Search

Background and purpose: Among the accidents that threaten human life, burn accidents are one of the worst. Burns are the fourth most common trauma worldwide and cause death, disability, pain, and many other problems. Faster healing of burn wounds is one of the health priorities of countries and it's important as a principle in the science of treatment. This research aims to determine and compare the effectiveness of hydrogel dressings containing allantoin and silver nanoparticles in the treatment of second-degree burn wounds. Materials and methods: This study was designed as a randomized controlled clinical trial. A total of 86 patients were selected in the study based on the inclusion and exclusion criteria and were randomly divided into two groups: A=43 and B=43, using a block method of 4. Group A patients received hydrogel containing silver nanoparticles and allantoin with a thickness of 2 millimeters and then sterile gauze and bandage on top of it, and group B patients received the usual treatment (Vaseline gauze, 0.5% acetic acid and 1% betadine). Local treatment was performed every 48 hours, and dressing was applied after each treatment. The condition of the wounds, including the presence or absence of granulation tissue, bleeding, pain, infection, and other wound complications or healing factors, was recorded and evaluated by visiting and observing every 48 hours. Results: The average age in the intervention group was 10.2 years and in the control group was 9.9 years, and the difference was not statistically significant, P=0.456. 48% of the patients in the intervention group were male 52% were female, and in the control group, 44% were male and 56% were female, and the difference was not statistically significant, P=0.665. The average percentage of burns in the intervention group was 9.04% and in the control group was 9.58%, which was not statistically significant P=0.289. The type of burn in the intervention group was liquid 69% and flame 31%, and in the control group, liquid 65% and flame 34%, which was not statistically significant P=0.645.The intervention group had 55% of limbs and 45% of trunk and the control group had 63% of limbs and 37% of trunk, which difference was not statistically significant, P=0.510. In other words, the two groups were homogenous in age, sex, average burn percentage, burn mechanism, and location, and there were no significant differences. The average onset of epithelialization in the intervention group was 4.5 days (74% of patients on day 4 and 23% on day 6) and 6.4 days in the control group (60% of patients on day 6 and 30% on day 8), which was statistically significant P

The research purpose is responding to the human resources compensation risk in Iran's insurance industry. By systematically studying the literature and interviewing 15 experts based on the snowball sampling , risks were identified and after screening based on the fuzzy Delphi, Fuzzy cognitive mapping has been used to respond to risk. the inflexibility of compensation was identified as the most central element of the cognitive risk mapping. In the next , the effect of different risk control policies on map elements was investigated in three scenarios. After controlling one factor and its lack of influence on the whole map, finally with the policy of controlling the key elements , seven key elements with the highest degree of centrality include inflexibility of compensation, lack of employee satisfaction, lack of transparency, internal and external inequality, and non-alignment of payment. And performance, the imbalance between short and long-term incentives and the non-compensation of extra-role behaviors of employees selected and with the aim of fully controlling these elements, values corresponding to these elements were considered equal to zero in the initial state vector. results show that by controlling key elements of mapping, whole mapping undergoes changes and risk of human resources compensation is reduced.

The main purpose of the research is to achieve a smart supply chain management model for FMCG industry in Iran. Since this research is of an exploratory mixture type, in qualitative section after reviewing the existing literature and collecting the relevant literature of the researchs, related articles identified and the obtained results analyzed by Multi-Grounded theory. After performing the meta-synthesis method, the selected articles extracted. Then after interviewing with 15 experts, the categories were coded. The result led to the extraction of the model. In the quantitative part, in order to refine the attributes, the DCSM used. Next in qualitative part, for model configuration, FsQCA method implemented. Quantitative data collected from 20 supply chain managers and experts in companies active in FMCG industry in Tehran. Based on the results obtained, the model has 6 main categories, 21 sub-categories and 113 attributes. Also, based on the results of the quantitative section, 92 attributes determined as the most appropriate attributes and then the most suitable combination of the attributes related to the paradigm model determined. The results of the research presented a conceptual model for smart supply chain management in FMCG industry in Iran, which can be used by industrialists and researchers.

Abstract Background The growing trend of informal settlements is a serious humanitarian crisis. Unmet need for health care services is an indicator to measure the state of equality and access to healthcare services. This study, for the first time in Iran, examined the prevalence of unmet needs for outpatient healthcare services and related socioeconomic inequalities among residents of informal settlements in Sanandaj city. Methods This cross-sectional study was conducted on informal settlements of Sanandaj city with a sample size of 1345 people. Data were collected using a questionnaire. Multivariate logistic regression was used to determine significant predictors of unmet needs for healthcare services. Concentration index (C) and concentration curve (CC) were calculated to measure inequality in the prevalence of unmet needs for healthcare services. Results The prevalence of unmet needs for outpatient healthcare services was 31.7%. Financial and physical barriers were the most common reasons for not using the needed services. The highest unmet need was related to dental (80.6%) and rehabilitation services (78.8%). Being elderly with about 2.3 times (OR: 2.37, 95% CI: 1.19–4.75), not having a job with about 1.7 times (OR: 1.70, 95% CI: 1.13–2.57) and having a low economic status with about 4 times (OR: 4.46, 95% CI: 2.39–9.70) increased the odds of experiencing unmet need for outpatient healthcare services. The value of concentration index showed that unmet need for outpatient healthcare services was significantly concentrated among people with lower economic status (C= -0.330, 95% CI: -0.432 to -0.227). Conclusion The unmet need is high among people living in informal settlements of Sanandaj city and a significant part of the residents of these settlements does not have access to required healthcare services. Regardless of the needs of people living in these settlements, who constitute a large population of Iran, access to universal health coverage is not possible in such areas. Removing the identified obstacles and causes behind the unmet needs requires the interdisciplinary participation of all actors, including the government, the nation, and civil society.

Background and Aim: A comprehensive understanding of the current state of geriatric care in Iran is necessary in order to strengthen and align it for responding to the current and future needs of the elderly in the country. The purpose of this study was to identify the challenges and barriers in the elderly care system in Iran. Materials and Methods: This was a qualitative study. Forty semi-structured interviews were carried out with various participants involved in providing care to the elderly across the country in 2019. Participants were selected using maximum variation sampling. Using MAXQDA10 software, data were analyzed by the qualitative content analysis method based on six building blocks of health systems developed by the world health organization. Results: Challenges and barriers in the elderly care system were categorized into six groups: service delivery, health workforce, health information system, access to essential medicine, financing, and governance/leadership. Also, some of the most important challenges of the elderly care system included: absence of a single organization with sufficient power as the steward for providing the elderly services, lack of integration of services for the elderly from primary care to specialized care; shortage or inadequate distribution of skilled manpower; lack of insurance coverage for home care services for the elderly; lack of registry system or database for the elderly; lack of or weakness in elderly-friendly activities in the service centers. Conclusion: The current elderly care system in Iran faces many challenges in all six building blocks of the World Health Organization. Reforming and redesigning the elderly care system based on the findings of this study is necessary and urgent in order to meet the needs of the elderly in the country.

