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Abstract Context Advance Care Planning (ACP), as a process for expressing and recording patients' preferences about end-of-life care, has received increasing attention in recent years. However, implementing ACP has been challenging in Iran. Objectives To assess the readiness for advance care planning and related factors in the general population of Iran. Methods This cross-sectional study was conducted on the general population of Iran in 2022. The data was collected using demographic information questionnaire and The RACP Scale. The purpose and methodology of the research was explained to all participants, and upon their agreement an informed consent was obtained. Participants were invited to fill out the questionnaires wherever is more convenient for them, either alone or if needed, with the help of the researcher to protect their privacy. Chi-square, fisher exact test and multiple logistic Regression model were used to assess the effective factors on the RACP. The data were analyzed by SPSS software version 26. Results A total of 641 people with an average age of 36.85 ± 12.05 years participated in this study. Of those, 377 (58.8%) had high RACP. The logistics model showed an association between the chance of readiness for receiving ACP with participants’ education level, such that the chance of readiness in those with Master's or Ph.D. degrees was three times higher than those with a diploma (p = 0.00, OR:3.178(1.672, 6.043)). However, the chances of readiness in those with bachelor’s degrees was not significantly different from those with a diploma (p = 0.936, OR: 0.984 (0.654, 1.479)). Moreover, the chance of readiness was 1.5 higher in participants over 40 years of age compared with participants under the age of 40 (P = 0.01, OR: 1.571(1.10, 2.23)). Conclusion According to the findings of this study, it can be concluded that there is a relatively RACP among people in Iranian society. The readiness of individuals for ACP increases by their age and education level. Therefore, by holding appropriate training intervention, we can increase the readiness of the public for ACP to improve their end-of-life outcome.

Purpose: The present article deals with investigating the effects of tissue heterogeneity consideration on the dose distribution of 192Ir and 60Co sources in high-dose-rate brachytherapy (HDR-BT). Materials and Methods: A Monte Carlo N-Particle 5 (MCNP5) code was developed for the simulation of the dose distribution in homogeneous and heterogeneous phantoms for cervical cancer patients. The phantoms represented water-equivalent and human body-equivalent tissues. Treatment data for a patient undergoing HDR-BT with a 192Ir source were used as a reference for validation, and for 60Co, AAPM Task Group 43 methodology was also applied. The dose values were calculated for both source types in the phantoms. Results: The results showed a good agreement between the calculated dose in the homogeneous phantom and the real patient’s treatment data, with a relative difference of less than 5% for both sources. However, when comparing the absorbed doses at critical points such as Point A right, Point A left, Point B right, Point B left, bladder International Commission on Radiation Units and Measurement (ICRU) point, and recto-vaginal ICRU point, the study revealed significant percentage differences (approximately 5.85% to 12.02%) between the homogeneous and heterogeneous setups for both 192Ir and 60Co sources. The analysis of dose–volume histograms (DVH) indicated that organs at risk, notably the rectum and bladder, still received doses within recommended limits. Conclusions: The study concludes that 60Co and 192Ir sources can be effectively used in HDR-BT, provided that careful consideration is given to tissue heterogeneity effects during treatment planning to ensure optimal therapeutic outcomes.

Abstract Although the electric energy supply from distributed generation (DG) resources is increasing, these sources also face limitations. Protection and power quality constraints are the most important issues that limit the maximum DG penetration in power systems. Changing the short circuit level due to DGs' presence—especially synchronous‐based (SDG) type—may lead to miscoordination of the protective relays. Also, standard harmonic limits may be violated due to harmonic injection of inverter‐based DGs and non‐linear loads. A protection coordination problem is solved for the basic configuration, and the optimal settings are applied. Then, using a proposed approach and a new objective function, the location, size, and type of DGs are optimized to maximize the DG penetration and the speed of protection system, while reducing power losses. Finally, the protection setting of SDGs is optimized and applied. In these optimizations, the protection coordination constraints and the power quality requirements are considered and met. IEEE 14‐bus system and a real sub‐transmission system are simulated to evaluate the proposed approach and the new objective function. The obtained results show significant power loss reduction and protection speed improvement for different scenarios and case studies.

