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Introduction: Batteries are widely used in all kinds of electrical and electronic equipment. These batteries contain several metals that lead to the leakage of metals into the soil and underground water in the burial places, which pose serious risks to human health and the environment. Materials and Methods: In this study, the concentration of 15 metals (Ag, Al, As, Ba, Cd, Co, Cs, Cu, Fe, Li, Mn, Pb, Sr, Zn, Ni) in different components of 7 used battery models was investigated using Waste Extraction Test (WET) and Toxicity Characteristic Leaching Procedure (TCLP) toxicity. The concentration of metals was measured by Inductively Coupled Plasma Optical Emission Spectroscopy (ICP-OES). Metal concentrations were compared with the United States Environmental Protection Agency (USEPA) and California Department of Toxic Substances Control (CDTSC) standards. Results: The results showed that the average concentration of metals in both WET and TCLP methods was high, but the concentration of most metals in WET method was relatively higher than in TCLP method. Conclusion: The results showed that the recovery of metals from batteries is necessary, moreover safe burial of batteries is essential to reduce environmental risks.

In the last decade, the use of response surface methodology (RSM) as an advanced technique for designing empirical tests has been developing. Investigations show that RSM is sometimes not used correctly in designing experiments, developing models, and optimizing various physicochemical processes to remove water and wastewater pollutants. Making serious mistakes can lead to misleading conclusions, and questions the validity of scientific research. In this study, the characteristics and mistakes of RSM application in the last decade have been systematically investigated. For the first time, a checklist has been designed to check the correct implementation of the RSM. Using this checklist, the quality of articles on photocatalytic removal of physicochemical pollutants from aqueous environments using TiO2 catalyst and UV light has been investigated, based on the correct implementation of RSM. According to our results, many mistakes were observed in using RSM in the included studies; 41% of the articles did not report the lack of fit value for their works. In 19% of the articles, the P-value of the equation’s main terms was insignificant. Higher than 20% and 61% of those studies did not perform the optimization of photocatalytic removal of pollutants and the confirmatory experiments after optimization, respectively. Contrary to expectation, the final score of the articles included in this evaluation had no proportion to the CiteScore of the respective journals. The trend of the average scores over time showed that the authors’ attention to the correct implementation of RSM requirements has not changed in a decade. The present study has a crucial role in advancing knowledge related to RSM and preventing potential common mistakes in this field. It also makes researchers pay more attention to the correct use of RSM. The checklist proposed can be used by researchers and reviewers who use RSM.

Nanomaterials, especially graphene derivatives, have become major tools in the biomedical area. Understanding the way that graphene interacts with component elements of biological systems, like biological membranes, is critical for the development of successful biomedical applications. The interaction mechanism of graphene sheets with a model cell membrane was investigated in this study using molecular dynamics (MD) simulations under three different conditions: pristine graphene (PG), carboxyl group-functionalized graphene (G-COOH), and amine group-functionalized graphene (G-NH2). The MD simulations demonstrated that functional groups on graphene surfaces improve their interaction with the head groups of the membrane. In 200 nanoseconds, PG reached equilibrium outside and near the phospholipid membrane. G-NH2 was positioned away from the model membrane’s surface, while G-COOH and G-NH2 also achieved equilibrium outside the membrane. It was shown by molecular dynamics simulations that after 200 ns, all three systems had attained their stable states. Crucially, it is discovered that the kind of functional groups greatly affected how the nanoparticles and membrane interacted. Each and every nanocarrier has a strong propensity to break through the membrane. The van der Waals interaction energies for the PG, G-NH2, and G-COOH systems were further shown by the obtained data to be roughly −400.66, −397.52, and −876.36 kJ/mol, respectively. These results support the notion that G-COOH interacts with the model cell bilayer more strongly than PG and G-NH2. This work highlights the influence of functional groups on the interaction of graphene sheets with biological membranes, offering important insights into the equilibrium behavior and entry mechanism of graphene sheets in a model cell membrane.

BackgroundThe University of California’s Diabetes Prevention Program (UC DPP) Initiative was implemented across all 10 UC campuses in 2018. The COVID-19 pandemic and accompanying mandates required swift changes to program delivery, including pivoting from in-person to virtual delivery (i.e., Zoom). Our goal was to assess multilevel constituent perceptions of the use of a virtual platform to deliver UC DPP due to COVID-19 mandates.MethodsWe conducted qualitative interviews with 68 UC DPP participants, coordinators, and leaders to examine the use of virtual platform delivery on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of UC DPP. Transcripts were analyzed using rapid qualitative analysis and emergent themes were categorized using domains corresponding to RE-AIM framework.ResultsAmong UC DPP participants (n = 42), virtual delivery primarily impacted perceptions of UC DPP effectiveness and implementation. Some participants perceived program effectiveness to be negatively impacted, given their preference for in-person sessions, which they felt provided more engagement, peer support, and accountability. Implementation challenges included problems with virtual format (e.g., “Zoom fatigue”); however, several benefits were also noted (e.g., increased flexibility, maintenance of DPP connections during campus closures). UC DPP coordinators (n = 18) perceived virtual delivery as positively impacting UC DPP reach, since virtual platforms provided access for some who could not participate in-person, and negatively impacting effectiveness due to reduced engagement and lower peer support. UC leaders (n = 8) perceived that use of the virtual format had a positive impact on reach (e.g., increased availability, accessibility) and negatively impacted effectiveness (e.g., less intensive interactions on a virtual platform). Across constituent levels, the use of a virtual platform had little to no impact on perceptions of adoption and maintenance of UC DPP.ConclusionPerceptions of the reach, effectiveness, and implementation of UC DPP using a virtual platform varied across constituents, although all groups noted a potential negative impact on overall program effectiveness. Unanticipated program adaptations, including virtual delivery, present potential benefits as well as perceived drawbacks, primarily across the effectiveness domain. Understanding differential constituent perceptions of the impact of virtual delivery can help maximize RE-AIM and inform future UC DPP delivery strategies.

