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In this paper, we study the one-parameter Lie groups of point transformations that leave invariant the biharmonic partial differential equation (PDE) uxxxx + 2uxxyy + uyyyy = f(u). To this end, we construct the Lie and Noether symmetry generators and present reductions of biharmonic PDE. When f is arbitrary function of u, we obtain the solution of biharmonic equation in terms of Green function. The equation is further analysed when f is exponential function and for general power law. Furthermore, we use Noether's theorem and the 'multiplier approach' to construct conservation laws of the PDE. [ABSTRACT FROM AUTHOR]

Over recent decades, second language acquisition (SLA) researchers have considered attention an important cognitive process mediating second language (L2) learning. The concept of noticing as conscious attention to form has become especially important in the field. The present study explored whether two pedagogical interventions, namely textual input enhancement (TIE) and learners’ output production (LOP), in isolation and in combination, promoted learners’ noticing and learning of English relative clauses (RC). The study was conducted with a sample of 113 freshmen majoring in English language and literature. The participants were assigned to three experimental groups and the control group based on the treatments they received, +TIE+LOP, +TIE-LOP, -TIE+LOP, and -TIE-LOP. Before treatment, all the participants took a test of English RCs as the pretest. Then, the participants were required to read the reading texts including instances of RCs and take note. While the participants in the +TIE groups read the enhanced input, the participants in the -TIE groups received the unenhanced input. Also, the participants in the +LOP groups were required to carry out output tasks, but the participants in the -LOP groups answered comprehension questions. Consequently, the participants took part in think-aloud processes. Finally, the test of RCs was administered again as the posttest. The findings revealed that LOP positively affected the participants’ noticing and learning of RCs. However, TIE was only effective in promoting the participants’ noticing, but not learning, of RCs.

Introduction: Increasing age is one of the most important predictors of mortality among aged population. Therefore, determining the causes of death among older people could be imperative. The purpose of this study was to investigate non-communicable disease mortality among a sample of older people in Iran from 2007 to 2018. Methods: This was a retrospective descriptive study that applied census sampling technique to investigate 1202 Medical Records of older adults (60 ≤ years old) died during 2007-2018 at three hospitals of Khuzestan province, Iran. Data analysis was conducted using SPSS version 24 software. Results: The mean age of participants was 77.4 ± 8.38. Of whom 50.7 % were male. The highest number of deaths were related to the internal ward (41.4%), CCU (29.3%) and ICU (25.6%), respectively. In addition, Angina pectoris, Respiratory disease and Cerebrovascular Accident were the most important cause of death among aged population. Also, the history of hospitalization (87.1%) and cardiovascular disease (82.2%), and hypertension (67.8%) were the prominent risk factors for mortality among aged population. According to chi-squared, there was a significant relationship between smoking and death attributed to cardiovascular diseases among older adults. Conclusion: Angina pectoris, Respiratory disease and Cerebrovascular accident diseases are the most important cause of death among older adults. Prevention and screening programs should be implemented to discern and screen these chronic diseases at the early stage among older people.

water user associations were established for the participation of farmers in water resources management. The purpose of this study is to explain the factors affecting the motivation of farmers’ participation in the Great Karun-Shushtar water user association in Khuzestan province. The study population was all Members of the Great Karoon water user association (N=671). 183 people were selected as the statistical sample using the Bartlett table and a random sampling method was used to collect data from farmers using the questionnaire. The face validity of the questionnaire was confirmed by experts. The reliability of the main scales of the questionnaires’ was examined by Cronbach's alpha coefficients, which ranged from 0.77 to 0.92, indicating the tool of study is reliable. Data analyses were performed using SPSSv24 software. Pearson correlation was used to investigate the relationship between independent and dependent variables and Regression analysis with Inter method was used to explain the factors affecting farmers' participation in water user association. Results indicated a significant positive correlation between motivation and self-identity, social norm, social capital, collective efficiencies expectations, cues to action, perception of partnership, Self-efficacy, and attitude of farmers. The results also showed that the variables of self-identity, cues to action and social capital have effect on the variable of motivation. These variables are able to predict 43% of the variance of motivation. Finally, based on the findings of the research, suggestions were made to increase the incentive of farmers' participation in the water user association.

