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Abstract This study aimed to assess the severity and outcomes of COVID-19 in pregnant women, focusing on laboratory and radiological discrepancies between pregnant women and matched nonpregnant women. In this retrospective cross-sectional analysis, we matched 107 nonpregnant women with 66 pregnant women in terms of age, comorbidities, and the interval between symptom onset and hospital admission. Demographic, clinical, laboratory, and radiological data were collected, and chest CT scans were evaluated using a severity scale ranging from 0 to 5. Logistic regression and adjusted Cox regression models were used to assess the impact of various factors on pregnancy status and mortality rates. Differences in several laboratory parameters, including the neutrophil-to-lymphocyte ratio, liver aminotransferases, alkaline phosphatase, urea, triglycerides, cholesterol, HbA1c, ferritin, coagulation profiles, and blood gases, were detected. Radiologic exams revealed that nonpregnant women had sharper opacities, whereas pregnant women presented with hazy opacities and signs of crypt-organizing pneumonia. A notable difference was also observed in the pulmonary artery diameter. The mortality rate among pregnant women was 4.62%, which was comparable to the 5.61% reported in nonpregnant patients. Compared with nonpregnant patients, pregnancy did not significantly affect the severity or mortality of COVID-19. Our study revealed discernible differences in specific laboratory and imaging markers between pregnant and nonpregnant COVID-19 patients.

Catfish (Clarias gariepinus) that are reared with probiotics as biofloc-forming agent is thought to increase the fish production. Applying swamp probiotics to the water media has never been studied to ensure the flocks' availability in the rearing media. This study aimed to determine the appropriate frequency of probiotics application collected from swamps for biofloc formation to improve the catfish production. This study used a completely randomized design with two treatments and three replications. The treatments were composed of different application frequency of swamp probiotics: (P1) once in 42 days of rearing and (P2) twice in 42 days of rearing. Data on flock volume, total bacterial colonies, absolute growth rate, feed efficiency, survival rate, and water quality were analyzed by T-test with a 95% confidence level. Meanwhile, the flock composition data were analyzed descriptively. The results showed that P2 obtained the best treatment with a floc volume of 68.33 ± 10.41 mL/L, absolute length growth of 8.18 ± 1.03 cm, absolute weight growth of 19.30 ± 3.12 g, feed efficiency of 135.24 ± 7.98%, survival rate of 89.33 ± 6.21%, biomass production of 24639.50 ± 1344.51 g, temperature of 28.85-29.59ºC, pH of 7.27-7.42, dissolved oxygen (DO) of 3.91-5.72 mg/L, ammonia of 0.45-1.15 mg/L, and total dissolved solids (TDS) of 717.33-885.50 mg/L. Therefore, swamp probiotics should be applied to catfish culture media twice for 42 days of rearing or once every 21 days. Keywords: Biofloc Catfish Probiotics from swamp

Abstract Substance abuse among adolescents has become a growing issue throughout the world. The significance of research on this life period is based on the occurrence of neurobiological changes in adolescent brain which makes the individual more susceptible for risk-taking and impulsive behaviors. Alcohol and nicotine are among the most available drugs of abuse in adolescents. Prolonged consumption of nicotine and alcohol leads to drug dependence and withdrawal which induce various dysfunctions such as memory loss. Coenzyme Q10 (CoQ10) is known to improve learning and memory deficits induced by various pathological conditions such as Diabetes mellitus and Alzheimer's disease. In the present study we investigated whether CoQ10 treatment ameliorates memory loss following a nicotine-ethanol abstinence. Morris water maze and novel object recognition tests were done in male Wistar rats undergone nicotine-ethanol abstinence and the effect of CoQ10 was assessed on at behavioral and biochemical levels. Results indicated that nicotine-ethanol abstinence induces memory dysfunction which is associated with increased oxidative and inflammatory response, reduced cholinergic and neurotrophic function plus elevated Amyloid-B levels in hippocampi. CoQ10 treatment prevented memory deficits and biochemical alterations. Interestingly, this ameliorative effect of CoQ10 was found to be dose-dependent in most experiments and almost equipotential to that of bupropion and naloxone co-administration. CoQ10 treatment could effectively improve memory defects induced by nicotine-ethanol consumption through attenuation of oxidative damage, inflammation, amyloid-B level and enhancement of cholinergic and neurotrophic drive. Further studies are required to assess the unknown side effects and high dose tolerability of the drug in human subjects.

Artificial intelligence (AI) has contributed to various facets of human lives for decades. Teachers and students must have competency in AI and AI-empowered applications, particularly when using online electronic platforms such as learning management systems (LMS). This study investigates the structural relationship between AI literacy, academic well-being, and educational attainment of Iranian undergraduate students. Using a convenience sampling approach, we selected 400 undergraduate students from virtual universities equipped with LMS platforms and facilities. We collected data using three instruments—an AI literacy scale, an academic well-being scale, and educational attainment scale—and analyzed the data using Smart-PLS3 software. Results showed that the hypothetical model had acceptable psychometrics (divergent and convergent validity, internal consistency, and composite reliability). Results also showed that the general model had goodness of fit. The study thus confirms the direct effect of AI on academic well-being and educational attainment. By measuring variables of academic well-being, we also show that AI literacy in China and Iran significantly affects educational attainment. These findings have implications for students, teachers, and educational administrators of universities and higher education institutes, providing knowledge about the educational uses of AI applications.

Further analysis of the effectiveness of integrating project-based learning (PjBL) in Invertebrate Zoology courses to improve students' science process skills and conceptual understanding needs to be carried out. This research was aimed to analyze the integration of PjBL in the Invertebrate Zoology course on scientific process skills and conceptual understanding of student. As for seeing the effect of each indicator from each predictor, a qualitative descriptive analysis was carried out. Respondents in this study were students of the Biology Education Study Program FTTE Universitas Bengkulu. A sample of 30 respondents was taken by random sampling technique. The research instrument is a questionnaire for scientific process skills and tests for understanding concepts. The hypothesis is tested using Analysis of Variance (ANOVA). The integration of PjBL has a significant influence on the scientific skills process of 0.038 with an F value of 4.524 and also has a significant influence on concept understanding at 0.018 with an F value of 0.018. It was concluded that there was an effect of the integration of PjBL on scientific process skills and conceptual understanding of Invertebrate Zoology, with a significance level of 0.05, so that it can be taken into consideration in developing learning in the Invertebrate Zoology course.

Background: This study aimed to evaluate the impact of remdesivir, alone or in combination with corticosteroids, on the time to death in COVID-19 patients. Methods: This retrospective cohort study was conducted between March 20, 2020, and March 18, 2021, on 5318 patients with confirmed COVID-19 at three tertiary educational hospitals in Tehran, Iran. The treated group consisted of COVID-19 patients who received remdesivir, either alone or in combination with corticosteroids, while the untreated group included infected patients who did not receive these treatments. The two groups were matched by propensity score matching method, which adjusted for 92 confounding factors such as demographic, sign and symptom, clinical, and treatment-related factors, to provide balanced covariates between the treated and untreated groups. Results: Of the 4,322 patients, 791 received remdesivir alone and 694 received remdesivir combined with corticosteroids. Among the patients who received remdesivir, 456 were male, and the mean (±standard deviation) age was 59.52±16.49 with a median hospitalization stay of 8 (interquartile range: 5–13) days. After applying the nearest neighbor propensity score matching method, there were no significant differences found in the hazard of death between patients who received remdesivir alone and those who did not receive treatment (hazard ratio: 0.94; 95 % confidence interval: 0.76, 1.16). In addition, the combination of remdesivir and corticosteroids was not associated with a reduced hazard of death (hazard ratio: 1.00; 95 % confidence interval: 0.80, 1.26). The median hospitalization stay was significantly longer in the group treated with remdesivir (alone/combined with corticosteroids) compared to the untreated group, both before and after matching. Conclusion: No association was observed between remdesivir treatment (alone/combined with corticosteroids) and a reduced hazard of death among COVID-19 patients. However, longer hospitalization stays were observed in patients receiving remdesivir, either alone or in combination with corticosteroids, compared to the untreated group.