This article aims to address the human rights obligations of pharma companies regarding access to vaccines and other drugs that are produced for the prevention and treatment of COVID-19. It seems that the UN Guidelines on Trade and Human Rights are among the most important documents and organizations which give pharma and vaccine companies some responsibility and fair access to vaccines and special medicines, in case of emergency. Since the right of access to vaccines is a fundamental human right, access must be provided fairly in the emergency conditions of a pandemic virus. Besides, discrimination, monopolies and nationalism must be avoided as much as possible. The results illustrate that public access to the COVID-19 vaccine is justified under the heading of social contract and it persuades human rights to support the idea of corporate social responsibility more broadly. Other results of this article indicate that there are many challenges to achieving universal access to vaccines, including nationalism, monopolies, exorbitant pricing, and the spread of corruption. It is hoped that, with proper monitoring by international organizations and the World Health Organization, these challenges can be reduced to pave the way for fair access to vaccines as a fundamental human right.

Abstract Background The existing grant review criteria do not consider unique methods and priorities of Dissemination and Implementation Science (DIS). The ImplemeNtation and Improvement Science Proposals Evaluation CriTeria (INSPECT) scoring system includes 10 criteria based on Proctor et al.’s “ten key ingredients” and was developed to support the assessment of DIS research proposals. We describe how we adapted INSPECT and used it in combination with the NIH scoring system to evaluate pilot DIS study proposals through our DIS Center. Methods We adapted INSPECT to broaden considerations for diverse DIS settings and concepts (e.g., explicitly including dissemination and implementation methods). Five PhD-level researchers with intermediate to advanced DIS knowledge were trained to conduct reviews of seven grant applications using both the INSPECT and NIH criteria. The INSPECT overall scores range from 0 to 30 (higher scores are better), and the NIH overall scores range from 1 to 9 (lower scores are better). Each grant was independently reviewed by two reviewers, then discussed in a group meeting to compare the experiences using both criteria to evaluate the proposal and to finalize scoring decisions. A follow-up survey was sent to grant reviewers to solicit further reflections on each scoring criterion. Results Averaged across reviewers, the INSPECT overall scores ranged from 13 to 24, while the NIH overall scores ranged from 2 to 5. Reviewer reflections highlighted the unique value and utility for each scoring criterion. The NIH criteria had a broad scientific purview and were better suited to evaluate more effectiveness-focused and pre-implementation proposals not testing implementation strategies. The INSPECT criteria were easier to rate in terms of the quality of integrating DIS considerations into the proposal and to assess the potential for generalizability, real-world feasibility, and impact. Overall, reviewers noted that INSPECT was a helpful tool to guide DIS research proposal writing. Conclusions We confirmed complementarity in using both scoring criteria in our pilot study grant proposal review and highlighted the utility of INSPECT as a potential DIS resource for training and capacity building. Possible refinements to INSPECT include more explicit reviewer guidance on assessing pre-implementation proposals, providing reviewers with the opportunity to submit written commentary with each numerical rating, and greater clarity on rating criteria with overlapping descriptions.

Abstract The present study aimed to investigate indigenous bacteria possibility in recycled paper and cardboard mill (RPCM) wastewater treatment through the isolation and identification of full-scale RPCM indigenous bacteria. The molecular characterization of the isolated bacteria was performed by 16S rRNA gene sequencing. Klebsiella pneumoniae AT-1 (MZ599583), Citrobacter freundii AT-4 (OK178569), and Bacillus subtilis AT-5 (MZ323975) were dominant strains used for RPCM wastewater bioremediation experiments. Under optimal conditions, the maximum values of chemical oxygen demand (COD) and color biodegradation by C. freundii AT-4 were 79.54% and 43.81% after 10 days of incubation, respectively. In the case of B. subtilis strain AT-5 and K. pneumoniae AT-1, the maximum values of COD and color biodegradation were 70.08%, 45.96%, 71.26%, and 32.06%, respectively. The results from optimal conditions regarding efficiency were higher in comparison with the efficiency obtained from the oxidation ditch treatment unit in full-scale RPCM-WWTP. Therefore, the present study introduces the isolated indigenous bacteria strains as a promising candidate for improving the RPCM-WWTP efficiency using bioremediation.