Buckling restrained braces (BRBs) have a similar behavior under compression and tension loadings. Therefore, they can be applied as a favorable lateral load resisting system for structures. In the performance-based earthquake engineering (PBEE) framework, an intermediate variable called intensity measure (IM) links the seismic hazard analysis with the structural response analyses. An optimal IM has desirable features including efficiency, sufficiency and predictability. In this paper, the efficiency and sufficiency of some traditional, cumulative-based, and advanced scalar IMs to predict maximum interstory drift ratio (MIDR) demand on low- to mid-rise steel structures with BRBs, under near-fault ground motion records having forward directivity, are investigated. The results indicate that most of the IMs contemplated are not sufficient with respect to source-to-site distance (R), for predicting MIDR. It is also demonstrated that decreasing the strain hardening ratio decreases the efficiency of the IMs. In addition, IMM(λ=0.5) and Saavg are more efficient and also sufficient with respect to pulse period (Tp), for predicting MIDR demand on the low-rise steel BRB frames under near-fault ground motions, when compared with the other IMs. In the case of mid-rise structures, PGV and IMM(λ=0.33) are selected as optimal IMs. As a result of the higher efficiency and sufficiency of the selected optimal IMs, the obtained fragility curves calculated applying these IMs, are more reliable in comparison with the fragility curves calculated using other IMs.

Climate change has imposed significant challenges on agriculture sector. This study aimed at identify factors affecting wheat growers' adaptation behavior in face with climate change in Kermanshah County. Study population was all wheat growers' of Kermanshah County (N=30000). Statistical sample was 380 Wheat growers' that determined by Krejcie and Morgan table and a Multi-Stage Cluster Sampling was used to collect data from grower using questionnaire. The face validity of the questionnaire was confirmed by expert. The reliability of the main scales of the questionnaires' was examined by Cronbach Alpha coefficients, which ranged from 0.54 to 0.89, indicating the tool of study is reliable. The results also showed that the variables of profit-orientation, concern, self-efficacy, risk perception, belief and knowledge has direct and indirect effects on the variable positive farm production practices. Collectively, these variables are capable, 38 percent of the variability adap farm production practices. Also the variables of concern, belief and knowledge has direct and indirect effects on the variable positive farm financial management. Collectively, these variables are capable, 22 percent of the variability adap farm financial management. Finally, the variables of concern, self-efficacy, belief and knowledge has direct and indirect effects on the variable positive government programs and insurance. Collectively, these variables are capable, 25 percent of the variability government programs and insurance.

The objectives of this study were 1) to provide an estimate of the value of the intraclass correlation coefficient (ICC) for dental caries data at tooth and surface level, 2) to provide an estimate of the design effect (DE) to be used in the determination of sample size estimates for future dental surveys, and 3) to explore the usefulness of multilevel modeling of cross-sectional survey data by comparing the model estimates derived from multilevel and single-level models. Using data from the United Kingdom Adult Dental Health Survey 2009, the ICC and DE were calculated for surfaces within a tooth, teeth within the individual, and surfaces within the individual. Simple and multilevel logistic regression analysis was performed with the outcome variables carious tooth or surface. ICC estimated that 10% of the variance in surface caries is attributable to the individual level and 30% of the variance in surfaces caries is attributable to variation between teeth within individuals. When comparing multilevel with simple logistic models, β values were 4 to 5 times lower and the standard error 2 to 3 times lower in multilevel models. All the fit indices showed multilevel models were a better fit than simple models. The DE was 1.4 for the clustering of carious surfaces within teeth, 6.0 for carious teeth within an individual, and 38.0 for carious surfaces within the individual. The ICC for dental caries data was 0.21 (95% confidence interval [CI], 0.204–0.220) at the tooth level and 0.30 (95% CI, 0.284–0.305) at the surface level. The DE used for sample size calculation for future dental surveys will vary on the level of clustering, which is important in the analysis—the DE is greatest when exploring the clustering of surfaces within individuals. Failure to consider the effect of clustering on the design and analysis of epidemiological trials leads to an overestimation of the impact of interventions and the importance of risk factors in predicting caries outcome. [ABSTRACT FROM PUBLISHER]

The present study set out to investigate the effect of a newly-developed model of writing instruction in comparison with Swalesian genre approach, and the traditionally-favored product-oriented approach on Academic Writing Motivation of Iranian EFL learners. The devised model was called System-Nested, Genre-Oriented, Structurally-Mediated Model of Writing Instruction. Next, with a quasi-experimental design, three groups of learners received writing instruction via traditionally-favored product-oriented approach (N = 8), Swales’ genre-based approach (N = 8), and the newly-developed model (N = 7). The participants received an academic writing motivation questionnaire prior and subsequent to their treatments as pretest and posttest. The results of ANCOVA revealed that the participants in the newly developed model group outperformed the other two groups on the posttest of writing motivation. Additionally, the learners in the Swalesian genre approach group performed significantly better than those in the product-oriented approach group. Language teachers are encouraged to incorporate the system-nested, genre-oriented, structurally-mediated model of writing instruction or other genre-based models to improve learners’ academic writing motivation.