Background: Department secretary position is one of the most important and practical jobs in the hospital, which is often neglected. The secretary of the nursing department is responsible for carrying out all office affairs of the department under the direct supervision of the supervisor; Therefore, proper planning for adequate supply of these forces in hospital departments is very important. Methods: This was a descriptive-cross-sectional research. Data was gathered through actively observing the operational process within the service field; professional meetings with department officials, nurses and departmental secretaries; studying relevant laws and regulations, reviewing personnel information systems, examining activity registers and management information systems. At the end, Workload Indicator of Staffing Needs (WISN) was used for analysis. Results: According to the results of the research, at the time of the study in Hazrat Zainab (S) Shiraz Hospital, 13 secretaries were working, and the required number of secretaries in the department was 12.94 based on the WISN; but, since a work measurement was done for each department separately, the result was different in each department. Conclusion: Results revealed that, in general, there is no shortage of secretaries in hospital departments, and there is no need to recruit new staff; however, in terms of workload, there is no balance between different departments, so it is necessary to balance the workload in different departments through proper planning.

Abstract In future modern power systems, reliability and resilience could be an extreme challenge caused by the stability issues of the bidirectional power converters (BPCs). The non‐linear dynamics of DC link voltage (DCLV) of BPCs in interaction with the existing linear control schemes may decrease the stability margin and cause operating‐point‐dependent instability issues. Existing approaches may solve this issue by reducing the DCLV control loop bandwidth, which considerably degrades the system performance. To tackle this issue, first, the root cause of the instability challenge is analytically investigated, and then, a non‐linear stabilizer control scheme based on Lyapunov theorem is proposed. Considering the non‐linear dynamic of the BPCs and the interaction between dynamics of DC link voltage and AC currents in the proposed stabilizer, it guarantees the stability of the converter in both directions of power flow and the full range of loading conditions. The performance of the proposed scheme is verified through simulation of the system under various operating conditions, considering uncertainties, disturbances, and short‐circuit events, and comparing it with that of prevalent controllers.

The prevalent narrative regarding the surge of inflationary pressures in the Iranian economy over the past five years emphasizes the growth of lending by the banking system. Monetary policy over the last few years has also focused on limiting the growth of broad money aggregates. However, despite a substantial reduction in the growth rate of M2, the rate of inflation has persisted above the long-run trend. Naturally, questions arise whether higher rates of inflation since 1397 are the consequence of higher monetary growth rates or whether other factors can explain the recent bouts of elevated inflationary pressures. Moreover, how effective is the announced policy of targeting the growth rate M2 aiming at reducing the inflation rate in the short and the long run? The present study proposes that the concurrence of three different but related factors - exchange rate fluctuations, weakening of asset demand for rial, and the lack of an effective policy anchor to curb inflationary expectations - provide a more accurate and complete narrative than a simple monetary explanation. We employ a structural vector autoregression model for short-run analysis and a vector error correction specification for the long-run analysis to identify which macroeconomic variables have had a more significant role in generating inflationary pressures during the 1367Q2-1402Q2 period.

ObjectiveThis systematic review and meta-analysis was conducted to compare the benefits of adrenalectomy and conservative treatment for comorbidities associated with mild autonomous cortisol secretion (MACS) in patients diagnosed with MACS.BackgroundMACS is the most common benign hormone-secreting functional adrenal incidentaloma. Overproduction of cortisol is observed in MACS patients, resulting in a variety of long-term health issues, including arterial hypertension (HTN), diabetes mellitus (DM), dyslipidemia, obesity, and osteoporosis; however, the classic clinical manifestations of Cushing’s syndrome (CS) are not present.MethodsA systematic search was conducted using MEDLINE, Embase, Web of Sciences, and Scopus databases on December, 2023. Two reviewers independently extracted data and assessed the quality of the included articles. A meta-analysis was performed to compare the beneficial effects of adrenalectomy versus conservative management for MACS-related comorbidities.ResultsFifteen articles were included in this study, which evaluated 933 MACS patients (384 Adrenalectomy and 501 Conservative treatment, and 48 excluded due to incomplete follow-up duration). MACS diagnosis criteria were different among the included articles. All studies, however, stated that there must be no overt CS symptoms. Meta-analysis demonstrates the overall advantage of adrenalectomy over conservative treatment for MACS-related comorbidities (Cohen’s d = -0.49, 95% CI [-0.64, -0.34], p = 0.00). Subgroup analysis indicated that the systolic blood pressure (pooled effect size = -0.81, 95% CI [-1.19, -0.42], p = 0.03), diastolic blood pressure (pooled effect size = -0.63, 95% CI [-1.05, -0.21], p = 0.01), and BMD (pooled effect size = -0.40, 95% CI [-0.73, -0.07], p = 0.02) were significantly in favor of adrenalectomy group rather than conservative treatment but no significant differences between the two treatment groups in other MACS-related comorbidities were reported.ConclusionDespite the limited and diverse data, this study demonstrates the advantage of adrenalectomy over conservative treatment for MACS-related comorbidities.

Objectives The aim of this study is a descriptive presentation of cases of acute watery diarrhoea (AWD) that were presented to Aleppo University Hospital (AUH) during the recent cholera outbreak in Syria.Design Prospective, observational, cohort study.Setting and participants A total of 1061 patients with AWD were admitted to AUH during the timeframe of 20 September 2022 to 20 October 2022. The data collection was done through a structured questionnaire. This includes comprehensive clinical observation, laboratory analyses, therapeutic interventions and holistic case evaluations.Results The analysis has revealed notable insights: a predominant proportion of patients (58.6%) were residents from urban areas and 40.3% were residents from rural areas. Intriguingly, a diverse range of potential infection sources emerged from patient data within our hospital, including uncontrolled well water, vegetables and faecal-oral transmission through contaminated street/fast food. At discharge, most patients were in good health (79.7%), followed by moderate health (17.6%) and poor health (2.3%), with a minimal percentage dying before discharge (0.4%). The most common complications reported at admission and during hospitalisation included electrolyte imbalance (28.2%), followed by severe dehydration (16.3%). In the follow-up period, the majority of patients exhibited good health (81.0%). Older patients (>60 years) had poorer outcomes, with 8.4% having poor health and 4.2% death rate.Conclusions The study found results consistent with previous AWD outbreaks in developing countries like Yemen, Nigeria and Lebanon. Preventative measures like improving water sanitation and hygiene practices are essential to prevent future outbreaks and ease the strain on healthcare systems. Therefore, future studies must investigate the risk factors that increase the spread and the severity of the disease and investigate the best management method.