Purpose: In this paper, the competition for the collection of electronic and electrical waste between the manufacturer and the retailer has been discussed to recover them, taking into account the improvement of the quality and greening of the collected products to increase the level of customer satisfaction and increase profits, and reducing dangerous effects on the environment. For this purpose, a closed two-loop supply chain has been designed with three models. A centralized model has been considered for cooperation in the collection channel of the entire chain with the integration of the manufacturer and retailer and two decentralized models for competition in the collection of returned products between the manufacturer and retailer with two scenarios. In the first scenario, the impact of improving the quality and greening of manufactured products of a decentralized two-person model has been analyzed, consisting of a manufacturer and a retailer, and its performance compared to a centralized model. In the second scenario, the profits-sharing agreement between a retailer and a manufacturer has been used in the decentralized model. Design/methodology/approach: The decisions of product quality improvement have been investigated in a simple dynamic environment and consumer preferences have been considered for new and remanufactured products as a performance of new product quality. In the developed model, the topic of quality and greening has been given, and the demand functions and profit functions have been written accordingly considering two demand functions for the manufacturer and retailer, and also two profit functions for the manufacturer and retailer. Mathematica software has been used for solving problems and also graphs related to sensitivity analysis. The discussion has been drawn and the analysis related to the profit functions of the manufacturer and the retailer has been done regarding the parameters. Findings: The results indicated that the manufacturer preferred to work with the retailer in a non-competitive manner. The retailer used the first scenario because due to its profit. The retailer’s profit was more concentrated in the second scenario. The proposed approach was suggested to be applied to multiple manufacturers and retailers in future studies. It was also recommended to consider the storage and inventory costs for the collection products and to estimate the duration in which, they can stay in the manufacturer's warehouse with no costs increase. Another suggestion was to consider the demand with different functions or with a stochastic variable. Research limitations/implications: The limitations of this research are: i) determining the quality level of collected products; ii) the location for remanufacturing by the manufacturer and recycling by the retailer; iii) sales estimate; iv) forecasting the number of products and types of products that have been collected; v) estimating consumer demand for remanufactured products; and vi) grading the greening of the collected products. Practical implications: In general, economic profitability is considered the main driving factor for the entry of original equipment manufacturers and independent remanufacturers of the remanufacturing industry. According to the results, manufacturing companies can remanufacture the valuable wastes after retailers collected them and then determine their quality level. By increasing the quality and production of greening products, they have entered the competitive market and have offered products at a lower cost and more profit, when a centralized model was used. Social implications: In today's society, one of the important issues is environmental sustainability. In this regard, the remanufacturing of returned products and the greening of products by the manufacturer have reduced the use of raw materials, saved energy, and reduced air pollution. In this paper, the subjects of competition for the collection and recycling of electronic and electrical waste (i.e, medical equipment, lighting devices and lamps, all kinds of audio and video equipment, IT equipment and household electrical appliances) between the manufacturer and the retailer, the improvement of the quality and greening of the collected products to increase the level of customer satisfaction/profits, and reducing dangerous effects on the environment were discussed. Originality/value: This study contributed to the quality improvement of returned products and greening products. Based on this research, product quality decisions are investigated in a simple dynamic environment, and consumer preferences for new and remanufactured products are considered as a function of new product quality. In summary, this research has examined the interactions between improving the quality of remanufactured products and greening.

Introduction: One of the most complex problems of elders is the balance problem and the increased risk of falling. Body percussion is an effective treatment for various diseases with cognitive, physical, and psychological deficits and improves the memory, motor, and coordination skills, as well as the social interaction of patients with neurological diseases. One of the problems in the elderly is the weakness in balance skills and falling. This study aimed to investigate the effect of body percussion exercises (BPE) on the balance of the elderly. Materials and Methods: This study was carried out as pretest-posttest research with two experimental and control groups. A 12-session therapeutic program was implemented 3 days a week each for 45-60 minutes. The subjects were evaluated using the Berg balance scale, functional reach, and timed up and go (TUG) tests. Data were analyzed by paired and independent t tests. Results: The results of the treatment group showed a significant effect of BPE on the balance (P

Abstract Objective Early marriage has many deleterious effects on the health of girls, such as sexual dissatisfaction, an inevitable result of the lack of sufficient knowledge about sexual issues at the time of the marriage. The goal of the present study was to determine the effectiveness of counseling based on functional analytic psychotherapy with enhanced cognitive therapy (FECT) on the sexual quality of life of married adolescent women. Methods This clinical trial was conducted between July and October 2019 on 150 married adolescent women who met the inclusion criteria. In the intervention group, FECTwas conducted in sixteen 90-minute sessions twice a week. The Sexual Quality of Life-Female (SQOL-F) questionnaire was used. When the study ended, the control group was given the choice of receiving the same intervention as the intervention group. Results The paired t-test showed a significant difference between the mean score of sexual quality of life before (52.33±23.09) and after (88.08±10.51) counseling in the intervention group (p

Background: Emergency personnel are frequently exposed to high-risk physical and psychological factors that lead to increased occupational stress. Objectives: This study aimed to evaluate the effect of aromatherapy with rosa damascena essential oil on nurses' occupational stress in the emergency department. Methods: This randomized controlled trial was conducted among sixty nurses in the trauma center of Besat Hospital, Tehran. The participants were selected by the convenience sampling method, and then randomly assigned to the aromatherapy with essential oil of Rosa damascena and control groups. Intervention in the experimental and control groups consisted of inhalation cotton swabs impregnated with two drops of essential oil of 40% Rosa damascena (Gole Mohammadi) and cotton soaked with two drops of distilled water as a placebo for 2 minutes, respectively. Nurses' stress level was assessed by the Nursing Stress Scale before and after the intervention. To analyze the data, independent t-test, paired t-test, and ANCOVA were performed in SPSS, version 22. Results: The mean age of the nurses was 29.07 ± 5.495 years, and the majority of them had a bachelor's degree. The results of this study showed that stress scores in the experimental group were lower than those in the control group after the intervention (p

Abstract Background Type 2 diabetes can negatively impact long term health outcomes, healthcare costs and quality of life. However, intensive lifestyle interventions, including the Diabetes Prevention Program (DPP), can significantly lower risk of incident type 2 diabetes among overweight adults with prediabetes. Unfortunately, the majority of adults in the US who are at risk of developing diabetes do not engage in DPP-based lifestyle change programs. Increased adoption of evidence-based obesity and diabetes prevention interventions, such as the DPP, may help large employers reduce health risks and improve health outcomes among employees. In 2018, the University of California Office of thePresident (UCOP) implemented the UC DPP Initiative, a novel, multi-component program to address diabetes and obesity prevention across the UC system. Methods The goal of our study is to conduct a multifaceted evaluation of the UC DPP Initiative using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Our evaluation will integrate unique and diverse UC data sources, including electronic health record (EHR) data, administrative claims, campus-based DPP cohort data, qualitative interviews and site visits. Our primary outcome of interest is the mean percent weight change among three groups of overweight/obese UC beneficiaries at risk for diabetes at 12-month follow-up. Secondary outcomes include mean percent weight change at 24-month follow-up, barriers and facilitators associated with implementatio, as well as the degree of program adoption and maintenance. Discussion Our study will help inform diabetes and obesity prevention efforts across the UC system. Findings from this evaluation will also be highly applicable to universities and large employers, as well as community organizers, healthcare organizations and insurers implementing the DPP and/or other health promotion interventions.