Background: Metabolic syndrome) MetS( is a complex risk factor which increases the risk of cardiovascular diseases and type 2 diabetes. There are many studies with various populations and results about the prevalence of MetS in Iran; in order to authenticate these studies and have an overall estimation of its prevalence in Iran, performing a meta-analysis seems to be necessary. Objective: This study aimed to investigate the prevalence of MetS and its components in Iran via meta-analysis method. Methods: All associated published papers in national and international journals of PubMed, Scopus, Web of Science, Magiran, Iranmedex, Science Direct, Medlib, and SID databases were searched from January, 2000 to October, 2016. All types of studies, including local and national surveys that reported the prevalence of MetS among healthy populations in Iran were reviewed. The effects of age, sample size and publication date as possible sources of heterogeneity among the study findings was examined by meta-regression. P-values less than 0.05 were considered as significant in heterogeneity tests. All analysis was done by R Ver. 3.2.1 and STATA (version 10). Results: Seventy eligible studies were selected for meta-analysis. The overall estimation of MetS prevalence was 25% (95% CI: 22-29%) based on the Adult Treatment Panel III (ATP III) criteria, 30% (95% CI: 25-36%) according to the International Diabetes Federation (IDF), and 39% (95% CI: 26-52%) based on the Joint Interim Societies (JIS) criteria. The prevalence of MetS was lower in men than in women (26.9% versus 35.7%). The prevalence of various MetS components including High TG (triglyceride), Low HDL-C, High BP and High FBS (fasting blood sugar) was 43%, 54%, 38% and 22% among the adult population. Conclusion: Findings from the present meta-analyses study displayed a high prevalence of metabolic syndrome in Iran, especially in women, which increases with age in both sexes. It alerts health care providers and policy makers to find solutions in order to take action to reduce MetS risk in society.

Background: Visual defects have dramatic effects on health, self-esteem, and educational function of students, and delayed diagnosis will cause complications, like academic failure and psychologic disorders. Objective: The present study aimed to investigate the prevalence of ocular disorders in Iranian students in a systematic review. Methods: We searched databases, including PubMed, SID, Magiran, Google Scholar, and Iranmedex using the following keywords in Persian and English: disorders, vision, amblyopia, refractive errors, astigmatism, student, and Iran with all the possible combinations, important, chief, and sensitive words. Search resulted in 28 articles, conducted during a period from 1996 to 2014 in Iran and their data was analyzed using meta-analysis and random effects model. Heterogeneity of studies was assessed using I2 index, and data was finally analyzed with R Software and STATA (Version 11.2). Results: Total number of subjects in the study was 1,117,274, aged 2 to 18 years. The prevalence of disorders related to amblyopia, refractive error, and strabismus was 8%, 7% and 1%, respectively. The greatest amount of refractive error was related to astigmatism (19%) followed by myopia (17%). Conclusion: According to the study results, the prevalence of visual disorders among Iranian students indicated the critical necessity of screening programs for prevention of visual disorders in this age group

Background: Contamination of hair dyes to heavy metals can threaten consumer's health. We investigated the concentrations of some important heavy metals in hair dyes and evaluates their non-carcinogenic effects. Methods: The most commonly used hair dyes were determined through questioners and 32 samples were collected from the market of Tehran in 2014. The concentration of 10 heavy metals (Fe, Ag, Co, Cr, Mn, Ba, Cd, Cu, Pb, and Al) was determined using ICP-MS. Based on the obtained data from distributed questionnaires and Monte Carlo simulation, the exposure to the evaluated heavy metals was estimated. Besides, using hazard quotient (HQ) and chronic hazard (HI), the risk of non-carcinogenic effects of investigated hair dyes consumption was specified. Results: Results indicated the average concentrations of Al, Ba, and Fe as 0.54, 0.86, and 1.19 mg kg-1 and those of Cd, Cu, and Pb as 0.45, 61.32, and 185.34 µg kg-1, respectively. Pb with HQ of 7.46e-4 had the highest risk and Fe with HQ of 3.4e-6 had the lowest level of risk. Among the investigated dyes, the ones made by Iran (HI=2.8e-4) and the dark brown color (HI=1.93e-4) had the highest level of risk among all the studied samples. Conclusion: Two indices of HI and HQ showed that heavy metal contents in the investigated samples had not probable non-carcinogenic risks for the consumers of these products.