In today's competitive business landscape, the efficient management of supply chains has become a cornerstone of success for economic enterprises. Supplier selection, as the initial link in the supply chain, holds significant sway over various critical factors, such as product quality, return rates, and production costs. However, the real world is rife with uncertainties, making the application of a fuzzy approach highly advisable. This study's primary objective is to develop a model for supplier selection and order quantity determination for perishable protein products in a retail setting under uncertain conditions. Initially, a comprehensive fuzzy multi-objective model is designed for Kourosh Protein, a company in the closed-loop supply chain, aiming to minimize costs, waste, and maximize profit, customer satisfaction, quality, and profit margin in the face of uncertainty. Subsequently, this full-fledged fuzzy multi-objective model is transformed into a deterministic single-objective model using the Sharma and Agarwal method (2018), yielding optimal order quantities from each supplier. The model's practical implementation in an Iranian retail store for protein products, such as sausages, bologna, hamburgers, etc., demonstrates its potential to reduce costs and boost profits.IntroductionThe global population's rapid expansion and shifts in lifestyle have significantly elevated the food sector's importance in the global economy, specifically in Sustainable Food Supply Chain Management (SFSCM). SFSCM plays a pivotal role in balancing economic, social, and environmental criteria to optimize supply chain performance. Within the complex food supply chain, suppliers wield considerable influence due to their impact on product attributes, safety, quality, and perishability. Supplier selection, a critical facet of SFSCM, substantially affects a company's strategic and operational performance, product pricing, and quality. In this context, this research introduces a fully fuzzy multi-objective model (FFMOP) to enhance the sustainable supply chain performance of a retail company's protein products. Given the inherent uncertainties associated with supplier selection, the proposed model incorporates an extensive array of variables to simulate real-world scenarios. This innovative approach aims to address identified gaps in existing literature, providing a more robust and realistic tool for bolstering supply chain sustainability.Materials and MethodsThis study constructs a full fuzzy multi-objective model with the objective of determining optimal order quantities within the food supply chain while integrating sustainability criteria. The analyzed supply chain network encompasses multiple suppliers, a single retailer, and end consumers, characterized by multi-product and multi-level interactions. The model seeks to optimize profit, customer satisfaction, brand acceptance, quality, profit margin, and minimize waste production while determining the optimal order volume for each product from each supplier. Reviewing the existing literature reveals various approaches to tackle Full Fuzzy Multi-Objective Problems. This research employs the methodology proposed by Sharma & Aggarwal in 2018 to solve the FFMOP model. After defuzzification, the final model is solved using GAMS software to determine the optimal values of decision variables.ResultsThis research utilizes a case study of an Iranian retail company with eight main suppliers providing 15 protein food products. However, the focus is primarily on four key products: sausages, bologna, hamburgers, and pizza cheese, which are examined. Data for the study was collected from historical company records and interviews with experts from June 2021 to 2022. Model parameters are defined using trapezoidal fuzzy numbers. A comparison of optimal order quantities with the company's actual orders and sales reveals that the proposed model for order allocation leads to reduced ordering, maintenance, and procurement costs for the company. Additionally, the model mitigates waste resulting from unsold products.ConclusionSupplier selection stands as a pivotal process in an effective supply chain, exerting substantial influence on a company's strategic outcomes and performance metrics. This study employs a full fuzzy multi-objective model to identify the most suitable supplier and determine optimal orders within a sustainable food supply chain context. To better mimic real-world conditions, variables and parameters are treated as trapezoidal fuzzy numbers. A comparison of the model's outputs with actual sales data indicates that this methodology aligns more accurately with sales figures. Consequently, applying this model has the potential to reduce waste production and economic consequences. The study's achievement lies in selecting a supplier through a methodology that simultaneously considers sustainability criteria within a fully fuzzy environment while determining optimal order quantities from various suppliers. Moreover, the model's flexibility allows for its application across diverse industries, including dairy and dried fruit, for procuring and selling an array of products from potential suppliers.

Background: Traumatic Spinal Cord Injury (TSCI) is one of the catastrophic events, the rate of which has been growing compared to the past decades. Complications caused by TSCI have a wide spectrum and can range from complete paralysis to numbness of the limbs. Additional to the injury severity and disability of the patient, the recovery rate depends on the treatment strategies. Despite extensive efforts and research in this field, there are still few treatment options for TSCI patients. Controversial results have been reported, however, spinal cord decompression is the only certainty for the treatment of these patients. In the present study, patients with thoracic and lumbar fractures were undergone decompression, less and more than 24 hours, and the recovery rate (RR) was compared after 6 months. Methods: In this study, patients with lumbar and thoracic fractures who were referred to the neurosurgery department of Ahvaz Golestan Hospital during May 2019 to December 2021 were included. Decompression was performed at the fracture level as a total and at the upper and lower levels of the fracture as a partial decompression. To evaluate fine motor movements, picking up a small object with toes and following a rectangular path were used. Also, the gross motor movements, upper and lower proximal and distal muscle forces were measured. Results: 160 patients including 133 men (83.1%) and 16.9% women (27) with 36±12 years mean age were included. The most fracture location was lumbar (53.1%), followed by the thoracic (43.1%) and fractures in both regions (3.8%). The most injured vertebras were L1 (27.5%) and T12 (18.8%). Six months later, 61.9% of patients had a good score for removing a small object with toe, of which 67.5% belonged to patients with

Objective: Today, productivity is one of the most important factors in economic growth. At the organizational level, a high level of productivity indicates optimal performance to gain a competitive advantage. Despite the important role of productivity of service organizations in economic growth, few studies have been conducted in this context. The purpose of this study is to evaluate service productivity by a combined fuzzy best-worst method and data envelopment analysis. Methods: In the first stage, carrying out a comprehensive review of the research literature, indicators of service productivity evaluation were identified. Then, the evaluation indicators were weighed using the fuzzy best-worst method. After weighing the indicators and determining the importance of each of them, using the data envelopment analysis approach, the efficiency, effectiveness, and productivity of Mazandaran Electricity Distribution Company were evaluated for five consecutive years from 2016 to 2020. Results: In this study, efficiency, effectiveness, and productivity were simultaneously evaluated using quantitative and qualitative indicators affecting the evaluation of the productivity of electricity distribution companies. Conclusion: The obtained results would help to assess service productivity by emphasizing both quantitative and qualitative aspects of services and paying attention to the dimensions of efficiency and effectiveness simultaneously. Productivity improvement strategies were also suggested based on the achieved results of the current study.

Background: The most important way to prevent COVID-19 is to observe health behaviors such as keeping social distance from one another. After getting COVID-19, care-seeking behaviors can affect the severity of the disease. The current study aimed to investigate and compare the communication styles, care-seeking, and health behaviors in patients with COVID-19.Methods: A cross-sectional study was performed using a selfadministered questionnaire on patients with COVID-19 in Maragheh in 2020. The study population included 450 people selected using simple random sampling. Chi-square, one-way ANOVA, and Pearson Product Moment Correlation tests were used to compare communication styles, care-seeking, and health behaviors among outpatients and inpatients with COVID-19. Data were analyzed using SPSS 23 software.Results: The first place to seek t reatment for outpatients and inpatients with COVID-19 was health centers (28.2%) and hospitals (44.5%), respectively. In terms of communication behaviors, close contact of family members with others at work, getting the disease from close friends or colleagues (45.8%), and having a history of contact with an infected COVID-19 person (43.5%) were the most reported items by outpatients. On the other hand, hospitalized cases reported close contact of family members with others at work (62.4%), attending physicians’ offices (43.8%), and attending gatherings (41.2%) more than other communication behaviors (P

Nowadays, quality management is an important field for organizations, including the banking system, which faces fierce competition. Organizational Excellence Models serve as guides to help organizations improve their quality. The main aim of this study was to investigate the dynamic relationships between the approaches and criteria of the EFQM organizational excellence model and optimize the simulation of these relationships. To do this, we first identified the common approaches in the organizational excellence model and clustered them using the fuzzy clustering method. Next, we used the systems dynamics method of causal rings to discover the dynamic relationships between these approaches. Finally, using data from the banking system in Iran, we simulated cases and optimized the growth rate of organizational excellence in the sample over 20 years (2018-2019).

Background: Conflicts between work and family wants are inevitable in organizations and families. This, in turn, creates psychological problems in people's personal and working life. The aim of this study is to present a model of work-family conflict management among employees of Iran University of Medical Sciences during COVID-19 pandemic. Methods: This was a qualitative study conducted in 2021. The statistical population of the research included 14 thematic and executive experts who were selected with judgmental-purposive method. The analytical model of the research was deductive-inductive and based on the qualitative method of thematic analysis. Data were collected by document method and through in-depth and semi-structured interviews with experts of Iran University of Medical Sciences. The content validity of the research model was 85%. Retest reliability was 70% and coder reliability was 87%. Results: After five stages of content analysis, 67 basic themes, 7 comprehensive themes (family stress stimulus (3 themes), supportive job variables (11 themes), moderating variables (7 themes), stress management (12 themes), negative consequences (17 themes), positive outcomes (2 themes), work stress stimuli (15 themes)) were counted and added. Finally, a work-family for the staff of Iran University of Medical Sciences was designed. Conclusion: According to the current research model, work-family conflict management in the period of COVID-19 requires a new way of working. It should be independent, flexible and compatible with individual conditions and preferences of employees more than before. Considering the importance of the negative consequences of work-family conflict, the vice-chancellor of management and resource development in the university can use the model presented in this research to prepare training programs needed by employees. He can also manage the negative consequences of work-family conflict and develop support and counseling programs needed by employees to be used during COVID-19 pandemic.

We studied the behavior of the earthquake network using the HEALPix spherical pixelization and square cells methods. In the first method, the geographical region is divided into isolatitude rhombic-spherical cells of the same areas using the HEALPix method. In the second method, we divided the geographical region into isolatitude equal areas of the square cells. To construct a network, if an earthquake happens in a cell, that cell will become a node, and two nodes will be connected with an edge for two successive events. The earthquake network is built from Iran’s seismic data from 1900 June 12 to 2015 December 12. We determined the Hurst exponent (H = 0.6) due to the rescaled range (R/S) analysis. This value reveals a long temporal correlation in earthquake time-series; therefore, the earthquake system is suggested to be self-organized. We showed that among the five major seismotectonic provinces of Iran (Alborz-Azarbayejan, Kope Dagh, Central-East Iran, Zagros, and Makran), the earthquake network hubs are located in the Zagros region, which is a seismically very active region. According to this result, the Zagros earthquakes affect the surrounding earthquakes. The probability distribution function’s power-law behavior with a network built in the pixelization rhombic-spherical cells shows scale free behavior’s properties than a network constructed based on the square cells. The mean clustering coefficient’s power-law nature with networks built using two methods shows that the earthquake network is scale-free and non-random. We concluded that the rhombic-spherical cell pixelization is a more reliable method for building the large geographical region’s earthquake network.