Background: In operating rooms, blood product wastage occurs with various reasons especially over-demand ordering during elective surgeries. Consequently, it imposes a heavy financial burden on health system. Therefore, managing blood consumption in the operating rooms is of special importance. Surgeons and anesthesiologists play a key role in blood transfusion practice in operating rooms. Objective: To investigate surgeons´ and anesthesiologists´ perspectives in regard to the effective strategies for better management of blood transfusion practice in operating rooms. Method: In this qualitative cross-sectional study, from January to March 2020, 60 surgeons and anesthesiologists were participated. All of them were working in surgical departments of the general hospitals affiliated with Shiraz University of Medical Sciences, in Shiraz, Southern Iran. Their viewpoints regarding the improvement of blood consumption management in operating rooms were recorded through interviews and several focus group sessions. Results: After content analysis, the most important recommendations with the highest scores were regular training programs for surgical team (23.3%), collaboration of surgeons, anesthesiologists, and managers of the surgical departments by arrangement of monthly meetings to estimate the number of required blood bags more accurately (23.3%), establishing a well-organized electronic requesting and registration system (13.3%), promoting the ordering process by a comprehensive preoperative evaluation (11.6%), and updating transfusion protocols based on the standards and monitoring the adherence to these standards (10%). Conclusion: Implementing the proposed policies, which are based on the invaluable experiences of related experts would be effective in improving blood consumption management in operating rooms.

Abstract Endocrine disrupting chemicals (EDCs) are organic compounds that have estrogenic activity and can interfere with the endocrine system. Bisphenol-A (BPA) is one of these compounds which possess a potential risk for breast cancer. The aim of this research was to evaluate BPA concentration in both the urine and breast adipose tissue samples of breast cancer mastectomy and mammoplasty patients and study correlations of BPA levels in breast adipose tissue with urine samples in the both groups. Urine and breast adipose tissue samples from 41 breast cancer mastectomy and 11 mammoplasty patients were taken. BPA concentrations were detected using an ELISA assay. Urinary BPA concentrations were significantly higher in cancerous patients (2.12 ± 1.48 ng/ml; P

Abstract Background and objective Saving blood products is an important public health issue especially in developing countries with limited financial resources. We aimed to suggest a new hypothetical model to make a change in the current blood transfusion policy in the newborn intensive care unit (NICU) to reduce wastage of blood supplies as well as the risk of exposure to multiple donors. Methods In this cross-sectional study, all transfused neonates (n = 70) who were admitted to NICU of Nemazee Hospital, a tertiary referral hospital in Southern Iran, were evaluated between March and June 2019. Based on the information of neonates’ transfusion during this study period and determined transfusion indices, a specific pediatric pack was suggested and the related total costs per transfusion, as well as the donor-exposure rate of the hypothetical and the current transfusion method, were compared. Results Considering the mean number of transfusions per neonate: 4 and mean volume of transfused packed red cells: 20 ml per transfusion, the cost-analysis of pediatric and the adult pack was presented. Arithmetically, we proved a higher total cost per transfusion for using adult pack comparing to pediatric pack. Additionally, using a pediatric pack set leads to a 24% reduction in RBCs wastage per transfusion and a 68.13% reduction in donor-exposure rate. Conclusions The assignment of a dedicated pediatric pack for neonates will be able to improve the cost-effectiveness by a substantial reduction in donor-exposure rate and blood wastage. This finding should be taken into consideration to generate economic growth and make improvements in child health status.

Introduction: With regard to the importance of the environment in sustainable development along with environmental literacy among citizens, the present study aimed to assess the levels of environmental literacy among citizens residing in the city of Yazd, Iran. Methods: In this descriptive--analytical study, the sample size was determined based on the Cochran formula of 410 individuals. The data selection tool was also a researcher-made questionnaire comprised of items on demographic characteristics information as well as levels of awareness, attitudes, and practices concerning the environment such as air pollution, waste management, etc. Face validity verified by 10 qualified individuals as the faculty members and Reliability was confirmed by Cronbach’s alpha coefficient of 0.93. The collected data was analyzed using the SPSS 22. In this study, significance level was considered as 0.05. Results: awareness score was statistically significant in terms of age, level of education, and employment status (p0.05). Moreover, a positive correlation was found between awareness, attitude, and practice scores (0.323≥ r ≥0.28, p

Objective: To investigate the effects of sesame oil extracted from tahini (Ardeh) on pain severity in patients with upper or lower limbs trauma. Methods: This double-blinded randomized clinical trial study was conducted on 120 patients with upper or lower trauma in Shahid Rajaee Hospital, Shiraz, Iran, from May the 1st through November 30th, 2016. The patients were randomly assigned to two groups using block randomization. The intervention group received topical sesame oil extracted from tahini (Ardeh) and the placebo group received cooking oil. Pain severity, pain sensitivity and heaviness of painful site were assessed. Results: Overall, we included 90 patients with traumatic limb injuries in this study who were randomized to two study groups. The mean age of the patients was 28.3 ± 6.8 (ranging from 25 to 35) years and there were 63 (70%) men and 27 (30%) women among the patients. In the sesame oil group, the mean changes in the pain severity (-1.53 ± 0.57, P Conclusion: Our findings suggest that the topical use of sesame oil extracted from Tahini has a pain reliever effect on the skin after bruising and it helps prevent skin discoloration in patients with traumatic injuries of limbs. Clinical Trial Registry: IRCT20171017036838N1

