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Abstract This study aims to evaluate the macular and the optic nerve head thickness and vascular profiles in KC patients and compare them with two groups of healthy emmetrope and subjects with myopic-astigmatism. This cross-sectional study was conducted at Khatam-Al-Anbia Eye Hospital between 2022 and 2023. Subjects aged 18 to 40 were prone to be included in the study. The participants in this study were grouped into three categories: emmetrope (E), myopic-astigmatic (MA), and keratoconus (KC). All participants underwent a comprehensive ocular examination, as well as macular and optic nerve head (ONH) optical coherence tomography angiography (OCTA). In this study, 143 subjects, 50 cases in the KCN group, 46 cases in the E group, and 47 cases in the MA group, enrolled. There was no difference between the three groups regarding age (p = 0.123) and gender (p = 0.632). The superficial and deep capillary densities at the fovea, parafovea, and perifovea were significantly lower in KC patients than in the control groups (p

Introduction: Heterologous vaccines enhance the immune response to new variants and allow flexibility in booster administration when the original vaccine is unavailable. Studies show that heterologous boosters can generate comparable or superior antibody responses compared to homologous boosters. Considering rare side effects is essential in evaluating COVID-19 vaccines, especially those associated with ChAdOx1-S (AstraZeneca) and Ad26.COV2.S (Janssen), including blood clotting and idiopathic thrombocytopenia. Severe side effects, such as myocarditis and pericarditis, may occur after Pfizer or Moderna boosters but are rare. Methods: This study administered two vaccines: the Sinopharm inactivated virus vaccine and the Razi-CoV-Pars (RCP) booster. Various evaluations included biochemical markers, coagulation factors, autoimmune antibodies, and antibodies against concerning variants. Results: All 90 participants exhibited a notable rise in antibody levels against the variant of concern (VOC). Participants receiving the Razi-CoV-Pars booster after Sinopharm/BBIBP-CorV showed significantly higher antibody levels (Wuhan ∼ 3.25 times, Delta ∼4 times, Omicron ∼ 14 times) compared to those receiving Sinopharm's homologous vaccine. No significant changes (P:

Summary: Background: Reports of high and rising maternal mortality ratios (MMR) in the United States have caused serious concern. We examined spatiotemporal patterns in cause-specific MMRs, in order to obtain insights into the cause for the increase. Methods: The study included all maternal deaths recorded by the Centers for Disease Control and Prevention from 1999 to 2021. Changes in overall and cause-specific MMRs were quantified nationally; in low-vs high-MMR states (i.e., MMRs

Pregnancy is a challenging time for maintaining quality sleep and managing stress. Digital self-monitoring technologies are popular because of assumed increased patient engagement leading to an impact on health outcomes. However, the actual association between wear time of such devices and improved sleep/stress outcomes remains untested. Here, a descriptive comparative pilot study of 20 pregnant women was conducted to examine associations between wear time (behavioral engagement) of self-monitoring devices and sleep/stress pregnancy outcomes. Women used a ring fitted to their finger to monitor sleep/stress data, with access to a self-monitoring program for an average of 9½ weeks. Based on wear time, participants were split into two engagement groups. Using a linear mixed-effects model, the high engagement group showed higher levels of stress and a negative trend in sleep duration and quality. The low engagement group showed positive changes in sleep duration, and quality and experienced below-normal sleep onset latency at the start of the pilot but trended toward normal levels. Engagement according to device wear time was not associated with improved outcomes. Further research should aim to understand how engagement with self-monitoring technologies impacts sleep/stress outcomes in pregnancy.

Abstract Non-small cell lung cancer (NSCLC) has constituted over 80% of the lung cancer population with a poor prognosis. Over the past decade, immunotherapy has been constructed in the enlargement of immune checkpoint inhibitors as a promising approach for NSCLC treatment. Evading the immune system using the PD-1/PD-L1 axis is an intelligent way for cancers, and T cells cannot respond fully and confront cancer. Recently, the miR-138 was reported as a PD-L1 regulator in NSCLC. However, its inhibitory impact on T-cell exhaustion has not been characterized. The present study aims to impair PD-L1 (B7-H1) expression in Adenocarcinoma cell lines using miR-138-5p and determines how it prevents Jurak cell exhaustion. To gain the purpose, first, 18 highly significant dysregulated miRNAs containing hsa-miR-138 and CD274-mRNA network were detected in NSCLC based on bioinformatics analysis. Moreover, our study revealed a high level of miR-138-5p could make significant changes like PDL1 downregulation, proliferation, and mortality rate in A549/Calu6 cells. We also simulate cancer environmental conditions by culturing Jurak cells and NSCLC cell lines under the influence of stimulator cytokines to show how miR-138-5p survives Jurak cells by targeting PD-L1/PD-1pathway.