Abstract Background Cholangiocarcinoma (CCA), as a rare malignancy of the biliary tree, has a poor prognosis most of the time. CCA is highly epigenetically regulated and several long non‐coding RNAs (lncRNA) have been investigated to have a diagnostic and prognostic role in CCA. The current study aimed to assess the studies finding relevant lncRNAs in CCA systematically. Methods International databases, including PubMed, Cochrane Library, and Embase, were comprehensively searched in order to identify studies investigating any lncRNA in CCA. After screening by title/abstract and full‐text, necessary data were extracted. Random‐effect meta‐analysis was performed for pooling the areas under the curve (AUCs), specificity, and sensitivity of lncRNAs for the diagnosis of CCA. Results A total of 33 studies were chosen to be included in the final analysis, comprised of 2677 patients. Meta‐analysis of AUCs for evaluation of CCA resulted in pooled AUC of 0.79 (95% CI: 0.75–0.82; I2 = 69.11, p

Abstract Detecting clinical keratoconus (KCN) poses a challenging and time-consuming task. During the diagnostic process, ophthalmologists are required to review demographic and clinical ophthalmic examinations in order to make an accurate diagnosis. This study aims to develop and evaluate the accuracy of deep convolutional neural network (CNN) models for the detection of keratoconus (KCN) using corneal topographic maps. We retrospectively collected 1758 corneal images (978 normal and 780 keratoconus) from 1010 subjects of the KCN group with clinically evident keratoconus and the normal group with regular astigmatism. To expand the dataset, we developed a model using Variational Auto Encoder (VAE) to generate and augment images, resulting in a dataset of 4000 samples. Four deep learning models were used to extract and identify deep corneal features of original and synthesized images. We demonstrated that the utilization of synthesized images during training process increased classification performance. The overall average accuracy of the deep learning models ranged from 99% for VGG16 to 95% for EfficientNet-B0. All CNN models exhibited sensitivity and specificity above 0.94, with the VGG16 model achieving an AUC of 0.99. The customized CNN model achieved satisfactory results with an accuracy and AUC of 0.97 at a much faster processing speed compared to other models. In conclusion, the DL models showed high accuracy in screening for keratoconus based on corneal topography images. This is a development toward the potential clinical implementation of a more enhanced computer-aided diagnosis (CAD) system for KCN detection, which would aid ophthalmologists in validating the clinical decision and carrying out prompt and precise KCN treatment.

Background and Introduction: Cardiac imaging is crucial for diagnosing heart disorders. Methods like X-rays, ultrasounds, CT scans, and MRIs provide detailed anatomical and functional heart images. AI can enhance these imaging techniques with its advanced learning capabilities. Method: In this scoping review, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Guidelines, we searched PubMed, Scopus, Web of Science, and Google Scholar using related keywords on 16 April 2024. From 3679 articles, we first screened titles and abstracts based on the initial inclusion criteria and then screened the full texts. The authors made the final selections collaboratively. Result: The PRISMA chart shows that 3516 articles were initially selected for evaluation after removing duplicates. Upon reviewing titles, abstracts, and quality, 24 articles were deemed eligible for the review. The findings indicate that AI enhances image quality, speeds up imaging processes, and reduces radiation exposure with sensitivity and specificity comparable to or exceeding those of qualified radiologists or cardiologists. Further research is needed to assess AI’s applicability in various types of cardiac imaging, especially in rural hospitals where access to medical doctors is limited. Conclusions: AI improves image quality, reduces human errors and radiation exposure, and can predict cardiac events with acceptable sensitivity and specificity.

Abstract Across the world, oral cancer is a prevalent tumor. Over the years, both its mortality and incidence have grown. Oral cancer metastasis is a complex process involving cell invasion, migration, proliferation, and egress from cancer tissue either by lymphatic vessels or blood vessels. MicroRNAs (miRNAs) are essential short non-coding RNAs, which can act either as tumor suppressors or as oncogenes to control cancer development. Cancer metastasis is a multi-step process, in which miRNAs can inhibit or stimulate metastasis at all stages, including epithelial-mesenchymal transition, migration, invasion, and colonization, by targeting critical genes in these pathways. On the other hand, long non-coding RNAs (lncRNAs) and circular RNAs (circRNAs), two different types of non-coding RNAs, can regulate cancer metastasis by affecting gene expression through cross-talk with miRNAs. We reviewed the scientific literature (Google Scholar, Scopus, and PubMed) for the period 2000–2023 to find reports concerning miRNAs and lncRNA/circRNA-miRNA-mRNA networks, which control the spread of oral cancer cells by affecting invasion, migration, and metastasis. According to these reports, miRNAs are involved in the regulation of metastasis pathways either by directly or indirectly targeting genes associated with metastasis. Moreover, circRNAs and lncRNAs can induce or suppress oral cancer metastasis by acting as competing endogenous RNAs to inhibit the effect of miRNA suppression on specific mRNAs. Overall, non-coding RNAs (especially miRNAs) could help to create innovative therapeutic methods for the control of oral cancer metastases.

BackgroundThe increasing prevalence of colorectal cancer (CRC) in Iran over the past three decades has made it a key public health burden. This study aimed to predict metastasis in CRC patients using machine learning (ML) approaches in terms of demographic and clinical factors.MethodsThis study focuses on 1,127 CRC patients who underwent appropriate treatments at Taleghani Hospital, a tertiary care facility. The patients were divided into training and test datasets in an 80:20 ratio. Various ML methods, including Naive Bayes (NB), random rorest (RF), support vector machine (SVM), neural network (NN), decision tree (DT), and logistic regression (LR), were used for predicting metastasis in CRC patients. Model performance was evaluated using 5-fold cross-validation, reporting sensitivity, specificity, the area under the curve (AUC), and other indexes.ResultsAmong the 1,127 patients, 183 (16%) had experienced metastasis. In the predictionof metastasis, both the NN and RF algorithms had the highest AUC, while SVM ranked third in both the original and balanced datasets. The NN and RF algorithms achieved the highest AUC (100%), sensitivity (100% and 100%, respectively), and accuracy (99.2% and 99.3%, respectively) on the balanced dataset, followed by the SVM with an AUC of 98.8%, a sensitivity of 97.5%, and an accuracy of 97%. Moreover, lower false negative rate (FNR), false positive rate (FPR), and higher negative predictive value (NPV) can be confirmed by these two methods. The results also showed that all methods exhibited good performance in the test datasets, and the balanced dataset improved the performance of most ML methods. The most important variables for predicting metastasis were the tumor stage, the number of involved lymph nodes, and the treatment type. In a separate analysis of patients with tumor stages I–III, it was identified that tumor grade, tumor size, and tumor stage are the most important features.ConclusionThis study indicated that NN and RF were the best among ML-based approaches for predicting metastasis in CRC patients. Both the tumor stage and the number of involved lymph nodes were considered the most important features.

Abstract This large-scale study aimed to investigate the trend of laboratory tests of patients with COVID-19. Hospitalized confirmed and probable COVID-19 patients in three general hospitals were examined from March 20, 2020, to June 18, 2021. The confirmed and probable COVID-19 patients with known outcomes and valid laboratory results were included. The least absolute shrinkage and selection operator (LASSO) and Cox regression were used to select admittance prognostic features. Parallel Pairwise Comparison of mortality versus survival was used to examine the trend of markers. In the final cohort, 11,944 patients were enrolled, with an in-hospital mortality rate of 21.8%, mean age of 59.4 ± 18.0, and a male-to-female ratio of 1.3. Abnormal admittance level of white blood cells, neutrophils, lymphocytes, mean cellular volume, urea, creatinine, bilirubin, creatine kinase-myoglobin binding, lactate dehydrogenase (LDH), Troponin, c-reactive protein (CRP), potassium, and creatinine phosphokinase reduced the survival of COVID-19 inpatients. Moreover, the trend analysis showed lymphocytes, platelet, urea, CRP, alanine transaminase (ALT), and LDH have a dissimilar trend in non-survivors compared to survived patients. This study proposed a novel approach to find serial laboratory markers. Serial examination of platelet count, creatinine, CRP, LDH, and ALT can guide healthcare professionals in finding patients at risk of deterioration.