Introduction: Planning in the field of medical tourism is of particular importance. The main objective of this research was to identify and analyze the factors affecting the growth of medical tourism in Iran. It could be a small step toward promoting entrepreneurship and increasing non-oil revenues in the country. Methods: Studies published in the Persian and English language during the years 2006-2019 in Science Direct, ProQuest, Springer, Medline, Scopus, Ovid, and SID databases were reviewed, and the findings were then compared. Results: A total of 75 articles out of 2631 unique publications were included in this study. Most articles reported studies performed for all patients, including the whole country (Iran) (n=22, 30%), Shiraz only (n=11, 15%), Tehran only (n=11, 15%), Mashhad only (n=6, 8%), Isfahan only (n=5, 6%), and Ardabil only (n=4, 5%). Conclusion: Given the history of Iranian hospitals in attracting foreign patients and the analysis of their status, there are many limitations in achieving a proper standing in the medical tourism industry. Strategies offered by various managers and authorities in tourism can lead to increased attraction of medical tourists to public and private hospitals in Shiraz, relying on the capabilities and potential of Shiraz and its health sectors, including climate and nature, cultural and historical attractions, renowned practitioners, advanced equipment, facilities, and methods, and thereby generating more foreign exchange earnings and employment.

Background: As research involving human participants increasingly occurs with the aid of digital tools (e.g., mobile apps, wearable and remote pervasive sensors), the consent content and delivery process is changing. Informed consent documents to participate in research are lengthy and difficult for prospective participants to read and understand. As the consent communication will need to include concepts and procedures unique to digital health research, making that information accessible and meaningful to the prospective participant is critical for consent to be informed. This paper describes a methodology that researchers can apply when developing a consent communication for digital health research.Methods: A consent document approved by a US institutional review board was deconstructed into segments that aligned with federal requirements for informed consent. Three researchers independently revised each segment of text with a goal of achieving a readability score between a 6–8th grade level. The team then consulted with an external readability expert well-versed in revising informed consent documents into “plain language.” The resulting text was evaluated using Microsoft Word and Online-Utility accessibility software. The final step involved adding visual images and graphics to complement the text. The Digital Health Checklist consent prototype builder was then used to identify areas where the consent content could be expanded to address four key domains of Access and Usability, Privacy, Risks and Benefits, and Data Management.Results: The approved consent was evaluated at a 12.6 grade reading level, whereas the revised language by our study team received 12.4, 12, and 12.58, respectively. The final consent document synthesized the most readable of the three revised versions and was further revised to include language recommended by the software tool for improving readability, which resulted in a final revised consent readability score of a 9.2 grade level. Moreover, word count was reduced from 6,424 in the original consent to 679 in the rewritten consent form.Conclusion: Utilizing an iterative process to design an accessible informed consent document is a first step in achieving meaningful consent to participate in digital health research. This paper describes how a consent form approved by an institutional review board can be made more accessible to a prospective research participant by improving the document readability score, reducing the word count and assessing alignment with the Digital Health Checklist.

Introduction: A large amount of pesticides is used worldwide in different locations including homes. Considering that using pesticides in the home is mainly done by women, this study was conducted to determine the knowledge, attitudes and practices of women regarding health hazards and proper methods of storage and use of pesticides in the home in Abarkouh. Materials and Methods: In this descriptive study, data were collected using cluster sampling and questionnaire by interviewing 210 eligible women in households. The questionnaire was included demographic information (age, education level, field of study, occupation, type of home), as well as knowledge, attitudes and practices of women. Validity and reliability of the questionnaire have been confirmed in previous studies. Data were analyzed by SPSS using nonparametric tests. Results: According to results, the mean score of attitude among different academic disciplines was statistically significantly (p = 0.049). In addition, there was a significant relationship between attitude score with practice (p = 0.003) and knowledge (p < 0.0001) scores. Conclusion: Considering the fact that people's knowledge about this subject was moderate, their knowledge should be increased to make their attitude and practice more desirable.

Background: Autism spectrum disorder (ASD) is a pediatric heterogeneous psychiatric and neurodevelopmental disorder with social and communication deficits, language impairment and ritualistic or repetitive behaviors. ASD has significant genetic bases but candidate genes and molecular mechanisms of disorder are not clarified. Neuregulin1 (NRG1) gene, located in 8p12 is involved in development of central nervous system and was indicated as candidate gene in schizophrenia. Methods: mRNA level of types I, II and III of NRG1 gene were studied in peripheral blood of 1540 ASD patients (IQ > 70) and 1490 control children by quantitative Real Time PCR. Also three domains of executive functions (working memory, response inhibition and vigilance) were examined in all subjects. Findings: All three types were significantly down regulated in ASD patients. Significant deficiencies in executive functions (EF) were found in ASD patients. EF deficiencies mostly were associated with down expression of mRNA level of types I and III. Also correlations were found between NRG1 expression with gender and severity of ASD symptoms. Interpretations: Findings primarily have been suggested involvement of NRG1 in etiology of ASD. Also correlation of NRG1 mRNA level with EF deficiencies could shed lights on EF mechanisms and may suggest targeted treatments to improve particular executive functions. Fund: Young researchers and elites club funded the project due to the annual grant of special talents of Club that gave to Arvin Haghighatfard. Keywords: Autism spectrum disorder, NRG1, Gene expression, Executive functions

Background: Reduction of errors is necessary to improve the quality of healthcare, promoting communication between the hospital staff and patients, and decreasing the patientchr('39')s complaints in hospitals. Due to the high probability of error in the operating room (OR), this study aimed to detect the potential errors in the OR of Nemazee hospital using FMEA. Materials and Methods: This study was a qualitative one which assessed Failure Mode and effects of OR in six steps using FMEA technique. At First, the OR activities were listed, then the failure modes were recognized. Next, the Risk Priority Number (RPN) of each error was calculated according to the indicators of Occurrence (O), Severity (S) and Detectability (D). Results: Totally,204 failure modes in 36 activities in five process in surgery ward were recognized.15.7 percent of failure modes classified as high risk factors (RPN ≥ 100). The most and the least distribution of origin factors were related to human and organization and technical errors, respectively. Conclusion: The majority of errors in OR was set in of human skills category. Besides, the most and the least failure modes were belonged to “patient anesthesia by circular activity number 20, RPN=1795.23)” and “not to oxygenation for patients (the activity number 36, RPN=99.33) respectively. Identification of 36 activities and 204 errors in the 5 processes of Operating Room represents the comprehensiveness of HFMEA method in the identification, classification, evaluation and analysis of the health system errors.