The entry of large volumes of industrial effluents containing organic pollutants and dyes into water has made pollution an important issue and led to more attention being paid to advanced oxidation processes for industrial wastewater treatment. Cavitation, due to its ability to produce active free radicals, is a technique that has been considered to increase the efficiency of water and wastewater treatment processes in order to remove organic chemical compounds and decompose pollutants resistant to biological decomposition. The purpose of this research is to use hydrodynamic cavitation to remove the methyl orange dye and optimize the operating parameters for color removal efficiency. For this purpose, cavitation was produced through the use of a pump and an orifice plate with a 4 mm diameter hole, and methyl orange with a concentration of 2 mg/L was tested at each stage. In the following, the effect of operating parameters, including pressure in the range of 0.5 to 6.5 bar, temperature in the range of 8 to 40 °C, pH in acidic, neutral, and alkaline conditions after 135 minutes was determined to achieve the maximum decolonization in optimal conditions. In this study, optimal conditions for achieving the highest removal efficiency (51.7%) were obtained at an inlet pressure of 5.5 bar and a cavitation number of about 0.14 (Ca≈0.14). The results of this investigation showed that the decomposition and removal of methyl orange dye using the hydrodynamic cavitation method is sensitive to the pH of the solution, especially in acidic conditions, which are more suitable conditions for the production of hydroxyl radicals than in alkaline conditions, and has higher efficiency in acidic conditions. Also, increasing the temperature of the solution due to the effect on the saturated vapor pressure will increase the decolonization rate.

This study aims to provide a green process implementation method for treating brine in the desalination system of brackish water with two stages of reverse osmosis. In this study, real samples taken from the first and second stages of the brackish water reverse osmosis (BWRO) plant were utilized to assess the performance of innovative sequencing batch electrocoagulation reactors (SBERs) with complementary processes (addition of chemicals and antiscalants, settling, microfiltration, UV, and ultrafiltration). According to the measurements, the TDS of the brackish water taken from the aquifer ranged from 3,229 to 3,664 mg/L, whereas that of the first-stage RO brine was between 5,500 and 7,700 mg/L, that of the second-stage RO brine was between 9,500 and 10,600 mg/L, and that of tap water was between 278 and 408 mg/L. The results of the study showed that the average removal of TDS, hardness, and ions in direct current (DC) was higher than in alternating current (AC) and that for Al-Al electrodes is more than that for Al-Fe electrodes. For the samples that were taken from the brine to the second stage RO with a TDS level of 9423 mg/L (with an increase in pH to 9 and with a temperature of 11 °C), the amount of TDS removal was 14%, and the amounts of hardness and scaling ions like calcium, magnesium, and sulfate (the amount of sulfate in quantities above 1400 mg/L) were removed equal to 35.5, 29, 35, and 30%, respectively. The TDS can be successfully reduced by electrocoagulation and scale-forming precursor ions can be eliminated by combining electrocoagulation and chemical precipitation.The results of the research showed that the third alternative was more advantageous than the others for the development phase of the desalination system under study after multiple options were analyzed technically, environmentally, and economically. The results of the research showed that the third alternative was more advantageous than the others for the development phase of the desalination system under study after multiple options were analyzed technically, environmentally, and economically.This option will direct brackish water to two RO (one stage)/SBERs processes. The RO desalination plant's brine and the SBER effluent are then combined to provide industrial water or irrigation water for plants that can tolerate salt. This method has been proposed as the best option for desalination system development because it reduces the total volume of rejected brine and increases the water supply (drinking, industrial, or agricultural).

