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Ayman Mubarak,1 Bahauddeen Alrfaei,2 Abdullah Aljurayyan,3 Mahfoudh M Alqafil,1 Mohamed A Farrag,1 Maaweya E Hamed,1 Bandar Alosaimi,4 Fahad Almajhdi,1 Wael Alturaiki5 1Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia; 2Stem Cells Unit, Department of Cellular Therapy, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Science, MNGHA, Riyadh, Saudi Arabia; 3Immunology and HLA Department, Pathology and Laboratory Medicine, King Fahad Medical City, Riyadh, Saudi Arabia; 4Research Center, King Fahad Medical City, Riyadh, Saudi Arabia; 5Department of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi ArabiaCorrespondence: Wael AlturaikiDepartment of Medical Laboratory Sciences, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Saudi ArabiaEmail w.alturaiki@mu.edu.saBackground: Middle East respiratory syndrome coronavirus (MERS-CoV) first emerged in the Kingdom of Saudi Arabia, is associated with a high mortality rate.Aim: To determine the effect of MERS-CoV on the immune response in infected patients and investigate cytokine production in the A549 epithelial cell line in response to a recombinant MERS-CoV spike protein (rSP) in the presence or absence of anti-dipeptidyl peptidase 4 (DPP4) antibody (3 independent experiments). Cytokine levels were measured using a cytokine ELISA array.Methods: A Bio-Plex multiplex assay and cytokine ELISA were used in our study to measure the cytokine levels.Results: Comparative analysis of MERS-CoV-infected patients (4 samples) and noninfected healthy controls (HCs) (5 samples) showed that serum levels of the following cytokines and chemokines were significantly higher in MERS-CoV patients than in the HCs (*p < 0.05): interferon (IFN)-α 2 (43.4 vs 5.4), IFN-β (17.7 vs 6.2), IFN-γ (43.4 vs 9.7), interleukin (IL)-8 (13.7 vs 0), IL-2 (11.2 vs 3), IL-27p28 (57.8 vs 13.8), and IL-35 (167.5 vs 87.5).Discussion: Our results revealed that MERS-CoV infection induced a slight increase in IFN levels but triggered a more pronounced increase in expression of the regulatory cytokines IL-27 and IL-35. A recombinant version of the full-length MERS-CoV spike protein increased the expression of IL-8 (160 pg/mL), IL-2 (100 pg/mL) and IL-12 (65 pg/mL) in A549 lung epithelial cells compared to that in the unstimulated control cells. The presence of anti-DPP4 antibody did not affect cytokine suppression or induction in A549 cells in vitro but decreased the level of IL-8 from 160 pg/mL to 65 pg/mL.Conclusion: MERS-CoV can decrease IFN levels to interfere with the IFN pathway and enhance the production of regulatory cytokines. Inhibition of the increases in IL-27 and IL-35 may contribute to halting MERS-CoV in the early stage of infection.Keywords: MERS-CoV, proinflammatory cytokines, regulatory cytokines, anti-DPP4, IFNs, A549 lung cells

Objectives The spread of misinformation through the internet can lead to dangerous behavioral changes and erode trust in reliable sources, especially during public health crises like coronavirus disease 2019 (COVID-19). To combat this issue, innovative strategies that leverage information technology are essential. This study focused on developing and evaluating a mobile application (app), COVID-Iran, aimed at countering COVID-19 misinformation by delivering accurate, reliable, and credible information. Methods The development of the app involved a multi-step, user-centered approach that integrated qualitative expert consultations with quantitative survey research to pinpoint and validate key features. The app was initially prototyped using Enterprise Architect software and subsequently developed using Android Studio and MySQL. We conducted a usability evaluation using the System Usability Scale (SUS), where participants engaged in various tasks related to information seeking, self-assessment, and health management. Data were analyzed using descriptive statistics in SPSS version 19. Results The findings revealed a high usability level (SUS score of 81.35), with participants reporting ease of use and learnability. The app effectively countered misinformation by providing access to trusted sources and evidence-based counterarguments. User feedback emphasized the app’s strengths in clarity, accuracy, trustworthiness, and its comprehensive approach. Plans for future improvements include the integration of artificial intelligence to deliver personalized content. Conclusions Despite limitations such as the small sample size and potential self-selection bias, this study highlights the significant potential of mHealth apps to provide reliable health information and combat misinformation.

The last decennia have witnessed spectacular advances in our knowledge about the influence of the gut microbiome on the development of a wide swathe of diseases that extend beyond the digestive tract, including skin diseases like psoriasis, atopic dermatitis, acne vulgaris, rosacea, alopecia areata, and hidradenitis suppurativa. The novel concept of the gut-skin axis delves into how skin diseases and the microbiome interact through inflammatory mediators, metabolites, and the intestinal barrier. Elucidating the effects of the gut microbiome on skin health could provide new opportunities for developing innovative treatments for dermatological diseases. Psoriasis is a complex disease with multiple factors contributing to its development, such as diet, lifestyle, genetic predisposition, and the microbiome. This paper has a dual purpose. First, we outline the current knowledge on the unique gut microbiota patterns implicated in the pathogenesis of psoriasis. Second, and of equal importance, we briefly discuss the reciprocal impact of psoriasis treatment and gut microbiome. In addition, this review explores potential therapeutic targets based on microbial interventions, which hold promise for providing new treatment options for psoriasis.

Abstract Deep learning neural networks are often described as black boxes, as it is difficult to trace model outputs back to model inputs due to a lack of clarity over the internal mechanisms. This is even true for those neural networks designed to emulate mechanistic models, which simply learn a mapping between the inputs and outputs of mechanistic models, ignoring the underlying processes. Using a mechanistic model studying the pharmacological interaction between opioids and naloxone as a proof-of-concept example, we demonstrated that by reorganizing the neural networks’ layers to mimic the structure of the mechanistic model, it is possible to achieve better training rates and prediction accuracy relative to the previously proposed black-box neural networks, while maintaining the interpretability of the mechanistic simulations. Our framework can be used to emulate mechanistic models in a large parameter space and offers an example on the utility of increasing the interpretability of deep learning networks.

Abstract This study explores the influence of inter-dot tunneling effects within a quantum dot molecule on the Fresnel diffraction phenomenon. Our findings indicate that the Fresnel diffraction of the output probe Gaussian field can be manipulated by adjusting the inter-dot tunneling parameter’s strength and the characteristics of the coupling field. The inter-dot tunneling effect establishes a closed-loop system, setting conditions for the interference of the applied fields. We specifically examine a Laguerre–Gaussian (LG) coupling field, investigating how its properties-such as strength, value, and sign of the orbital angular momentum (OAM)-impact the Fresnel diffraction of the output probe field. Increasing the inter-dot tunneling parameter and the coupling LG field’s strength allows for control over the spatial distribution of the Fresnel diffraction pattern. Notably, the inter-dot tunneling parameter can disturb the symmetry of the diffraction patterns. Additionally, considering a negative OAM for the coupling LG field transforms the diffraction pattern into its inverse shape. This suggests that, in the presence of the inter-dot tunneling effect, the Fresnel diffraction pattern is contingent on the direction of rotation of the helical phase front of the coupling LG field. Our results offer insights into quantum control of Fresnel diffraction patterns and the identification of OAM in LG beams, presenting potential applications in quantum technologies.

