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Abstract This study addresses the challenges associated with emergency department (ED) overcrowding and emphasizes the need for efficient risk stratification tools to identify high-risk patients for early intervention. While several scoring systems, often based on logistic regression (LR) models, have been proposed to indicate patient illness severity, this study aims to compare the predictive performance of ensemble learning (EL) models with LR for in-hospital mortality in the ED. A cross-sectional single-center study was conducted at the ED of Imam Reza Hospital in northeast Iran from March 2016 to March 2017. The study included adult patients with one to three levels of emergency severity index. EL models using Bagging, AdaBoost, random forests (RF), Stacking and extreme gradient boosting (XGB) algorithms, along with an LR model, were constructed. The training and validation visits from the ED were randomly divided into 80% and 20%, respectively. After training the proposed models using tenfold cross-validation, their predictive performance was evaluated. Model performance was compared using the Brier score (BS), The area under the receiver operating characteristics curve (AUROC), The area and precision–recall curve (AUCPR), Hosmer–Lemeshow (H–L) goodness-of-fit test, precision, sensitivity, accuracy, F1-score, and Matthews correlation coefficient (MCC). The study included 2025 unique patients admitted to the hospital’s ED, with a total percentage of hospital deaths at approximately 19%. In the training group and the validation group, 274 of 1476 (18.6%) and 152 of 728 (20.8%) patients died during hospitalization, respectively. According to the evaluation of the presented framework, EL models, particularly Bagging, predicted in-hospital mortality with the highest AUROC (0.839, CI (0.802–0.875)) and AUCPR = 0.64 comparable in terms of discrimination power with LR (AUROC (0.826, CI (0.787–0.864)) and AUCPR = 0.61). XGB achieved the highest precision (0.83), sensitivity (0.831), accuracy (0.842), F1-score (0.833), and the highest MCC (0.48). Additionally, the most accurate models in the unbalanced dataset belonged to RF with the lowest BS (0.128). Although all studied models overestimate mortality risk and have insufficient calibration (P > 0.05), stacking demonstrated relatively good agreement between predicted and actual mortality. EL models are not superior to LR in predicting in-hospital mortality in the ED. Both EL and LR models can be considered as screening tools to identify patients at risk of mortality.

Introduction: Non-Suicidal Self-Injury (NSSI) has high prevalence among the patients with psychiatric disorders. Self-Injury plays an important role in the treatment, prognosis and risk of suicide, which highlights the need for an appropriate tool to assess the nature and psychological functions of NSSI. Therefore, the aim of this study was to determine the psychometric properties of the Persian version of the Ottawa Self-Injury inventory (OSI) in hospitalized patients. Methods: The present study was a psychometric study based on analytical method. The research has been performed on 310 patients with non-suicidal self-injury who have been referred to Nekoei-Hedayati Hospital in Qom City. Sample group completed Persian version of the Ottawa Self-Injury inventory. Data were analyzed using SPSS-16 and Cronbach’s alpha coefficient, Content Validity Index (CVI) and Content Validity Ratio (CVR). Results: The results showed that content validity index in this study was more than 0.75 and content validity ratio for validity of questions was more than 0.79. The impact score of all items (Except for the tenth question) was higher than 1.5 that confirmed the face validity of inventory. The total Cronbach's alpha coefficient was calculated 0.71. Another result of this study was that 52% of patients reported at least one addictive characteristic. Conclusion: The finding showed that Persian version of Ottawa Self-Injury inventory has appropriate validity (face /content) and reliability in the inpatient population.

Background and Objectives: Various studies have emphasized the main role of alexithymia and poor in eating disorders. This study aims to investigate the mediating role of alexithymia in predicting eating disorders based on body image in Iranian college students. Methods: This is a descriptive-correlational study using structural equation modeling (SEM). Participants were 369 students of the Islamic Azad University of Qom Branch in 2020-2021, who were selected by a convenience sampling method. Data were collected using the eating attitude test, body image concern inventory, and Toronto alexithymia scale. Data were analyzed by path analysis. Results: The results showed that alexithymia increases the path between body image and eating disorders by 14% (β=0.140), indicating its minor mediating role in predicting eating disorders based on body image. Conclusion: Alexithymia has a minor mediating role in the relationship between eating disorders and body image in Iranian college students. For more understanding of the relationship between eating disorders and body image, it is recommended to assess the possible role of other biological and psychological factors.