Avian Influenza is a contagious zoonotic disease that can be transmitted from birds to mammals. In this study, we conducted a systematic review and meta-analysis to investigate and summarize the occurrence of avian influenza H9N2 in humans and other mammals in Iran. Data were collected systematically until July 1 2023 from four English and two Persian databases. According to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and inclusion criteria, 14 eligible studies were obtained. Occurrences of AI H9N2 are reported in humans, dogs, and water buffaloes (Bubalus bubalis) in Iran. The pooled prevalence of AI H9N2 using a random model among humans was 0.15 (95% CI, 0.12-0.18). Pooled prevalence using the HI test was 0.16 (95% CI, 0.13-0.20). The pooled prevalence by different cut-offs for the HI test was equal to 0.34, 0.11, 0.02, and 0.01, respectively for cut-offs 1:20 to 1:160. Pooled prevalence using the HI test, among persons with possible exposure, hospitalized persons and hospital staff (0.20, 0.31, and 0.30) was higher than the prevalence in apparently healthy individuals (0.01). The group of individuals with possible exposure revealed the highest pooled prevalence of 0.25 (95% CI, 0.17-0.33) using the HI test. This was observed predominantly in slaughterhouse workers. The pooled prevalence using the ELISA test was 0.27 (95% CI, 0.23-0.31). These results can help policymakers to create prevention and control programs for possible epidemics in the future and can help researchers to tailor the design and objectives of future studies in this area.

BackgroundPhysical activity (PA) confers numerous benefits to health and health care costs, yet most adults are not meeting recommended PA guidelines. Stress may be a factor that influences PA behavior. Research investigating the impact of stress on PA has yielded inconsistent findings. Most studies find that stress negatively impacts PA, but there is some evidence that habitual exercising buffers this association.ObjectiveThis study aims to examine the relationship between stress and exercise habits among habitual exercisers with internet-connected home fitness equipment (Peloton Bike) during the COVID-19 lockdown.MethodsParticipants were recruited through Facebook (N=146) and asked to complete an internet-based survey that assessed COVID-19-related stressors, perceived stress associated with those stressors, and general perceived stress. Self-reported exercise was assessed on the survey using the Godin Leisure-time Exercise Questionnaire (GLTEQ). Participants were also asked for consent to access their Peloton usage data through the Peloton platform. From their usage data, the frequency and duration of cycling classes was calculated for 4 weeks prior to and 12 weeks following the survey. Hierarchical regression equations tested the association between stress reported on the survey and subsequent exercise participation. Exercise participation was quantified both as the frequency and duration of Peloton cycling over the 12 weeks following the survey and as self-reported moderate to vigorous activity on a second survey completed by a subset of participants 12 weeks after the initial survey.ResultsThere were 146 participants in our Peloton analysis sample and 66 in the self-reported exercise analysis. Peloton user data showed that study participants cycled frequently (mean 5.9 times per week) in the month prior to the initial survey, and that presurvey Peloton use was a strong predictor of exercise frequency (R2=0.57; F2,143=95.27; P

Abstract Aim To investigate predictors of low birth satisfaction in a sample of Iranian postpartum women during the COVID‐19 epidemics' fifth wave. Design A cross‐sectional study. Methods This study was conducted on 676 postpartum women admitted to postpartum wards of Mobini maternity hospital using a convenience sampling method between 2 Aug and 18 September 2021 in Iran. We used the general linear model and multiple linear regression analyses to determine predictors of birth satisfaction. Results The mean and standard deviation values of age and education were 28.7 ± 6.6 and 11.1 ± 4.1 (years), respectively. The mean scores of the three scales were as follows: FVC‐19S (14.7 ± 7.5), WHO‐5 (67.5 ± 13.0) and BSS‐R (28.6 ± 7.3). Sixty‐five point nine percent (65.9%) of the participants were multiparous. Overall predictors of low birth satisfaction were emergency caesarean, instrumental birth, episiotomy, Entonox analgesia, low level of well‐being score

Wolbachia are the most widespread intracellular alphaproteobacteria in insects with a variety of phenoptypic effects on the fitness and reproduction of their host, but much less is known about how these bacteria affect host behavior. In this study, we asked whether Wolbachia affects the foraging behavior of the parasitoid wasp Habrobracon hebetor (Hym.: Braconidae), an important biological control agent of many lepidopteran larvae. To test this, we analyzed the functional and numerical responses of Wolbachia-infected and uninfected (tetracycline cured) wasps, as well as morphological parameters. Functional response analysis showed Holling type II responses in both the Wolbachia-infected and uninfected females. The handling time and searching efficiency of Wolbachia-infected and uninfected females were similar, although the estimated maximum parasitism rate was shorter in infected females. Regardless of Wolbachia infection status, there was a negative non-linear relationship between the number of larvae parasitized by a female and an increase in the host density, reflecting a decrease in the total number of eggs laid. Our results also showed that Wolbachia had no effect on morphological traits of the parasitoid wasp. Together, these results suggest that Wolbachia which are prevalent in H. hebetor have limited impact on foraging behavior and morphology.

