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In this research, a combined method was developed to determine the erodibility of bends in the Karkheh River. For this purpose, a 40 km reach of the Karkheh River downstream of the Karkheh Dam was considered. The value of the shear stress was the calculated using the CCHE2D model. The results from the model show that in 1996 (before construction of the Karkheh dam), the length of the erodible reach was 1314 m; in 2011 (after construction of the Karkheh dam), this length was reduced to 840 m. Furthermore, the model illustrates that the location of the maximum shear stress is a function of the relative curvature (R/W) in the bends. For small values of the R/W (less than 1.5), the maximum shear stress occurs on the convex bank of a river bend. By increasing the R/W, the location of the maximum shear stress transfers to the concave bank of the river bend. Also, this location is displaced towards downstream by increasing the R/W.

Introduction Patients with generalised joint hypermobility, including knee hypermobility (GJHk), often experience knee pain and are typically managed with low-intensity strength training and/or proprioceptive training as part of standard care. However, not all patients experience satisfactory outcomes. High-load strength training may offer additional benefits, such as increased muscle cross-sectional area, neural drive and tendon stiffness, which may reduce pain and improve active knee joint stability during movement tasks and daily activities. So far, no randomised controlled trials (RCTs) have compared high-load strength training with traditional treatment strategies (standard care) for this patient group.Methods and analysis In this RCT, we aim to recruit patients with GJHk and knee pain from primary care physiotherapy clinics in the Region of Southern Denmark and via social media. Patients with competing injuries or experience with high-load strength training will be excluded. Patients will be randomised (1:1 ratio) to either 2 weekly sessions of high-load strength training or standard care for 12 weeks. The primary outcome is self-reported knee pain during an activity nominated by the patient as the most aggravating for their present knee pain measured using the Visual Analogue Scale for Nominated Activity (VASNA, 0–100; 0=no pain and 100=worst imaginable pain). This will be collected at baseline, 6 weeks, 12 weeks and 12 months. Secondary outcomes include self-reported knee function and adverse events (collected at baseline, 12 weeks and 12 months), objective measurements including a 5-repetition maximum single-leg press, proprioception and single-leg-hop for distance (collected at baseline and 12 weeks), and a range of other outcome measures such as fear of movement, tendon stiffness and global perceived effect. We aim to recruit 90 patients in total to detect a 10 mm group difference in the primary outcome with 80% power.Ethics and dissemination This study was funded by Independent Research Fund Denmark (grant number 2034-00088B) on 14 June 2022; the Regional Committees on Health Research Ethics for Southern Denmark approved it (S-20230050) on 30 August 2023. The first recruitment site opened on 15 February 2024, and the final results will be submitted to a peer-reviewed journal to inform rehabilitation strategies for symptomatic GJHk.Protocol version 1, dated 4 July 2024.Trial registration number NCT06277401.

Objective: To synthesize the evidence on conservative interventions for shoulder symptoms in hypermobile Ehlers-Danlos Syndrome (hEDS) and hypermobility spectrum disorder (HSD). Data Sources: A literature search was conducted using data sources Medline, PEDro, CINAHL, AMED, Elsevier Scopus, and the Cochrane Library from January 1998 to June 2023. Study Selection: The review included primary empirical research on adults diagnosed with hEDS or HSD who experienced pain and/or mechanical shoulder symptoms and underwent conservative interventions. Initially, 17,565 studies were identified, which decreased to 9668 after duplicate removal. After title and abstract screening by 2 independent authors, 9630 studies were excluded. The full texts of the remaining 38 were assessed and 34 were excluded, leaving 4 articles for examination. Data Extraction: Two authors independently extracted data using a predefined extraction table. Quality assessment used the Joanna Briggs Institute checklists and the Template for Intervention Description and Replication. Data Synthesis: The review covered 4 studies with a total of 7 conservative interventions, including exercise programs, kinesiology taping, and elasticized compression orthoses. Standardized mean differences were calculated to determine intervention effects over time. The duration of interventions ranged from 48 hours to 24 weeks, showing positive effect sizes over time in the Western Ontario Shoulder Instability Index, pain levels, improved function in activities of daily living, and isometric and isokinetic strength. Small to negligible effect sizes were found for kinesiophobia during completion of exercise programs. Conclusions: Shoulder symptoms in hEDS/HSD are common, yet significant gaps in knowledge remain regarding conservative interventions, preventing optimal evidence-based application for clinicians. Further research is necessary to explore the most effective intervention types, frequencies, dosages, and delivery methods tailored to the specific requirements of this patient population.