Active Banks in the recent economic environment are obliged to encounter in a massive gamut of risks which are closely following them. If cash is regarded as cash at hand, then Liquidity risk is a kind of loss which arises of lack of fund or more specifically endured loss originating from inability of funding required capital in a reasonable way or selling off assets or being forced to have them pledged in order to cover solicited or unsolicited commitments. Hence Liquidity risk is comprised of economic loss incurred due to of providing cash and is deemed vital for operational activities of enterprises. Liquidity Mismatch in banks or maturity mismatch of sensitive assets to cash or debt may culminate in divergent of cash inflow or outflow during elapse of time which is actually stressed as Liquidity risk. Quarterly performance of 23 quoted banks in either Tehran Stock Exchange or Iran Farabourse are executed to model forecasted Banks’ Liquidity risk by means of implementing Artificial Neural Network algorithms. Applying genetic algorithm and Levenberg algorithm helped utilizing the best Training method and subsequently by facilitating Principal Component Analysis (PCA) method, we managed to optimize independent variables. Finally having hidden layers been determined and exercising calculations by Bayesian network model, the Artificial neural network is modeled and tested. All the mentioned process is performed by MATLAB software. Eventually fulfilling the asserted stages, a robust model for anticipating listed banks’ Liquidity risk is developed and findings of models for forcasted data is elaborated.

Abstract Determination of self-organized criticality (SOC) is crucial in evaluating the dynamical behavior of a time series. Here, we apply the complex network approach to assess the SOC characteristics in synthesis and real-world data sets. For this purpose, we employ the horizontal visibility graph (HVG) method and construct the relevant networks for two numerical avalanche-based samples (i.e., sand-pile models), several financial markets, and a solar nano-flare emission model. These series are shown to have long-temporal correlations via the detrended fluctuation analysis. We compute the degree distribution, maximum eigenvalue, and average clustering coefficient of the constructed HVGs and compare them with the values obtained for random and chaotic processes. The results manifest a perceptible deviation between these parameters in random and SOC time series. We conclude that the mentioned HVG’s features can distinguish between SOC and random systems.

Purpose: Perishable products suffer from spoilage and quality loss after a period, so their demand decreases. To raise the level of demand and reduce the cost due to product spoilage and increase in waste, a markdown policy is used. This paper aims to find the optimal amount of discount and the initial order amount so that the total profit is maximized. The discount is offered twice during the sales period; the first discount is provided before the onset of deterioration, when and attractiveness of the product for purchase decreases. The second one is given after the deterioration starts when product spoilage is visible. Design/methodology/approach: After an extensive literature review, the initial mathematical model has been shaped and solved using an analytical approach. Considering experts' opinions, the internal validity of the proposed model has been checked and confirmed. Also, the concavity conditions of the objective function and the existence of the global optimal point of the model have been investigated. Then, the values ​​of parameters have been determined by experts and placed in the model. Finally, Ofoq Kourosh Chain Stores' original sales data have been collected as a case study and the model has been solved in MATLAB software. Findings: In this paper, the amount of the initial order was determined. Then, the optimal amount of the discount was obtained to reach the maximum profit. In this paper, the authors’ observation indicated that using the markdown pricing strategy is more profitable than the fixed pricing strategy during the sales period. This result is the most important finding of the paper, which can be calculated during the sales period examined in the Ofoq Kourosh Chain Stores. It can help decision makers of the discount chain store to set better strategies for their fresh and dairy products. Research limitations/implications: Choosing a demand function that takes into account all factors affecting demand; also, Considering the optimal discount times, corresponding to the optimal discount values ​​as decision variables, complicates the model. It should be mentioned that due to limitations in the IT infrastructure of the case study and our boundaries to get information from these brick-and-mortar chain stores, it is not possible to record data in short periods (hourly) and the warehouse inventory is only available daily. Practical implications: Since one of the main goals of the institution is to obtain maximum profit, by applying the markdown pricing strategy on perishable products, due to the quality of perishable goods being proportional to their price from the customer's point of view, it is possible to encourage them to buy the product and increase their demand. Besides, it can reduce waste which also leads to the maximization of profit. It should be noted that with the implementation of the proposed model in Ofoq Kourosh Chain Stores, it is practically shown that its implementation can make an important contribution to increasing profits. Social implications: The results of this research can be used to improve the sales of perishable products, seasonal products, and fashion goods and can increase the profitability of products and reduce waste. This is also possible for consumers to have access to fresh or seasonal products at various and lower prices with different income levels. Such changes can lead to greater equality in society. Originality/value: The literature review shows that the inventory control models have discussed more optimal order amount and time and less about pricing strategies and price discounts, simultaneously. The subject that is less considered in the literature, to the best of the authors’ knowledge, is the determination of discount values ​​to maximize profit, which was considered in this paper.

Abstract Background Informal payments are one of the major obstacles to health system reform in many developing countries, and its elimination is on the agenda of health system policymakers in many countries, including Iran. This study was conducted to identify the causes of informal payments in the Iranian health system. Methods This was a qualitative and exploratory study. The study environment included the Ministry of Health, physicians' offices, medical universities, and hospitals and health centers. The study population included health care providers (physicians and hospital staff, managers, supervisors, and nurses) and health care recipients (patients or patients who had a history of dealing with informal payments). Data were collected using open-ended questions and semi-structured interviews. Snowball sampling method was used to select managers, chief executive officers (CEOs) and nurses. Convenience sampling was used to select physicians due to their lack of participation and cooperation. Content analysis method was used to analyze the data. Results Reasons for informal payments were divided into 4 themes including: Economic factors (improper tariff valuation of services; failure to increase tariffs proportionate to inflation; lack of comprehensive participation of stakeholders in determining tariffs; tariff inconsistency in the public, private and charity sectors; etc.); socio-cultural factors (decreased social capital of the medical community among the people; improving the quality of life; incorrect comparison of providers' income levels with the income of doctors in other countries; existence of a culture of gratitude and appreciation; health as a priority for society; pride of service recipients; pride of service providers; etc.); service delivery challenges (high professional skills of the doctor; use of modern medical equipment; the monopoly of some doctors, etc.) and legal-political factors (inadequate monitoring by upstream organizations; lack of strict rules; difficulty of proving informal payments; presence of stakeholders in management and policy making processes). Conclusions Knowing the causes of informal payments can help reduce or eliminate it. The results of this study identified the causes of informal payments in the Iranian health system. Accurate knowledge of the needs and motivations of both health care providers and recipients can be effective in accurately identifying and eliminating this phenomenon.

Differential rotation plays a crucial role in the dynamics of the Sun. We study the solar rotation and its correlation with solar activity by applying a modified machine learning algorithm to identify and track coronal bright points (CBPs) from the Solar Dynamics Observatory/Atmospheric Imaging Assembly observations at 193 Å during cycle 24. For more than 321,440 CBPs, the sidereal and meridional velocities are computed. We find the occurring height of CBPs to be about 5627 km above the photosphere. We obtain a rotational map for the corona by tracking CBPs at the formation height of Fe xii (193 Å) emissions. The equatorial rotation (14.°40 to 14.°54 day ^−1 ) and latitudinal gradient of rotation (−3.°0 to −2.°64 day ^−1 ) show very slightly positive and negative trends with solar activity (sunspots and flares), respectively. For cycle 24, our investigations show that the northern hemisphere has more differential rotation than the southern hemisphere, confirmed by the asymmetry of the midlatitude rotation parameter. The asymmetry (ranked) of the latitudinal gradient of the rotation parameter is concordant with the sunspot numbers for 7 yr within the 9 yr of the cycle; however, for only 3 yr, it is concordant with the flare index. The minimum horizontal Reynolds stress changes from about −2500 m ^2 s ^−2 (corresponding to high activity) in 2012 and 2014 to −100 m ^2 s ^−2 (corresponding to low activity) in 2019 over 5° to 35° latitudes within cycle 24. We conclude that the negative horizontal Reynolds stress (momentum transfer toward the Sun’s equator) is a helpful indication of solar activity.