Mandibular canal is the most important anatomical landmark in the body of mandible which always must be considered for implant surgery in posterior mandibular region. Damage to vessels and inferior alveolar nerve that passes through the mandibular canal can cause problems such as hemorrhage and neurosensory disturbances. Damage to the mandibular canal can occur during implant surgery. Depending on the severity of injuries, it would result in temporary or permanent neurosensory disturbances. We have reported a case that mandibular canal narrowing occurred following implant surgery and resulted in anesthetic and hypoesthetic areas in the lower lip. Patient had a history of implant surgery in the region of teeth numbered 30 and numbered 31. The inserted implant failed after 6 years, and reimplantation was done in this area, but due to lower lip numbness in the right side, the second implant was removed, and another implant was inserted in the region of the tooth numbered 32. After 2 years, right lower lip numbness was reported again by the patient. Cone beam computed tomography images showed canal narrowing in the region of the tooth numbered 31 where the second implant was inserted. It seems that the main cause for anesthesia and hypoesthesia in this patient is canal narrowing due to damage during implant replacement and removal.

Multiple sclerosis (MS) is the most prevalent disease caused by the inflammatory demyelinating process that causes progressive nervous system degeneration over the time. Optical Coherence Tomography (OCT) is a non-invasive optical imaging technology, which can measure the thickness of retinal nerve fiber layer as well as the diameter of the macula. The purpose of the study is evaluation OCT findings in two common types of multiple sclerosis. For doing the cross-sectional study, 63 patients with two prevalent types of multiple sclerosis (35 patients with Relapse Remitting Multiple Sclerosis (RRMS) and 28 patients with Secondary Progressive Multiple Sclerosis (SPMS) were evaluated for 6 months. Exclusion criteria of the study were a history of optic neuritis, suffering from diabetes mellitus, hypertension, ocular disease, and the presence of other neurologic degenerative diseases. Then, the thickness of retinal nerve fiber layer (RNFL), as well as thickness and volume of the macula, were measured in the patients using OCT technology. The disability rate of patients was evaluated according to Expanded Disability Status Scale (EDSS). Finally, data was analyzed by means of SPSS software. Overall, 35 patients with RRMS (with mean age of 32.37+10.01, average disease period of 3.81+3.42 and mean EDSS of 1.84+0.45) and 28 patients with SPMS (with mean age of 39.21+9.33, average disease period of 11.32+5.87 and mean EDSS of 5.12+1.46) were assessed and compared in terms of retinal nerve fiber layer and size and thickness of macula. In all of these sections, the thicknesses were smaller in SPMS patients than patients with RRMS. But, there was a significant difference in total thickness (81.82µm versus 96.03µm with P=0.04) and thickness of temporal sector (54.5 µm versus 69.34 µm with P=0.04) of retinal nerve fiber layer and macular size at the superior sector of external ring (1.48 mm³ versus 1.58 mm³ with P=0.03), and nasal sector of external ring surrounding macula (1.53 mm³ versus 1.66 mm³ with P=0.03). No significant correlation was found among rising disability and reduced thickness of macula and optic nervous layer. Based on the study results, it can be said that OCT is a useful method for showing axonal degeneration severity and evaluation of various drugs effects on the course of MS disease, and thus we can change drugs based on OCT findings for achieving best results.

Introduction: In Iran, cancer is the third reason of the death and every year 500,000 new cases were detected, and 14% of all death is related to cancer. The most common system that is affected by cancer (after the skin) is gastrointestinal (GI) system. The purpose of the study is evaluation of the 7 years incidence (2002-2008) of the GI cancers in Ilam province in the west of Iran. Materials and Methods: In this retrospective cross-sectional study, total 307 record health related to the patients affected by the gastro-intestinal system cancer were evaluated after referring to the pathologic centers of the Ilam province and neighboring provinces. Patient's data were recorded from their file based on the standard questionnaire. Result: The mean age ± standard deviation of participants was 63.8+1.5. More than half of participants study was men (58.3%). The prevalence of the esophagus, stomach, small intestine and colorectal cancers was significantly higher in the men than the women (unlike liver cancer) (p