High-order harmonic generation (HHG) in semiconductor thin films from ultrashort mid-infrared laser drivers holds the potential for the realization of integrated sources of extreme ultraviolet light. Here, we demonstrate solid-state HHG in zinc oxide thin films synthesized by the radiofrequency reactive magnetron sputtering process directly on the cleaved facets of optical fibers. Harmonics 3 to 13 of the radiation from a fiber-based laser system delivering 500 kW, 96 fs pulses at 3130 nm are produced in the thin film and guided along the fiber. A proper choice of the laser wavelength and fiber material allows for filtering out the mid-IR pump laser and achieving the HHG mode selection. The possibility to nanostructure the fiber exit by, e.g., focused ion beam milling paves the way to an increased control over the HHG spatial mode.

Key Clinical Messages Early diagnosis of cryptococcal infection is the key to improving outcomes, any newly diagnosed HIV patient presenting with subacute or chronic headache, particularly those who are CD4‐deplete, should be investigated for cryptococcal meningitis. We had some delay in our patient management, including delay in HIV diagnosis, delay in doing LP and delay in initiation of anti‐cryptococcal treatment and also early start of ART before specific cryptococcal treatment exacerbated IRIS in the patient. So, paying attention to these points can improve the prognosis of such patients. Abstract Cryptocccus is a fungal pathogen and the causative agent of Cryptococcosis among human immunodeficiency virus (HIV) positive people. Meningoencephalitis is the most common manifestation of cryptococcal infection, while pulmonary cryptococcosis is often neglected due to nonspecific clinical and radiological presentation leading to a delay in diagnosis and disseminated disease. Here, we reported a 67‐year‐old man with newly diagnosed HIV who presented with concurrent cryptococcal meningoencephalitis and pulmonary cryptococcosis that admitted with the complaint of dyspnea and productive cough for 1.5 months, worsening shortness of breath, fever and weight loss since 15 days prior to admission. He also had severe oral candidiasis. Lung computed tomography (CT) revealed ill‐defined subpleural cavitary lesion in left lower zone with bilateral diffuse ground glass opacity and air bronchogram. His HIV PCR test was positive with absolute CD4 count less than 50 cells/mm3. After starting antiretroviral therapy (ART), he gradually developed a headache and decreased level of consciousness. Cerebrospinal fluid (CSF) analysis revealed 450 cells, predominantly lymphocytes, with protein of 343 mg/dL and glucose of 98 mg/dL (corresponding blood glucose 284 mg/dL). CSF India ink staining was positive for crypococcus spp. Liposomal amphotericin B in combination with fluconazole (due to the unavailability of flucytosin) was stated. He was intubated because of hypoxia and his bronchoalveolar lavage was positive for Cryptococcus spp. too. He died 2 weeks after starting antifungal therapy based on this study it should be mentioned that neurologic and respiratory symptoms may be the first presentation of acquired immunodeficiency syndrome.

Wetting front (WF) and redistribution wetting front (RWF) depend on different parameters such as soil type, soil layering, land slope, and emitter discharge rate. Experiments were conducted on the physical model applying constant 24 litres of irrigation water, three different slopes (0, 10, and 20%), and three different discharge rates (2, 4, and 8 L/h). Three homogeneous soils with light, medium, and heavy textures, and two non-homogeneous soils with horizontal layers (LMH: a light texture in the top layer, a medium texture in the middle layer, and a heavy texture in the bottom layer; HML: a heavy texture in the upper layer, a medium texture in the middle layer, and a light texture in the lower layer) were used. The results showed that when the dripper flow rate doubled, in LMH soil, where the light texture was in the top layer, the amount of wetting depth was, on average, 20% higher than HML soil in which the top layer had a heavy texture. In all experiments, the highest increases in the maximum wetting depths of the RWF in five measurement stages within 24 h after irrigation were related to slopes of 0%, 10%, and 20%, respectively. A comparison between homogeneous and non-homogeneous soils showed that the change in soil layering has a significant effect on the radius and depth of wetting. This matter needs to be considered in the design of drip irrigation systems.

The economic and social consequences of capital flight from developing and underdeveloped countries indicate the importance of this phenomenon. Capital flight causes economic and political uncertainty and can be an obstacle to poverty reduction, economic growth, and domestic and international investments. Also, capital outflow and public and social expenses will decrease, especially in the education, water, health, and sanitation sectors, and economic and social inequalities will become more visible. Also with capital outflow, public and social expenses will decrease, especially in the education, water, health, and sanitation sectors, and economic and social inequalities will become more visible. Knowing more about this phenomenon, such a study can help the literature on this topic in analyzing the determining factors of capital flight from developing countries. In this research, using the Erbe-World Bank method, the amount of capital flight was measured for a sample of 24 developing countries during the period 2000-2021. Then, to investigate and analyze the determinants of capital flight using the generalized method of moments (GMM), the effect of institutional and governance factors and economic factors on capital flight was investigated. The results of the research show that inflation, sanctions, and economic growth fluctuations have positive and significant effects, and the corruption control index and the economic freedom index have negative and significant effects on capital outflow. As a result inflation, sanctions, and economic growth volatility accelerate capital outflow, and improvement in institutional quality and governance reduces capital outflow from developing countries. Countries that are trying to prevent the outflow of capital should review their governance structures and take steps to eliminate internal corruption with greater institutional transparency.

High-harmonic generation is a light up-conversion process occurring in a strong laser field, leading to coherent bursts of extreme ultrashort broadband radiation [Lewenstein et al., Phys. Rev. A 49, 2117 (1994)]. As a new perspective, we propose that ultrafast strong-field electronic or photonic processes such as high-harmonic generation can potentially generate nonclassical states of light well before the decoherence of the system occurs [Gorlach et al., Nat. Commun. 11, 4598 (2020); Stammer et al., Phys. Rev. Lett. 128, 123603 (2022)]. This could address fundamental challenges in quantum technology such as scalability, decoherence, or the generation of massively entangled states [Lewenstein et al., Luca Argenti Michael Chini, 27 (2024)]. Here, we report experimental evidence of the nonclassical nature of the harmonic emission in several semiconductors excited by a femtosecond infrared laser. By investigating single- and double-beam intensity cross-correlation [Loudon, Rep. Prog. Phys. 43, 913 (1980)], we measure characteristic nonclassical features in the single-photon statistics. We observe two-mode squeezing in the generated harmonic radiation, which depends on the laser intensity that governs the transition from super-Poissonian to Poissonian photon statistics. The measured violation of the Cauchy-Schwarz inequality realizes a direct test of multipartite entanglement in high-harmonic generation [Wasak, Phys. Rev. A 90, 033616 (2014)]. This result is supported by the theory of multimodal detection and the Hamiltonian from which the effective squeezing modes of the harmonics can be derived [Gonoskov et al., Phys. Rev. B 109, 125110 (2024); Christ et al. New J. Phys. 13, 033027 (2011)]. With this work, we show experimentally that high-harmonic generation is a new quantum bosonic platform that intrinsically produces nonclassical states of light with unique features such as multipartite broadband entanglement or multimode squeezing. The source operates at room temperature, using standard semiconductors and a standard commercial fiber laser, opening up new routes for the quantum industry, such as optical quantum computing, communication, and imaging.