The regular behavior of the pulsations of high-amplitude δ Sct (HADS) stars gives a greater chance to investigate the interiors of stars. We analyzed seven HADS stars showing peak-to-peak amplitudes of more than 0.3 mag that were newly observed by TESS. We obtained that TIC 374753270, TIC 710783, and TIC 187386415 pulsate in fundamental radial mode; also, TIC 130474019 and TIC 160120432 show double radial modes. On the other hand, TIC 148357344 and TIC 278119167 demonstrate triple-mode behavior. Our analysis shows that these seven stars are close to the red edge of the (inside) instability strip in the Hertzsprung–Russell diagram. The fundamental mode of these seven targets follows the period–luminosity (PL) relation for δ Sct stars. However, TIC 278119167 deviates slightly from the fundamental PL relation. The double-mode and triple-mode HADS stars (TIC 130474019, TIC 160120432, TIC 148357344, and TIC 278119167) are in agreement with the period ratio ranges (fundamental to first and second overtones). Using the information of 176 HADS stars (Netzel and Smolec), we find a scaling relation ( $[\mathrm{Fe}/{\rm{H}}]\propto \mathrm{log}({M}^{7.95\pm 0.15}{L}^{-1.83\pm 0.11}{\rm{P}}{0}^{0.79\pm 0.14}{T}_{\mathrm{eff}}^{0.047\pm 0.02}$ )) between the metallicity ([Fe/H]) and mass ( M ), luminosity ( L ), effective temperature ( T _eff ), and the fundamental period (P0). We estimate the metallicity of the seven newly identified HADS stars ranging from −0.62 to 0.37 dex.

Solar and stellar magnetic patches (i.e., magnetic fluxes that reach the surface from the interior) are believed to be the primary sources of a star’s atmospheric conditions. Here, we apply the complex network approach and investigate its efficacy in the identification of these features. For this purpose, we use the line-of-sight magnetograms provided by the Helioseismic and Magnetic Imager on board the Solar Dynamics Observatory. We construct the magnetic network following a specific visibility graph condition between pairs of pixels with opposite polarities and search for possible links between these regions. The complex network facilitates the construction of node degrees and PageRank images, and applying the downhill algorithm to node-degree images allows for the grouping of pixels into features corresponding to one-to-one matches with magnetogram patches. This approach promisingly serves to identify the nontrivial morphological structure of the magnetic patches for small and large sizes. We observe that the changes in the features of the node-degree images effectively correspond to the cospatial magnetic patches over time. Through visual assessment, we estimate an average false-negative error rate of approximately 1% in identifying small-scale features (one or two pixels in size).

Objective: Considering the large volume of mineral resources in Iran and the geographical extent of mines and related industries in the country, its transportation is of particular importance. Although this product is known as a rail-friendly product in terms of transportation mode, but the 39% share of the rail transportation industry is far from the capabilities and expectations of this field. Therefore, in order to increase the share of rail transportation, it is necessary to identify the factors in the attractiveness of rail transport compared to road one. Identifying the factors in mode choice of transportation is one of the most important issues that has always been of interest to researchers in this field. Several studies have been conducted on understanding the behavior of customers to choose the mode of transport. In this paper, the most important factors that affect the mode choice have been identified and the demand function for minerals rail transport is estimated. Methods: For this purpose, at first step, the affective factors in choosing the mode of transportation have been identified with the revealed preference method through literature review and background studies. Using the multiple regression model and the SPSS software, the correlation between the dependent variable (share or demand) and independent variables have been measured and a list of variables that effect on attracting demand and have a significant presence has been identified. In the end, using the double logit model and NLOGIT software, the rail utility function has been estimated to absorb the demand for minerals. The logit model is a discrete choice model, which in this research includes a utility function with different choice options and parameters affecting them. The structure of these models is of the probability type and in it the behavior of the decision maker and his efforts to maximize the utility resulting from the choice are modeled through mathematical relationships. The "forward selection" method has been used to build the model. In this method, the independent variables are entered into the model one by one in the order of their influence on the dependent variable and are evaluated, and at each stage, according to their t test statistic sign, chi-square test statistic and model fit. The next step is to obtain the final model of the utility function. Finally, the validity of the model was measured by the in-sample method, which shows a 3% error in demand forecasting Results: The results show that the most important factors affecting the choice of mineral transportation method are the ratio of rail transportation tariff to road tariff per ton, the bulk of the mine load, and the accessibility of the origin and destination to the rail network. This means that with the increase in the price of the rail tariff compared to the road, the desirability of rail transportation decreases and the probability of transferring cargo to the road increases. Also, having origin and destination access to the rail network was identified as one of the favorable factors for the rail transportation. This can be included in network development policies for investing in connecting major cargo centers to the network. On the other hand, the lack of access to the network increases the cost of combined transportation, which, in addition to wasting time, causes additional time and unloading and loading operations, which will lead to a decrease in the attractiveness of rail. Load accumulation with a threshold of 200 million ton-km increases the possibility of attracting demand to the rail side. Also, by increasing the ratio of rail to road distance on a fixed route, the possibility of rail and road competition decreases. Conclusion: The results of this model help the transportation service providers to focus on improving the identified factors that lead to the growth of their performance in the transportation market of this product.

Strategic planning is necessary for success and creating competitive advantage in a complex and dynamic environment of today's organizations. Balanced Scorecard is a relatively new tool for planning strategies and implementing strategy. One of the main stages related to the Balanced Scorecard deployment in organizations or companies, is prioritization of strategic objectives in the strategy map. In this paper, prioritized strengths, weaknesses, opportunities and threats of the organization are considered as criteria for evaluating strategic goals. There are different approaches for strategic objective prioritization. In this paper, strengths, weakness, opportunities, and threats were considered as criteria of a decision matrix. Then Fuzzy Technique for Ordering Preferences Similarity to Ideal Solution (TOPSIS) technique, one of the best techniques in Multi-Criteria Decision Making, was used for prioritization of strategic objectives. Using Fuzzy TOPSIS needs to weight of criteria. According to the internal relationships between strengths, weakness, opportunities, and threats, Analytical Network Process (ANP) was used to weight them. Finally, a case study is provided to illustrate the effectiveness of the proposed method.

Abstract Background Nurses, as the primary human resource in the fight against COVID-19, encounter several obstacles and concerns. As a result, the current study used a qualitative method to describe the problems and adaptation techniques of nurses caring for COVID-19 patients. Methods The current study used a qualitative conventional content analysis technique with 30 nurses working in COVID-19 wards in Tehran hospitals. Purposive sampling, snowball sampling, and semi-structured interviews were used to get access to participants and gather data. The data was examined using conventional qualitative content analysis and the MAXQDA-18 program. To assess the quality of study findings, Guba and Lincoln’s trustworthiness criteria were fulfilled. Results The data analysis revealed two main categories and sixteen subcategories: (1) experiences and challenges (lack of protective equipment, high work pressure, marginalized physical health, problems related to the use of protective equipment, being excluded, a lack of a supportive work environment, problems related to patients, psychological problems, fear, marginalized personal and family life, and the challenge of communicating with patients’ families); and (2) adaptation strategies for work conditions (performing religious-spiritual activities, creating an empathetic atmosphere in the workplace, spiritualizing their work, trying to convince the family and gaining their support, and strengthening their sense of self-worth and responsibility). Conclusion Nurses’ working conditions can be improved by providing adequate protective equipment, a suitable work environment, and more social and financial support; paying more attention to nurses’ physical and mental health; and considering appropriate communication mechanisms for nurses to communicate with their families and patients’ families.

BACKGROUND: The present study aimed to evaluate the epidemiology, clinical characteristics, and outcome of confirmed and suspected hospitalized coronavirus disease 2019 (COVID-19) cases in Iran hospitals affiliated with the Kurdistan University of Medical Sciences, Sanandaj, Iran. METHODS: This cross-sectional study was performed on all confirmed and suspected hospitalized COVID-19 cases in hospitals affiliated with the Kurdistan University of Medical Sciences between March and September 2020. Required data were obtained from the Hospital Intelligent Management System of hospitals. Independent t-test, chi-square test, Fisher's exact test, and one-way analysis of variance (ANOVA) were used for univariate analysis. Variables with P-value < 0.3 in univariate analysis were entered into the multivariate model, and the adjusted odds ratio (AOR) was calculated. RESULTS: Out of 9176 cases, 3210 cases (35.03%) were confirmed with COVID-19. The mean and standard deviation (SD) of age of the cases was 56.5 ± 19.3 in the confirmed and 57.5 ± 20.6 in the suspected cases. The confirmed and suspected cases’ mortality rate was 15.0% and 10.2%, respectively. In both groups, the most common symptoms of admission to the hospital were respiratory distress, coughing, fever, and muscular pain. The variables of older age, male gender, being transferred to hospitals by ambulance, intensive care unit (ICU) hospitalization, being intubated, blood oxygen saturation level less than 93, and having an underlying disease were statistically associated with an increased chance of death. CONCLUSION: The mortality rate among both confirmed and suspected hospitalized COVID-19 cases was significant, and this rate was higher for the confirmed cases. Death-related risk factors should be considered in resource allocation, management, and patient prioritization to reduce the outcome of death.