Purpose: In cataract surgery, the defected lens is replaced with an artificial intraocular lens (IOL). The refraction power of this lens is specified by ophthalmologists before the surgery. There are different formulas that propose the IOL power based on corneal power and axial length. Six common formulas is used in this study and the one which minimizes the postoperative error for a specific patient have to be selected. Methods: Refraction is measured three times at most, during six month after surgery and the best result is considered as postoperative refraction for each patient. A Support Vector Machine (SVM) is used to classify the data to two groups based on axial length and corneal power. Each class needs a formula with a specific tendency toward stronger or weaker IOL lenses according to the feature vector. Results: Experimental tests lead to a nearly diagonal confusion matrix which supports the performance of the proposed method strongly. Mean Absolute Error (MAE) is 0.47 which shows 6% decrease in postoperative refraction error compared to the best reported result. Conclusions: In calculating IOL power, we expect stronger IOL powers for eyes having shorter axial length or weaker corneal power. In the contrary, a weaker IOL power is expected for longer axial length and stronger corneal power. But experimental results show that for the first group, formulas proposing weaker powers win the race for decreased postoperative refraction error while for the second group, formulas leading to stronger powers perform better. This shows that these formulas overestimate and underestimate for marginal cases.

Hearing aids (HAs) only partially restore the ability of older hearing impaired (OHI) listeners to understand speech in noise, due in large part to persistent deficits in consonant identification. Here, we investigated whether adaptive perceptual training would improve consonant-identification in noise in sixteen aided OHI listeners who underwent 40 hours of computer-based training in their homes. Listeners identified 20 onset and 20 coda consonants in 9,600 consonant-vowel-consonant (CVC) syllables containing different vowels (/ɑ/, /i/, or /u/) and spoken by four different talkers. Consonants were presented at three consonant-specific signal-to-noise ratios (SNRs) spanning a 12 dB range. Noise levels were adjusted over training sessions based on d' measures. Listeners were tested before and after training to measure (1) changes in consonant-identification thresholds using syllables spoken by familiar and unfamiliar talkers, and (2) sentence reception thresholds (SeRTs) using two different sentence tests. Consonant-identification thresholds improved gradually during training. Laboratory tests of d' thresholds showed an average improvement of 9.1 dB, with 94% of listeners showing statistically significant training benefit. Training normalized consonant confusions and improved the thresholds of some consonants into the normal range. Benefits were equivalent for onset and coda consonants, syllables containing different vowels, and syllables presented at different SNRs. Greater training benefits were found for hard-to-identify consonants and for consonants spoken by familiar than unfamiliar talkers. SeRTs, tested with simple sentences, showed less elevation than consonant-identification thresholds prior to training and failed to show significant training benefit, although SeRT improvements did correlate with improvements in consonant thresholds. We argue that the lack of SeRT improvement reflects the dominant role of top-down semantic processing in processing simple sentences and that greater transfer of benefit would be evident in the comprehension of more unpredictable speech material.

The most common complaint of older hearing impaired (OHI) listeners is difficulty understanding speech in the presence of noise. However, tests of consonant-identification and sentence reception threshold (SeRT) provide different perspectives on the magnitude of impairment. Here we quantified speech perception difficulties in 24 OHI listeners in unaided and aided conditions by analyzing (1) consonant-identification thresholds and consonant confusions for 20 onset and 20 coda consonants in consonant-vowel-consonant (CVC) syllables presented at consonant-specific signal-to-noise (SNR) levels, and (2) SeRTs obtained with the Quick Speech in Noise Test (QSIN) and the Hearing in Noise Test (HINT). Compared to older normal hearing (ONH) listeners, nearly all unaided OHI listeners showed abnormal consonant-identification thresholds, abnormal consonant confusions, and reduced psychometric function slopes. Average elevations in consonant-identification thresholds exceeded 35 dB, correlated strongly with impairments in mid-frequency hearing, and were greater for hard-to-identify consonants. Advanced digital hearing aids (HAs) improved average consonant-identification thresholds by more than 17 dB, with significant HA benefit seen in 83% of OHI listeners. HAs partially normalized consonant-identification thresholds, reduced abnormal consonant confusions, and increased the slope of psychometric functions. Unaided OHI listeners showed much smaller elevations in SeRTs (mean 6.9 dB) than in consonant-identification thresholds and SeRTs in unaided listening conditions correlated strongly (r = 0.91) with identification thresholds of easily identified consonants. HAs produced minimal SeRT benefit (2.0 dB), with only 38% of OHI listeners showing significant improvement. HA benefit on SeRTs was accurately predicted (r = 0.86) by HA benefit on easily identified consonants. Consonant-identification tests can accurately predict sentence processing deficits and HA benefit in OHI listeners.