Abstract Background Short-term exposure to PM2.5 has been associated with human health risks. However, evidence on the association between short-term exposure to PM2.5 and the risk of chronic obstructive pulmonary disease (COPD) remains limited and controversial. This study aimed to specifically assess the relationship between exposure to PM2.5 and the risk of hospitalization due to COPD. Methods A systematic search was conducted in PubMed, Web of Science, and Google Scholar databases from January 1, 2010 to May 1, 2022. The odds ratio (OR) statistic was calculated as a common measure of effect size. Publication bias was also examined in all eligible studies on COPD hospitalization using funnel plots and Egger’s test, as well as trim-and-fill method for missing studies on COPD hospitalization. Results A total of 19 studies were included in this meta-analysis. Random-effects models were plotted to calculate the pooled effect size by measuring OR (χ2 = 349.95; df = 18; I2 = 94.86%; P = 0.007; Z = 2.68; P

BackgroundOne of the common concerns of healthcare systems is the potential for re-admission of COVID-19 patients. In addition to adding costs to the healthcare system, re-admissions also endanger patient safety. Recognizing the factors that influence re-admission, can help provide appropriate and optimal health care. The aim of this study was to assess comorbidities that affect re-admission and survival in COVID-19 patients using a joint frailty model.MethodsThis historical cohort study was done using data of patients with COVID-19 who were re-hospitalized more than twice in a referral hospital in North of Iran. We used the joint frailty model to investigate prognostic factors of survival and recurrence, simultaneously using R version 3.5.1 (library "frailtypack"). P-values less than 0.05 were considered as statistically significant.ResultsA total of 112 patients with mean (SD) age of 63.76 (14.58) years old were recruited into the study. Forty-eight (42.9%) patients died in which 53.83% of them were re-admitted for a second time. Using adjusted joint model, the hazard of re-admission increased with cancer (Hazard ratio (HR) = 1.92) and hyperlipidemia (HR = 1.22). Furthermore, the hazard of death increased with hyperlipidemia (HR = 4.05) followed by age (HR = 1.76) and cancer (HR = 1.64). It Also decreased with lung disease (HR = 0.11), hypothyroidism (HR = 0.32), and hypertension (HR = 0.97).ConclusionConsidering the correlation between re-admission and mortality in the joint frailty model, malignancy and hyperlipidemia increased the risk of both re-admission and mortality. Moreover, lung disease probably due to the use of corticosteroids, was a protective factor against both mortality and re-admission.

Background and purpose: Today, development of telemedicine technology has led to wide use of smartphone to connect patients and health care teams to improve patient care. The aim of this study was to determine the effect of a self-care application on pain and mobility rehabilitation in patients following total knee arthroplasty surgery. Materials and methods: A randomized controlled clinical trial was carried out in 100 patients who were candidates for knee arthroplasty surgery at Tehran Baqiyatullah (Aj) Hospital. In this study, the experimental group was provided with a self-care application and the control group received routine hospital care. At days 7 and 14 after the surgery, the two groups were evaluated for pain and mobility rehabilitation using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Von Korff Pain Intensity and Disability Score. Results: Out of 100 people, 30 were men and 70 were women with an average age of 48.66±15.62. Findings showed significant differences between the two groups, at day 14 after the surgery, in mobility rehabilitation (P= 0.004) and pain (P= 0.001) at 95% confidence interval. Conclusion: According to this study, the self-care application improved pain and motor recovery after total knee arthroplasty surgery. (Clinical Trials Registry Number: IRCT20210724051973N1)

HIV maturation inhibitors such as bevirimat (BVM) interfering with Gag processing are emerging as alternative anti-retroviral drug candidates. Here, the authors report structures of assemblies of HIV-1 Gag fragments spanning the CA C-terminal domain and SP1 region bound to BVM.

Background: Sporadic lymphangioleiomyomatosis (S-LAM) is a rare disease that generally affects young women and involves the abnormal proliferation of smooth muscle cells (LAM cells) in the lungs (pulmonary LAM). There are two types of LAM, sporadic and LAM with tuberous sclerosis, which is an autosomal dominant genetic disease caused by mutations in the Tsc1 and Tsc2 genes. The most common manifestation of this disease is pneumothorax due to cyst rupture. Median transplant-free survival for pulmonary LAM is 23 years from diagnosis. Factors associated with a poor prognosis are often those associated with a more rapid decline in lung function. Case Presentation: The patient was a 24-year-old woman who presented with pneumothorax and multiple bullae in both lungs. The patient had no family history of respiratory disease, and the patient herself had no symptoms other than mild shortness of breath following activity from a year ago. A lung CT scan was performed for the patient and multiple bullae were evident in both lungs, which confirmed the diagnosis. There was no evidence of involvement of other organs but the lung. For the patient in the ICU with the diagnosis of left pneumothorax, a chest tube was inserted and she underwent mechanical ventilation. Finally, after 24 days of hospitalization, oxygen therapy of the patient was performed with a normal mask, and she underwent left lung pleurodesis with talcum powder, and a few days later, right lung pleurodesis was performed on the patient. On the 36th day of hospitalization, her general condition improved and she was discharged from the ICU. The patient was discharged in good general condition and had no problem on her four months follow-up. Conclusion: Fortunately, with the diagnosis of LAM for the patient according to the CT scan of the patient's lung, she was treated with insertion of a chest tube and by performing pleurodesis, the recurrence of pneumothorax was prevented. In a young woman with spontaneous pneumothorax, sporadic LAM is one of the differential diagnoses.

Over the course of the Coronavirus disease 2019 (COVID-19) pandemic, numerous complications have been documented. In this report, we have detailed an unexpected complication of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection that occurred in a 73-year-old female patient who was simultaneously afflicted with mucormycosis and another unanticipated problem. Due to the lack of recovery of the patient after receiving mucormycosis treatment and continued fever, cough and hemoptysis, bronchoscopy was performed for her. During bronchoscopy, we encountered a foreign body that was the cause of the patient’s fever, cough, and hemoptysis. Rigid bronchoscopy was performed and the foreign body was removed from the left main bronchus. The lack of a favorable treatment response after administering antifungal therapy suggested that the presence of a foreign body could potentially act as an underlying nidus, thus influencing the suboptimal therapeutic outcome. Mucormycosis is usually characterized by distinct radiological patterns. However, this case did not present predictable imaging findings, further complicating the diagnostic process associated with this invasive fungal infection.

Abstract Background and Aim Scientific collaborations play a vital role in advancing research in various disciplines, including medical informatics, health information management, medical librarianship, and information sciences. This study aims to provide an overview of Iranian researchers' scientific output in three disciplines and their collaboration networks. Methods The study utilized data from Scopus database and analyzed 2086 records of Iranian researchers' research outcomes over 10 years. Each article's citations were averaged to determine its impact factor. The study also reviewed the number of articles and citations in the past decade. Results The findings show that scientific output in the disciplines of medical informatics, health information management, medical librarianship, and information sciences has significantly increased among Iranian researchers in the past decade. The analysis of collaboration networks indicates a strong connection between these disciplines, with medical informatics having the highest degree of collaboration. Conclusion This study provides valuable insights into the scientific collaborations among Iranian researchers in medical informatics, health information management, medical librarianship, and information sciences. The findings can be used to inform future research and collaboration initiatives in these disciplines. The results suggest that Iranian researchers in these disciplines have made significant progress in scientific output and collaboration. However, further efforts are required to improve the quality and impact of their research.