Abstract The present paper is conducted to develop a new structure of an electromagnetic pump capable of controlling the magnetic field in a rectangular channel. Common electromagnetic pumps do not create uniform velocity profiles in the cross-section of the channel. In these pumps, an M-shape profile is created since the fluid velocity in the vicinity of the walls is higher than that in its center. Herein, the arbitrary velocity profiles in the electromagnetic pump are generated by introducing an arrayed structure of the coils in the electromagnetic pump and implementing 3D numerical simulation in the finite element software COMSOL. The dimensions of the rectangular channel are 5.5 × 150 mm2. Moreover, the magnetic field is provided using a core with an arrayed structure made of low-carbon iron, as well as five couples of coils. 20% NaoH solution is utilized as the fluid (conductivity: 40 S/m). The arrayed pump is fabricated and experimentally created an arbitrary velocity profile. The pressure of the pump in every single array is 12 Pa and the flow rate is equal to 3375 mm3/s. According to the results, there is a good agreement between the experimental test carried out herein and the simulated models. Article highlights This is the first time that the idea of arrayed electromagnetic pump is presented. This pump uses a special arrayed core with coils; by controlling the current of each coil and the direction of the currents, the magnetic field under the core could be adjusted. By changing the magnetic field at any position in the width of the channel, the Lorentz force alters, which leads to different velocity and pressure profiles. Using COMSOL multiphysics software, the electromagnetic pump was simulated in real size compared to the experimental model. Subsequently, the simulation model was verified and different velocity profiles were generated by activation and deactivation of different coils. The pressure and velocity curves and contours were extracted. The experimental setup was manufactured and assembled. NaOH solution was utilized as the fluid. Afterwards, different modes of coil activations were investigated and the pressure and velocity profiles of the pump were calculated.

Background & Aims: In recent years, wound infections caused by Staphylococcus aureus have substantially grown. Lack of easy access, medications expensive, side effects, and in particular the development of drug resistance, the use of biological materials are proposed as an alternative solution. The recent study was aimed to evaluate the topical effect of Dianthus essential oil on cutaneous excisional wound healing in mice infected with S. aureus. Materials & Maethods: This study was performed on 36 mice (weight 25±3 g). After general anesthesia, 0.5 mm circle wound was created with biopsy punch between the shoulder, and immediately 50 γ of the suspension containing 107 CFU/ml S. Aureus was applied to the wound. Then tested animals, grouping in three groups of 12 mice each (control, treated with ointment 2% and 4%). During the project, image was obtained on days 3, 6, 9 and 12 images for assessment of wound area, and in 3, 7 and 14 from wounds in order to histopathology assessment. Results: The results of the wound size showed that the wound area decreased significantly in the treated groups (p< 0.05) compared with the control group. On histological examination, a significant (p< 0.05) reduction was observed in the migration of immune cells, the migration of fibroblasts and fibrocytes into the wound, the collagen synthesis and secretion. In addition, the thickness of the epithelium thickest increased in the treatment groups compared with the control group (p< 0.05). Conclusion: Based on the results of this study, topical application of Dianthus essential oil, especially at higher therapeutic doses, can be considered a viable option for treatment of infected wounds by the bacteria S. aureus.

Introduction: This study was aimed at determining the effects of a 12-week aerobic exercise program on markers of hypertension in men. Methods: The study was of a semi-experimental design featuring repeated measurements. A total of 40 men (age range=37.9 ± 2.68) with primary hypertension were divided into two groups, namely, the exercise group (n=20) and the control group (n=20) (systolic blood pressure [SBP]: 140.531 ± 0.23, diastolic blood pressure [DBP]: 90.71 ± 0.05). The exercise group participated in a 12-week aerobic exercise program (55% to 70% of HRmax). Blood samples were taken from both groups at the baseline and at the 4th, 8th, and 12th weeks of the training program for the assessment of adiponectin, paraoxonase-1 (PON-1), and hydrogen peroxide (H2 O2 ) levels as the markers for investigation. A linear mixed model was also used to evaluate the association among the markers. Results: In the exercise group, exercise reduced the SBP and DBP at week 12 (P=0.031 and 0.023, respectively), and adiponectin increased at weeks 8 and 12 (P=0.014 and 0.001, respectively). The plasma PON-1 level showed a significant increase in all the three stages of measurement (P=0.007, 0.004, and 0.002 at weeks 4, 8, and 12, respectively), whereas the H2 O2 levels showed a significant decrease at weeks 8 and 12 (P=0.013 and 0.011, respectively). The control group exhibited significantly decreased PON-1 (P=0.003) and adiponectin (P=0.025) levels but significantly increased SBP at week 12 (P=0.032). Conclusion: The exercise-induced reduction of oxidative stress exerts a considerable effect on the reduction of blood pressure in hypertensive patients. According to our results increase in oxidative stress has the great impact on the of blood pressure.