Abstract Gastric cancer (GC), with a 5-year survival rate of less than 40%, is known as the fourth principal reason of cancer-related mortality over the world. This study aims to develop predictive models using different machine learning (ML) classifiers based on both demographic and clinical variables to predict metastasis status of patients with GC. The data applied in this study including 733 of GC patients, divided into a train and test groups at a ratio of 8:2, diagnosed at Taleghani tertiary hospital. In order to predict metastasis in GC, ML-based algorithms, including Naive Bayes (NB), Random Forest (RF), Support Vector Machine (SVM), Neural Network (NN), Decision Tree (RT) and Logistic Regression (LR), with 5-fold cross validation were performed. To assess the model performance, F1 score, precision, sensitivity, specificity, area under the curve (AUC) of receiver operating characteristic (ROC) curve and precision-recall AUC (PR-AUC) were obtained. 262 (36%) experienced metastasis among 733 patients with GC. Although all models have optimal performance, the indices of SVM model seems to be more appropiate (training set: AUC: 0.94, Sensitivity: 0.94; testing set: AUC: 0.85, Sensitivity: 0.92). Then, NN has the higher AUC among ML approaches (training set: AUC: 0.98; testing set: AUC: 0.86). The RF of ML-based models, which determine size of tumor and age as two essential variables, is considered as the third efficient model, because of higher specificity and AUC (84% and 87%). Based on the demographic and clinical characteristics, ML approaches can predict the metastasis status in GC patients. According to AUC, sensitivity and specificity in both SVM and NN can be regarded as better algorithms among 6 applied ML-based methods.

Abstract Background Pulmonary thromboembolism (PTE) is a common complication of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), which raises the COVID‐19 disease's fatality rate from 3% to 45%. Nevertheless, due to fairly indistinguishable clinical symptoms and a lack of validated clinical prediction models, PTE diagnosis in COVID‐19 patients is challenging. This study aims to investigate the applicability of hematological indices to predict PTE incidence and its severity in SARS‐CoV‐2 patients. Methods A retrospective cohort study was conducted on hospitalized patients with a confirmed diagnosis of SARS‐CoV‐2 infection who underwent CT angiography to assess probable PTE in them. The correlation between complete blood count parameters 1 day before CT angiography and CT angiography outcomes, and simplified pulmonary embolism severity index (s‐PESI) was investigated. Results We discovered that among individuals with a probable PTE, males and those with higher platelet‐to‐lymphocyte (PLR) and neutrophil‐to‐lymphocyte (NLR) ratios had a greater likelihood of PTE incidence (p

Abstract We aimed to propose a mortality risk prediction model using on-admission clinical and laboratory predictors. We used a dataset of confirmed COVID-19 patients admitted to three general hospitals in Tehran. Clinical and laboratory values were gathered on admission. Six different machine learning models and two feature selection methods were used to assess the risk of in-hospital mortality. The proposed model was selected using the area under the receiver operator curve (AUC). Furthermore, a dataset from an additional hospital was used for external validation. 5320 hospitalized COVID-19 patients were enrolled in the study, with a mortality rate of 17.24% (N = 917). Among 82 features, ten laboratories and 27 clinical features were selected by LASSO. All methods showed acceptable performance (AUC > 80%), except for K-nearest neighbor. Our proposed deep neural network on features selected by LASSO showed AUC scores of 83.4% and 82.8% in internal and external validation, respectively. Furthermore, our imputer worked efficiently when two out of ten laboratory parameters were missing (AUC = 81.8%). We worked intimately with healthcare professionals to provide a tool that can solve real-world needs. Our model confirmed the potential of machine learning methods for use in clinical practice as a decision-support system.

Moodle has provided a variety of plugins to accommodate the needs of online learning activities. One of them is H5P which can increase the interactivity of content presented in the Learning Management System (LMS). Based on monitoring through the UNP Executive Information System (SIE), only 0.085% used H5P out of 10,593 course sessions. The results of observations showed that sessions using H5P also show that there is an inappropriate use of H5P. This needs to be evaluated with the aim of revealing the student's perspective on the use of H5P and the obstacles that students face while using H5P-based content. This research is a descriptive study using a non-experimental design with a cross-sectional quantitative approach conducted at Universitas Negeri Padang. The research sample selected using the purposive sampling method was given a questionnaire that assessed aspects of the usability, integration, impact, and characteristics of the H5P content. The results show that the student's perspective on H5P as an interactive learning medium to support the LMS of Universitas Negeri Padang is very positive both in terms of usability, integration, impact, and characteristics of the material, although there are still students who think that it is not optimal because of the obstacles students face. Therefore, in order to optimize the use of H5P content for students, lecturers, and universities, it is important to consider issues related to networks, devices, technical use of H5P, work orders, navigation, and time as summarized in this study. Moodle telah menyediakan beragam plugin untuk mengakomodasi kebutuhan aktivitas pembelajaran online. Salah satunya adalah H5P yang dapat meningkatkan interaktivitas konten yang disajikan di Learning Management System (LMS). Berdasarkan pantauan melalui sistem, hanya 0,085% yang menggunakan H5P dari 10.593 sesi mata kuliah. Hasil observasi terhadap sesi mata kuliah yang menggunakan H5P juga menunjukkan bahwa ada penggunaan H5P yang kurang tepat. Hal ini perlu dievaluasi dengan tujuan mengungkap bagaimana perspektif mahasis terhadap penggunaan H5P dan kendalah yang mahasiswa hadapi selama menggunakan konten berbasis H5P. Penelitian ini merupakan penelitian deskriptif menggunakan desain non-eksperimental dengan pendekatan kuantitatif cross sectional yang dilakukan di Universitas Negeri Padang. Sampel penelitian yang dipilih dengan metode purposive sampling diberikan angket yang menilai aspek kegunaan, integrasi, dampak, dan karakteristik konten H5P. Hasilnya menunjukkan bahwa perspektif mahasiswa terhadap H5P sebagai media pembelajaran interaktif untuk mendukung LMS Universitas Negeri Padang sangat positif baik dari aspek kegunaan, integrasi, dampak dan karakteristik materi, meskipun masih terdapat mahasiswa yang menilai tidak maksimal karena kendala yang mahasiswa hadapi. Jadi, untuk optimalisasi penggunaan konten H5P mahasiswa, dosen, dan perguruan tinggi penting mempertimbangkan masalah terkait jaringan, perangkat, teknis penggunaan H5P, perintah kerja, navigasi, dan waktu seperti yang dirangkum pada penelitian ini.

Objectiv (s): One of the ways to reduce costs in hospitals is to establish a day surgery ward. This study aimed to analyze the cost of surgeries before and after the establishment of the day care department in a teaching hospital affiliated to Iran University of Medical Sciences in Tehran, Iran. Methods: This descriptive study was conducted in 2020 using the data of the hospital's accounting system and the patients' clinical records during 2015-2019. To analyze the data and compare the costs the records of patients with selected surgeries such as removal of deep screw or pin, closed metacarpal fracture treatment, treatment of nasal fracture, placement of external fixation device, removal of plaque or rod inside the canal, adjustment of external fixation system, maxillofacial fixation, treatment of open mandibular complex fracture were included (251 people for the inpatient wards and 243 people for the daily surgery ward). Results: The greatest economic savings per surgery were related to the treatment of complex mandibular fractures. The least economical savings were made for each operation of removing the plate or rod inside the canal, installing an external fixator. In total, the cost of eight selected surgeries in the day care department showed an average cost reduction of 26% compared to the men's general surgery department. Conclusion: The establishment of the day care department seems cost effective. The day care unit reduces hospital costs, frees up hospital beds, and reduces the patient's physical and psychological complications.