Introduction: In the recent years, transcranial direct current stimulation (tDCS) has been considered by researchers as one of the possible effective approach in the treatment of major depressive disorder. However, the results of these investigations are often contradictory. According to this, the purpose of this study was to determine the effectiveness of tDCS in reducing symptoms of people with major depressive disorder. Methods: In the sham-controlled randomized trial, twenty people with major depressive disorder referred to a private psychiatric clinic in Tehran City, Iran. They were selected by convenience sampling and divided into the intervention and control groups by randomized block design. tDCS was administered 2 mA, 20 minutes per session, for 10 sessions, 3 days per week. Immediately after, and one month after the intervention, the scores of the two groups were assessed in the Hamilton Depression Rating Scale and Beck Depression Inventory. The data were analyzed using SPSS version 16 software and using statistical methods of repeated analysis of variance and independent and dependent t-test. Results: The results of repeated analysis of variance for Hamilton (F = 43.5 and P = 0.017) and Beck (F = 125.12 and P = 0.022) depression scores showed the significance of the interaction effect of time (four stages of measurement) and group membership (experiment and control) (P < 0.05). In depression scores in both Hamilton and Beck scales in the experimental group in the intervention stages (Hamilton scale, P = 0.019, Beck scale = P = 0.017) and follow-up (Hamilton scale, P = 0.01, Beck scale = P = 0.03) was significantly reduced compared to the control group. Conclusion: The results of this study confirmed the effectiveness of tDCS in reducing symptoms of major depressive disorder. More clinical trials are needed to prove the effectiveness of tDCS compared to a variety of treatments

Abstract Background PTEN hamartoma tumour syndrome (PHTS) is a rare hereditary disorder caused by germline pathogenic mutations in the PTEN gene. This study presents a case of PHTS referred for genetic evaluation due to multiple polyps in the rectosigmoid area, and provides a literature review of PHTS case reports published between March 2010 and March 2022. Case presentation A 39-year-old Iranian female with a family history of gastric cancer in a first-degree relative presented with minimal bright red blood per rectum and resistant dyspepsia. Colonoscopy revealed the presence of over 20 polyps in the rectosigmoid area, while the rest of the colon appeared normal. Further upper endoscopy showed multiple small polyps in the stomach and duodenum, leading to a referral for genetic evaluation of hereditary colorectal polyposis. Whole-exome sequencing led to a PHTS diagnosis, even though the patient displayed no clinical or skin symptoms of the condition. Further screenings identified early-stage breast cancer and benign thyroid nodules through mammography and thyroid ultrasound. Method and results of literature review A search of PubMed using the search terms “Hamartoma syndrome, Multiple” [Mesh] AND “case report” OR “case series” yielded 43 case reports, predominantly in women with a median age of 39 years. The literature suggests that patients with PHTS often have a family history of breast, thyroid and endometrial neoplasms along with pathogenic variants in the PTEN/MMAC1 gene. Gastrointestinal polyps are one of the most common signs reported in the literature, and the presence of acral keratosis, trichilemmomas and mucocutaneous papillomas are pathognomonic characteristics of PHTS. Conclusion When a patient presents with more than 20 rectosigmoid polyps, PHTS should be considered. In such cases, it is recommended to conduct further investigations to identify other potential manifestations and the phenotype of PHTS. Women with PHTS should undergo annual mammography and magnetic resonance testing for breast cancer screening from the age of 30, in addition to annual transvaginal ultrasounds and blind suction endometrial biopsies.

The probabilities of xn-, pxn-, and αxn-evaporation channels in excited superheavy nuclei were evaluated using the Monte Carlo method. The calculations utilized microscopically determined nuclear level densities and were compared with results obtained from the phenomenological Jackson formula. Effective temperatures derived from the microscopic approach were incorporated into the Jackson formula for different evaporation channels at low and moderate excitation energies. Additionally, an analytical formula was introduced to estimate the average kinetic energy of emitted particles in multi-step processes.