In this paper, two different sub-problems are considered to solve a resource constrained project scheduling problem (RCPSP), namely i) assignment of modes to tasks and ii) scheduling of these tasks in order to minimize the makespan of the project. The modified electromagnetism-like algorithm deals with the first problem to create an assignment of modes to activities. This list is used to generate a project schedule. When a new assignment is made, it is necessary to fix all mode dependent requirements of the project activities and to generate a random schedule with the serial SGS method. A local search will optimize the sequence of the activities. Also in this paper, a new penalty function has been proposed for solutions which are infeasible with respect to non-renewable resources. Performance of the proposed algorithm has been compared with the best algorithms published so far on the basis of CPU time and number of generated schedules stopping criteria. Reported results indicate excellent performance of the algorithm.

Advancement in machining technology of curved surfaces for various engineering applications is increasing. Various methodologies and computer tools have been developed by the manufacturers to improve efficiency of freeform surface machining. Selection of the right sets of cutter path strategies and appropriate cutting conditions is extremely important in ensuring high productivity rate, meeting the better quality level, and lower cutting forces. In this paper, cutting force as a new decision criterion for the best selection of tool paths on convex surfaces is presented. Therefore, this work aims at studying and analyzing different finishing strategies to assess their influence on surface texture, cutting forces, and machining time. Design and analysis of experiments are performed by means of Taguchi technique and analysis of variance. In addition, the significant parameters affecting the cutting force in each strategy are introduced. Machining strategies employed include raster, 3D-offset, radial, and spiral. The cutting parameters were feed rate, cutting speed, and step over. The experiments were carried out on low curvature convex surfaces of stainless steel 1.4903. The conclusion is that radial strategy provokes the best surface texture and the lowest cutting forces and spiral strategy signifies the worst surface texture and the highest cutting forces.

Background: Poisoning is a significant public health concern, encompassing a broad range of sudden and severe health issues resulting from the ingestion, inhalation, or contact with toxic substances. The potential for injury or fatality necessitates urgent medical attention and care. With the ongoing advancements in artificial intelligence (AI) and its increasing integration into medical and pharmaceutical domains, there is a growing interest in exploring the role of AI in the context of poisonings. This study aims to investigate the potential applications of AI in the management and treatment of poisoning.Materials and methods: This research is a review by searching the keywords ("Artificial intelligence") [TIAB] AND (poisoning [TIAB] OR toxicity[TIAB] OR intoxication[TIAB] OR Toxin[TIAB] OR poison[TIAB]) was searched in the internet databases PubMed, Scopus, and Google Scholar search engine in 2016-2024.Conclusion: Enhancing system management and treatment approaches is crucial in preventing accidental and intentional poisoning. This can be achieved by incorporating cutting-edge medical equipment, such as those equipped with AI. AI technology can recognize complex patterns beyond predefined rules and process large amounts of data, exceeding human capabilities. In the future, more progress in AI will likely affect various areas of healthcare, including poison prevention and treatment, to improve patient outcomes and reduce the burden of poisoning on healthcare systems.

Background and Aim: Aluminum phosphide poisoning is one of the fatal poisonings in Asian countries, including Pakistan and India, which requires urgent treatment. Since one of the most important symptoms in patients poisoned with aluminum phosphide is cardiovascular manifestations; it seems that electrocardiogram and echocardiographic changes are one of the important things that need to be measured in patients poisoned with this substance. Therefore, the study was designed to investigate electrocardiogram and echocardiographic changes in patients poisoned with aluminum phosphide. Materials and Methods: The present study was conducted cross-sectionally 2019-2021 on 107 patients poisoned with aluminum phosphide who referred to the poisoning emergency of Baharloo Hospital in Tehran. All patients were included in the study due to taking tablets, solution or inhalation of aluminum phosphide. Finally, the patients› information was collected based on the variables investigated in this study including age, gender, poisoning dose, time interval between taking pills and admission to the hospital, systolic blood pressure level, electrocardiogram and echocardiography changes. Results: The mean systolic blood pressure was 107 mmHg at the beginning of the study that changed to 103 mmHg after 24 hours. In addition, the mean diastolic blood pressure was 71.19 mmHg at the beginning of the study that changed to 68.66 mmHg after 24 hours. The blood pH of the patients at the beginning of the study and after 24 hours, was 6.99 and 7.39, respectively (P-value= 0.081). The mean EF was 40.68at the beginning of the study which, on average, changed to 46.57 mmHg after 24 hours (%5.21 increase, P-value= 0.029). Conclusion: The results of the present study showed that extensive changes in the echocardiography of the heart, especially the left ventricular ejection fraction, as well as the patient›s ECG could indicate the severity of heart poisoning in patients poisoned with aluminum phosphide.