Abstract Background Colorectal cancer (CRC) has been regarded as one of the most frequently diagnosed malignancies among the leading causes of cancer-related morbidity and mortality globally. Diagnosis of CRC at the early-stages of tumour might improve the survival rate of patients. The current study sought to determine the performance of fecal Fusobacterium nucleatum (F. nucleatum) and Streptococcus bovis (S. bovis) for timely predicting CRC. Methods Through a case–control study, the fecal sample information of 83 individuals (38 females, 45 males) referring to a hospital in Tehran, Iran was used. All patients underwent a complete colonoscopy, regarded as a gold standard test. Bacterial species including S. bovis and F. nucleatum were measured by absolute quantitative real-time PCR. The Bayesian univariate and bivariate latent class models (LCMs) were applied to estimate the ability of the candidate bacterial markers in order to early detection of patients with CRC. Results Bayesian univariate LCMs demonstrated that the sensitivities of S. bovis and F. nucleatum were estimated to be 86% [95% credible interval (CrI) 0.82–0.91] and 82% (95% CrI 0.75–0.88); while specificities were 84% (95% CrI 0.78–0.89) and 80% (95% CrI 0.73–0.87), respectively. Moreover, the area under the receiver operating characteristic curves (AUCs) were 0.88 (95% CrI 0.83–0.94) and 0.80 (95% CrI 0.73–0.85) respectively for S. bovis and F. nucleatum. Based on the Bayesian bivariate LCMs, the sensitivities of S. bovis and F. nucleatum were calculated as 93% (95% CrI 0.84–0.98) and 90% (95% CrI 0.85–0.97), the specificities were 88% (95% CrI 0.78–0.93) and 87% (95% CrI 0.79–0.94); and the AUCs were 0.91 (95% CrI 0.83–0.99) and 0.88(95% CrI 0.81–0.96), respectively. Conclusions Our data has identified that according to the Bayesian bivariate LCM, S. bovis and F. nucleatum had a more significant predictive accuracy compared with the univariate model. In summary, these intestinal bacteria have been highlighted as novel tools for early-stage CRC diagnosis.

Background: Strength training has been a common intervention used to improve neuromuscular activity within the synergic and/or agonist-antagonist muscles. This study aimed to evaluate simultaneous electrical activity of quadriceps and hamstring muscles after strength eccentric training versus concentric training.Methods: This experimental study has a between-group comparison design with a population of 26 males divided into two groups, namely the eccentric training group and the concentric training group. Maximal knee extension force and bipolar surface electromyography (EMG) signals from quadriceps and hamstring muscles were simultaneously recorded pre- and post-concentric and eccentric strength training. After EMG pre-processing for noise reduction, EMG signals were evaluated in two groups by time and frequency analysis. Nine EMG features (six time features and three frequency features) were analyzed in two groups pre- and post-training by statistical analysis.Results: The results showed that the maximal voluntary isometric contraction (MIVC) of quadriceps muscles was significantly increased in both groups from pre- to post-training (p 0.05).Conclusion: Based on the current results, great changes in time and frequency features of quadriceps and hamstring EMGs were achieved using eccentric training. Thus, eccentric strength training could be more effective in triggering neuromuscular activity within the agonist and antagonist muscles simultaneously.

Background: This study aimed to evaluate the changes in fatigue of patients with coronary artery diseases after the rehabilitation intervention based on demographic and clinical variables. Methods: This study was a single-arm clinical trial with a pre and post-intervention design. The statistical population of the study included patients with coronary artery diseases who underwent coronary artery bypass surgery or percutaneous coronary interventions, 4-6 weeks after discharge, referred to Khorramabad Cardiac Rehabilitation Center. They were selected by a purposeful sampling method. The data were collected through demographic and clinical information questionnaires and Piper Fatigue Measurement Questionnaire. Education on risk factors at home (weeks 4 and 8) was presented in the area of rehabilitation, the data were analyzed with descriptive and analytical statistics in SPSS software. Results: Most of the patients were male (54.4%), married (87%), and in the age group of 47-58 years (50%). Their mean age was 54.63 ± 8.87 years, and the mean duration of heart disease in the subjects (by months) was 33.24 ± 50.84. Comparing the mean changes in fatigue after the intervention based on some influencing demographic variables of the patients, including age, gender, type of treatment, and the duration of the disease showed no significant difference (p>0.05). Conclusion: The implementation of a home cardiac rehabilitation program by nurses, as a low-cost, accessible, and feasible intervention, can be considered an effective step in reducing the fatigue of patients with coronary artery disease and should be considered by managers.

Graphene has emerged as an exceptional material for industrial usage and has widely been implemented. In this regard, the current study examines the enhanced characteristics of graphene nanoplatelets (GNP) by depositing the magnetite iron oxide (Fe3O4) on its surface. Ethylene glycol solvent was taken in Fe3O4 and GNP samples formation which were synthesized by the time parameter at various intervals. The Physicochemical characterizations were carried out by FTIR, XPS, XRD, and FESEM. It was observed that the successful grafting of iron particles on the GNP surface was achieved at a high time interval, and the results were more significant. FESEM images reveal a spherical structure on the surface of the graphene nanoplatelets in the GG 1, GG 2, and GG 4 sample. Fe3O4 has an irregular morphology with pores observed on the surface of GNP. However, the surface morphology of the graphene changes to a crinkled and rough surface.

The aim of this study is to determine the effect of nanoparticle concentration (φ) and temperature on the thermal conductivity of polyethylene glycol (PEG)-carbon dot nanofluid (NF). The considered range for temperature and φ is 20–60 °C and 0–7%, respectively. The results indicated an ascending trend of NF thermal conductivity with boosting both temperature and φ. The percentage of increase in thermal conductivity of NF with temperature and φ compared to the base fluid was in the range of 7.23–13.43% and 75.08–85.17%, respectively. Moreover, two efficient data-driven approaches, namely Multi-variate linear regression (MLR) and response surface methodology (RSM) schemes were developed to simulate the thermal conductivity of the PEG-carbon dot NF and fit the predictive relationships. The outcomes of modeling revealed that RSM model (R = 0.984 and RMSE = 0.013 W/m.K), due to taking into account the interaction between volume fraction and temperature, yielded more accuracy than MLR (R = 0.960 and RMSE = 0.021 W/m.K).

Background: Chemotherapy-induced nausea and vomiting (CINV) is a major side effect seen among cancer patients under chemotherapy. Ginger (Zingiber officinale) and cinnamon (Cinnamomum zeylanicum) are among the traditional antiemetic drugs. The aim of this study was to determine the effect of oral consumption of ginger and cinnamon on CINV. Methods: This study was designed as a double-blind randomized clinical trial. The target population was cancer patients undergoing chemotherapy in medical centers affiliated with Isfahan University of Medical Sciences. Patients were randomly divided into two groups of treatment (Ginger and Cinnamon) and Control. The effect of cinnamon and ginger combination on CINV was measured using the INVR (The index of nausea, vomiting and retching) questionnaire. Using the American Clinical Oncology Guideline, nausea levels from chemotherapy drugs was classified into three categories: high, medium and low. Findings: Seventy-two patients in the control group and 65 patients in the treatment group (ginger and cinnamon) entered the final analysis. Comparisons made between the treatment and control groups was not statistically significant at first, but there was a statistically significant difference between the nausea score of the treatment group and the control group on days two and three as depicted by the standard questionnaire. Conclusion: The combination of ginger and cinnamon is effective in controlling nausea and vomiting caused by chemotherapy. Most of the effect of ginger and cinnamon combination in reducing nausea and vomiting occurred on the second and third day after chemotherapy.