Key Clinical Message Although immunodeficient patients are less prone to develop Coronavirus disease 2019 (COVID‐19)‐mediated cytokine storm, secondary infections can cause serious complications in this vulnerable population. They are more likely to develop opportunistic infections that can mimic the symptoms of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection. Herein, we presented a 27‐year‐old male patient of SARS‐CoV‐2 infection, who was complicated with Pneumocystis jirovecii pneumonia (PJP), following treatment with rituximab. First, he was hospitalized for 5 days with fever, cough, and dyspnea due to COVID‐19 infection, and treated with remdesivir and glucocorticoid. Then, he has been referred to our center with cough, dyspnea, body pain, and fever. Due to persistent fever, the progression of pulmonary lesions, and reduced oxygen saturation, we began treatment with piperacillin + tazobactam, vancomycin, and levofloxacin. Nevertheless, the patient's fever did not stop after the aforementioned empiric treatment and his condition got worse and he was admitted to the intensive care unit. The result of BAL fluid, tested for P. jirovecii by RT‐PCR, turned out to be positive. Therefore, we started trimethoprim‐sulfamethoxazole and dexamethasone, which improved his condition. We hope this article helps clinicians consider causes other than COVID‐19, especially opportunistic infections such as PJP, in patients with respiratory symptoms and fever.

The continuing emergence or re-emergence of vector-borne zoonotic Q fever (caused by Coxiella burnetii) and Crimean Congo hemorrhagic fever (CCHF, caused by Orthonairovirus) include indispensable extraordinary threat around the world. Low infectious dose and long-term environmental residence are major risks. Wildlife and domestic livestock act as hosts or reservoirs of the CCHF virus and ticks are carriers. The disease also poses a threat to public health services owing to its epidemic potential, high case fatality ratio (up to 40%) as well as difficulties in treatment, prevention, and control. Q fever is another zoonotic febrile disease mainly affecting workers involved in farming livestock. The causative agent of Q fever causes abortion in livestock. The pathogen is shed in large numbers in the waste of infected animals (amniotic fluids and placenta during parturition) and is transmitted by inhalation of contaminated aerosols. Vaccination is the most effective way of protecting against Q fever. The main way to prevent Q fever is to avoid contact with animals, especially while animals are giving birth, or consumption of unpasteurized milk and contaminated dairy products. Due to the increasing importation of livestock to meet the growing demand for dairy and meat products, new diseases are likely to be introduced. In our growing globalized world, where trade between countries increases, it is necessary to conduct more research on zoonotic diseases and to monitor any possible disease introduction to new areas. A continuing surveillance program and pathogen testing are important in tracking the emergence of new pathogens.

BackgroundDespite the increasing development of different smartphone apps in the health care domain, most of these apps lack proper evaluation. In fact, with the rapid development of smartphones and wireless communication infrastructure, many health care systems around the world are using these apps to provide health services for people without sufficient scientific efforts to design, develop, and evaluate them. ObjectiveThe objective of this study was to evaluate the usability of CanSelfMan, a self-management app that provides access to reliable information to improve communication between health care providers and children with cancer and their parents/caregivers, facilitating remote monitoring and promoting medication adherence. MethodsWe performed debugging and compatibility tests in a simulated environment to identify possible errors. Then, at the end of the 3-week period of using the app, children with cancer and their parents/caregivers filled out the User Experience Questionnaire (UEQ) to evaluate the usability of the CanSelfMan app and their level of user satisfaction. ResultsDuring the 3 weeks of CanSelfMan use, 270 cases of symptom evaluation and 194 questions were recorded in the system by children and their parents/caregivers and answered by oncologists. After the end of the 3 weeks, 44 users completed the standard UEQ user experience questionnaire. According to the children’s evaluations, attractiveness (mean 1.956, SD 0.547) and efficiency (mean 1.934, SD 0.499) achieved the best mean results compared with novelty (mean 1.711, SD 0.481). Parents/caregivers rated efficiency at a mean of 1.880 (SD 0.316) and attractiveness at a mean of 1.853 (SD 0.331). The lowest mean score was reported for novelty (mean 1.670, SD 0.225). ConclusionsIn this study, we describe the evaluation process of a self-management system to support children with cancer and their families. Based on the feedback and scores obtained from the usability evaluation, it seems that the children and their parents find CanSelfMan to be an interesting and practical idea to provide reliable and updated information on cancer and help them manage the complications of this disease.

Background: The present study aimed to investigate the one-year prevalence of SARS-CoV-2, common comorbidities and demographic information among negative- and positive rRT-PCR in health care workers (HCW), hospitalized and outpatients. Also, the association between SARS-CoV-2 cycle threshold (Ct) and the outcomes of patients were analyzed in Babol, northern Iran. Methods: This large retrospective cross-sectional study was performed between March 2020 and March 2021. The records of 19232 hospitalized, outpatients and HCW suspected to COVID-19 were collected from teaching hospitals in the North of Iran. Results: Out of the 19232 suspected to COVID-19 patients, 7251 (37.7%) had a positive rRT-PCR result; 652 (9%), 4599 (63.4%) and 2000 (27.6%) of those were categorized as HCW, hospitalized and outpatients, respectively. Moreover, between the hospitalized and the outpatient group, 10.2 and 0.8% cases died, whereas no death cases were reported in the HCW. Furthermore, it seems that death rate was significantly different between the three groups of Ct value, the highest mortality in those with Ct between 21 and 30 (group B=7.6%) and the lowest in the group with the highest Ct (between 31 and 40 = 5.5%) (p

Abstract Background This study aimed to determine the characteristics, vaccination status, and outcomes of confidence interval (COVID‐19) patients, admitted to a tertiary hospital in Iran during the predominant severe acute respiratory syndrome‐coronavirus 2 (SARS‐CoV‐2) Delta variant period. Methods This retrospective study assessed the medical records of all hospitalized COVID‐19 patients, who were admitted to a tertiary hospital from July 10 to September 15, 2021. Adjusted binary logistic regression analyses were conducted to determine factors associated with poor outcomes. Results More than 25% of hospitalized patients received at least one vaccine dose of SARS‐CoV‐2. The Sinopharm BIBP vaccine (China) was the most commonly received vaccine (73.3%). After adjusting for age and comorbidities, the adjusted odds ratio (AOR) for poor outcomes was significantly lower in hospitalized patients who received Remdesivir compared to those not receiving Remdesivir (AOR: 0.35; 95% confidence interval [CI]: 0.15, 0.78; p

Monkeypox is a zoonotic disease caused by a double-stranded DNA virus belonging to the genus Orthopoxvirus. Despite being endemic in Central and West Africa, the disease has received relatively little research attention until recent times. As the Coronavirus disease 2019 (COVID-19) pandemic continues to affect the world, the rising number of monkeypox cases in non-endemic countries has further stoked global public health concerns about another pandemic. Unlike previous outbreaks outside Africa, most patients in the present outbreak had no history of travel to the endemic regions. The overwhelming majority of patients were initially identified amongst homosexual men, who had attended large gatherings. Mutations in the coding regions of the viral genome may have resulted in fitness adaptation, enhancement of immune evasion mechanisms, and more efficient transmissibility of the 2022 monkeypox virus. Multiple factors such as diminished cross-protective herd immunity (cessation of smallpox vaccination), deforestation, civil war, refugee displacement, farming, enhanced global interconnectedness, and even climate change may facilitate the unexpected emergence of the disease. In light of the increasing number of cases reported in the present outbreak, healthcare professionals should update their knowledge about monkeypox disease, including its diagnosis, prevention, and clinical management. Herein, we provide an overview of monkeypox, with a focus on the 2022 outbreak, to serve as a primer for clinical practitioners who may encounter the disease in their practice.