Introduction: Many studies have shown that the prevalence of celiac disease (CD) is increasing in the patients with irritable bowel syndrome (IBS), but the present evidences are controversy and all of the researches don’t suggest evaluation of the patients with IBS for the CD. Methods: In the cross-sectional study, 1000 patients that affected by IBS with the predominant feature of diarrhea who referred to the gastroenterology clinic were evaluated during 2009-2012 years. Blood samples were taken from the patients for ELISA of IgA tissue transglutaminase (TTG) Ab. Then biopsy was taken from the second part of duodenum of all of patients by endoscopy and the sample was referred to pathologist for histopathology evaluation in order to confirm diagnosis. Results: About half of the patients with IBS were women (50.3%) and the mean age ± Standard deviation of the men and women was 29.59±11.41 and 28.42±11.73, respectively. The mean titer of TTG IgA Ab in the women and men affected by IBS was 5.25±17.77 and 7.22±25.4, respectively. 76 cases (7.6%) that affected by IBS had high serum level of Ab titer (TTG IgA.Ab≥10) that including 41 women and 35 men. In the patients with high serum level of Ab titer, 57 cases (75%) were affected by celiac disease (based on histopathology report). Therefore, the prevalence of CD was 5.7% among patients with IBS. Conclusion: In the current study the incidence of CD was evaluated 5.7 cases per each 100 people with IBS. It’s suggested that all of the patients with diarrhea predominant IBS and high serum level of TTG IgA Ab must be examined for evaluation of CD.

Objective: Sperm analysis is an important step to evaluate and diagnose male’s infertility. The present study aimed to determine associated factors with males’ infertility by using semen analysis. Materials and Methods: In this study 96 men were evaluated who attended to the infertility clinics of Ilam province, western Iran between May 2010 to May 2011. Semen analysis was done using the Weili Dynamic Sperm Analysis software adapted to the WHO classification. Based on movement and speed characters, sperms were classified to either A, B, C or D classes. Participants were stratified into two groups that called “Oligospermia (OS)” with sperm counts of less than 20 million in mL (n=48) and “Non-Oligospermia (NOS)” with values more than determined cutoff point (n=48). Results: The Mean age ±SD for OS and NOS group were 29.9 ±5.1 y and 31.17 ±5.24 y, respectively (p>0.05). Overall, 62.5% of OS and 31.2% of NOS were clinically infertile (OR=3.6, CI, 1.5-8.5, p=0.01). A significant difference was found between job and live ratio(A+B+C) in NOS group (F=2.8, p

Background: Preferred learning styles of learners are different, which depend on tastes, mentality preparedness, as well as physical condition, in terms of sensory modalities. Identifying and employing appropriate learning styles could play an important role in selecting teaching styles, which can improve education ultimately. Aim: The present study aimed to assess the diversity of learning styles amongst medical students of a medical sciences university which was located west of Iran, in 2010. Methods: A cross-sectional study which employed VARK learning style’s questionnaire was done on 141 first year medical sciences students at Ilam University of Medical Sciences in 2010. Data was collected with use of VARK questionnaire. The validity of the questionnaire was assessed on basis of experts’ views and its reliability was calculated by using Cronbach’s alpha coefficients (α=0.86). Data were analysed by using SPSS software and Chi-square test. Results: Overall, 41.6% of the samples preferred to use a single learning style (Uni-modal). Of these, 17.7% preferred the Aural style, 17% preferred Reading and Writing, 6.4% preferred Kinesthetic style and 0.7% preferred Visual styles. Among the rest of the 82 students who preferred more than one style (multimodal), 17% chose two modes (bimodal), 13.5% chose three modes (tri-modal), and 27.6% chose four modes (quad-modal). There was a significant difference between educational levels and majors on one hand and choice of quad modal of VARK styles on the other hand (p=0.008). A significant association was also found between participants’ genders and selection of visual and reading/writing styles (p=0.03). Conclusion: The preferred learning styles of medical students in the present study were aural and reading/writing. It is suggested that all medical students must be tested to determine their desired learning styles by using VARK questionnaire, also to choose appropriate teaching methods and to improve educational goals.