Post-acute sequelae of SARS-CoV-2 (PASC) is defined as persistent symptoms after apparent recovery from acute COVID-19 infection, also known as COVID-19 long-haul. We performed a retrospective review of electronic health records (EHR) from the University of California COvid Research Data Set (UC CORDS), a de-identified EHR of PCR-confirmed SARS-CoV-2-positive patients in California. The purposes were to (1) describe the prevalence of PASC, (2) describe COVID-19 symptoms and symptom clusters, and (3) identify risk factors for PASC. Data were subjected to non-negative matrix factorization to identify symptom clusters, and a predictive model of PASC was developed. PASC prevalence was 11% (277/2,153), and of these patients, 66% (183/277) were considered asymptomatic at days 0-30. Five PASC symptom clusters emerged and specific symptoms at days 0-30 were associated with PASC. Women were more likely than men to develop PASC, with all age groups and ethnicities represented. PASC is a public health priority.

Abstract Background The immunity induced by primary vaccination is effective against COVID-19; however, booster vaccines are needed to maintain vaccine-induced immunity and improve protection against emerging variants. Heterologous boosting is believed to result in more robust immune responses. This study investigated the safety and immunogenicity of the Razi Cov Pars vaccine (RCP) as a heterologous booster dose in people primed with Beijing Bio-Institute of Biological Products Coronavirus Vaccine (BBIBP-CorV). Methods We conducted a randomized, double-blind, active-controlled trial in adults aged 18 and over primarily vaccinated with BBIBP-CorV, an inactivated SARS-CoV-2 vaccine. Eligible participants were randomly assigned (1:1) to receive a booster dose of RCP or BBIBP-CorV vaccines. The primary outcome was neutralizing antibody activity measured by a conventional virus neutralization test (cVNT). The secondary efficacy outcomes included specific IgG antibodies against SARS-CoV-2 spike (S1 and receptor-binding domain, RBD) antigens and cell-mediated immunity. We measured humoral antibody responses at 2 weeks (in all participants) and 3 and 6 months (a subgroup of 101 participants) after the booster dose injection. The secondary safety outcomes were solicited and unsolicited immediate, local, and systemic adverse reactions. Results We recruited 483 eligible participants between December 7, 2021, and January 13, 2022. The mean age was 51.9 years, and 68.1% were men. Neutralizing antibody titers increased about 3 (geometric mean fold increase, GMFI = 2.77, 95% CI 2.26–3.39) and 21 (GMFI = 21.51, 95% CI 16.35–28.32) times compared to the baseline in the BBIBP-CorV and the RCP vaccine groups. Geometric mean ratios (GMR) and 95% CI for serum neutralizing antibody titers for RCP compared with BBIBP-CorV on days 14, 90, and 180 were 6.81 (5.32–8.72), 1.77 (1.15–2.72), and 2.37 (1.62–3.47) respectively. We observed a similar pattern for specific antibody responses against S1 and RBD. We detected a rise in gamma interferon (IFN-γ), tumor necrosis factor (TNF-α), and interleukin 2 (IL-2) following stimulation with S antigen, particularly in the RCP group, and the flow cytometry examination showed an increase in the percentage of CD3 + /CD8 + lymphocytes. RCP and BBIBP-CorV had similar safety profiles; we identified no vaccine-related or unrelated deaths. Conclusions BBIBP-CorV and RCP vaccines as booster doses are safe and provide a strong immune response that is more robust when the RCP vaccine is used. Heterologous vaccines are preferred as booster doses. Trial registration This study was registered with the Iranian Registry of Clinical Trial at www.irct.ir , IRCT20201214049709N4. Registered 29 November 2021.