Background and Objectives: Evaluating higher education is a systematic process for identifying student’s progress in order to reach predefined goals. In this study we aimed at evaluating educational program of Bachelor of Sciences in health services management using CIPP model in Tabriz. Material and Methods: A descriptive-analytical study was conducted with the sample size of 94 people, of which 18 were faculty members, 55 were students and the others were graduated. A questionnaire was used to collect data which its validity and reliability were confirmed in Kerman University of Medical Sciences. We used SPSS software and descriptive and analytical statistics to analyze the data. Results: Total scores of the studied curriculum in aspects of context, input, process, and product were 64.96, 64.11, 63.45, and 63.97 percent, respectively. Generally, the curriculum was assessed as partly appropriate. Conclusion: It seems that considering revision in some lessons and putting the major focus on teaching skills can improve the utility of the curriculum.

Objective: Acne vulgaris is a disease of pilosebaceous unit with multifactorial pathogenesis and threats patients' social functioning. There is a growing research to find faster, more effective, and easy to use treatments. The aim of this study is to evaluate the efficacy of benzoyl peroxide 5% (BP) with and without concomitant intense-pulsed light (IPL) therapy in mild-to-moderate acne vulgaris. Methods: In this controlled trial, 58 eligible patients with mild-to-moderate acne and Fitzpatrick skin phototype III and IV were randomly allocated to two groups. All patients were asked to use a thin layer of BP every night. The IPL therapy was administered at the end of first, 2nd, and 3rd months. Acne Global Severity Scale (AGSS), Acne Severity Index (ASI), and total lesion counting (TLC) along with patient satisfaction were recorded. Patients were also examined 1 month after the final therapeutic visit. Findings: The IPL group showed greater reduction in AGSS (P < 0.001) and TLC (P = 0.005) than the control group. However, the difference in ASI was not significant (P = 0.12). Patients in IPL groups were more satisfied than control group (P < 0.001). Conclusion: Adding IPL to BP can result better response to BP alone. In acne treatment, combination therapy such as IPL and other topical agents should be kept in mind.

Abstract Background: Carbon tetrachloride is one of the chemical toxins, disturbing bone marrow texture and changing the serum blood proteins. In this study, the protective effect of Avicennia marina leaf extract on bone marrow texture of rats induced by carbontetrachloride is investigated. Materials and Methods: 42 male rats were divided randomly in to 6 groups: group induced by CCl4 (carbon tetrachloride 1:1 with olive oil, 2 ml/kg single dose, i,p), sham(taking olive oil, 2ml/kg i,p single dose) and control (taking normal saline, 2ml/kg, i,p single dose ). Treated groups (1,2 and3): induced by carbon tetrachloride 1:1 with olive oil, 2ml/kg single dose and then after two hours treated by 200mg/Kg, 400mg/Kg and 800mg/kg AME /day for 96 hrs, i,p) After the examination the blood samples were collected from heart directly and WBC and blood proteins such as Albumin, total protein separation of serum and Sections sternum bone were analyzed. Data were analyzed by ANOVA and statistical significance differences were accepted at(p

Introduction: Nurses are one of the largest providers of health and treatment services in the healthcare setting. A well-designed information system is one of the necessities for nurses. For this purpose, a proper evaluation of available systems is needed. The aim of this study to evaluate nurses’ perspectives on nursing information systems in hospitals of Tabriz University of Medical Sciences. Methods: This is a cross-sectional study. Two hundred and seventy-five nurses participated in this study. The evaluation instrument was HIS-monitor and 41 specific questions that were related to nurses in four criteria were selected. The validity of the questionnaires was confirmed by experts and the reliability of the instrument was calculated by Cronbach Alpha (α =0.88). Data were analyzed by SPSS Statistics version 16 using descriptive and analytic statistics. Results: 50.8% stated that the studied NIS supports nursing admission process well or very well and 47.7% believed that these NISs improve access to patient-related information and documentation of nursing care (48.1%) .25% evaluated the function of NIS in the nursing care plan poor or very poor. Conclusion: According to the results, the status of nursing information systems is approximately acceptable and more attention is needed in designing and manufacturing hospital software.