This study aimed to evaluate the effectiveness of a Persian Medicine-based dietary protocol (PM diet) in patients infected with COVID-19. A randomized clinical trial was performed from July 2020 to January 2021 in Tehran, Iran. Eighty patients admitted due to pulmonary dysfunction caused by COVID-19 were randomly allocated into two groups: the PM diet or the common hospital (CH) diet. Eight beds in 2 rooms were considered for each group. Patients were randomly hospitalized in these rooms and received these diets up to discharge or death. The details of the PM diet were published before (Hospital diet for COVID-19, an acute respiratory infectious disease: An evidence-based Protocol of a Clinical Trial). O2 saturation level and duration of hospitalization, the rate of mortality, duration of fever, and duration of cough were considered as the primary and secondary outcomes, respectively. O2 Saturation and fever durationwere not different between groups (P-value= 0.08, 0.312, respectively). But the duration of hospitalization and the duration of cough in the PM diet group were significantly shorter than in the CH diet (P-value= 0.002, 0.009, and HR=2.02, 1.86 respectively). The mortality rate was significantly lower in the PM diet group than in the CH diet group (Odds ratio: 0.12, P-value=0.026). PM diet caused a lower mortality rate, shorter hospital stay, and better improvement in cough, but did not have a significant effect on O2 saturation and fever.

An upward trend in the incidence of Parkinson’s disease (PD), known as one of the most prominent neurodegenerative maladies, has evoked great concerns among medical community over the past decades. Recently, studies have suggested the initiation of PD in the gastrointestinal tract decades before the advent of manifestations. Accumulating evidence suggests that intracellular deposition of α-synuclein (α-syn) in patients with PD is associated with systemic inflammation leading to the neuroinflammation and neuropsychiatric disorders. The α-syn protein accumulation can be initiated from GI cells and distribute into CNS cells through trans-synaptic cell to cell transmission. Without doubt, gut microbiota affects the enteric nervous system (ENS) known as the “second brain”. Patients with PD have a different balance of bacteria in their intestines, as compared to healthy population. Metabolites from gut microbiota affect the enteric wall such as neurodegeneration. Probiotics have a substantial role in the neutralization or inhibition of reactive oxygen species (ROS) and free radicals and thus improve the PD symptoms. The anti-inflammatory role of probiotics also inhibits the neurodegeneration and PD development. Hence, probiotics contribute to the improvement of PD through several mechanisms which need more in-depth verification.

Objective(s): This study aimed to evaluate antibiotic resistance profiles and presence of virulence genes among Salmonella enterica serovar Enteritidis (S. Enteritidis) isolated from patients with gastroenteritis in various regions of Iran. Moreover, genetic relatedness among the strains was assessed by pulsed-field gel electrophoresis (PFGE).Materials and Methods: From April through September 2017, 59 Salmonella strains were isolated from 2116 stool samples. Of these strains, 27 S. Enteritidis were recovered. These strains were subjected to disk diffusion tests, polymerase chain reaction (PCR) for detection of virulence genes (invA, hilA, pefA, rck, stn, ssrA, ssaR, sefA, spvC, sipA, sipC, sopB, sopE, and sopE2), and PFGE.Results: High prevalence of resistance towards cefuroxime (n = 20, 74.1%) and ciprofloxacin (n = 13, 48.2%) were demonstrated. All tested strains possessed invA, hilA, sefA, sipA, sopB, and sopE. The least prevalent virulence gene was rck (n = 6; 22.2%). Based on combinations of virulence genes, 12 virulotypes were observed. The most common virulotype was VP2 (n = 12; 44.4%), harboring all of the virulence genes except for rck. PFGE typing showed only two distinct fingerprints among tested strains. Each fingerprint had completely different virulotypes. Notably, VP4 (harboring all genes except for rck and spvC) was only presented in pulsotype A, while VP2 was confined to pulsotype B.Conclusion: S. Enteritidis strains were derived from a limited number of clones, suggesting that it is highly homogenous. Future works should consider combinations of other genotyping methods together with larger sample sizes from more diverse sources.

Abstract Protozoan diseases such as malaria, leishmaniasis, Chagas disease, and sleeping sickness still levy a heavy toll on human lives. Deplorably, only few classes of anti-protozoan drugs have thus far been developed. The problem is further compounded by their intrinsic toxicity, emergence of drug resistance, and the lack of licensed vaccines. Thus, there is a genuine exigency to develop novel anti-protozoan medications. Over the past years, melittin, the major constituent in the venom of European honeybee Apis mellifera, has gathered the attention of researchers due to its potential therapeutic applications. Insofar as we are aware, there has been no review pertinent to anti-protozoan properties of melittin. The present review outlines the current knowledge about anti-protozoan effects of melittin and its underlying mechanisms. The peptide has proven to be efficacious in killing different protozoan parasites such as Leishmania, Plasmodium, Toxoplasma, and Trypanosoma in vitro. Apart from direct membrane-disruptive activity, melittin is capable of destabilizing calcium homeostasis, reducing mitochondrial membrane potential, disorganizing kinetoplast DNA, instigating apoptotic cell death, and induction of autophagy in protozoan pathogens. Emerging evidence suggests that melittin is a promising candidate for future vaccine adjuvants. Transmission-blocking activity of melittin against vector-borne pathogens underscores its potential utility for both transgenic and paratransgenic manipulations. Nevertheless, future research should focus upon investigating anti-microbial activities of melittin, alone or in combination with the current anti-protozoan medications, against a far broader spectrum of protozoan parasites as well as pre-clinical testing of the peptide in animal models.

Abstract Background Extracorporeal blood purification has been proposed as one of the therapeutic approaches in patients with coronavirus infection, because of its beneficial impact on elimination of inflammatory cytokines. Methods This controlled trial has been conducted on critically ill COVID-19 patients admitted in the state hospital affiliated to Babol University of Medical Sciences, Iran who received different antiviral and antibacterial drugs, and different modalities of respiratory treatments and did not have positive clinical improvement. No randomization and blindness was considered. All of the participants underwent three sessions of resin-directed hemoperfusion using continuous renal replacement therapy with a mode of continuous venovenous hemofiltration (CVVH). Results Five men and five women with a mean age of 57.30 ± 18.07 years have been enrolled in the study; and six of them have improved after the intervention. Peripheral capillary oxygen saturation (SpO2) changed after each session. Mean SpO2 before the three sessions of hemoperfusion was 89.60% ± 3.94% and increased to 92.13% ± 3.28% after them (p

Abstract Background Severe side effects after vaccination with coronavirus disease 2019 (COVID‐19) vaccines are rare but can be fatal. To date, vaccine‐induced immune thrombotic thrombocytopenia (VITT) cases have been reported after injection of mRNA and adenoviral vectors COVID‐19 vaccines. Here, we report the second suspected case of VITT after vaccination with the Sinopharm vaccine, an inactive vaccine. Key Clinical Question The Key Clinical Question was to determine whether inactivated COVID‐19 vaccines could induce VITT and how to diagnose and treat such cases. Clinical Approach and Conclusions Our patient developed deteriorating symptoms the day after vaccination and was admitted to the emergency department on day 5 after vaccination. After performing laboratory analysis, thrombosis with thrombocytopenia was suggested, further confirmed by highly positive anti‐heparin–platelet factor 4 antibodies assay and color Doppler ultrasonography. He was then treated with high‐dose intravenous immunoglobulin, corticosteroid, and nonheparin anticoagulant.