The distal third of the tibia, ankle and heel area is difficult to reconstruct. For small to medium size defects, local flaps are often an easier alternative than free flap. In lower limb surgery, the sural flap is based on this principle and this flap is becoming increasingly popular. The distally based superficial sural artery flap, first described as a distally based neuro skin flap by masquelet et al., is a skin island flap supplied by the vascular axis of the sural nerve. The main disadvantage of distally based sural artery flap is sacrifice of the sural nerve because it is described the concept of neurocutaneus island flap. We describe one case of reverse sural flap without sural nerve .The aim of this paper is to establish the reliability of this flap even without sural nerve.

Systems of care (SOC) is a proven and community-based service network addressing the mental health needs of children and families. Child and adolescent psychiatrists play a crucial role in leading SOCs, utilizing skills such as partnership building and strategic planning. Barriers to mental health care, including access issues and stigma, can be tackled through multisector collaboration. Overcoming challenges such as cultural differences and fragmented systems requires effective leadership. In a SOC, core principles involve culturally competent care, evidence-based practices, collaborative decision-making, and smooth transitions of care. Championing these principles fosters a holistic and supportive environment for those facing mental health challenges., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Public engagement in health research is vital for addressing health disparities and promoting inclusivity among minoritised communities who often face barriers to accessing healthcare. Minoritised communities are groups, which have been made minorities by a dominant culture, race, ethnic group and/or social class and may experience health inequalities as a result. By incorporating diverse perspectives and lived experiences of minoritised communities, this approach aims to achieve contextually relevant research outcomes that reduce health inequalities and improve overall well-being. However, underrepresentation and lack of inclusivity challenges persist, necessitating the establishment of inclusive partnerships and grassroots participatory methodologies., To foster inclusive public engagement, it is important to overcome structural and cultural barriers, address socioeconomic challenges, and build trust with minoritised communities. This can be achieved by promoting a cultural shift that values inclusivity, providing comprehensive training to researchers, and collecting rigorous data on engagement demographics for transparency and accountability. Involving minoritised communities in decision-making through participatory research approaches enhances trust and yields successful outcomes. Additionally, allocating sufficient resources, collaborating in co-production, and prioritising the diverse needs and perspectives of stakeholders contribute to fostering inclusive public engagement in research., Overall, inclusive engagement practices particularly in primary care research have the potential to reduce health inequalities and cater to the unique requirements of minoritised communities, thereby creating more impactful outcomes and promoting equitable healthcare access.

Chronic diarrhea in infants can stem from various etiologies, including congenital disorders affecting intestinal function. Here, we present a case of a one-year-old boy with persistent watery diarrhea, vomiting, and failure to thrive, ultimately diagnosed with DGAT1 deficiency through genetic testing. Despite initial investigations ruling out common causes like celiac disease, genetic analysis confirmed DGAT1 enteropathy. Management included intensive nutritional support and close monitoring, resulting in clinical improvement. This case underscores the importance of early genetic testing and tailored management in congenital enteropathies to prevent severe complications and improve patient outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Mehmood et al.)

Introduction: Remote (digital and/or telephone) access and consultation models are being driven by national policy with the goal being that the National Health Service operate on a remote-first (digital-first) basis by 2029. Previous research has suggested that remote methods of access to care and consulting may act to widen health inequalities for certain patients and/or groups such as those from ethnic minorities. South Asian (SA) patients comprise the largest ethnic minority group in England. Understanding the experiences and needs of this group is critical to ensuring that general practice can deliver equitable, quality health care., Methods: Qualitative study. 37 participants (from Indian, Pakistani and/or Bangladeshi background) were recruited to take part in either in-person preferred language focus groups or remote semistructured interviews in the English language. Thematic analysis was conducted to identify themes in the qualitative data., Findings: Three major interlinked themes were identified: (1) reduced access, (2) reduced patient choice and (3) quality and safety concerns. The findings highlight access issues split by (i) general issues with appointment access via any remote means and (ii) specific issues related to language barriers creating additional barriers to access and care. Some patients valued the convenience of remote access but also raised concerns regarding appointment availability and reduced patient choice. Face-to-face consultations were preferable but less available. The findings underscore how participants perceived remote care to be of lesser quality and less safe. Concerns were greatest for those with limited English proficiency (LEP), with the removal of non-verbal aspects of communication and 'hands-on' care leading to perceptions of reduced psycho-social safety., Conclusion: SA patients' experiences of remote-led primary care access and care delivery were negative with only a minority viewing it positively and for certain limited scenarios. Face-to-face models of care remain the preferred mode of consultation, particularly for those with LEP. Hybrid models of access offer patients the greatest choice, and are likely to meet the varying needs of the South-Asian patient population going forwards. The remote first approach to primary care may be achievable as a service ideal, but its limitations need to be recognised and accounted for to ensure that primary care can be an equitable service, both now and in the future., Public Contribution: Members of the public were involved in all phases of research in the study. This included co-working in partnership throughout the study including, reviewing patient-facing documents, recruiting participants, data facilitation, translation work, interpretation of the data and co-authors on this manuscript. The key to the success of our study was collaborative teamwork, which involved experienced members of the public with SA cultural knowledge working together with and integral to the research team for all components., (© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