Within the realms of human and artificial intelligence, the concepts of consciousness and comprehension are fundamental distinctions. In the clinical sphere, patient awareness regarding medication and its physiological processes plays a crucial role in determining drug efficacy and outcomes. This article introduces a novel perspective on prescription practices termed “Ultra-Overt Therapy” (UOT). A review of current supporting evidence was conducted through a non-systematic search in PubMed and Google Scholar, focusing on concepts such as the “mind–body relationship,” “placebo response,” “neuroscience,” and “complementary medicine.” Our findings, rooted in the mechanisms of the “placebo effect,” the intricacies of “intersubjective therapy,” the potency of “interoceptive awareness,” and other domains of medical science, suggest that UOT holds theoretical promise. Future research endeavors focusing on these areas may elucidate the global impact of this method on medical treatment and patient care.

The assessment of sprinkler system performance is crucial in ensuring the efficient use of water resources. The commonly used indicators of the uniformity of water distribution in sprinkler systems are Christiansen's uniformity (CU) and distribution uniformity (DU) coefficients. A more comprehensive analysis of water distribution is essential in situations where the reliability of these coefficients as indicators of water distribution patterns is limited. In the present research, distribution maps of water depth were prepared from water application profiles using catch cans experiments that were carried out in the research farm of the Agriculture and Natural Resources Faculty of the University of Tehran, which is located in Alborz province. In this way, water application profile data were obtained at different operating pressures (200, 250, 300, 350, and 400 kPa). By using this data, 2D and 3D distribution maps of water depth were created due to the overlapping of sprinklers in different arrangements, spacing, and pressures. In addition, CU and DU coefficients in square, rectangular, and triangular arrangements with different spacing and pressures from 200 to 400 kPa. A total of 11,250 different simulations were calculated and analyzed. Distribution maps of water depth contribute to advancing the understanding of sprinkler irrigation system performance and aid in the optimization of water management practices. HIGHLIGHTS CU and DU coefficients provide only an overall measure of uniformity and do not demonstrate the spatial variability of water depth, which could lead to over- or under-irrigation in certain areas of the field.; Water depth distribution maps offer a more accurate assessment of spatial variability and allow for the identification of specific areas that require attention to improve sprinkler system performance.;

Abstract Acute myeloid leukemia (AML) comprises a multifarious and heterogeneous array of illnesses characterized by the anomalous proliferation of myeloid cells in the bone marrow microenvironment (BMM). The BMM plays a pivotal role in promoting AML progression, angiogenesis, and metastasis. The immune checkpoints (ICs) and metabolic processes are the key players in this process. In this review, we delineate the metabolic and immune checkpoint characteristics of the AML BMM, with a focus on the roles of BMM cells e.g. tumor-associated macrophages, natural killer cells, dendritic cells, metabolic profiles and related signaling pathways. We also discuss the signaling pathways stimulated in AML cells by BMM factors that lead to AML progression. We then delve into the roles of immune checkpoints in AML angiogenesis, metastasis, and cell proliferation, including co-stimulatory and inhibitory ICs. Lastly, we discuss the potential therapeutic approaches and future directions for AML treatment, emphasizing the potential of targeting metabolic and immune checkpoints in AML BMM as prognostic and therapeutic targets. In conclusion, the modulation of these processes through the use of directed drugs opens up new promising avenues in combating AML. Thereby, a comprehensive elucidation of the significance of these AML BMM cells' metabolic and immune checkpoints and signaling pathways on leukemic cells can be undertaken in the future investigations. Additionally, these checkpoints and cells should be considered plausible multi-targeted therapies for AML in combination with other conventional treatments in AML. Video Abstract

This study aimed at exploring the impact of mentor text modelling on Iranian English as a Foreign Language (EFL) learners' accuracy and fluency in writing tasks with different cognitive complexity in comparison with two conventional approaches to teaching writing; namely, process-based and product-based approaches. To this end, 60 Iranian EFL learners in three comparison groups were taught English writing adopting one of the three approaches enumerated above. To investigate any changes in the learners' performance as a result of the study course, their fluency and accuracy in writing tasks with high, moderate, and low cognitive complexity levels were gauged before and after the training. Based on the results of covariate analysis, mentor text modelling yielded higher degree of fluency compared to a product-based approach; however, the approach was found to be inferior to a process-based approach in terms of enhancing fluency in writing. Additionally, Mentor text modelling was found to be as effective as a product-based approach, and at the same time, more effective than a process-based approach in improving accuracy, regardless of the writing tasks' cognitive complexity level. The findings may have several implications for EFL teachers and course designers interested in developing writing syllabuses.

