Search

Abstract: The objective of this study was to determine ADL (Activity of daily living) in survivors of the Iran-Iraq war with bilateral lower limb amputation. The cross-sectional survey 335 amputees participated in the study (response rate = 58 %) and ADL (KATZ) questionnaire were used. The average age of the patients was 42.05 (SD = 6.33). The majority of the cases 97.6 % (n = 327) were married. The most common type of amputation was both below-knee 37.6 % (n = 126). Two hundred and six subjects (61.5 %) were prosthetic ambulates. Shell and landmine were the most common cause of amputation. The most dependency in ADL was related to transport 26.4% (n=90) which was followed by taking shower 19.6% (n= 67). The results of this study suggest a rehabilitation programs to improve the independency in amputees.

Abstract The growing concern over the environmental and social impacts of mining activities has increased interest in evaluating the alignment of mining practices with global sustainability goals. This study provides an in-depth examination of five major Iranian mining complexes including: GolGohar, Sarcheshmeh, Sungun, Zarshuran, and Sangan, and their adherence to the Sustainable Development Goals (SDGs), which encompass a broad spectrum of environmental, social, and economic challenges. The study employs a novel methodology to quantify and assess the degree of alignment between these mining complexes and the SDGs. The SDGs were systematically categorized into three key areas: environmental sustainability, social and economic well-being, and responsible operations and partnerships. The performance of each mining complex within these categories was evaluated using targeted questions and a set of indicators, providing a holistic view of both strengths and areas needing improvement. The findings revealed significant challenges in environmental sustainability, particularly in climate action and clean energy, with Sungun achieving the highest scores and Zarshuran the lowest. In social and economic well-being, progress was evident in poverty reduction and education, though concerns persisted in gender equality and healthcare access, where GolGohar led and Zarshuran lagged behind. Responsible operations and partnerships showed successes in industry innovation, yet there was a need for greater focus on sustainable urban development and partnerships. Zarshuran excelled in this area, while Sungun exhibited the weakest performance. Overall, the study highlights the need for substantial improvements in environmental practices and social inclusion across all complexes, including the top-performing GolGohar, to better align the mining sector with the SDGs and foster a more responsible and inclusive industry.

Abstract Hodgkin lymphoma (HL) is a rare malignancy affecting the lymphatic system. Our study examined the incidence rates of adult HL based on sex, race/ethnicity, age, and histological subgroups in the United States (US) from 2000 to 2020. Data for this study were extracted from the Surveillance, Epidemiology, and End Results 22 database. HL patients were identified utilizing the International Classification of Diseases for Oncology version 3 and categorized as classical HL, lymphocyte-rich/mixed cell/lymphocyte depleted, nodular sclerosis, classical HL, not otherwise specified, and nodular lymphocyte-predominant HL. The study reported average annual percent change (AAPC). All estimates were presented as counts and age-standardized incidence rates (ASIRs) per 100,000 individuals. Between 2000 and 2019, a total of 70,924 cases of HL were reported in the US. Classical HL was the predominant subtype (94.27%), and most incident cases were among non-Hispanic Whites (66.92%) and those aged 20–29 years (24.86%). The ASIR per 100,000 population was 3.83 for men and 2.92 for women. Both sexes showed declines in the AAPCs between 2000 and 2019 (− 0.64% [− 0.99, − 0.28] and − 0.40% [− 0.77, − 0.03] for men and women, respectively). There was a significant decrease in ASIRs after COVID-19 among both sexes (percent change: − 7.49% [− 11.58, − 3.40]). Throughout all age groups, men had a higher incidence rate compared to women, except for those aged 20–29 years. Although the overall HL incidence rate was lowered in the study period from 2000 to 2019, a dramatic decrease in ASIRs of HL patients following COVID-19 pandemic was observed.

Abstract Background We aimed to assess the relationship between Metabolic Score for Insulin Resistance (METS-IR) and the incidence of coronary heart disease (CHD), stroke, mortality, diabetes, hypertension, and chronic kidney disease (CKD) in a population from the Middle East and North Africa (MENA) region. Method Individuals aged ≥ 20 years were enrolled. Cox proportional hazards regression models were applied to assess the association between METS-IR and incident CHD, stroke, all-cause mortality, diabetes, hypertension, and CKD. Results Over a median follow-up period of 9–18 years, 1080 (10.6%), 267 (2.6%), 1022 (9.6%), 1382 (16.4%), 2994 (58.5%), and 2002 (23.0%) CHD, stroke, all-cause mortality, diabetes, hypertension, and CKD events occurred, respectively. Compared to the lowest quartile (reference), the hazard ratios (HR) associated with the highest quartile of METS-IR were 1.527 (95% confidence interval [CI]: 1.208–1.930, P for trend 0.001), 1.393 (0.865–2.243, > 0.05), 0.841 (0.682–1.038, > 0.05), 3.277 (2.645–4.060, 0.05) for CHD, stroke, all-cause mortality, diabetes, hypertension, and CKD, respectively. METS-IR, as a continuous variable, was significantly associated with the risk of incident CHD [HR, 95% CI: 1.106, 1.034–1.184], diabetes [1.524, 1.438–1.616], and hypertension [1.321, 1.265–1.380]. These associations were also independent of metabolic syndrome (METS) and remained unchanged in a subgroup of individuals without METS and/or diabetes. Conclusions Increasing levels of METS-IR were significantly associated with a greater risk of incident CHD, diabetes, and hypertension; therefore, this index can be a useful tool for capturing the risk of these clinical outcomes.