Background and Objectives: Patients have certain rights that are expected to be observed and respected by healthcare providers. These rights include universal as well as local rights determined by the social and cultural context of any society. Patient’s rights consist of statements issued to declare the duties of the health providers pertaining to patients. There are charters of patient rights in different countries including Iran. However, it seems necessary to investigate more exactly the patient rights in accordance with the Islamic perspective as the fundamental value system of the country. This study was conducted to explore and explain the patient’s rights from the clerics’ point of view. Methods: This was a conventional qualitative content analysis study. The participants were 20 clerics living in Qom selected through purposeful sampling, who met the inclusion criteria and could provide their understanding of the patient’s rights in the context of Islam. Deep semi-structured interviews were conducted. The interviews were coded and categorized through qualitative content analysis. Results: This study led to the identification of four themes as the main features of patient’s rights from the clerics’ point of view including respect for patient autonomy, considering non-physical needs of patients, high-quality healthcare, and moral conduct. Conclusion: According to the findings of this study, patient rights from the viewpoint of the clerics includes besides attending other needs of patients, their spiritual needs that should be addressed by healthcare providers.

Abstract Purpose The study was aimed to assess the prognostic power The Pediatric Risk of Mortality-3 (PRISM-3) and the Pediatric Index of Mortality-3 (PIM-3) to predict in-hospital mortality in a sample of patients admitted to the PICUs. Design and methods The study was performed to include all children younger than 18 years of age admitted to receive critical care in two hospitals, Mashhad, northeast of Iran from December 2017 to November 2018. The predictive performance was quantified in terms of the overall performance by measuring the Brier Score (BS) and standardized mortality ratio (SMR), discrimination by assessing the AUC, and calibration by applying the Hosmer-Lemeshow test. Results A total of 2446 patients with the median age of 4.2 months (56% male) were included in the study. The PICU and in-hospital mortality were 12.4 and 16.14%, respectively. The BS of the PRISM-3 and PIM-3 was 0.088 and 0.093 for PICU mortality and 0.108 and 0.113 for in-hospital mortality. For the entire sample, the SMR of the PRISM-3 and PIM-3 were 1.34 and 1.37 for PICU mortality and 1.73 and 1.78 for in-hospital mortality, respectively. The PRISM-3 demonstrated significantly higher discrimination power in comparison with the PIM-3 (AUC = 0.829 vs 0.745) for in-hospital mortality. (AUC = 0.779 vs 0.739) for in-hospital mortality. The HL test revealed poor calibration for both models in both outcomes. Conclusions The performance measures of PRISM-3 were better than PIM-3 in both PICU and in-hospital mortality. However, further recalibration and modification studies are required to improve the predictive power to a clinically acceptable level before daily clinical use. Practice implications The calibration of the PRISM-3 model is more satisfactory than PIM-3, however both models have fair discrimination power.

An experimental study of 256Rf spontaneous fission following the fusion reaction of 50Ti+208Pb was performed using the velocity filter SHELS of the Flerov laboratory at JINR. The average number of neutrons of ν‾=4.30±0.17 and variance of σν2=3.2 from the prompt neutron multiplicity distribution were obtained. The alpha decay branching ratio of bα=0.003−0.003+0.005 and the half-life of T1/2=(6.7±0.2) ms of the isotope were determined. For the first time, our neutron detector system allowed us to extend investigation of the prompt neutron multiplicity study to the superheavy element region.