BackgroundPerceived social support (PSS) plays a considerable role in mental health. The Multidimensional Scale of Perceived Social Support (MSPSS) is one of the most widely used scales, leading to much research evidence. The present study investigated its measurement model, equivalence across gender (male and female) and age groups (older patients= above 60 and non-older patients= below 60), and concurrent validity.MethodsA cross-sectional survey was conducted between March and October 2020, on patients hospitalized due to COVID-19 in Tehran, Iran. The scales were administered to 328 COVID-19 patients (54.6% male, aged 21 to 92) from two general hospitals; participants completed MSPSS (including friends, family, and significant others subscales), Pittsburgh Sleep Quality Index (PSQI, include sleep latency, subjective sleep quality, habitual sleep efficiency, sleep duration, use of sleep medication, daytime dysfunction, and sleep disturbances subscales), and the Perceived Stress Scale-10 (PSS-10, to assess patients’ appraisal of stressful conditions).ResultsThe MSPSS three-factor structure was confirmed among COVID-19 patients by Confirmatory Factor Analysis (CFA). The results support the MSPSS internal consistency and configural, metric, and scalar invariance across gender and age groups. Nevertheless, small but significant differences were found across ages based on the latent factor mean of the MSPSS from friends, with a lower mean level in older patients. The coefficients of Cronbach’s alpha (ranging from.92 to.96), the ordinal theta (ranging from.95 to.98), and Omega (ranging from.93 to.97) suggested high internal consistency of MSPSS. The concurrent validity of MSPSS was evidenced by its significant negative correlation with PSS-10 (τb = -.13, p

Background: Since the health and treatment staff are constantly exposed to critical and stressful situations during the outbreak of the Covid-19 pandemic, the present study aims to investigate the relationship between spiritual health and resilience in the personnel of hospitals accepting patients with the corona virus affiliated to Tehran University of medical Sciences. Materials and Methods: The current study is a descriptive and analytical study that was conducted cross-sectionally in 2019. The study population included medical staff, including doctors, nurses, paramedics, and service personnel who participated in the fight against Covid-19. In order to measure resilience, Connor and Davidson's questionnaire was used, and Polotzin and Ellison's spiritual health questionnaire was used to measure spiritual health. 145 questionnaires were included in the study. Statistical tests of mean, standard deviation, Pearson correlation coefficient, analysis of variance and independent t were used to analyze the data. Results: The average resilience score among the subjects was 64.3. The results showed that resilience in the field of spiritual effects with an average of 3.07 was the highest and in the field of tolerance of negative effects and strength against stress with an average of 2.33 had the lowest average. Spiritual health in 55.9% of the studied units was at a moderate level and none of them had a low level of spiritual health. Resilience and all its domains had a statistically significant positive correlation with spiritual health and its domains. Conclusion: Managers' attention to the spiritual health of health center staff can reduce stress and pressures caused by work in critical situations and be an effective step towards greater productivity of human resources.