Postdural puncture headache (PDPH) is an incapacitating complication that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia. We present a case of a 32-year-old G2P1 female who was admitted for induction of labor and received epidural catheter placement for analgesia. After an inadvertent dural puncture and development of a PDPH, the patient was offered conservative measures for the first 48 hours without improvement. An epidural blood patch (EBP) was placed achieving only moderate relief. Two days later, a second EBP was performed and the patient developed severe back pain which radiated bilaterally to her buttocks. Magnetic resonance imaging (MRI) demonstrated the presence of blood in the intrathecal space. This could be the cause of sacral radiculitis, an uncommon complication of an EBP. This suggests that EBPs could potentially cause neurologic symptoms which may be more common than people previously thought. As complicated outcomes have followed both conservative and aggressive management, MRI can be an early diagnostic tool in such cases and a multidisciplinary approach should be taken.

Postdural puncture headache (PDPH) is an incapacitating complication that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia. We present a case of a 32-year-old G2P1 female who was admitted for induction of labor and received epidural catheter placement for analgesia. After an inadvertent dural puncture and development of a PDPH, the patient was offered conservative measures for the first 48 hours without improvement. An epidural blood patch (EBP) was placed achieving only moderate relief. Two days later, a second EBP was performed and the patient developed severe back pain which radiated bilaterally to her buttocks. Magnetic resonance imaging (MRI) demonstrated the presence of blood in the intrathecal space. This could be the cause of sacral radiculitis, an uncommon complication of an EBP. This suggests that EBPs could potentially cause neurologic symptoms which may be more common than people previously thought. As complicated outcomes have followed both conservative and aggressive management, MRI can be an early diagnostic tool in such cases and a multidisciplinary approach should be taken.

Many of the social and security issues of the Zayandeh-Rud basin are the result of the government becoming the sole agent of governance and the gaps in the command-control governance structure. It is clear that the main issue to achieve participatory governance is the gap in stakeholder relations and the lack of a coherent and flexible agenda to improve these relations. Therefore, the objective of this study was to provide solutions for improving relationships as a starting point and key to reforming the governance structure. The management and transition framework (MTF) was used to analyze the stakeholders and the relationships between them that showed the concentration of tension in the relationship between Isfahan farmers and the Ministry of Energy (Isfahan Regional Water Company). Also, using the MTF database and the participatory model building (PMB) based on interviews with key Stakeholders, the causes, solutions, consequences, and obstacles to improve these relationships were extracted in the form of causal circles. Finally, by focusing on the solutions, the conceptual model of improving the relations between the Stakeholders and the solutions presented by the interviewees, including holding local elections and convening the Zayandeh-Rud Basin water assembly, mediation with interdisciplinary knowledge approach, participatory management working groups, the formation and strengthening of the economic committee improve the livelihood of farmers, the holding of government meetings with farmers and industries were reviewed.

Abstract This study applies three methods, Gene Expression Programming (GEP), M5 tree (M5T) model and optimized Artificial Neural Network by Genetic Algorithm (ANN-GA) for estimation of reference evapotranspiration in Ahvaz and Dezful in the southwest of Iran. Comparison between results of the FAO Penman-Monteith (FPM) method and the mentioned three methods shows that ANN-GA with the Levenberg-Marquardt training method is the best method and the M5T model is the second appropriate method for estimation of reference evapotranspiration. In Ahvaz, R 2 and RMSE of ANN-GA method are 0.996, 0.184 mm/day. For M5T method, these values are 0.997 and 0259 mm/day, and for GEP method, they are 0.979 and 0.521 mm/day. In Dezful, R 2 and RMSE of ANN-GA method are 0.994, 0.235 mm/day. For M5T method, these values are 0.992 and 0265 mm/day, and for GEP method, they are 0.963 and 0.544 mm/day. In addition, sensitivity analysis shows that the maximum temperature is the most effective parameter, and the wind speed is second effective parameter. In Dezful, the effect of the maximum temperature is more than those of Ahvaz but the effect of wind speed is less than those of Ahvaz. Because Ahvaz is more flatter than Dezful (the movement of wind in Ahvaz is freer than those of Dezful). The third effective meteorological parameter is the average relative humidity in Ahvaz and the sunny hours in Dezful. The reason for this subject is the less distant of Ahvaz from the Persian Gulf (it is source of moisture).