Abstract Background: Governance in the health system is not just a vision, or a model for delivering services, but a key element in planning, implementing and evaluating activities to improve health. The main purpose of this study was to design a pattern for assessing Iran's Health System Governance. Methods: The present study was descriptive in terms of purpose, qualitative in terms of application, and qualitative in terms of data type, which was conducted based on thematic analysis and deductive-inductive approach. 14 health system experts were selected through non-random-purposive sampling. To calculate reliability, test-retest reliability and coder reliability were used, which were 70 and 87 %, respectively. Also, Waltz and Basel method was used to assess the content validity of the extracted indices which was 85 %. Results: After 6 stages of thematic analysis, 137 basic themes, 15 organizing themes and 5 comprehensive themes (health system accountability, health system participation, health system policy formulation, health system service provision, health system efficiency and quality) were obtained, and finally, a model for assessing the governance of the health system in the Islamic Republic of Iran was designed. Organizational accountability included 7 themes, ethical accountability, 9, and legal accountability included 6 .Financial accountability included 8 basic themes, and efficiency and quality, 10 basic themes. Implementation included 8 themes, comprehensiveness, 4, reporting, 12, and transparency, 6. Structural policy included 23 themes, social inclusion and justice policy, 6, and fiscal policy included 11 basic themes. Medical services included 4 themes, financial services, 7, human services and human rights, 9, and information and technology services included 7 basic themes. In this pattern, participation and policy formulation were considered input, and accountability, efficiency and quality and service delivery were considered output. Conclusion: Lack of a clear definition for an appropriate interdepartmental cooperation, Lack of meritocracy, having a guild oriented attitude, conflict of interests, not using a policymaking approach based on a collective evidence and wisdom are among the shortcomings of the current health system governance. In addition, healthcare costs imposed on people are too high.

Objective: Organizational excellence is not an unknown concept in management and organization; in addition, developing novel models, differences between the 2020 model and the old model of EFQM, and different firms’ efforts to develop customized OEM methodology all indicate the dynamics and importance of focusing on this fundamental concept. Therefore, in the present study, an attempt was made to configure and test organizational excellence methodology in Iran’s oil industry. Methods: This research was conducted by using Multi-Grounded Theory (MGT), a complementary and extended method of Grounded Theory (GT), that provides a comprehensive framework to develop distinctive theories. To validate the results, expert surveys were used in a separate stage. The result verified the validity of the acquired results and appropriateness of the final model from the perspective of understandability, comprehensiveness, applicability, and innovation. Results: Analyzing the gathered data by reviewing more than 70 models developed over the last 40 years and conducting interviews with 22 experts selected through a combination of purposive and snowball sampling methods led to the development of a model with seven criteria, 32 subcriteria, and 102 concepts which improve the excellence of Iran’s oil industry in terms of "Strategic leadership and management development", "Management of organizational capital", "Organizational diplomacy", "Operation and customers", "Results of managerial and supportive processes", "Stakeholders results", and "Value chain results". Conclusion: The obtained results of the present study can be applied in developing a roadmap for organizational excellence, evaluating and determining plans to improve Iran’s oil industry.

Playground is effective on behavior of children; however, the severity of this effect and its variety in different playgrounds is still unclear. Identifying the playing area, reviewing local observations, evaluating interactions and their extent, and analyzing the level of communication between children can lead to correct ranking of playgrounds. Features of playground and the created space along with vegetation and plants are effective factors in attracting children and encouraging them to increase interactions. Various features of playground can determine the extent to which a child participates in social interactions. These features, along with other environmental factors, allow the development of social behaviors for children. Therefore, playgrounds must have potential facilities and capabilities for influencing children to provide high quality. This study will analyze the Pasdaran Park playground using quantitative method and distributing questionnaires. Field study is required to obtain the results. To this end, a questionnaire containing 18 questions was developed using parameters and factors previously defined and scored on a 5-point Likert scale. Fifty park visitors were questioned. According to the results, the most important factors, which can increase satisfaction and meet visitor needs include providing new access routes and improving the existing ones, increasing children interactions in green spaces, using vegetation in the environment, improving the environment according to the needs of users. The results of this study can be used as guideline for designing and developing this space and similar spaces.

هدف: هدف از این پژوهش بررسی و شناسایی چالش‌های پیاده‌سازی سیستم‌های خدمات محصول هوشمند و ارزیابی و اولویت‌بندی این چالش‌ها، به‌عنوان یکی از اقدام‌های اساسی اولیه برای اجرای این سیستم است. روش: در این مقاله ابتدا چالش‌های پیاده‌سازی سیستم‌های خدمات محصول هوشمند، از طریق مرور ادبیات، بررسی اسناد، مصاحبه با صاحب‌نظران و روش دلفی فازی شناسایی شد. در ادامه با استفاده از روش بهترین بدترین راف ـ فازی، چالش‌های شناسایی‌شده اولویت‌بندی شدند. یافته­ها: بیست چالش پیاده‌سازی سیستم‌های خدمات ـ محصول هوشمند، در هفت گروه اصلی طبقه‌بندی و به‌روش بهترین بدترین راف ـ فازی ارزیابی شدند. بر اساس نتایج، چالش‌های مالی و فرایندی، مهم‌ترین گروه شناخته شد. روش بهترین بدترین راف ـ فازی با بررسی هم‌زمان عدم قطعیت درون‌فردی و بین‌فردی باعث می‌شود که ارزیابی به‌دست‌آمده، دقت و عینیت بیشتری را در مقایسه با روش بهترین بدترین مبتنی بر منطق فازی یا مبتنی بر تئوری راف ارائه دهد. نتیجه­گیری: با استفاده از نتایج این پژوهش شرکت‌های تولیدی و خدماتی، می‌توانند چالش‌های پیش‌ِرو در مسیر پیاده‌سازی سیستم‌های خدمات محصول هوشمند را دقیق‌تر ارزیابی کنند و به‌نحوی مناسب،­ منابع محدود سازمانی را برای رفع چالش‌های شناسایی‌شده اختصاص دهند.

Background and objectivesThe estimation of a cost- Effectiveness (CE) threshold from the perspective of those who have experienced a life-threatening disease can provide empirical evidence for health policy makers to make the best allocation decisions on limited resources. The aim of the current study was to empirically determine the CE threshold for cancer interventions from the perspective of cancer patients in Iran.MethodsA composite time trade-off (cTTO) task for deriving quality adjusted life-year (QALY) and a double-bounded dichotomous choice (DBDC) approach followed by open-ended question for examining patients’ willingness-to-pay were performed. A nationally representative sample of 580 cancer patients was recruited from the largest governmental cancer centers in Iran between June 2021 and January 2022, and data were gathered using face-to-face interviews. The CE threshold was calculated using the nonparametric Turnbull model and parametric interval-censored Weibull regression model. Furthermore, the factors that affect the CE threshold were determined using the parametric model.ResultsThe estimated CE threshold using the nonparametric Turnbull model and parametric interval-censored Weibull regression model was IRR 440,410,000 (USD 10,485.95) and IRR 595,280,000 (USD 14,173.33) per QALY, respectively. Gender, age, education, income, type of cancer, and current treatment status were significantly associated with the estimated CE threshold.ConclusionsThe value of parametric model-based threshold in this study was 1.98 times the Iranian GDP per capita, which was lower than the CE threshold value recommended by the WHO (i.e., 3 times the GDP per capita) for low-and middle-income countries.