Introduction: Patient satisfaction is crucial to the long-run success in health care center. With regard to the highest patients’ referral to the emergency department and the existing challenges due to the patient’s need to urgent care, we aimed to evaluate health care services quality in this unit to find out whether the patients have different expectations from health care providers and if they perceive some dimensions of care more important than others. Method: The SERVQUAL scale method was used in this cross-sectional study on 100 patients in June 2015. Patient satisfaction questionnaire based on SERVQUAL model was evaluated with high content validity and the reliability was 0.97 and 0.81. The data collected were analyzed using SPSS, version 20.0 (IBM, USA). Statistical analyses included descriptive statistics, paired and independence sample t-test and ANOVA at the significance level 0.05. Results:The results showed that the quality gap in all dimensions was significant (P

Background: The subjectschr('39') demographic characteristics are factors influencing their viewpoints about healthcare quality and have a positive association with the clients’ satisfaction. This study aimed at investigating the role of demographic variables on medical touristschr('39') viewpoints about service quality of hospitals in Shiraz. Materials and Methods: This descriptive-analytical and cross-sectional study was conducted on 200 foreign patients who referred to Shiraz hospitals during the first six months of 2013. Data collection tool was a questionnaire consisting of two parts. In the first part, medical touristschr('39') information was collected and in the second part, their expectations and perceptions of services quality were measured using adapted SERVQUAL scale. The validity was checked out by experts and reliability confirmed by Cronbach’s Alpha test for expectations and perceptions separately (90% and 89%). Finally, data analyzed through SPSS v.16 software using independent t-test and ANOVA. Result: According to the results, the mean score of the quality gap was estimated -0.26 for people over the age of 50 years, as it was lower than other groups. Also, the lowest total values of this quantity were related to the individuals with low level of literacy and those who stayed less than 7 days for treatment which were estimated -0.32 and -0.36 respectively. In addition, based on statistically significant dimensions, married tourists, people from Oman and those who had received eye surgery had lower gap mean score than the other patients as their total values were estimated -0.42, -0.21 and -0.22, respectively. Conclusion: In order to develop the medical tourism industry, the demographic characteristics of the subjects should be considered in policy making and service design which can be result in majority satisfaction.

Introduction: Medical tourism is one of the branches of the tourism industry and, due to its low cost vs. high ‎income, many countries seek to maximize their competitive resources in order to develop this ‎industry. Moreover, improving service quality is considered a key factor in gaining medical ‎tourists' satisfaction. In Iran, Shiraz is one of the main destinations of medical tourists; therefore, ‎the present study aimed to determine medical tourists' expectations and perceptions of the ‎quality of services provided by hospitals in Shiraz, Iran. Methods: The current study is an analytical,‎‏ ‏applied,‎‏ ‏and cross-sectional study which‏ ‏was carried out in ‎‎2013. The study population‏ ‏consisted of 200 medical tourists who referred to hospitals in Shiraz (Ordibehesht, Doctor Khodadoust, Pars, Madar and Koudak, and Markazi‏ ‏and Dena). In order ‎to‏ ‏collect‏ ‏information, an adaptation of the SERVQUAL questionnaire‏ ‏was used. The validity of ‎this questionnaire was approved by experts and its reliability was confirmed separately for ‎expectations and perceptions using Cronbach’s alpha (90% and 89%, respectively).‎‏ ‏Data‏ ‏were ‎analyzed‏ ‏using‏ ‏paired t-test in SPSS software. Results: The findings of this study showed negative gaps in all dimensions of quality. Overall quality gap ‎was estimated to be -0.38. The largest gap pertained to the dimension of reliability (-0.6) and‏ ‏the ‎smallest‏ ‏was related to‏ ‏the dimension of access‏ ‏ to‏ ‏care (-0.08). Conclusion: The present study showed that the‏ ‏quality of services‏ ‏did not‏ ‏correspond to medical tourists’ ‎expectations‏ ‏and needed improvement. Moreover, improving the reliability aspect of the services provided by hospitals can be an effective factor in increasing the satisfaction of medical tourists.

Introduction: Medical tourism is a main source of national income. Thus, evaluating the viewpoints of medical tourists about the quality of service provided by healthcare centers may be useful in planning to develop this industry. The present study aimed to measure the gap between medical tourists' expectations and perceptions of the quality of service offered by the hospitals in Shiraz using the SERVQUAL model. Methods: This cross-sectional study was performed on 200 medical tourists referred to hospitals in the city of Shiraz which is located in the south of Iran. The subjects were selected randomly over the first 6 months of 2013. Data collection tools were a descriptive questionnaire and an adaptation of the SERVQUAL questionnaire. Results: The results showed that the mean age of medical tourists was 49.67 and most of them were from Oman. Overall, the patients' expectations exceeded their perceptions of the provided quality of service, and all gap mean scores were negative. The largest negative gap score pertained to reliability with an overall average of -0.59, followed by responsibility, assurance, tangibility, empathy, and access to care. Conclusion: The research findings can effectively help managers identify problems with the current quality of service and improve performance so as to increase the medical tourists' satisfaction level. Also, highlighting the most important service attributes, which are highly attractive to patients, will help authorities improve their operation performance and develop innovative ideas on both strategic and tactical levels.

Introduction: Hearing loss from birth up to the age of 3 years has a negative effect on speech/language development and results in sensory, cognitive, emotional, and academic defects in adulthood by causing delayed development of communicative-linguistic abilities. The present study was performed in order to assess the effect of early intervention on language development in Persian children aged 6-7 years with severe sensorineural hearing loss. Materials and Methods: Thirty boys and girls aged 6-7 years participated in this study, all of them had severe congenital sensorineural hearing loss in both ears. All children were using bilateral behind-the-ear hearing aid, and had similar economic/socio-cultural backgrounds. Subjects were categorized into two groups based on the age of identification/intervention of hearing loss (3-6 and 12-15 months of age). The Persian TOLD-P3 test was used to evaluate language development in all subjects. Data collection was accomplished by observation, completion of questionnaires, and speech recording. Results: There was a significant difference in language development in 11 sub-tests and five lingual gains on the Persian TOLD-P3 test between early (3-6 months of age) and late identified/intervened (12-15 months of age) hearing-impaired children (P

To test whether the negative relationship between perceived stress and quality of life (Hypothesis 1) can be buffered by perceived social support in patients with dementia as well as in caregivers individually (Hypothesis 2: actor effects) and across partners (Hypothesis 3: partner effects and actor-partner effects).A total of 108 couples (N = 216 individuals) comprised of one individual with early-stage dementia and one caregiving partner were assessed at baseline and one month apart. Moderation effects were investigated by applying linear mixed models and actor-partner interdependence models.Although the stress-quality of life association was more pronounced in caregivers (β = -.63, p