BackgroundThe unique features of smartphones have extended their use in different fields, especially in the health care domain. These features offer new opportunities to support patients with chronic conditions by providing them with information, education, and self-management skills. We developed a digital self-management system to support children with cancer and their caregivers in Iran (low- and middle-income country). ObjectiveThis study is aimed at the development and preliminary evaluation of a cancer self-management system (CanSelfMan) tailored to the needs of children with cancer and their parents or caregivers. MethodsThis study was conducted in collaboration with a multidisciplinary team between January and February 2020 at MAHAK’s Pediatric Cancer Treatment and Research Center. We developed a self-management system in six stages: requirement analysis, conformity assessment, preparation of educational content, app prototyping, preliminary evaluation, and developing the final version. ResultsA total of 35 people (n=24, 69% parents and n=11, 31% children) volunteered to participate in the study. However, only 63% (15/24) of parents and 73% (8/11) of children were eligible to participate. By adopting a user-centered design approach, we developed a mobile app, CanSelfMan, that includes five main modules (knowledge base, self-management tips, self-assessment report, ask a question, and reminders) that provide access to reliable information about acute lymphocytic leukemia and the self-management skills required for side effect measurement and reporting. A web-based dashboard was also developed for oncologists and included a dashboard to monitor users’ symptoms and answer their questions. ConclusionsThe CanSelfMan app can support these groups by providing access to reliable information about cancer, facilitating communication between children or parents and health care providers, and helping promote medication adherence through a reminder function. The active participation of the target group can help identify their needs. Therefore, through the involvement of stakeholders such as patients, caregivers, and oncologists in the design process, we improved usability and ensured that the final product was useful. This app is now ready to proceed with feasibility studies.

BackgroundGastric cancer is one of the most common gastrointestinal cancers. Patients with gastric cancer experience disabilities and complications that lead to reduced quality of life. Empowering these patients by providing them with information and self-management skills can help reduce side effects and improve their quality of life. ObjectiveThe aim of this study was to identify the user requirements for developing a mobile-based self-management app to support patients with gastric cancer. MethodsData were analyzed using descriptive statistics and frequency distribution reports using IBM SPSS Statistics software. ResultsAll of the data elements and functional requirements except “data recording times” and “weight changes in graphs” were identified as essential by clinical experts and patients. Among the functional requirements required in a gastric cancer self-management app, the capabilities related to informing, announcing warnings, and reminders are included. In the demographic data section, most patients (14/26, 53%) did not comment on the importance of recording data such as name, surname, and place of residence, and the demographic data section was met with less agreement from patients than clinicians. ConclusionsApplying the requirements mentioned in this study can improve the self-management of patients with gastric cancer. Such apps can play an important role in empowering patients and improving their quality of life. However, the apps need to be designed and implemented to see how they can meet users’ requirements.

The electrochemical CO2 reduction reaction (CO2RR) on polycrystalline copper (Cu) electrode was performed in a CO2-saturated 0.10 M Na2CO3 aqueous solution at 278 K in the absence and presence of low-frequency high-power ultrasound (f = 24 kHz, PT ~ 1.23 kW/dm3) in a specially and well-characterized sonoelectrochemical reactor. It was found that in the presence of ultrasound, the cathodic current (Ic) for CO2 reduction increased significantly when compared to that in the absence of ultrasound (silent conditions). It was observed that ultrasound increased the faradaic efficiency of carbon monoxide (CO), methane (CH4) and ethylene (C2H4) formation and decreased the faradaic efficiency of molecular hydrogen (H2). Under ultrasonication, a ca. 40% increase in faradaic efficiency was obtained for methane formation through the CO2RR. In addition, and interestingly, water-soluble CO2 reduction products such as formic acid and ethanol were found under ultrasonic conditions whereas under silent conditions, these expected electrochemical CO2RR products were absent. It was also found that power ultrasound increases the formation of smaller hydrocarbons through the CO2RR and may initiate new chemical reaction pathways through the sonolytic di-hydrogen splitting yielding other products, and simultaneously reducing the overall molecular hydrogen gas formation.

Abstract Background Egyptian Upper Cretaceous waste clay samples from Yunis Mines, Qusseir vicinity, Eastern Desert, were investigated for their chemical and mineralogical compositions as well as for firing. These investigations were carried out to assess the suitability to use the waste clays for the production of lightweight bricks. X-ray fluorescence (XRF), scanning electron microscopy (SEM), X-ray diffraction (XRD), and Fourier transform infrared (FTIR) techniques were applied for characterizing chemical and mineral compositions of the raw clays. On the other side, densification parameters of the fired samples up to 1100 °C were examined by using Archimedes water-saturation methods and by determining the density and crushing strength of the fired bodies. Results Two types of concrete were prepared using different grain sizes: coarse and a mix of coarse and fine aggregates. Concrete batches were prepared, and the mechanical strength and the bulk density were determined. Mineralogically, the waste samples consist of montmorillonite as the predominant clay mineral, with quartz, calcite, fluorapatite, anhydrite, and pyrite as impurities. Bulk density and apparent porosity of the fired clay sample at 1100 °C were 0.89 g/cm3 and 67.19%, respectively, while the bulk density of the two types of concrete range from 0.76 g/cm3 in coarse type with no fines to 0.90 g/cm3 in the coarse with 20% fine fraction. The crushing strength of both types is 25 kg/cm2 for coarse type and 45 kg/cm2 for coarse and fine types, respectively. Conclusions The results showed that the data provides a useful application of waste clay ramps of ancient Yunis mining tunnels in Qussier area with an additional mean to assess their suitability for the production of lightweight brick concretes to reduce density and their relatively good strength in modern buildings for non-loading building units and to enhance the thermal insulation of buildings.

Introduction: The continuous increase in the demand for specialized skin care services, together with the unbalanced geographical distribution of these specialists, has limited the access of patients to these services. Teledermatology is one of the innovative approaches that can be considered as a solution to improve the access to specialized skin care services with minimal material resources in developing countries such as Iran. Methods: The present study is an applied and aimed to re-designing and evaluating tele-dermatology software. In this research, redesign of the software was done through obtaining the users feedback after being used in clinical setting, then final version of the software designed and usability evaluation test was conducted. Results: The usability testing result, show dermatologist and GP were very satisfied with the system and overall average scores obtained were 8 out of a total of 9 achievable scores. The scores earned was respectively: 7.8 for overall reaction to the system, 8.5 for screen feature, 7.9 for terminology and system information, 8.3 for Learning and 7.5 for system capability. Conclusion: The experience gained from this research shows that for the successful development and use of telehealth tools, need engage and collaboration with main stakeholder, identify, understand and modeled work flows and processes related to the provision of patient services and treatment. Also in order to increase the usability and user satisfaction, the design and development of systems should be based on the principle of user-centered design and engagement of system stakeholders at all stages of system design and development.

Abstract Nano-structures excited by light can enhance locally the electric field when tuned to plasmonic resonances. This phenomenon can be used to boost non-linear processes such as harmonic generation in crystals or in gases, Raman excitation, and four wave mixing. Here we present a theoretical investigation of the near-field phase matching of attosecond pulses emitted by high-order harmonic generation (HHG) of an atom immersed in a multi-cycle femtosecond infrared laser field and a spatially inhomogeneous plasmonic field. We demonstrate that the spatial inhomogeneity factor of the plasmonic field strongly affects the electron trajectory and recombination time which can be used to control the attosecond emission. For further insight into the plasmonic field effect, we monitor the phase of each quantum path as a function of the inhomogeneity strength. Moreover, we investigate the attosecond emission as a function of near-field phase matching effects. This is achieved by calculating the coherent field superposition of attosecond pulses emitted from various intensities or field inhomogeneities. Finally, far-field and near-field phase matching effects are combined to modulate the harmonic spectral phase towards the emission of a single attosecond pulse.