Background and ObjectivePsychometric evidence to support the validity and reliability of the EuroQol-5 Dimensions (EQ-5D) in cancer patients is limited. This study aimed to test the validity and reliability of the EQ-5D-5L (5L) in comparison with EQ-5D-3L (3L) in cancer patients.MethodsData of 650 cancer patients were collected through consecutive sampling method from three largest governmental cancer centers in Iran between June 2021 and January 2022. The data were gathered using the 3L, 5L, and the European Organization for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) instruments. The 3L and 5L were compared in terms of ceiling effect, discriminatory power, convergent and known-groups validity, relative efficiency, inconsistency, agreement, and reliability.ResultsCompared with the 3L, ceiling effect decreased by 27.86%. Absolute and relative informativity of discriminatory power improved by 45.93% and 22.92% in the 5L, respectively. All convergent validity coefficients with 5L were stronger than with 3L. Both 3L and 5L demonstrated good known-groups validity, and the relative efficiency was higher for 5L in 4 out of 7 patients’ characteristics. The two instruments showed low overall inconsistency (1.45%) and 92.57% of the differences of observations between the 3L and 5L were within the 95% limit of agreement. The interclass correlation coefficient (ICC) for 3L and 5L indexes were 0.88 and 0.85, respectively, and kappa coefficients in the 3L dimensions (range=0.66-0.92) were higher than the 5L(range=0.64-0.79).ConclusionsThe 5L demonstrated to be better than the 3L in terms of ceiling effect, inconsistency, discriminatory power, convergent validity, relative efficiency.

This research investigates the impact of the layout of the interior spaces, as an independent variable, on the distribution of daylight factor, uniformity rate, drift magnitude, maximum radial line of sight and visual mean depth as dependent variables in medical centers. A quantitative-qualitative research methodology was adopted, including library studies and computer-assisted simulations using Relux software. Also, Depthmap software was utilized to study the indices of space visual quality through Isovist analyses under some scenarios. Results indicated that the appropriate and utilization-oriented layout of interior elements takes a significant part in improving the space visual quality experienced by the users. In this study, an L-type layout with openings oriented toward the light source and vertical partitions along the path through which the daylight got into space was presented as a suitable plan for medical centers as far as optimal and appropriate distribution of daylight within standard ranges were concerned. This layout provided a uniformity rate of 0.5 and a daylight factor close to 5%, with the indicators of space visual quality being more favorable, as compared to the other layouts considered in this study.

Abstract Background and Aims The aim of this study was to investigate the prevalence and desire towards performing elective cosmetic surgery and its relationship with socioeconomic, mental, and spiritual health in Sanandaj, the capital of Kurdistan province in the west of Iran. Methods This cross‐sectional descriptive‐analytical study was performed on 492 subjects in Sanandaj using multistage sampling method. Data collection tools included two checklists and two questionnaires. Data analysis was performed using the Chi‐square test and multiple logistics regression model by the help of SPSS software version 20. Results The mean (standard deviation) age of participants was 32.58 (9.67) years. The prevalence of cosmetic surgery and the desire to perform it were 12.8% (n = 63) and 19.1% (n = 94), respectively. The most common type of cosmetic surgery was rhinoplasty with 5.5% (n = 27). The prevalence of symptoms of mental disorders among people with cosmetic surgery and people willing to perform cosmetic surgery was significantly higher than all subjects (p

Abstract Background and Aims The aim of this study was to assess unmet needs for health care and its determinants during COVID‐19 pandemic among pregnant women in Iran. Methods This cross‐sectional study was performed among pregnant women in Kurdistan province in 2020 with a sample size of 800 people who were selected by multistage sampling method. Data were collected using a structured questionnaire that was completed through interviews. Also, multiple logistic regression was used to determine the relationship between independent variables and outcome variable. Statistical tests were performed using Stata software package. Results The highest unmet needs for health care were related to dental services with 66%, rehabilitation services with 58.6%, and psychological services with 43.2% and the lowest were related to hospital services with 12%, midwifery services with 15.6%, and physician visit services with 39.1%. The most important reasons for unmet needs for health care were fear of getting COVID‐19 and the cost of the services. The variables of age group and spouse education for physician visit services; age group for midwifery services; age group, education and employment status for dental services; age group, supplementary insurance and economic status for rehabilitation services; and age group and economic status for psychological services were significantly associated with unmet needs for health care (p

Abstract Background COVID-19 is a public health emergency with a high mortality rate and it reduces the patient’s Health-Related Quality of Life (HRQoL) significantly. This effect is measured in the current study. Methods In a cross-sectional study in Iran, 320 randomly selected treated patients from COVID-19 were studied. To collect the required data, we applied a questionnaire that included socio-demographic factors, clinical characteristics, and questions on the patients’ HRQoL. Time trade-off (TTO) approach was used to measure the lost HRQoL attributed to COVID-19. Besides, we applied a two-limit Tobit regression model to determine the effects of the socio-demographic factors on patients’ health utility and the visual analogue scale approach was used to estimate the perceived total current health status. Results The overall mean (SE) and median (IQR) of the health utility values were 0.863 (0.01) and 0.909 (0.21) respectively. These values for the traders (those who were willing to lose a part of their remaining time of life to avoid the disease) were estimated at 0.793 (0.01) and 0.848 (0.17), respectively. The lowest amount of utility value belonged to the elderly (mean (SE) = 0.742 (0.04); median (IQR) = 0.765 (0.42)) and those living in rural areas (mean (SE)) = 0.804 (0.03); median (IQR) = 0.877 (0.30)). The univariate analysis showed that age, place of residence, and household size had a statistically significant effect on health utility. Moreover, findings of the regression analysis indicated that the participants’ age and hospitalization status were the key determinants of COVID-19 health utility value. Conclusion COVID-19 is associated with a substantial and measurable decrease in HRQoL. This decline in HRQoL can be directly compared with that induced by systemic health states.

The purpose of this study was to develop an agent based model that could simulate the steel supply chain and estimate its production and consumption, taking into account the key factors of the steel industry. The approach of the present study is mixed (quantitative and qualitative). In the first part of the research (qualitative), the agents of the steel chain consumption model were obtained through interviews with experts using thematic analysis method. In the second part of the research (quantitative), a questionnaire was used to survey the causal relationships of the factors extracted from the interviews and the thematic analysis method, and then the relationship model was tested by the DEMATEL method. Finally, by using AnyLogic software and coding in Java language, a model of steel supply chain and its consumption was designed throughan agent-based approach, and according to the opinion of steel industry experts, the model explanation process was also approved. The combination of agents identified in this study is consistent with the influence of factors on production, consumption, import and export of the steel chain in the proposed structural model.

Background: Nowadays, administrative violations are becoming a major problem for health care organizations. Therefore, the present study aimed to determine the type and extent of violations among staff working at a medical sciences university in Iran. Methods: This Study was a cross-sectional as well as a descriptive study carried out in 2018. Data were gathered from the administrative violations investigation office of one of the medical sciences universities in Iran. All of the administrative violation records with a final verdict in 2017 were reviewed using the census method. Data entered into the Excel software V.2016, and SPSS16 were analyzed using descriptive statistics. Results: The most frequent reasons for committing the violations were personal and family problems (30 %), the prohibition to work by a spouse (11 %), illness (10 %), and intention to immigrate to another country (8 %). Other causes of administrative violations included heavy work shifts and night shifts; a sense of responsibility towards patients of other doctors; a defect in the doctorchr('39')s timetable registration system; commuting problems; inadequate payment and benefits; lack of familiarity with workplace laws; delay in the payment of fee-for-service in comparison to doctors; and the decision to continue education. Conclusion: Organizations need to develop an effective mechanism to prevent administrative violations and manage them efficiently. If a mechanism is not competently designed to investigate and identify the deviations and threats to organizational health, it can lead to violation of rights within the organizations.

Nowadays, inter-organizational relationships and market expansion through mutual cooperation is gaining ground as an important factor that can increase organizational capabilities and boost organizational expansion. The role of small and medium-sized companies in meeting the market needs of large companies is thus a promising topic. The current study set out to design a model for empowering small and medium-sized enterprises based on the capabilities of large companies. To this end, the network of inter-organizational communications was initially identified and analyzed based on Social Network Analysis approach. The central network issues were initially identified and, a model was designed, informed by the strengths and weaknesses of small and medium-sized enterprises, for their empowerment by large companies based on Grounded theory. To serve the purpose of designing the final model, the research data were coded through open, pivotal and selective coding systems. The findings from current study can help the identification and analysis of current collaborative networks and provide a model to enhance these collaborations.

Objective: Nowadays, entering the field of quality management is one of particular importance to organizations. This is due to the intense competition, globalization and diversified product services that have made the need for quality development at all levels in organizations inevitable. The country's banking system is no exception because of the fierce competition. Organizational Excellence Models are the tools that guide organizations along this path. Organizations including the country's banking network, are adopting a variety of approaches within their organization to realize the values of excellence models. However, the limitation of available resources such as cost, manpower, organizational culture, etc. does not allow all of these approaches to be deployed. Therefore, the key question is which approaches will have the most impact on quality improvement. Methods: The main purpose of this study is to explore the dynamic relationships between approaches and criteria and sub-criteria of EFQM organizational excellence model. For this purpose, first, the usual approaches in organizational excellence model are extracted and due to their high volume, they are clustered by fuzzy clustering method and finally, causal loops between variables are extracted by system dynamics method. Results: The result of leading research is the causal linkage model between the categories of common approaches in the organizational excellence model. Conclusion: Conclusion: In this study, common approaches in I.R. Iran’s banking network are identified and during of using system dynamics, it is possible to simulate the behavior of the system using causal loops.