Aim and Background: With the increase of divorce phenomenon and social changes, couples' communication patterns have changed and it is necessary to discover and identify them. The purpose of this research was to analyze the communication patterns of couples on the verge of separation. Materials and Methods: The qualitative research design was of thematic analysis type and the community included all couples referred for separation to counseling centers and family courts in Isfahan city, who were selected by purposive sampling method and according to the entry criteria. These people were investigated using a semi-structured interview and the data reached saturation with 12 interviews. Data analysis was performed according to the Claizian model. Findings: After analyzing the data and coding them, 104 initial codes, 17 central codes and 3 main codes were extracted. Disregarding communication pattern, avoidant communication patterns and aggressive communication pattern in the main code and not paying attention to the other, not caring and ignoring the other, lack of companionship and empathy, not having the opportunity to be together, not participating, not giving the other a chance to speak, not expressing Emotions, forgetfulness, silence, giving reasons, condemning the other party, mental reading, alternative mechanisms, using inappropriate verbal and non-verbal ways, comparing with others, harassing the other party, lack of trust were classified in the central code. Conclusion: Based on the findings of the research, it can be concluded that neglectful, avoidant, and aggressive communication patterns can each lead to the tendency to divorce among couples. Paying attention to the categories of the current research can be effective in order to prevent marital conflicts and reduce the divorce rate.

Protective antibodies in the upper respiratory tract prevent the spread of COVID-19 in the community. Intranasal vaccines could raise the specific secretory IgA and IgG levels. This is a single-center, randomized, double-blind, placebo-controlled clinical trial to evaluate the safety and immunogenicity of Razi Cov Pars (RCP) intranasal recombinant protein subunit COVID-19 vaccine as a booster in adults. We compared specific IgG and IgA levels in the intranasal RCP group (n = 97) versus placebo (n = 96) in serum, saliva, and nasal mucosal secretions on days 0 and 14 and reported their Geometric Mean Ratios (GMR) and 95% confidence intervals (CI). We showed significant increases in IgA and IgG anti-RBD in the nasal mucosa in the RCP group, but their increase was not detectable in the serum and saliva. Anti-spike IgA in the nasal mucosa also increased in the RCP group compared to the placebo. This increase against the COVID-19 variant Omicron was also similar to that of the Wuhan. We detected no serious adverse reactions or anaphylaxis and all adverse events resolved completely during the follow-up period and were similar in both groups. Intranasal RCP is safe, stimulates the respiratory mucosal immunity, and could be a booster on various COVID-19 vaccines and be effective against new virus variants.

Abstract Background and aim Different Salmonella serotypes are considered one of the most important food pathogens in the world. Poultry meat and eggs are the primary carriers of Salmonella in human populations. This study aimed to estimate the Salmonella enteritidis and Salmonella typhimurium contamination rates of retail hen and quail eggs in Karaj, Iran. Moreover, the antimicrobial resistance patterns of the strains were evaluated, and the efficiency of the standard culture method and multiplex polymerase chain reaction (m‐PCR) were compared. Materials and methods In this descriptive cross‐sectional study over 1 year (Jan–Dec 2022), 150 commercial and 150 backyard hen eggs and 300 commercial quail eggs, without cracks and fractures, were collected randomly from best selling groceries in Karaj city. All samples were examined for Salmonella contamination independently by standard culture and m‐PCR approaches. A standard disc diffusion method was employed to assess the antimicrobial susceptibility of the strains against 18 antimicrobial agents. Results Out of 300 examined eggs, 2 S. enteritidis strains were isolated from the shell of backyard hen eggs. The same serotype was also detected in the contents of one of these two eggs. One S. typhimurium was isolated from the shell of a commercial hen egg. Overall, the Salmonella contamination of the shell and contents was 1% and 0.3%, respectively. Salmonella was not isolated from the eggshells or the contents of the quail eggs. There was complete agreement between the results of m‐PCR and the standard culture methods. Among the 18 tested antibiotics, the highest resistance was recorded for colistin (100%), followed by nalidixic acid (75%). Conclusion As most Salmonella spp. are associated with human food poisoning, continuous surveillance is required to effectively reduce the risk posed by contaminated poultry eggs. Furthermore, mandatory monitoring of antimicrobial use on Iranian poultry farms is recommended.