Background: Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP) worldwide, especially among children and debilitated populations. The present study aimed to investigate a loop-mediated isothermal amplification (LAMP) technique for rapid detection of M. pneumoniae in clini-cal specimens collected from patients with pneumonia. Methods: Throat swabs were collected from 110 outpatients who suffered from pneumonia. Throat swab samples were obtained from patients referred to the hospital outpatient clinics of Tehran University hospitals, Iran in 2017. The presence of M. pneumoniae in the clinical specimens was evaluated by LAMP, PCR and culture methods. Sensitivity and specificity of the LAMP and PCR assays were also determined. Results: Out of 110 specimens, LAMP assay detected M. pneumoniae in 35 specimens. Detection limit of the LAMP assay was determined to be 33fg /μL or ~ 40 genome copies/reaction. Moreover, no cross-reaction with genomic DNA from other bacteria was observed. Only 25 specimens were positive by the culture method. The congruence between LAMP assay and culture method was ‘substantial’ (κ=0.77). Specificity and sensitivity of LAMP assay were 88.2%, 100% in compare with culture. However, the con-gruence between LAMP assay and PCR assay was ‘almost perfect’ (κ=0.86). Specificity and sensitivity of LAMP assay were 92.5%, 100% in compare with PCR. Conclusion: Overall, the LAMP assay is a rapid and cost-efficient laboratory test in comparison to other methods including PCR and culture. Therefore, the LAMP method can be applied in identification of M. pneumoniae isolates in respiratory specimens.

The nucleation and growth of sol-gel derived TiO2 colloidal nanoparticles have been studied using experiment and theory as well. In this study, the temperature effect on the formation of TiO2 nanoparticles was discussed and some effective parameters such as the supply rate of solute (Q0), the mean volumic growth rate of stable nuclei during the nucleation period (u), the diffusion coefficient of [Ti]+4 ions and the nucleus size were determined. The formation of TiO2 nanoparticles in three different temperatures (60, 70 and 80°C) was studied. The obtained results showed that the process temperature has a considerable impact on the nucleation and growth of TiO2 nanoparticles. It can be concluded that increasing the temperature leads to a decrease of the supersaturation and an increase of the nucleus size, supply rate of monomer, nanoparticles density and growth rate as evident from LaMer diagram.

Introduction: Recent advances in mobile technology combined with medical specialties, have introduced a new option called mobile health that provides new opportunities to improve patients’ health. Mobile health has changed the traditional delivery of healthcare services and also previous assumptions of concepts such as service providers, patients, health care services and lifestyle. The aim of this study was to introduce mobile health concept and application of this technology in management and treatment of skin lesions. Methods: This is a comprehensive review aimed to introduce mobile health application in providing skin care and diagnostic services and clinical outcomes of this method. In this review article, articles on the telemedicine, mobile health, and teledermatology were searched using online databases such as Pubmed, Scopus, Google scholar, Web of Science, and Ebsco. Results: Studies in this area show that use of mobile health in dermatology is superior to the conventional method of teledermatology and this method can be used for diagnosis, treatment, screening, triage, and also management of patients with chronic conditions in their home. Conclusion: Mobile health can be potentially used as a cost effective and available method for providing professional skincare services especially in the economically or geographically-disadvantaged area, thereby, the gap of access to professional services will be filled.

Stainless steels (SUS) and dual-phase (DP) steels have tension-compression asymmetry (TCA) in mechanical responses to full loading cycles. This phenomenon can significantly influence sheet metal forming of such metals, however, it is difficult to describe this behaviour analytically. In this research, a novel analytical method for asymmetric elastic-plastic pure bending using the Cazacu–Barlat 2004 asymmetric yield function is proposed. It only uses material parameters in tension along with an asymmetry coefficient related to the yield function. Bending operations of SUS304 and DP980 are investigated as two case studies. In the pure bending for both SUS304 and DP980, moment–curvature diagrams are analytically obtained. Furthermore, linear and nonlinear springback behaviours of SUS304 are analytically investigated. Moreover, using the analytical model as a user-defined material, a numerical model is developed for both steels under pure bending. In the V-bending case of SUS304 with and without TCA effects, the springback behaviours of the material are investigated numerically. In addition, considering friction effects, the analytical method is further modified for predicting springback behaviours in the V-bending of 16 types of SUS304 with various strengths are determined. All the analytical and numerical results have good agreement with those experimental results from literature for validation.

Letter to the Editor

Nowadays, organizations can use of main capabilities and competencies of other organizations to optimize abilities and increase the effectiveness of each other and elevate level of their customer satisfaction instead of having the best performance in all fields themselves. This participation requires an accurate and systematic management system and directing components’s goals of the chain in a common way as if it’s been neglected cause organization misses it’s competitive advantages and thus gives it’s competitive share to other competitors. Performance management system should facilitate balanced development in organization and play a key role in managing and mitigating conflicts within it. Moreover, it’s expected from Performance management system beside attention to financial measures, be able to reflect the characteristics that make advantages in modern business environment also beyond the financial standards, can consider other issues such human resources development, knowledge creation, innovation, processes development and promotion. More importantly, the performance management system should be linked with the vision and strategies. Balanced scorecard capabilities in covering the cases mentioned above cause it become a popular approach for performance management. This article points out some limitations of balanced scorecard approach and some potential and capacities of system dynamics as well, furthermore propose a new framework that is combining system dynamics causal loop diagram and balanced scorecard as a solution to improve the process of formulating a strategy map. Finally, after drawing the supply chain management causal loop diagram and creating balanced scorecard in related to it, supply chain management strategy map is achieved.

Introduction: Tele-dermatology is considered by telemedicine service providers about more than a decade. Many reasons, including safety, high diagnostic accuracy compared with physical examination, image-based diagnosis and relatively low cost for installing required systems are making Tele-dermatology successful remarkable. This study introduced Tele-dermatology and its kind and the results of different studies were conducted in clinical area in compare with physical examination is investigated. Method: This review article was done using available library resources and searching online database and articles which published between 2000–2014 in Tele-dermatology field were assessed. Results: Findings showed that, in average the conformity of the proposed diagnosis in skin disease for Tele-dermatology compared with visiting were (79.4 %), for treatment plans were (76.7 %) and reduction of attended visiting was(% 55.6). Also about the servicing fees skin a significant reduction of direct and indirect costs of skin care services show cost- effectiveness of Tele-dermatology. Conclusion: Although most of the researchers and experts agree with the effectiveness of Teledermatology for providing professional health care services and increasing the accessibility of these services, this method is not the final solution to overcome all difficulties related to the shortage of human and financial resources in healthcare system. It should be considered as a complementary to resolve some problems in providing high quality healthcare.