Diplazium esculentum is one of the medicinal plants used by Dayak tribes in Central Kalimantan to cure acne. The potential of D. esculentum can be proved through information on the active compounds of the extract obtained in decoction and infusa methods. Thus, a liquid chromatography-mass spectrophotometry (LC-MS)-based method is developed to identify the active compounds of D. esculentum extract in either decoction method or infusa method. The chemical compound potential of D. esculentum extract was then analysed using bioinformatics approach based upon the database of PASS online server. Results showed that the D. esculentum extract contained 81 chemical compounds in decoction method and 68 compounds in infusa method, in which the dominant compound was flavonoid. Moreover, PASS online web server analysis found 7 flavonoid compound groups potential as anti-acne containing antisebor, AR expression inhibitor and CYP1A1 inhibitor. This information could be very useful for designing a clinical test on plant natural compound potential for traditional drug development.

Abstract Objective The actual impact of the pandemic on COVID-19 specific mortality is still unclear due to the variability in access to diagnostic tools. This study aimed to estimate the excess all-cause mortality in Iran until September 2021 based on the national death statistics. Results The autoregressive integrated moving average was used to predict seasonal all-cause death in Iran (R-squared = 0.45). We observed a 38.8% (95% confidence interval (CI) 29.7%–40.1%) rise in the all-cause mortality from 22 June 2020 to 21 June 2021. The excess all-cause mortality per 100,000 population were 178.86 (95% CI 137.2–220.5, M:F ratio = 1.3) with 49.1% of these excess deaths due to COVID-19. Comparison of spring 2019 and spring 2021 revealed that the highest percent increase in mortality was among men aged 65–69 years old (77%) and women aged 60–64 years old (86.8%). Moreover, the excess mortality among 31 provinces of Iran ranged from 109.7 (Hormozgan) to 273.2 (East-Azerbaijan) per 100,000 population. In conclusion, there was a significant rise in all-cause mortality during the pandemic. Since COVID-19 fatality explains about half of this rise, the increase in other causes of death and underestimation in reported data should be concerned by further studies.

Background: The body position change, as a common intervention in the intensive care unit (ICU), may affect endotracheal tube cuff pressure changes.Aim: This study investigated the effect of body position change and vital signals on endotracheal tube cuff pressure in children after bidirectional Glenn shunt surgery.Method: This randomized controlled trial was conducted on 29 children with an oral endotracheal tube hospitalized in the ICU after Glenn shunt surgery. The endotracheal tube cuff pressure was measured at the patient’s bed placed at a 30-degree angle. Other positions included right and left lateral in bed at a 30° upward angle as well as right and left lateral in bed angle at a 45° angle, respectively. The measurements were repeated every 10 min three times in different positions. Vital signals were measured in each group. The data were analyzed using SPSS 20.Results: The results showed a significant relationship (P

Abstract Gastric cancer (GC) is the fifth most frequent malignancy worldwide and the third leading cause of cancer-associated mortality. The study’s goal was to construct a predictive model and nomograms to predict the survival of GC patients. This historical cohort study assessed 733 patients who underwent treatments for GC. The univariate and multivariable Cox proportional hazard (CPH) survival analyses were applied to identify the factors related to overall survival (OS). A dynamic nomogram was developed as a graphical representation of the CPH regression model. The internal validation of the nomogram was evaluated by Harrell’s concordance index (C-index) and time-dependent AUC. The results of the multivariable Cox model revealed that the age of patients, body mass index (BMI), grade of tumor, and depth of tumor elevate the mortality hazard of gastric cancer patients (P

Abstract Background Liver cancer (LC) is considered as one of the most dominant malignant tumors which ranked 4th and in terms of global mortality and incidence, respectively. This work aimed to investigate the global temporal trends in LC mortality-to-incidence ratio (MIR) and its components, with a particular focus on examining long-term effect of human development index (HDI) on these metrics in a 30-year follow-up. Methods The age-standardized LC incidence and mortality data were derived from the global burden of disease (GBD) study 2019. We first leveraged joinpoint piecewise linear regression analysis to ascertain time trends in LC incidence, mortality, and MIR complement [1-MIR] and the average annual percentage change (AAPC) of the rates over the period 1990–2019. Then, the association between the metrics and HDI was explored through longitudinal multilevel models (LMMs). Results The incidence rates paralleled the mortality rates worldwide and they had similar significant monotonic decrementing trends with AAPC values of − 1.10% (95% confidence interval (CI): − 1.40, − 0.90%) and − 1.40% (− 1.50, − 1.30%), respectively from 1990 to 2019. The [1-MIR] rates were around 0 and showed an increasing pattern from 1.70 to 8.10 per 100,000 people (AAPC, 4.90%) at the same period of time. Results from the LMMs displayed that the majority of the variation lies at the country level accounted for about 88% of the total variance. Moreover, our analysis supported that the HDI was negatively associated with either incidence or mortality over time (p

Knowledge management (KM) comprises several processes, and one of the most important is the knowledge sharing activities. The ability of an organization to manage its organizational knowledge, specifically in the context of knowledge sharing, may enhance the organization’s overall performance. Various approaches and technologies have been introduced to assist the process in achieving that target. Ontology as one of the knowledge representation methods has been becoming popular to assist knowledge sharing in the organization. Previous reviews have mainly focused on general KM issues, with little emphasis on the use of ontology in knowledge sharing. Thus, this article reviews several ontology-based KM tools that can support knowledge-sharing activities to provide some insight into future research in this area. Thirteen ontology-based KM tools were reviewed using ten elements’ comparison criteria: the motivation, domain, source of knowledge, type of knowledge, knowledge extraction, knowledge input process, knowledge retrieval process, knowledge sharing technology, source of ontology component, and ontology methodology. The review found that several elements can be further studied to improve KM implementation in the organization, especially on the knowledge sharing dimension. This includes simplifying the knowledge extraction and retrieval process to explore various knowledge domains from implicit knowledge sources. The review’s outcome also includes proposed components and functions of an ideal ontology-based KM tool.

Abstract Background During general anesthesia especially when the nurse or anesthesiologist forgets to change manual to controlled mode after successful endotracheal intubation, capnography shows End-tidal Co2 above 20 mmHg after checking the place of the tracheal tube and will remain on the screen permanently. In this scenario, the patient receives a high concentration of oxygen, and Spo2 (oxygen saturation) does not drop for a long time which is too late to intervene. It has been all-time questionable which one of the cardiac dysrhythmias or Spo2 dropping occurs earlier. Results Medical records of seven deceased patients reviewed. All of them had electrocardiogram changes including premature ventricular contraction or bradycardia as a first warning sign. Oxygen saturation remains above 95% even with cardiac dysrhythmia. Conclusions Bradycardia and premature ventricular contraction were the first warning findings for severe hypercapnia during general anesthesia and occurred earlier than dropping oxygen saturation. Furthermore, the normal capnography waveform is more reliable than the End-tidal Co2 number for monitoring.