A 1995 classification of combined homicide-suicide was based on the psychopathology of the perpetrator and the relationship between the perpetrator and the victim(s). A three-part model was proposed for the study and potential understanding of individual homicide-suicide acts. This triarchic model consisted of the concepts of ego weakness, stress, and vector, the vector representing the ideational component. Today, approaching a quarter of a century after this initial classification based on a review of the literature available then, a considerable volume of experience and investigative knowledge has been published advancing our knowledge of homicide-suicide. The present review updates and revises the original classification, retains the two-part, psychopathological and relational classification, and adds several categories. Because this updated classification is more expansive than the original, it is presented in three parts. Part I, the present article, provides the introduction to this classification and the classification of mental conditions that may attend homicide-suicide. Parts II and III will address intrafamilial and extrafamilial homicide-suicide, respectively, the two major divisions of the classification based on the relationship between the actor and the homicide victim(s). All three parts are integral to this classification and belong together., (© 2023 American Academy of Forensic Sciences.)

The subclassification of homicide-suicide into psychopathology and intrafamilial homicide-suicides having been presented in the foregoing Parts I and II, this Part III concerns extrafamilial homicide-suicides. Extrafamilial homicide-suicides are divided into adversarial, autogenic mass, cult, and terrorist homicide-suicides. Adversarial homicide-suicides involve a "formal" relationship between actor and homicide victims, further divided according to the role of the actor in their relationship as employee, current or former pupil/student as in school shootings, patient, and litigant. For comparison, school shootings were divided into those resulting in 10 or more homicide victims and those with fewer. The autogenic mass homicide-suicide, wherein victims are strangers to the actor, was heuristically bifurcated here depending on the number of homicide victims, 10 or more or fewer. As expected, the homicide-suicides with larger numbers of victims were more homogenous., (© 2023 American Academy of Forensic Sciences.)

This Part II of the three-part presentation of the updated classification of combined-homicide published in the Journal of Forensic Sciences addresses intrafamilial homicide-suicides (H-Ss). Intrafamilial H-Ss in this classification includes all close relationships including dating and intimate partners, not just traditional family relationships, in contrast to extrafamilial H-Ss where the victim(s) of homicide are either strangers or in a more formal but nonintimate relationship with the actor. Intrafamilial H-Ss are further divided and classified as intimate partner, filicide, familicide, parricide, and siblicide H-Ss, respectively, and are typically so grouped in the literature., (© 2023 American Academy of Forensic Sciences.)

Background: Long-term care facilities (LTC) plays a pivotal role in caring for geriatric population. However, the risk of suicide in long-term care institutions among older individuals is little understood (e.g., nursing homes, assisted living facilities)., Objective: The purpose of this systematic review is to pool and meta-analyze the data on prevalence of suicidal behaviors in geriatric population residing in long-term care facilities., Methods: We have conducted the systematic review in accordance with the PRISMA guidelines. The utilized databases are Pubmed, Medline, Google scholar and Scopus. The Meta-analysis was done using OpenMeta [analyst] software. Subgroup analysis was also performed., Results: After running an analysis on pooled data from twenty cross-sectional studies with 3,023,224 participants, the prevalence of suicidal behavior is 6.4% (95% CI = 5.7-7) in LTC., Conclusion: This meta-analysis shows pooled prevalence of suicidal behavior among geriatric residents of LTC was found to be moderately high all over the world., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.