So far, many studies have examined the effects of surface (FF) and drip (DF) fertigation compared to surface (FC) and drip (DC) irrigation along with fertilization at different levels of fertilizer on crop yield indices, nutrient use efficiency (NUE), and irrigation water productivity (WP); however, each of them have been conducted under different conditions. Because of the scattered results and the lack of a general conclusion from the published results, conducting a meta-analysis as a structured method for arriving at an overall conclusion regarding the effects of different fertigation methods on different indices is essential. This study was conducted to examine the effects of surface and drip fertigation methods and different fertilizer application levels on crop yield, NUE, and WP. To this end, eight global databases of publications (e.g., Scopus and Web of Science) were reviewed. A total of 5494 studies were extracted, of which 32 studies met the entry criteria for the meta-analysis. To assess the effects of fertigation, each study was used to extract the effect sizes for each index. A total of 119 effect sizes were obtained for crop yield, 85 for NUE, and 84 for WP. The meta-analysis results showed that surface and drip fertigation methods increased the average yield by 20%. NUE and WP on an average increased by 26% and 51%, respectively. Based on the reported results, the optimal fertilizer application level is 75% of the recommended dose, which can reduce fertilizer use by 25% without significantly reducing the yield. In general, fertigation can be recommended as an effective operation for improving the proposed indices examined in both surface and drip fertigation methods.

Identifying operational losses in irrigation canals can be difficult due to inaccurate simplification in designing and operating national guidelines. However, this study aims to provide a practical solution to this problem by identifying operational losses, which are the primary cause of off-farm irrigation water losses. The method involves simulating the daily delivered water to individual Irrigation Units (IUs) through off-take structures using hydraulic simulation. The daily agricultural water demand for individual IUs is then calculated using a crop growth model and irrigation system efficiency. This approach offers an effective way to accurately identify operational losses in agricultural water distribution systems. The Roodasht irrigation district in central Iran was used test proposed method. The water distribution simulation was conducted using an open-source Irrigation Conveyance System Simulation (ICSS) in three separate scenarios, including 29, 22, and 55 days, and each showed a typical operation based on history. The IUs’ agricultural water demand, at each off-take location, was calculated by the Aquacrop estimation including the existing information of the on-farm water efficiency depending on irrigation system. According to the study, the amount of water lost daily varied between 60% and 82%, 50–70%, and 44–61% in IUs that used drip, sprinkler, and surface water application systems, respectively, during normal operational scenarios. In situations where water was scarce, the water loss range was 4–87%, 68–80%, and 60–70%, respectively.The results of this study confirmed that losses in the conveyance and distribution systems varied according to the distance from the source and were often higher than the recommended guidelines for irrigation system design and operation (such as the 10–20% suggested in Iranian guidelines). The proposed methodology can be used to improve estimation of actual water losses for irrigation districts with similar operation systems and climatic conditions.

Abstract Innate and adaptive immune cells patrol and survey throughout the human body and sometimes reside in the tumor microenvironment (TME) with a variety of cell types and nutrients that may differ from those in which they developed. The metabolic pathways and metabolites of immune cells are rooted in cell physiology, and not only provide nutrients and energy for cell growth and survival but also influencing cell differentiation and effector functions. Nowadays, there is a growing awareness that metabolic processes occurring in cancer cells can affect immune cell function and lead to tumor immune evasion and angiogenesis. In order to safely treat cancer patients and prevent immune checkpoint blockade-induced toxicities and autoimmunity, we suggest using anti-angiogenic drugs solely or combined with Immune checkpoint blockers (ICBs) to boost the safety and effectiveness of cancer therapy. As a consequence, there is significant and escalating attention to discovering techniques that target metabolism as a new method of cancer therapy. In this review, a summary of immune-metabolic processes and their potential role in the stimulation of intracellular signaling in TME cells that lead to tumor angiogenesis, and therapeutic applications is provided. Video abstract

Abstract Acute myeloid leukemia (AML) is a type of leukemia with a poor prognosis and survival characterized by abnormal cell proliferation and differentiation. Despite advances in treatment, AML still has a low complete remission rate, particularly in elderly patients, and recurrences are frequently seen even after complete remissions. The major challenge in treating AML is the resistance of leukemia cells to chemotherapy drugs. Thus, to overcome this issue, it can be crucial to conduct new investigations to explore the mechanisms of chemo-resistance in AML and target them. In this review, the potential role of autophagy induced by FLT3-ITD and acid ceramidase in chemo-resistance in AML patients are analyzed. With regard to the high prevalence of FLT3-ITD mutation (about 25% of AML cases) and high level of acid ceramidase in these patients, we hypothesized that both of these factors could lead to chemo-resistance by inducing autophagy. Therefore, pharmacological targeting of autophagy, FLT3-ITD, and acid ceramidase production could be a promising therapeutic approach for such AML patients to overcome chemo-resistance. Video abstract