Abstract Background The incidence rate of colorectal cancer (CRC) is increasing among patients below 50 years of age. The reason for this is unclear, but could have to do with the fact that indicative variables, such as tumour location, gender preference and genetic preponderance have not been followed up in a consistent mann er. The current study was primarily conducted to improve the hereditary CRC screening programme by assessing the demographic and clinicopathological characteristics of early-onset CRC compared to late-onset CRC in northeast Iran. Methods This retrospective study, carried out over a three-year follow-up period (2014–2017), included 562 consecutive CRCs diagnosed in three Mashhad city hospital laboratories in north-eastern Iran. We applied comparative analysis of pathological and hereditary features together with information on the presence of mismatch repair (MMR) gene deficiency with respect to recovery versus mortality. Patients with mutations resulting in absence of the MMR gene MLH1 protein product and normal BRAF status were considered to be at high risk of Lynch syndrome (LS). Analyses using R studio software were performed on early-onset CRC (n = 222) and late-onset CRC (n = 340), corresponding to patients ≤50 years of age and patients > 50 years. Results From an age-of-onset point of view, the distribution between the genders differed with females showing a higher proportion of early-onset CRC than men (56% vs. 44%), while the late-onset CRC disparity was less pronounced (48% vs. 52%). The mean age of all participants was 55.6 ± 14.8 years, with 40.3 ± 7.3 years for early-onset CRC and 65.1 ± 9.3 years for late-onset CRC. With respect to anatomical tumour location (distal, rectal and proximal), the frequencies were 61, 28 and 11%, respectively, but the variation did not reach statistical significance. However, there was a dramatic difference with regard to the history of CRC in second-degree relatives between two age categories, with much higher numbers of family-related CRCs in the early-onset group. Expression of the MLH1 and PMS2 genes were significantly different between recovered and deceased, while this finding was not observed with regard to the MSH6 and the MSH2 genes. Mortality was significantly higher in those at high risk of LS. Conclusion The variation of demographic, pathological and genetic characteristics between early-onset and late-onset CRC emphasizes the need for a well-defined algorithm to identify high-risk patients.

Abstract Background Medical scoring systems are potentially useful to make optimal use of available resources. A variety of models have been developed for illness measurement and stratification of patients in Emergency Departments (EDs). This study was aimed to compare the predictive performance of the following six scoring systems: Simple Clinical Score (SCS), Worthing physiological Score (WPS), Rapid Acute Physiology Score (RAPS), Rapid Emergency Medicine Score (REMS), Modified Early Warning Score (MEWS), and Routine Laboratory Data (RLD) to predict in-hospital mortality. Methods A prospective single-center observational study was conducted from March 2016 to March 2017 in Edalatian ED in Emam Reza Hospital, located in the northeast of Iran. All variables needed to calculate the models were recorded at the time of admission and logistic regression was used to develop the models’ prediction probabilities. The Area Under the Curve for Receiver Operating Characteristic (AUC-ROC) and Precision-Recall curves (AUC-PR), Brier Score (BS), and calibration plots were used to assess the models’ performance. Internal validation was obtained by 1000 bootstrap samples. Pairwise comparison of AUC-ROC was based on the DeLong test. Results A total of 2205 patients participated in this study with a mean age of 61.8 ± 18.5 years. About 19% of the patients died in the hospital. Approximately 53% of the participants were male. The discrimination ability of SCS, WPS, RAPS, REMS, MEWS, and RLD methods were 0.714, 0.727, 0.661, 0.678, 0.698, and 0.656, respectively. Additionally, the AUC-PR of SCS, WPS, RAPS, REMS, EWS, and RLD were 0.39, 0.42, 0.35, 0.34, 0.36, and 0.33 respectively. Moreover, BS was 0.1459 for SCS, 0.1713 for WPS, 0.0908 for RAPS, 0.1044 for REMS, 0.1158 for MEWS, and 0.073 for RLD. Results of pairwise comparison which was performed for all models revealed that there was no significant difference between the SCS and WPS. The calibration plots demonstrated a relatively good concordance between the actual and predicted probability of non-survival for the SCS and WPS models. Conclusion Both SCS and WPS demonstrated fair discrimination and good calibration, which were superior to the other models. Further recalibration is however still required to improve the predictive performance of all available models and their use in clinical practice is still unwarranted.