The use of artificial neural networks has increased in many areas of engineering. In particular, this method has been applied to many geotechnical engineering problems and demonstrated some degree of success. A review of the literature reveals that it has been used successfully in modeling soil behavior, site characterization, earth retaining structures, settlement of structures, slope stability, design of tunnels and underground openings, liquefaction, soil permeability and hydraulic conductivity, soil compaction, soil swelling and classification of soils. The method of conjugate gradients provides a very effective way to optimize large, deterministic systems by gradient descent. In its standard form, however, it is not amenable to stochastic approximation of the gradient. Here we explore a number of ways to adopt ideas from conjugate gradient and Back Propagation in the stochastic setting, using fast Hessian-vector products to obtain curvature information effectively. In our benchmark experiments the resulting highly scalable algorithms converge about an order of magnitude faster than ordinary stochastic gradient descent. The objective of this paper is to provide a general view to describe this method in predicting mechanical behavior and constitutive modeling issues in geo-mechanical behavior of cohesive soil to be used in geo-mechanics. In this research the Batching Back Propagation method (BBP) has been employed and the characterized parameters are introduced as initial void ratio, liquid limit, plasticity index, natural density, moisture percent, solid density of grain, over consolidation ratio, and pre-consolidation pressure. The paper also intends to present how much the input memory may cover the accuracy of predicted behavior of standard triaxial drained and undrained tests. The paper also discusses the strengths and limitations of the proposed method compared to the other modeling approaches. Also, the sensitivity of intended parameters is investigated.

Over the last decade telemedicine services particularly in dermatology domain has seen significant advances and it became as routine medical services in many parts of the world. In Iran although it is not being used in usual practice but many research projects have been conducted on this issue. The main and important point that has not yet been paid enough attention is meeting standard guidelines in telemedermatology services. Ignoring these points can result in misdiagnosis by medical specialists. The value of this matter is that important that American Telemedicine Association has suggested a comprehensive standard guideline about it. Having considered that any similar paper has not yet been published in Iran, this paper aims to conduct a comprehensive review on available resources and guidelines and published papers between 1997-2013 in Teledermatology domain such as the minimum requirements for photography in teledermatology , skin lesions photography techniques , distances, resolution, macro imaging , use of flash, compression, attention to balance between image size and the quality of images for a Teledermatology consultation service.

The increasing availability of volunteered geographic information (VGI) enables novel studies in many scientific domains. However, inconsistent VGI can negatively affect these studies. This paper describes a workflow that checks the consistency of Volunteered Phenological Observations (VPOs) while considering the synchrony of observations (i.e., the temporal dispersion of a phenological event). The geographic coordinates, day of the year (DOY) of the observed event, and the accumulation of daily temperature until that DOY were used to: (1) spatially group VPOs by connecting observations that are near to each other, (2) define consistency constraints, (3) check the consistency of VPOs by evaluating the defined constraints, and (4) optimize the constraints by analysing the effect of inconsistent VPOs on the synchrony models derived from the observations. This workflow was tested using VPOs collected in the Netherlands during the period 2003⁻2015. We found that the average percentage of inconsistent observations was low to moderate (ranging from 1% for wood anemone and pedunculate oak to 15% for cow parsley species). This indicates that volunteers provide reliable phenological information. We also found a significant correlation between the standard deviation of DOY of the observed events and the accumulation of daily temperature (with correlation coefficients ranging from 0.78 for lesser celandine, and 0.60 for pedunculate oak). This confirmed that colder days in late winter and early spring lead to synchronous flowering and leafing onsets. Our results highlighted the potential of synchrony information and geographical context for checking the consistency of phenological VGI. Other domains using VGI can adapt this geocomputational workflow to check the consistency of their data, and hence the robustness of their analyses.

In this paper the principle subject is to survey the short-run return of initial public offering (IPO) in Tehran security exchange market. Three empirical patterns are documented and analyzed: short-run underpricing, hot issue markets and long-run underperformance. In this article the IPOs in Tehran stock exchange market since 1378 to 1382 are analyzed. In this period market has extended very much and many IPOs entered it. In the period in question, the results of this paper indicate that the short-run return of IPOs is higher than the short-run return of the market. This observed pattern is similar to other markets performance around the world. Moreover, the influence of some factors on the underperformance of IPOs is analyzed. Among these factors, only audit firms have influenced the underperformance of IPOs in Tehran market. But considering the joint effect of this factors, also audit firms lost her effect and no one of these factors can explain the observed pattern (underperformance of IPOs) i n Tehran stock exchange.

Recent improvements in online information communication and mobile location-aware technologies have led to the production of large volumes of volunteered geographic information. Widespread, large-scale efforts by volunteers to collect data can inform and drive scientific advances in diverse fields, including ecology and climatology. Traditional workflows to check the quality of such volunteered information can be costly and time consuming as they heavily rely on human interventions. However, identifying factors that can influence data quality, such as inconsistency, is crucial when these data are used in modeling and decision-making frameworks. Recently developed workflows use simple statistical approaches that assume that the majority of the information is consistent. However, this assumption is not generalizable, and ignores underlying geographic and environmental contextual variability that may explain apparent inconsistencies. Here we describe an automated workflow to check inconsistency based on the availability of contextual environmental information for sampling locations. The workflow consists of three steps: (1) dimensionality reduction to facilitate further analysis and interpretation of results, (2) model-based clustering to group observations according to their contextual conditions, and (3) identification of inconsistent observations within each cluster. The workflow was applied to volunteered observations of flowering in common and cloned lilac plants (Syringa vulgaris and Syringa x chinensis) in the United States for the period 1980 to 2013. About 97% of the observations for both common and cloned lilacs were flagged as consistent, indicating that volunteers provided reliable information for this case study. Relative to the original dataset, the exclusion of inconsistent observations changed the apparent rate of change in lilac bloom dates by two days per decade, indicating the importance of inconsistency checking as a key step in data quality assessment for volunteered geographic information. Initiatives that leverage volunteered geographic information can adapt this workflow to improve the quality of their datasets and the robustness of their scientific analyses.

Background: The MI-GENES clinical trial (NCT01936675), in which participants at intermediate risk of coronary heart disease (CHD) were randomized to receive a Framingham risk score (FRS g , n=103), or an integrated risk score (IRS g , n=104) that additionally included a polygenic risk score (PRS), demonstrated that after 6 months, participants randomized to IRS g had higher statin initiation and lower low-density lipoprotein cholesterol (LDL-C)., Objectives: In a post hoc 10-year follow-up analysis of the MI-GENES trial, we investigated whether disclosure of a PRS for CHD was associated with a reduction in adverse cardiovascular events., Methods: Participants were followed from randomization beginning in October 2013 until September 2023 to ascertain adverse cardiovascular events, testing for CHD, and changes in risk factors, by blinded review of electronic health records. The primary outcome was the time from randomization to the occurrence of the first major adverse cardiovascular event (MACE), defined as cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and non-fatal stroke. Statistical analyses were conducted using Cox proportional hazards regression and linear mixed-effects models., Results: We followed all 203 participants who completed the MI-GENES trial, 100 in FRS g and 103 in IRS g (mean age at the end of follow-up: 68.2±5.2, 48% male). During a median follow-up of 9.5 years, 9 MACEs occurred in FRS g and 2 in IRS g (hazard ratio (HR), 0.20; 95% confidence interval (CI), 0.04 to 0.94; P =0.042). In FRS g , 47 (47%) underwent at least one test for CHD, compared to 30 (29%) in IRS g (HR, 0.51; 95% CI, 0.32 to 0.81; P =0.004). IRS g participants had a longer duration of statin therapy during the first four years post-randomization and a greater reduction in LDL-C for up to 3 years post-randomization. No significant differences between the two groups were observed for hemoglobin A1C, systolic and diastolic blood pressures, weight, and smoking cessation rate during follow-up., Conclusions: The disclosure of an IRS that included a PRS to individuals at intermediate risk for CHD was associated with a lower incidence of MACE after a decade of follow-up, likely due to a higher rate of initiation and longer duration of statin therapy, leading to lower LDL-C levels., Competing Interests: Disclosure of Interest The authors declare no conflict of interest.