inhomogeneous texture development over the circumference.