BackgroundDigital health interventions for managing chronic conditions have great potential. However, the benefits and harms are still unclear. ObjectiveThis systematic review and meta-analysis aimed to investigate the benefits and harms of digital health interventions in promoting physical activity in people with chronic conditions. MethodsWe searched the MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials databases from inception to October 2022. Eligible randomized controlled trials were included if they used a digital component in physical activity promotion in adults with ≥1 of the following conditions: depression or anxiety, ischemic heart disease or heart failure, chronic obstructive pulmonary disease, knee or hip osteoarthritis, hypertension, or type 2 diabetes. The primary outcomes were objectively measured physical activity and physical function (eg, walk or step tests). We used a random effects model (restricted maximum likelihood) for meta-analyses and meta-regression analyses to assess the impact of study-level covariates. The risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. ResultsOf 14,078 hits, 130 randomized controlled trials were included. Compared with usual care or minimal intervention, digital health interventions increased objectively measured physical activity (end of intervention: standardized mean difference [SMD] 0.29, 95% CI 0.21-0.37; follow-up: SMD 0.17, 95% CI 0.04-0.31) and physical function (end of intervention: SMD 0.36, 95% CI 0.12-0.59; follow-up: SMD 0.29, 95% CI 0.01-0.57). The secondary outcomes also favored the digital health interventions for subjectively measured physical activity and physical function, depression, anxiety, and health-related quality of life at the end of the intervention but only subjectively measured physical activity at follow-up. The risk of nonserious adverse events, but not serious adverse events, was higher in the digital health interventions at the end of the intervention, but no difference was seen at follow-up. ConclusionsDigital health interventions improved physical activity and physical function across various chronic conditions. Effects on depression, anxiety, and health-related quality of life were only observed at the end of the intervention. The risk of nonserious adverse events is present during the intervention, which should be addressed. Future studies should focus on better reporting, comparing the effects of different digital health solutions, and investigating how intervention effects are sustained beyond the end of the intervention. Trial RegistrationPROSPERO CRD42020189028; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189028

Abstract Background The high prevalence of diabetes and the importance of long-term follow-up of these patients encourage finding an inexpensive and applicable educational method to control the disease. Distance education based on mobile technology and Short message service (SMS) can be an effective way to manage this disease by eliminating time and place limitations. Due to the world’s high penetration rate, SMS is one of the best ways to transfer information and health education. Objective This study aimed to compare the effect of SMS- and group-based education in managing diabetes type 2 and compare them with a control group. Method A total of 168 patients with diabetes type 2 under the coverage of three family physician clinics were randomly allocated into three groups. The education was conducted in 12 one-hour sessions once a week in the group-based arm, and a daily short message was sent to the participants in the SMS group. The control group also underwent routine care at the family physician clinic. The duration of the education was 3 months. At baseline and 3 months later, fasting blood sugar (FBS), 2 hours postprandial sugar (2hppBS), and HBA1c, as well as diabetes self-management questionnaire score (DSMQ), were measured. Results The comparison of the three groups in terms of changes in FBS (P-value: 0.001), 2hppBS (8 P-value:

Abstract COVID-19 infection is a serious threat to patients with primary diseases, especially multiple cancers. Studies suggest that cancer patients are one of the most susceptible populations to experience severe COVID-19 and death. In addition, a number of studies suggest various mechanisms for SARS-CoV-2 in cancer progression. In this study, we discussed the role of SARS-CoV-2 in the induction of autophagy and we hypothesized that autophagy induced by COVID-19 not only can contribute to viral replication but also potentially can lead to cancer progression, chemo-resistance, and tumor recurrence in multiple cancer patients. Therefore, targeting autophagy-related signaling pathways and cellular and molecular processes could be a potentially promising therapeutic approach for cancer patients with COVID-19. Hence, this study can shed light on a new window on the management of such patients. However, more investigations in the future are required to understand other pathological effects of COVID-19 infection on cancer patients to provide new therapeutic strategies to combat these complications in these patients.