Background: Reactive dyes have extensively been used in textile industries, the effluence of the waste containing such dyes into water resources can pose hazardous effects on the environment and to the human health because of their carcinogenic, mutagenic, allergenic and toxic nature. The present research was performed to study the efficiency of residues of Rosa Damasena powder in removing Reactive red 198 dye from aqueous solutions. Methods: In the present experimental study, effects of various operating parameters such as pH (4-10), initial concentration of dye (25 and 50 mg/L), contact time (15-180 mines) and adsorbent dosage (0.2-0.6 g/L) were investigated. Results: Result showed that maximum adsorption capacity of the residues of Rosa Damasena powder was 5.19 mg/g at pH 4, contact time of 120 min and adsorbent dosage of 0.4 g/L. Besides, the equilibrium data were also fitted into the Langmuir and Freundlich equilibrium isotherm models which the data better fitted with Freundlich (R2=0.913) model than Langmuir's (R2=0.825). Conclusion: According to results of the present study, it was found that residues of Rosa damasena powder has a high capacity to remove Reactive red 198 dye from aqueous solutions and textile industry wastewater.

Background and Objective: Various industries such as petrochemical, oil refinery, pharmaceutical, plastics, paper, steel and, resin produce a substantial of phenol and its derivatives. Wastewaters containing phenol need careful treatment before discharging into the environment due to their poor biodegradability and high toxicity. The objective of this study was to remove phenol by multiwall carbon nanotubes from aqueous solution. Materials and Methods: Adsorption process was implemented in a laboratory-scale batch with emphasis on the effect of various parameters such as contact time (5 to 120 minutes), pH (3- 11), initial concentration of phenol (5 - 50 mg/l) and the sulfate and chloride ions (20 - 200 mg/l) on adsorption process. To achieve a better realization of adsorption process, sorption kinetics and equilibrium isotherms were also determined. Results: The results indicated that maximum adsorption capacity occurred at concentration 50 mg/L and t =30 minutes. The uptake fluctuated very little in the pH range of 3–9, and at greater than 9 the absorption decreased suddenly. Moreover, the presence of sulfate and chloride ions had no effect on the process. It was found that adsorption kinetics and equilibrium data follow a pseudo-second-order kinetics model and a Freundlich isotherm model respectively. Conclusion: It is concluded that carbon nanotubes being effective in a wide range of pH, short time to reach equilibrium and the absence of competing ions on the absorption process can be used effectively in removing phenol from aqueous solution.

Human cystic echinococcosis (HCE), a zoonotic infection of the larval stage of Echinococcus granulosus, has high effect on public health in human population all around the world. Iran is one of the most important endemic areas in the Middle East. This systematic review and meta-analysis was performed to evaluate the seroprevalence of HCE in Iranian population. An electronic search for articles from 1985 until April 2015 was performed using data bases PubMed, Scopus, Google Scholar, Magiran, IranMedex, Iran Doc, and Scientific Information Database (SID) both in English and in Persian. A random-effects meta-analysis was used to combine results from individual studies. The information was analyzed by STATA version 11.1. A total of 33 articles met our eligibility criteria and were included in a meta-analysis. The pooled estimate of the prevalence of HCE based on random-effects model was estimated 6.0% (95% CI: 4.0%, 7.0%). The prevalence of the disease significantly increased with age and prevalence rate in males was significantly lower than females (p

Recently, the quaternary InGaAsN alloy system has attracted a great deal of attention due to its potential application in devices such as next generation multi-junction solar cells and optoelectronic devices for example laser diodes for optical communications in IR region. In this paper, we have investigated the role of nitrogen on the improvement of optical efficiency in InGaNAs nanostructures by photoluminescence spectroscopy. These characterizations are because of variation of InGaNAs band structure due to existence of nitrogen, and could be explained by using band anticrossing model which is a result of interaction between the extended conduction band of the InGaAs matrix (EM) and the nitrogen-related localized level (EN). The band-gap of InGaNAs is very sensitive to the nitrogen content, so it has decreased by increasing of nitrogen content. Therefore accessibility to emission light wavelength at IR region is controllable. Moreover, nitrogen has created the potential fluctuations in the InGaNAs so it is the cause of trap centers that leads to localized excitons. Thus the probability of exciton recombination has increased and improved optical efficiency of these structures. But in other cases, nitrogen has made fluctuations especially in the common surface of the well and barrier in InGaNAs quantum structures so they increase non-radiative recombination.

Background: Proper structure and function of mammal’s central nervous system (CNS) is based on inborn neuronal function. Sensory experience-based development deeply affects these processes in the critical period. The aim of this study was to investigate the effects of change in visual experience in critical period of brain development on rat’s spatial learning and memory using Morris water maze (MWM). Methods: This experimental study was carried out on 30 Wistar male rats at 45 days old randomly distributed in 3 groups (n=10 for each group); the CO (Control) group was in 12 h light/12 h dark cycle through birth to the end of the study; the LR (Light Reared) group was in complete light (24 hours) and the DR (Dark Reared) group was in complete darkness. Using MWM, the animals learned to find a hidden platform for 4 trials/day at 5 days. After removing platform, spatial memory was tested at day 5 in one trial. The spent time and distance in the correct quadrant measured and analyzed by repeated measure ANOVA test. Findings: In the learning stage, the CO rats spent less time and distance to find the hidden platform than the other groups (P < 0.0001). There was no difference between all groups in probe trial. Conclusion: Change in visual experience impairs rat's spatial learning and spatial memory formation would not been influenced. Key words: Sensory experience, Spatial learning, Spatial memory, Morris water maze, Rat.