Background and Aim: The American Psychiatric Association identifies suicide as the third leading cause of death among people aged 15 to 24. This study was conducted with the aim of investigating factors affecting of the occurrence of suicides leading to death in corpses referred to the Forensic Medicine Organization of Tehran Province from 2010 to 2019. Materials and Methods: This research was a descriptive and analytical cross-sectional study in 2019 year. The statistical population includes all bodies referred to forensic medicine. The information related to all corpses referred to forensic medicine which was analyzed between 2010 and 2019 were 5471 cases. Descriptive and analytical statistical methods were used to analyze the data. P-value less than 0.05% was considered valid. Results: The results showed that 50% of suicide deaths were under 32 years old. Sixty-nine point two percent of suicides leading to death are male and the rest are female. The highest frequency in terms of method was related to the hanging method, 39.3%, and in the youth age group, in terms of the level of education in men, high school diploma and diploma in women. The highest frequency of suicide related to singles was 47.1% and 27.4% in the summer season. The most common method of suicide was hanging, with more than 39%, followed by poisoning with poison, with more than 25% of cases. The least used method was drowning. Conclusion: Based on the results of this study, it seems that factors such as age, sex, level of education, and even geographic and social factors are among the factors that affect suicide, which can help policymakers, managers, psychologists, psychiatrists, and related organizations. Paying attention to educational literacy, employment status and income level of people, special attention of families to adolescent and young boys and girls and especially their marital status can be effective measures to prevent suicide.

Background & Aim: Volunteers’ perceptions may affect their future decisions to participate in crisis intervention. Few studies in Iran have been conducted to examine the experiences of medical personnel who volunteered during the COVID-19 pandemic. This qualitative study describes the experiences of medical volunteers during COVID-19 in Iran. Methods & Materials: A total of 17 healthcare volunteers who worked in COVID-19 hospital wards were recruited using purposive sampling. All participants were recruited in the current study from the hospitals affiliated with the Tehran University of Medical Sciences if they expressed their willingness to participate and had at least two months experience of working as healthcare volunteers in COVID-19 wads. In-depth video-call semi-structured interviews were conducted from August to November 2020. The data were analyzed using the qualitative thematic analysis method. Results: One main theme “from nuisance to helpful assistants” and four sub-themes including the “feeling of inefficiency”, “negligent managing”, “situation orientation”, and “transformation for integrity” emerged from the data. Conclusion: Despite experiencing challenges, the volunteers and hospital staff tried to change their approaches to joint collaboration by improving their capabilities for situation awareness and creating integrity. These findings provide policymakers with a better understanding of health volunteers' challenges in hospitals during crises.

Background:The most important and difficult process in any organization is to create change in the organization because today organizations have to react to changes in the environment.The purpose of this study was to investigate the effect of transformational management on quality of work life of the staff of Shohada-ye Tajrish Hospital in Tehran. Materials & Methods:The is a descriptive-analytic and cross-sectional study that was conducted in Shohada-ye Tajrish Hospital in Tehran in 2020. Data collection tools were Transformational Management Questionnaire(Bass and Olivier)and Quality of Work Life Questionnaire(Walton 1973). Based on Cochran's formula, 234 employees of Shohada-ye Tajrish Hospital in Tehran were selected as study population.The reliability and validity of the measuring tools were evaluated using Cronbach's alpha coefficient and confirmatory factor analysis. Pearson correlation test and structural equation test were used to analyze the data. Results:The research findings indicated that there was a positive and significant correlation between transformational management with safe and healthy work environment, growth opportunity and security, fair and adequate pay, employee legalism,social affiliation,social cohesion and integration, development of human capabilities and the general atmosphere of working life. In addition, 92% of the variance in quality of work life was explained by the research model. Conclusion:Considering the impact of transformational management on the development of human capabilities, senior managers should formulate and implement appropriate programs to improve the quality of work life and provide conditions for employees to enjoy their organization and work.

# Background and Objectives There are limited studies regarding suicidal ideation among Iranian medical students. We aimed to evaluate the prevalence of suicidal ideation and its association with hopelessness among Tehran University of Medical Sciences (TUMS) medical students. # Methods We designed a cross-sectional study conducted in TUMS in 2018. We developed a questionnaire consisting of three parts; the Beck Hopelessness Scale (BHS), four questions regarding suicidal ideation, and questions regarding demographic characteristics. We used the available sampling technique and sent the questionnaire to 517 medical students of TUMS. # Results In total, 224 medical students completed and sent back the questionnaire (response rate=43.32%). Participants' mean age was 22.68 (SD=3.38) years, and 140 participants (62.5%) were female. One hundred seven students (47.76%) had mild, 58 (25.89%) had moderate, and 13 (5.8%) had severe hopelessness. Males, senior students, and dissatisfied students with their academic performance experienced more severe hopelessness (P\