The mechanical and impact performance of Multi-Wall Carbon Nanotube (MWCNT) and Graphene Nanoplatelets (GNPs) dispersed Carbon/Basalt Fiber-reinforced Polymer (CBFRP) intra-ply hybrid composites were examined. The MWCNT and GNP dispersed CBFRP nanocomposites were fabricated by Vacuum-assisted Resin Infusion Molding (VARIM) method. The mechanical properties such as modulus of elasticity, tensile strength, impact characteristics such as maximum contact force and maximum absorbed energy were measured for fabricated composite materials. The fiber content ratios (35%, 40%, and 45%) of MWCNT (0, 0.25, and 0.5) and GNP nanoparticles (0, 0.25, and 0.5) were considered as the analysis parameters in three levels. The experiments were conducted using Taguchi L9 orthogonal array. Taguchi's DOE, and the S/N ratio results were applied to determine the optimum level and to identify the most significant parameters affecting the mechanical and impact characteristics of MWCNT and GNP-introduced CBFRP nanocomposites. According to the results, increasing the fiber content ratio (FCR) and the nanoparticles percentage improved the mechanical and impact properties of the fabricated composites. Furthermore, the FCR parameter had a better contribution than the two others and was the most effective on the analysis responses. [ABSTRACT FROM AUTHOR]

Background and Objectives: The spread of COVID-19 has led to numerous changes in different domains of life throughout the world, including health habits, jobs, consumption patterns, lifestyles, and religious ceremonies. Phenomenological questions, religious challenges, and many questions regarding the cause of the pandemic also resulted from these changes. Therefore, the goal of the present study was to explore the role of the COVID-19 pandemic on the religious and spiritual experiences of the Iranian population. Methods: A qualitative design based on a phenomenological approach was used. The sample included 18 subjects who were selected using a purposeful sampling method. The data were collected using semi-structured interviews. Results: The Colaizzi method was used to analyze the data and member checking, selfmonitoring, and immersion were used to examine the credibility of the results. The study findings included 175 primary codes, of which two main categories and 11 subcategories were extracted. Belief in God and religion was the first category extracted that included the following subcategories: no change in belief in God, no change in lack of belief in God, reconsidering one’s own beliefs, amazed by the power of God, amazed by the knowledge of God, Expecting miracles from God, and Increased sense of spirituality or closeness to God. The second category was beliefs about existence that included the following subcategories: no change in Beliefs, believing that human abilities are limited, thinking about existence, and believing in the importance of changing our behavior towards nature. Conclusion: According to the study result, the experience of COVID-19 had affected participants’ attitude towards religion, spirituality, God, nature, and the system of the world; most of the participants reported improvements in their previous beliefs and attitudes as a result of these changes. Therefore, some conversations, such as the epidemic of a disease (COVID-19) can affect the religious attitudes and beliefs of individuals.

The ratios of negative-to-positive parity level densities in 94,96,98Mo isotopes are calculated using a microscopic formalism based on the Bardeen-Cooper-Schrieffer (BCS) model. In this calculation, the single-particle energies are obtained with the Nilsson model. Mass number, shell, and deformation effects on the parity equilibration phenomenon in these isotopes are discussed in this work. Key words: nuclear level density, parity, nuclear models, nuclear deformation. Nous utilisons un formalisme microscopique base sur le modele BCS pour calculer les rapports de densite des niveaux de parite negative-positive dans les isotopes 94,96,98Mo. Dans ce calcul, les energies des etats a une particule sont obtenues du modele de Nilsson. Nous analysons ici les effets du nombre de masse, de la couche et de la deformation, sur les phenomenes d'equilibrage de parite dans ces isotopes. [Traduit par la Redaction] Mots-cles : densite de niveau de Nilsson, parite, modeles nucleaires, deformation du noyau., 1. Introduction Nuclear level density (NLD) is an important parameter in the study of nuclear structure and nuclear interactions. NLD is used in different fields, such as cross section calculation [...]