Background and Aim: Craniotomy is a surgery in which a flap of the skull is opened to access the affected area in the brain. Since paying attention to the aesthetic aspects of the patient’s head after surgery is very important for the patient’s mental health and social life, surgeons should try to adopt a method that minimizes damage to the scalp and follicles. Methods and Materials/Patients: In this clinical trial study, patients who were candidates for frontotemporoparietal craniotomy surgery were selected. Twenty-three selected patients were randomly divided into 2 groups consisting of a 12-member intervention group (L.G. Kempe) and an 11-member control group (Standard Reverse Question mark). Patients underwent a pre-operative biopsy of the scalp and a follow-up biopsy 6 months post-operatively. In the evaluation of aesthetic aspects, the created scar was scored using the Stony Brook Scar Evaluation Scale (SBSES). Patients were also directly asked about their satisfaction with the operation and the scar created. Results: In 23 patients, the results showed that patients who underwent LG Kempe incision craniotomy received significantly higher scores in SBSES scoring evaluations (P=0.005). There was no significant difference in subjective evaluations by asking patients about their satisfaction with the scar site and the operation area (P=0.75). In the analysis of post-operative hair follicle density between the 2 groups (P=0.910), general changes in pre-operative and post-operative follicle density in all samples (P= 0.657) as well as comparing the changes between 2 groups, no significant difference was found between follicular density changes between the intervention and control groups (P=0.137). Conclusion: Patients treated with L.G. Kempe incision had significantly higher SBSES scores, which can be considered an aesthetically superior method that could prevent the formation of undesirable scar.

Objectives Health-related quality of life (HRQoL) is one of the most important outcome measures for patients. The purpose of this study was to evaluate HRQoL and related factors in Coronavirus disease 2019 (COVID-19) patients. Methods A total of 420 COVID-19 patients who had been discharged from hospital were selected using a systematic sampling. The EuroQol 5-dimensional-5 levels (EQ-5D-5L) questionnaire along with medical records of the patients were used to gather the data. The t test and analysis of variance were employed to test the difference between mean EQ-5D-5L scores, and the BetaMix model was used to investigate factors associated with EQ-5D-5L scores. Results The mean score for the patients who completed the EQ-5D-5L questionnaire (n = 409) was 0.6125. The EQ-5D-5L scores were significantly higher in males, patients with younger age, those with a low level of education, the employed, patients who worked in uncrowded workplaces, patients without diabetes, and those who were not admitted to intensive care unit. The BetaMix model showed that gender, age, education, employment status, having diabetes, heart failure, and admission to the intensive care unit were significant independent predictors of the EQ-5D-5L index values. Conclusion The mean score for EQ-5D-5L in COVID-19 patients was low in this study. Some of the factors, especially aging and having diabetes, should be considered in the aftercare of patients to improve their HRQoL.

Objective: Humanitarian operations begin quickly with disasters to save lives, reduce the suffering of the injured and meet their needs. Appropriate strategies and solutions should be used to help the injured. In this regard, this paper aims to provide a hybrid approach to select effective strategies in the humanitarian supply chain.Methods: In this study, firstly the needs of the injured were identified and categorized, and then the weight of each one was obtained using Fuzzy SWARA technique. Then, a combination of QFD approach and multi-objective modeling was used to select strategies to meet the needs of the injured. The epsilon-constraint method and GAMS software were used to solve the multi-objective model.Results: The needs of earthquake victims in the country were identified and classified into five categories: food needs, hygienic, mental health, housing and living facilities. The results showed that the need for nutrition and food, evacuation of the affected groups from the accident site and access to drinking water are the most important needs of the victims during the earthquake. To help victims, 14 strategies were divided into three categories: strategies related to construction, infrastructure improvement, and strengthening relief processes.Conclusion: In order to reduce the damage during an earthquake, light materials should be used in construction, the culture of lightening should be strengthened, and at the same time, the awareness of people in using durable materials should be promoted. Also, worn-out water, electricity and gas systems should be developed and integration should be between them. In addition, the improved communication system, and inventory management and evacuation location should be strengthened during relief efforts.

Absence of coordination between different sections of pharmaceutical supply chain has been announced as the most important challenge in the medicine industry. These sections are often in conflict and it is possible that their related decisions become suboptimal for the whole supply chain. In this study, a multi-objective mathematical model is offered for pharmaceutical supply chain problem. The model helps make strategic decisions in unexpected disaster occurences such as earthquake and flood. To improve the humanitarian relief in disaster, the model concurrently minimizes the total costs, maximizes the dispersion of distribution centers and minimizes the percentage of drug undersupply as three different objective functions. The model is solved by Torabi-Hassini approach and the performance and importance of objective functions have been compared. In order to verify the proposed model and the relations of different levels of supply chain, Tehran earthquake crisis is considered through different scenarios as the case study. The results illustrate that the highest and lowest demand is in the case of Ray and Mosha fault activation, respectively. Finally, it is shown that increasing the utility of minimizing the percentage of drug undersupply and maximizing dispersion of distribution centers inflicts higher costs on the system.

Objective: The purpose of the present study is to identify priority indicators -based on the qualitative analysis of the results of the research carried out- and also to provide a framework for measuring the performance of the information security service supply chain. Methods: The methodology of this research is essentially descriptive and qualitative and has been carried out in two stages. In the first phase, 133 papers were reviewed, after evaluation, 28 articles were approved. Then, by using the CASP method, finally, 15 articles on the measurement of the performance of the service chain received the minimum score for conducting a qualitative analysis of the content. By reviewing these articles, a conceptual framework for measuring the performance of the service chain was presented in the form of a "logic model". This model is a tool that illustrates the logic of doing things in the four components of inputs, processes, outputs and outcomes. After verifying the reliability of the results, in the second stage, in order to map the proposed framework into the field of information security services, by referring to ten experts in this field and receiving their views in the three rounds of the Fuzzy Delphi, validation and final modeling of the research was designed. Results: The evaluation of the performance of the information security service supply chain for 19 indicators and 35 effective sub-indicators, under the logic model, were agreed with the coefficient of coordination of Kendal of 0.742 between experts and specialists. Conclusion: The review of experts' opinions showed that the sub-indicators of knowledge and skills, the provision of new and up-to-dated security technologies and the confidentiality and security of information make the most important and rate of personnel turnover sub-indicator, assessing the least important in the performance evaluation of the information security services supply chain.

The aim of this study was to analyze the characteristics of spatial configuration and the effect of layout and spatial organization in the form of schools plan on integration, depth, connectivity, visual connectivity (Transparency), Intelligibility.For this purpose, the Dar al-Fonun school as the first modern-style educational building with central organization and the Shahpour (Beheshti) school as Examples of modern schools with linear organization, were selected for analysis. The main question of this research is that what is the relationship between how the spatial organization is organized and the index of integration, depth, connectivity, visual connectivity (transparency), Intelligibility in the form pattern of case study schools plans? The research method used in the research is descriptive-analytical in the case sample and, ultimately, logical reasoning. The tool used in research includes library studies, field observation, and finally simulation using space syntax. The findings showed that at tow Schools, the highest degree of integration, connectivity, and visual connectivity and the lowest depth are for central space. And the numerical values of the attributes listed in Dar Al-Fenun School with Central Organization are greater than the Shahpur School with Linear Organization.Both schools also have numerical Intelligibility above0/7. Then,There was a significant relationship between the type of spatial organization and the amount of indices in the schools studied. Therefore, the use of a central model in school plan has been one of the important factors in creating spatial cohesion and integration among the school spaces.