Background: Paying attention to the issue of mental health in the workplace, especially with current pandemic conditions of COVID-19 is of significant importance. Therefore, this study aimed to determine the factors affecting occupational burnout among health care center staff during the pandemic of coronavirus infection. Methods: The present study was a case-control study carried out in the first half of the year 2020 on medical staff working in hospitals in Tehran. The sample size was 324 individuals, including 175 employees working in general (non-COVID) wards and 149 people working in COVID-19 wards. Demographic characteristics questionnaire and two standard questionnaires of Maslach Burnout Inventory and Parker and DeCotiis Job Stress Scale were distributed. Results: Total score of job stress and its two dimensions (time and pressure) had a significant relationship with different levels of occupational burnout. Logistic regression analyses showed significant relations between job stress with emotional exhaustion (95% CI, 1.11-1.19, OR=1.15) and depersonalization. Participants in both wards experienced statistically significant increasing trends given the different components of occupational burnout concurrently by increasing their total stress score. Conclusion: Hospital staff’s levels of stress and occupational burnout regardless of where they worked (COVID-19 wards or general wards) were not significantly different and existed among the members of both groups. On the other hand, job stress and its dimensions (time pressure and anxiety) had a significant relationship with the main dimensions of occupational burnout.

Background: Gender determination is an important challenge in the identification of skeletal remnants and dismembered bodies. The femur bone is more likely to be preserved during accidents and over time; thus, it is one of the most useful bones in gender determination. Methods: This cross-sectional study was conducted on 54 fresh femur pairs of ˃19-yearold Iranians without anomalies or trauma. We studied the length of the femur, vertical head diameter, bicondylar width, shaft angle with the horizon, and collo-diaphyseal angle in male and female samples. Data were analyzed in SPSS using t-test and Receiver Operating Characteristic curves. P0.05). The vertical head diameter, maximum length, bicondylar width, and the shaft angle were significantly larger in the males, compared to females. The mean degree of collodiaphyseal angle was significantly wider in females, compared to males (P

Background: It is a challenge in forensic medicine to identify deceased bodies when body dismembered from remaining body parts, such as hands, arms, and feet. We aimed to determine gender and the correlation between stature, and index and ring fingers in an Iranian population. Methods: In this cross-sectional study, 200 Iranian students aged between 18 and 25 years were included (2016-2017). The length of the nondominant index and ring fingers were measured from proximal crease to the tip. The exclusion criteria were a history of heavy physical work by hand, hand vocational sports, anatomical musculoskeletal deformities, and chronic internal diseases (diabetes, thyroid disorders, renal failure, etc.). The obtained data were analyzed using SPSS. t-test, Pearson’s correlation coefficient, and correlation and regression models were used to analyze the achieved data. Results: The mean height was 179 cm in males and 164 cm in females. The mean index and ring fingers lengths were 73 mm and 74 mm in males, and 68 mm and 68 mm in females, respectively. The mean sum of index and ring fingers lengths were 147 mm in males and 136 mm in females. Height, index and ring fingers length, and the sum of them significantly differed between genders (P

Background: A primary aim of forensic medicine is gender determination. Although hip is the optimal bone for this purpose, different determining criteria of this bone do not have the same accuracy. This is important in conditions that only parts of hip remain to determine gender. This study aimed to evaluate the accuracy of different hip criteria in gender determination. Methods: This cross-sectional study evaluated a total of 160 paired hips (80 males and 80 females) removed from the bodies for bone transplantation. Morphometric criteria were vertical and horizontal acetabular diameters and superior and inferior pubic ramus widths. Morphological criteria were a greater sciatic notch, obturator foramen, pubic body, preauricular sulcus, acetabular fossa position, and ischial tuberosity. The obtained data were analyzed using Cross Tab, t-test, and logistic regression analysis by SPSS. The significance level was set at P0.05). In gender determination, acetabular diameter and greater sciatic notch had the highest accuracy (85%), and obturator foramen (67.5%) and superior and inferior pubic ramus widths (65%) had the lowest accuracy. Conclusion: Hip bone is not always completely available and preserved to determine gender. Moreover, sometimes not all anthropometric criteria of the bone are in favor of one gender. Therefore, investigating the accuracy of different criteria can be very important in interpreting the results. Thus, it has always been emphasized on the use of all available information in gender determination.