Abstract Using a rehabilitation program for the survivors of acute respiratory distress syndrome (ARDS) could be one of the important and fundamental steps to improve the pulmonary function and health-related quality of life (HRQoL) of patients. This study was carried out to evaluate the effect of two rehabilitation techniques (Family-Based Empowerment Model (FECM)/Continuing Care Model (CCM), or both of them) on pulmonary function, and HRQoL in ARDS survivors. From December 2009 to June 2016, ARDS survivors from mixed medical-surgical ICUs at four academic teaching hospitals in Tehran, Iran, were randomly assigned to one of three intervention groups (A, B, or C) or a control group (D). Pre- and post-interventions, pulmonary functions and HRQoL status of patients in all groups were collected 48 times via clinical measurements and various questionnaires during 5 years of follow-up. Significantly improvement was seen in the intervention groups compared to the control group, and the greatest benefit was observed in patients who received mixed of FCEM and CCM rehabilitation techniques. Co-administration of FCEM and CCM can improve pulmonary function as well as the life satisfaction of ARDS survivors. As a result, the execution of the empowerment model by nurses is recommended for ARDS survivors and the participation of their families at the same time. Trial registration: NCT02787720 (ClinicalTrial.gov, 24/05/2016).

IntroductionPancreatic cancer (PC) is one of the most fatal malignancies, and its incidence and mortality rates are growing annually throughout the world. In this research, we aimed to investigate the time trends and identify the spatial clusters of incidence and mortality on a global scale over the last 30 years, using the Global Burden of Disease (GBD) study 2019 data.MethodsAge-standardized incidence and mortality data due to PC were extracted from the GBD study, which was carried out from 1990 to 2019. A Joinpoint regression analysis was utilized to examine trends in the incidence and mortality of PC over the past three decades. As such, spatial analyses were undertaken to detect the spatial distribution and clustering of the metrics globally.ResultsIt was observed that both the incidence and mortality rates were higher in males than in females worldwide. The global mortality and incidence rates significantly increased by 0.8% per year over the time of follow-up period (pConclusionsCollectively, the temporal trends disclosed a gradual rise in PC incidence and mortality rates over the period 1990-2019, reflecting the global health concern. We further found geographical variations in the patterns and identified high- and low-risk areas for incidence and mortality. These findings facilitate the design and implementation of more resource-efficient and geographically targeted treatments. Given the results of the current study, a practical approach to minimizing the future PC burden involves planned population-wide interventions, as well as primary prevention through healthier lifestyles.

There has been no development or preparation of microtechnical modules on the material structure and function of plant tissues equipped with preparations. Therefore, the purpose of this research and development was to produce modules equipped with microtechnical preparations and analyze their quality through validation of teaching materials experts, material experts, and readability by teachers and students on small- and large-scale trials. This type of research was Research and Development (R&D) with the ADDIE development model which has five stages, namely: analysis, design, development, implementation, and evaluation. The results of the development research were in the form of a product of a biology practicum module with microtechnical preparations. The quality of the modules according to the teaching materials experts and materials experts was very good with the percentages of 80.6% and 99.4%, respectively. The result of the teacher's response was 81.4% with a very good category and readability by students on a small and large scale respectively 88% and 82.7%. Based on this assessment, it shows that the module with this preparation was suitable for use as teaching material by teachers in biology learning activities on the structure and function of plant tissue.

Abstract Aims Survival rates after in‐hospital cardiac arrest remain very low. Although there is evidence that the use of audiovisual feedback devices can improve compression components, there are no data on patient survival. Therefore, we conducted this study to analyse the survival rate of patients with in‐hospital cardiac arrest after discharge from the intensive care unit. Methods and results This study was a secondary analysis of a prospective, randomized, controlled, parallel study of patients who received either standard manual chest compression or a real‐time feedback device. Parametric and semi‐parametric models were fitted to the data. Different survival time of length of stay was investigated by univariate and multiple analyses. Pearson's correlation between length of stay and hospital length of stay was obtained. A total of 900 patients with a mean survival time of 35 days were included. Intervention was associated with a higher length of stay. Relative time was significant in adjusted fitted log‐normal regression for intervention group, female gender, and cardiopulmonary resuscitation in the night shift. A positive correlation between length of stay and hospital length of stay was found. Conclusions Implementation of feedback device improved survival and length of stay. Cardiopulmonary resuscitation performance during the night shift decreased the survival time, which could be due to the inexperienced staff available outside working hours.

Purpose: This study aimed to evaluate a lie-detection system by non-linear analysis of video-based eye movement. Materials and Methods: The physiological signals, as well as video-based eye movement in horizontal and vertical channels, were recorded based on a Control Question Test (CQT). The dynamics of eye movement signals were then analyzed by Recurrence Quantification Analysis (RQA). Statistical analysis was performed by ANOVA and Linear Discriminate Analysis (LDA). Results: In this study, 40 subjects participated. The statistical analysis results of vertical eye movement indicated that ENT measures increased significantly for relevant questions in comparison to other questions. Moreover, a significant increase was observed in all RQA parameters except Lmax and DET for horizontal eye movement. The results of LDA using psychophysiology features. The accuracy percentage of 78.4% and 81.86% were obtained for lie detection using physiological signals and optimal RQA parameters of video-based eye movements, respectively. Conclusion: The accuracy of lie detection by significant RQA parameters was more than the accuracy of physiological signals. So, the results of this study illustrate that the dynamic technique is well suited to analyze eye movement signals under stress and it could be recommended as a useful method in lie detection.

Background: Animal models of absence epilepsy are widely used in childhood absence epilepsy studies. Absence seizures appear in the brain’s electrical activity as a specific spike wave discharge (SWD) pattern. Reviewing long-term brain electrical activity is time-consuming and automatic methods are necessary. On the other hand, nonlinear techniques such as phase space are effective in brain electrical activity analysis. In this study, we present a novel SWD-detection framework based on the geometrical characteristics of the phase space. Methods: The method consists of the following steps: (1) Rat stereotaxic surgery and cortical electrode implantation, (2) Long-term brain electrical activity recording, (3) Phase space reconstruction, (4) Extracting geometrical features such as volume, occupied space, and curvature of brain signal trajectories, and (5) Detecting SDWs based on the thresholding method. We evaluated the approach with the accuracy of the SWDs detection method. Results: It has been demonstrated that the features change significantly in transition from a normal state to epileptic seizures. The proposed approach detected SWDs with 98% accuracy. Conclusion: The result supports that nonlinear approaches can identify the dynamics of brain electrical activity signals.

Background: The appropriate activity of the knee agonist-antagonist muscles is important to resist against abnormal abduction-adduction moments loads around knee joint and reduce the risk of knee injuries. Exercise training has been commonly used as an intervention to improve neuromuscular activity of the synergic and/or agonist-antagonist muscles. However, maximizing the effectiveness of exercise interventions for improving neuromuscular activity between muscle groups has been less investigated. The aim of this study was to investigate the improvement in neuromuscular activity of quadriceps and hamstrings muscles after resistance eccentric training versus concentric training. Methods: 26 male subjects randomly recruited for this controlled laboratory study. Subjects were randomly divided into two groups, eccentric training group (No = 13), and concentric training group (No = 13). Maximal knee extension force and bipolar surface electromyography (EMG) signals from quadriceps and hamstrings muscles were recorded before and after concentric and eccentric strength training. Root mean square (RMS) was computed from raw EMG signals.Results: Percent increase in maximal voluntary isometric contraction (MIVC) of quadriceps muscle after eccentric training was significantly higher than that after concentric training (P < 0.05). Moreover, eccentric training resulted in a greater increase in RMS of EMG for quadriceps and hamstrings muscles compared to concentric exercise training (P < 0.05).Conclusion: The higher increase in neuromuscular activities within the quadriceps and hamstring muscles observed after eccentric exercise may indicate that resistance training using eccentric contraction is more effective in improving neuromuscular activity of the agonist and antagonist muscles.