The synthesis of novel metal-organic coordination polymers (MOCP) with the chemical formula [Mn2L (SCN)2(OH)2]3·CH3OH [L = 1,5-bis(pyridine-4-ylmethylene) carbonohydrazide] {1} was accomplished using two different techniques: solvothermal and sonochemical ultrasonic-assisted. An investigation was carried out to examine the impact of various factors such as reaction time, sonication power, temperature, and reactant concentration on the morphology and size of the crystals. Interestingly, it was found that sonication power and temperature did not affect the crystals’ morphology and size. To further analyze the prepared microcrystals of MOCPs, SEM was utilized to examine their surface morphology, and XRD, elemental evaluation composition. The identification of the functional groups present in the prepared Mn-MOCPs was accomplished through the utilization of FT-IR spectroscopy. Subsequently, the calcination of 1 in an air atmosphere at 650 °C led to the formation of Mn3O4 nanoparticles. The geometric and electronic structure of the MOCPs was evaluated using density functional theory (DFT). The utilization of molecular docking methodologies demonstrated that the best cavity of the human androgen receptor possessed an interaction energy of −116.3 kJ mol−1. This energy encompassed a combination of both bonding and non-bonding interactions. The Results showed that steric interaction and electrostatic potential are the main interactions in AR polymer and Mn(II). These interactions in the defined cavity indicated that this polymer could be an effective anti-prostate candidate, because AR is involved in the growth of prostate cancer cells, and these interactions indicated the inhibition of prostate cancer cell growth.

In today's modern world where people get lost in the maze of wide streets and stairs and live hard in the layers of cold and soulless iron cities. In some cities there are areas of old structures that Walking in these areas brings peace and slowing down the passage of time. Objective of the study: Application of sustainable urban regeneration in the historical context of the Prophetic neighborhood of Qazvin Research The present study is a combination of quantitative and qualitative methods and has practical aspects. In a quantitative way, the study of housing indicators in order to identify the current state of housing in the historical context. Qualitative method with in-depth interview technique. Formation of a 15-member panel of experts in order to apply sustainable urban regeneration in the historical context of Qazvin. Geographical area of the study: The study area includes the historical context of Qazvin, the neighborhood of the Prophet, the market area and the adjacent residential context. This neighborhood is limited to Imam Khomeini Street from the north, Peyghambriyeh Street from the east, Ansari from the south and Rumi from the west.In the stage of reviewing housing indicators in the historical context of Qazvin city, Peyghambrieh neighborhood can be analyzed: Housing in this context needs seismic improvement in order to strengthen, economic empowerment, identification through revitalization of historical housing species. The second stage, based on the application of sustainable urban regeneration, was summarized by the method of in-depth interviews with experts on the most important aspects of regeneration in the historical context of Qazvin, Peyghambriyeh neighborhood. Results: The main result of this research is the application of institutional mechanisms to move towards the application of integrated tissue management in the first step and then the establishment of sustainable urban regeneration in this context.

The world has been affected by COVID-19 coronavirus. At the time of this study, the number of infected people in the United States is the highest globally (31.2 million infections). Within the infected population, patients diagnosed with acute respiratory distress syndrome (ARDS) are in more life-threatening circumstances, resulting in severe respiratory system failure. Various studies have investigated the infections to COVID-19 and ARDS by monitoring laboratory metrics and symptoms. Unfortunately, these methods are merely limited to clinical settings, and symptom-based methods are shown to be ineffective. In contrast, vital signs (e.g., heart rate) have been utilized to early-detect different respiratory diseases in ubiquitous health monitoring. We posit that such biomarkers are informative in identifying ARDS patients infected with COVID-19. In this study, we investigate the behavior of COVID-19 on ARDS patients by utilizing simple vital signs. We analyze the long-term daily logs of blood pressure (BP) and heart rate (HR) associated with 150 ARDS patients admitted to five University of California academic health centers (containing 77,972 samples for each vital sign) to distinguish subjects with COVID-19 positive and negative test results. In addition to the statistical analysis, we develop a deep neural network model to extract features from the longitudinal data. Our deep learning model is able to achieve 0.81 area under the curve (AUC) to classify the vital signs of ARDS patients infected with COVID-19 versus other ARDS diagnosed patients. Since our proposed model uses only the BP and HR, it would be possible to review data prior to the first reported cases in the U.S. to validate the presence or absence of COVID-19 in our communities prior to January 2020. In addition, by utilizing wearable devices, and monitoring vital signs of subjects in everyday settings it is possible to early-detect COVID-19 without visiting a hospital or a care site.

BackgroundThe physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement.ObjectiveThe aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user's engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components.MethodsA case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app-based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data.ResultsDecreased resting heart rate was significantly correlated with increased heart rate variability (r=-0.92, P