Abstract Background Female genital mutilation/cutting (FGM/C) is a clear violation of women’s rights and can have adverse and irreversible health effects as well. Worldwide, more than 200 million women and girls have undergone FGM/C. Utility value of FGM/C has not been estimated yet, so we designed this study to extract the health utility value of FGM/C for the first time in the world. Methods In a cross-sectional study in Iran, 125 girls and women who underwent FGM/C procedure were examined by the trained midwives in order to determine its type. In addition, a questionnaire was completed for identifying the socio-demographic factors and extracting the health utility of these individuals. Health utility was measured using Time Trade-off method and also to determine the effects of the socio-demographic factors on the health utility a two-limit censored regression model was applied. Results The mean and median of the health utility of women with FGM/C were 0.971 (SE: 0.003) and 0.968 (IQR: 1–0.95), respectively. Number of non-traders was 58 (46.4%) who reported perfect health utility. However, the mean of health utility among traders was 0.946 (SE: 0.002). Only type 1 (Clitoridectomy) and type 2 (Excision) FGM/C were seen in this study. Women with Type 1 FGM/C had significantly lower health utility value (Mean: 0.968, Median: 0.957) than their type 2 counterparts (Mean: 0.987, Median: 1.00). Moreover, women in the age group of 31–45 years (Mean: 0.962, Median: 0.956), single (Mean: 0.950, Median: 0.954), divorced (Mean: 0.951, Median: 0.950), employed (Mean: 0.959, Median: 0.956), and with supplementary insurance (Mean: 0.962, Median: 0.950) had significantly lower health utility than their counterparts. Conclusion FGM/C affects physical and psychological well-being of these individuals, resulting in a lack of personal and marital satisfaction, which ultimately leads to a 3% reduction in their health related quality of life. Therefore, preventing from this practice is very important and should be considered by health system policy makers more than before.

Abstract Background Women, with more vulnerabilities and less access to resources, are often seen as victims of natural disasters. Therefore, the present study aimed to investigate the experiences of rural women with damages resulting from an earthquake in Iran. Methods In this research, a qualitative approach, as well as the conventional content analysis was employed. The study population consisted of rural women residing in the earthquake-stricken areas of Sarpol-e Zahab and Salas-e Babajani counties in Kermanshah Province, Iran. Semi-structured interviews were used for data collection. Moreover, sampling was purposeful, theoretical saturation was achieved by conducting 22 interviews, and the data analysis process was performed according to the steps proposed by Graneheim and Lundman. For the strength and transferability of the research, Lincoln and Guba’s Evaluative Criteria were used. Results There were seven categories regarding the experiences of rural women after the earthquakes including neglecting the health needs; tension in the family and marital relations; gender inequality in the provision of assistance; feeling insecure; ignoring the ruling culture of the region; concealing needs for fear of stigmatization, and incoherent mourning as well as two categories regarding their reactions to and interaction with the earthquake consequences including positive and negative interactions. Conclusions Paying more attention to the needs of rural women, taking the culture governing the village into account at the time of service delivery, and helping them with positive adaptations are some indispensable measures that should be taken.

Background: The current study aimed to determine the cumulative effective dose caused by diagnostic imaging and its associated risk for cancer development in trauma patients referred to an emergency department. Methods: This study was carried out retrospectively in an emergency department (Kashan, Iran) from April 2015 to October 2015. Then, the types of diagnostic radiologic studies performed on adult trauma patients in their first 24 h upon presentation were recorded. Finally, the cumulative effective dose of trauma patients and its associated risk for cancer development were obtained. Results: In total, the patients received 3323 radiologic examinations including 2169 radiographs and 1154 computed tomography (CT)-scans. The most common type of plain radiographic and CT-scan examinations included anterior posterior and posterior anterior chest as well as head, respectively. The mean cumulative effective dose received by trauma patients referred to the emergency department was 2.47 ± 4.29 mSv. Most of the effective dose was from CT-scan examinations (90.65% of total cumulative effective dose; 2181.91 mSv). The majority of patients (83.40%) received between 0.00 and 5.00 mSv cumulative effective dose. Moreover, the cancer risk per average cumulative effective dose received by trauma patients was 1.01 × 10−4. Conclusions: In current study, the mean cumulative effective dose per each trauma patient (2.47 mSv) was relatively less than that of the other evaluated studies. It was also found that although the number of CT-scans was relatively few compared to plain radiographs, most of the cumulative effective dose of patients resulted from CT-scans; hence, using unnecessary CT-scan examinations should be avoided.

Being COVID-19 positive and then dying causes a slew of personal, familial, and social issues for family members. Therefore, the current study was carried out to analyze the lived experiences and issues of COVID-19 victims' families in Tehran, Iran. The phenomenological approach was used in the qualitative analysis of 21 first-degree relatives of COVID-19 victims. From August 22 to October 21, 2020, data was gathered by phone (4 people) and in-person (17 people) using semi-structured interviews. The subjects were chosen through purposeful and snowball sampling. The MAXQDA-2018 program was used to organize the data, and the Colaizzi analytical technique was used to analyze it. Guba and Lincoln’s criteria were also used to assess the findings' quality. After analyzing the data, 2 main categories and 14 subcategories were extracted, including (1) challenges in caring for a COVID-19 patient (being rejected, limited access to medical facilities, dissatisfaction with the behavior of medical staff, disruption of family life, the challenge of managing family members' behavior with the patient, and living with doubts and worries (2) challenges after a COVID-19 patient’s death (incomplete farewell to the corpse, unbelievability of the death, ambiguity and tension in the burial process, lonely burial, the twinge of conscience, worry about not respecting the deceased, incomplete condolences, and abandonment). The troubles of victims' families can be ameliorated by developing the skills of caring for COVID-19 patients at home, providing medical and psychological services to families before and after the patient’s death, appropriately informing the families to guarantee them about dignity and respect and respect of the deceased at the interment, and developing a culture of virtual condolence to provide emotional support to survivors.

Introduction: The evidence has shown that specific exercises effectively treat acute low back pain. This study aimed to investigate the effects of lumbar spinal loading in both directions in the sagittal plane in patients with acute lumbosacral radiculopathy. Materials and Methods: A total of 20 patients with unilateral acute lumbosacral radiculopathy voluntarily participated in the study. The patients randomly performed flexion or extension back exercise ten times in three sets with 1-min rest between each set. Pain intensity, range of forward bending and straight leg raising (SLR), time of sit to stand, and soleus H-reflex were measured before and after the exercise. Results: This study showed that flexion compared to extension loading exercises significantly improved pain intensity, SLR degree of freedom, forward bending range of motion, time of sit to stand, and H-reflex latency (P˂0.05). There was no significant improvement in the H-reflex amplitude of the patients doing either of the exercises (P=0.07). Conclusion: Flexion loading exercises are recommended for reducing pain intensity and improving spinal mobility and neurophysiological function of the nerve root functional status in patients with acute lumbosacral radiculopathy. It seems that flexion exercises with the flatting of lumbar lordosis and opening intervertebral space reduce disk pressure and neural tissue tension.

One of the essential factors of project success is selecting the proper delivery method. This study aimed to provide a new hybrid decision-making framework to assist project stakeholders in evaluating and selecting the most appropriate Project Delivery System (PDS) and documenting the decision process. For this purpose, the selection factors of PDSs were obtained from a literature review, and critical selection factors were screened based on the fuzzy Delphi method, whereby expert feedback was on Information and Communication Technology (ICT) projects was obtained. Subsequently, the ICT project risks were identified and categorized into six competitive constraints, including time, cost, quality, reputation, value, and scope, and the risk factors were prioritized in each area. Then, the effect of project risks on the decision criteria was investigated using a fuzzy cognitive map (FCM). Finally, the PDSs were ranked through Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (FTOPSIS). This article researched a novel multi-layer decision system combining the FCM and FTOPSIS techniques. The decision criteria received their weights from the evaluation of the causal relationships between PDS selection factors and project risks. Thus, PDSs were ranked based on different project characteristics, the opinions of stakeholders, and the effect of project risks on the decision-making process; this increased the likelihood of project success. The results showed that the impact of the most critical project risks on the selection factors was so severe that they changed the weight of the criteria in the decision matrix and, subsequently, changed the ranking of decision options.

Objective: Today, one of the most important concerns of managers is to find a way to measure the maturity level of Business Process Management (BPM) and to recognize improvement conditions. Hence, the aim of this research is to measure and plan various scenarios in order to develop business process management. A Maturity Model has three dimensions: Levels, factors and measurement tools. In this paper, the dimensions are recognized via a comprehensive literature review. Finally, they are conceptualized, measured and a scenario planning is developed. Methods: In this research, the extracted factors and indices form the basic approach of the conceptual model and are validated by a confirmatory factor analysis. Regarding the structure of the conceptual model, factors and indices of all levels of process maturity, a causal loop has been developed based on a fuzzy cognitive map that illustrates the maturity aspects and their relationships to provide scenario planning for developing maturity. Results: The developed BPM maturity model classifies the maturity levels into the following stages, primary, managed, standardized, predictable and innovative. Also, the findings show that there are 33 process concepts that lead to the development of a business process maturity level. Furthermore, by the result of this research, if the deployment level of concepts in the organization is determined, organizations can measure the level of their BPM maturity and provide scenario planning. Conclusion: 33 BPM maturity concepts can support organizations as a road map to promote maturity level from 0 to 100. In addition, the implementation of the results of this research into case study show that the current status of business processes is graded as level 3 of the maturity level and its score is 36 of 100.