Background & Objective: In conceptualizing addiction, the role of personality elements in the emergence and continuation of dependence to substances has attracted the attention of researchers. Accordingly, the purpose of this study was to investigate the frequency of personality disorders and temperament-character traits of personality in substance-dependent individuals. Materials &Methods: In this descriptive cross-sectional study, 150 patients referred to Nekooe-Forghani Hospital in Qom and 145 healthy people working in this hospital were selected by convenience sampling. The two groups were evaluated and compared by Multidimensional Clinical Questionnaire (III). Data were analyzed using descriptive and inferential statistics (ANOVA, Tukey post hoc test). Results: The results showed that the prevalence of personality disorders was 56% in substance dependent individuals. Borderline personality disorder with 16%, antisocial personality with 14%, and avoidance personality with 6.67% had the highest frequency in the case group, respectively. Also, generally, subjects with substance dependence had higher scores in novelty-seeking and lower scores in self-directed dimensions compared with normal group. Moreover, sedative drugs users had more scores in harm avoidance, stimulant users in self-transcendence and normal subjects in persistence than other groups. Conclusion: The results of the research indicated that there was a high prevalence of personality disorders among drug-dependent individuals. In addition, study showed that there was a significant difference between personality dimensions of temperament-character in substance dependent individuals and normal people.

Hypothesis: In recent years, some modern techniques such as plasma, ultraviolet irradiation and ozone treatment have been used in surface modification of polymers. Surface modification of polymeric fibers is aimed to improve dying and to achieve desirable physical properties like high moisture absorption and lower anti-static. In this study in an attempt to modify the surface of polyester fibers, a new complex method through ultraviolet/ozone treatment in two wet and dry forms has been applied. Methods: Surface modification of polyester fibers was performed by ultraviolet/ozone treatment on dry samples, as well as on samples impregnated with water, hydrogen peroxide and hydrogen peroxide/sodium silicate solutions. In order to study and compare the functional groups and morphology of the polyester fibers with those of control sample, Fourier-transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM) were used. Also, the moisture absorption and static electricity of the samples were studied.Findings: The results of FTIR spectra revealed that by ultraviolet/ozone treatment the number of oxygen-containing functional groups has increased considerably. Also, nanoscale surface roughness of the treated samples was revealed by SEM images. Additionally, the results indicated that moisture absorption of the treated polyester fibers has risen and consequently their static electricity has decreased. According to the results, the impregnation of polyester fibers can remarkably enhance surface oxidation process.

Introduction Seasonal influenza is a significant public health challenge worldwide. This study aimed to investigate the epidemiological characteristics and spatial patterns of severe hospitalized influenza cases confirmed by polymerase chain reaction (PCR) in Iran. Methods Data were obtained from Iran’s Ministry of Health and Medical Education and included all hospitalized lab-confirmed influenza cases from January 1, 2016, to December 30, 2018 (n = 9146). The Getis-Ord Gi* and Local Moran’s I statistics were used to explore the hotspot areas and spatial cluster/outlier patterns of influenza. We also built a multivariable logistic regression model to identify covariates associated with patients’ mortality. Results Cumulative incidence and mortality rate were estimated at 11.44 and 0.49 (per 100,000), respectively, and case fatality rate was estimated at 4.35%. The patients’ median age was 40 (interquartile range: 22–63), and 55.5% (n = 5073) were female. The hotspot and cluster analyses revealed high-risk areas in northern parts of Iran, especially in cold, humid, and densely populated areas. Moreover, influenza hotspots were more common during the colder months of the year, especially in high-elevated regions. Mortality was significantly associated with older age (adjusted odds ratio [aOR]: 1.01, 95% confidence interval [CI]: 1.01–1.02), infection with virus type-A (aOR: 1.64, 95% CI: 1.27–2.15), male sex (aOR: 1.77, 95% CI: 1.44–2.18), cardiovascular disease (aOR: 1.71, 95% CI: 1.33–2.20), chronic obstructive pulmonary disease (aOR: 1.82, 95% CI: 1.40–2.34), malignancy (aOR: 4.77, 95% CI: 2.87–7.62), and grade-II obesity (aOR: 2.11, 95% CI: 1.09–3.74). Conclusions We characterized the spatial and epidemiological heterogeneities of severe hospitalized influenza cases confirmed by PCR in Iran. Detecting influenza hotspot clusters could inform prioritization and geographic specificity of influenza prevention, testing, and mitigation resource management, including vaccination planning in Iran.