Background: Patientchr('39')s preferences in decision-making procedure are defined as the patientchr('39')s willingness to participate in self-care management and decision-making. The aim of present study was to assess patientschr('39') preferences in decision-making procedure and perceived participation in care and their relationship with demographic in selected educational hospitals of Yazd in 2019. Methods: The study was conducted on 195 inpatients of the gynecology, internal medicine and surgery wards of teaching hospitals in Yazd of Iran. The inpatients were selected through stratified sampling method. The data was collected by 2 questionnaires: Degner and Sloanchr('39')s control preferences scale and patientschr('39') perceived involvement in care scale of Lerman et al. parametric and non-parametric tests used to analyze the data. Results: In general, 49.20 % of patients preferred a relatively passive role in the decision-making process, and 36.40 % of them had high level of willingness to participate in their medical care decisions. The difference between the types of patients chr('39')decision-making preferences was significant for education level, type of hospital and type of inpatient ward, type of basic insurance (p ≤ 0.05). The mean score of Patientschr('39') perceived participation was 62.08 ± 14.92. The difference observed in the mean score of patientschr('39') perceived participation in care for gender, type of disease, type of hospital, history of hospitalization, type of basic insurance was significant (p < 0.05). Conclusion: A large percentage of patients in the present study preferred a relatively passive role in decision-making, so it is best for health care providers to provide patients with understandable information about available treatment options and the benefits / risks associated with those choices. Also, the necessary interventions to promote shared decision-making, especially to help female patients and patients with more acute illnesses, as well as to support health care providers to participate in the shared decision-making process with patients, are of particular importance.

Plantae material is one of the materials that requires a direct observation process to determine the characteristics, morphology, metagenesis, and benefits for the environment, especially in Pteridophyte material. So far, students only use textbooks and students have not been invited to learn with contextual learning objects. Thus, media is needed to facilitate direct observation and identification of plants. The purpose of this research is to produce learning media Pteridophyte catarium (Catalog Herbarium). This type of research is research and development (R&D) with the ADDIE development model. The results showed that the quality of the product according to media experts was very feasible with an assessment percentage of 77.08%, as well as according to material experts who said it was very feasible with a 95% rating percentage. The results of the teacher's response were 79.16% and the results of readability by students on a small and large scale respectively were 76.5% and 81.16%, indicating very decent quality. It was concluded that the product in the form of Pteridophyte catarium learning media was very suitable to be used as a teacher's learning media in plantae biology learning activities.

Background: Provision of patient-centered services is one of the values of any health care system. Patient-centered means giving importance to the patientchr('39')s rights and entitlements in all areas related to treatment and involving the patient in decisions throughout the process of rendering services to the patient. The purpose of this study was to translate and validate the Stewart Patient-Centered Questionnaire and to provide an appropriate and valid tool to assess the patient-centered rate in the provision of medical services. Methods: The present descriptive methodological study was conducted in 2020. Initially, Stewart patient-centered questionnaire was translated using the forward-backward method. Later, the translated version was examined by the research team to establish cultural compatibility with Iranian culture. The validity of its content was assessed by obtaining the opinions of 15 health management specialists and its face validity was assessed by 15 patients. The internal reliability of the questionnaire was assessed using the opinions of 30 patients and Cronbachchr('39')s alpha coefficient was calculated using SPSS 22 software. The construct validity was assessed according to the opinions of 283 patients in the study population through STATA 15 software. Results: Based on the content validity results, all items of the main questionnaire had acceptable CVR and the CVI index was 0.87 for this questionnaire. The face validity also confirmed all the statements. Cronbachchr('39')s alpha coefficient of the whole questionnaire was calculated as 0.976 and thus the internal reliability of the questionnaire was confirmed. Based on the results of the confirmatory invoice analysis GFI (0.988), RMR (0.048), and CFI (0.984), the translated questionnaire had suitable construct validity and all questions were retained. Conclusion: The questionnaire can be applied as a valid and applicable tool for assessing patient-centered care in the Iranian health care system.

Abstract Background The projection studies are imperative to satisfy demands for health care systems and proper response to the public health problems such as inflammatory bowel disease (IBD). Methods To accomplish this, we established an illness-death model based on available data to project the future prevalence of IBD in Asia, Iran in particular, separately from 2017 to 2035. We applied two deterministic and stochastic approaches. Results In 2035, as compared to 2020, we expected a 2.5-fold rise in prevalence for Iran with 69 thousand cases, a 2.3-fold increment for North Africa and the Middle East with 220 thousand cases, quadrupling of the prevalence for India with 2.2 million cases, a 1.5-fold increase for East Asia region with 4.5 million cases, and a 1.6-fold elevation in prevalence for high‐income Asia‐Pacific and Southeast Asia regions with 183 and 199 thousand cases respectively. Conclusions Our results showed an emerging epidemic for the prevalence of IBD in Asia regions and/or countries. Hence, we suggest the need for immediate action to control this increasing trend in Asia and Iran. However, we were virtually unable to use information about age groups, gender, and other factors influencing the evolution of IBD in our model due to lack of access to reliable data.

Abstract Type 1 Interferons (IFNs) have been associated with positive effects on Coronaviruses. Previous studies point towards the superior potency of IFNβ compared to IFNα against viral infections. We conducted a three-armed, individually-randomized, open-label, controlled trial of IFNβ1a and IFNβ1b, comparing them against each other and a control group. Patients were randomly assigned in a 1:1:1 ratio to IFNβ1a (subcutaneous injections of 12,000 IU on days 1, 3, 6), IFNβ1b (subcutaneous injections of 8,000,000 IU on days 1, 3, 6), or the control group. All three arms orally received Lopinavir/Ritonavir (400 mg/100 mg twice a day for ten days) and a single dose of Hydroxychloroquine 400 mg on the first day. Our utilized primary outcome measure was Time To Clinical Improvement (TTCI) defined as the time from enrollment to discharge or a decline of two steps on the clinical seven-step ordinal scale, whichsoever came first. A total of 60 severely ill patients with positive RT-PCR and Chest CT scans underwent randomization (20 patients to each arm). In the Intention-To-Treat population, IFNβ1a was associated with a significant difference against the control group, in the TTCI; (HR; 2.36, 95% CI 1.10–5.17, P-value = 0.031) while the IFNβ1b indicated no significant difference compared with the control; HR; 1.42, (95% CI 0.63–3.16, P-value = 0.395). The median TTCI for both of the intervention groups was five days vs. seven days for the control group. The mortality was numerically lower in both of the intervention groups (20% in the IFNβ1a group and 30% in the IFNβ1b group vs. 45% in the control group). There were no significant differences between the three arms regarding the adverse events. In patients with laboratory-confirmed SARS-CoV-2 infection, as compared with the base therapeutic regiment, the benefit of a significant reduction in TTCI was observed in the IFNβ1a arm. This finding needs further confirmation in larger studies. Trial Registration Number: ClinicalTrials.gov, NCT04343768. (Submitted: 08/04/2020; First Online: 13/04/2020) (Registration Number: NCT04343768).