Currently, due to the high costs of production and expensive raw materials, approaches, including, making models smaller and lighter, are especially considered in the design of structures. In order to better describe the capabilities, efficiency, and limitations of an innovative field called topology optimization, various practical problems under different loadings and boundary conditions were evaluated in this study. Optimization algorithms were used in ANSYS software for the optimization of a cantilever beam under static loading, double-girder beam and a dome-shaped geometry under static and thermal loading, a hot fluid transfer tee and an engine exhaust manifold under static loading and convection heat transfer. The results showed that the reduced volume in the final models were equal to 66.29%, 52.88%, 50.05%, 51.85%, and 35.02%, respectively. Consequently, this reduced volume causes some increase in the tension, and displacement of the final model, which can adjust them according to the limitations governing the problem. Furthermore, the amount of increase in the average value of the stress in the cantilever beam, double-girder beam, and dome-shaped geometry were 88, 800, and 6 MPa, and the average amount of displacement in these samples increased by 10.2%, 200%, and 3.3%, respectively. Challenges, and manufacturability of optimized problems were investigated by 3D printing of a dome-shaped model using the FDM method, which illustrated that the output product has a suitable level of accuracy and smoothness. Subsequently, by using supporting structures, three-dimensional holes were created with proper precision in the 3D-printed sample, which satisfied the manufacturability of relatively complex models.

Background The aim of this study was to assess how early‐adulthood body mass index (BMI) and waist circumference (WC) relate to long‐term cardiovascular structure, function, and prognosis in individuals without obesity and with low cardiovascular risk factor (CVRF) burden. Methods and Results A total of 2024 participants aged 18 to 30 from the CARDIA (Coronary Artery Risk Development in Young Adults) study, without obesity and with low CVRFs defined as the absence of cardiovascular disease (CVD), diabetes, hypertension, current smoking, and dyslipidemia were included. A CVRF‐optimal subgroup was also defined, with blood pressure

BackgroundSerious illness conversations may help patients avoid unwanted treatments. We previously piloted the telehealth Serious Illness Care Program (SICP) for older adults with acute myeloid leukemia and myelodysplastic syndrome. ObjectiveIn this study, we aimed to understand the experience of the telehealth SICP from the clinician’s perspective. MethodsWe studied 10 clinicians who delivered the telehealth SICP to 20 older adults with acute myeloid leukemia or myelodysplastic syndrome. Quantitative outcomes included confidence and acceptability. Confidence was measured using a 22-item survey (range 1-7; a higher score is better). Acceptability was measured using an 11-item survey (5-point Likert scale). Hypothesis testing was performed at α=.10 (2-tailed) due to the pilot nature and small sample size. Clinicians participated in audio-recorded qualitative interviews at the end of the study to discuss their experience. ResultsA total of 8 clinicians completed the confidence measure and 7 clinicians completed the acceptability measure. We found a statistically significant increase in overall confidence (mean increase of 0.5, SD 0.6; P=.03). The largest increase in confidence was in helping families with reconciliation and goodbye (mean 1.4, SD 1.5; P=.04). The majority of clinicians agreed that the format was simple (6/7, 86%) and easy to use (6/7, 86%). Clinicians felt that the telehealth SICP was effective in understanding their patients’ values about end-of-life care (7/7, 100%). A total of three qualitative themes emerged: (1) the telehealth SICP deepened relationships and renewed trust; (2) each telehealth SICP visit felt unique and personal in a positive way; and (3) uninterrupted, unrushed time optimized the visit experience. ConclusionsThe telehealth SICP increased confidence in having serious illness conversations while deepening patient-clinician relationships. Trial RegistrationClinicalTrials.gov NCT04745676; https://www.clinicaltrials.gov/study/NCT04745676

Frank Ramsey’s philosophy, developed in the 1920s in Cambridge, was in conversation with the debates surrounding intellectualism in the early twentieth century. Ramsey made his mark on the anti-intellectualist tradition via his notion of habit. He posited that human judgments take shape through habitual processes, and he rejected the separation between the domain of reason, on one hand, and the domain of habit, on the other. Ramsey also provided the ground to explore the nature of knowledge employed in acting from habit. That ground was passed onto Margaret MacDonald who came up with the distinction between knowing that something is the case and knowing how to apply a rule (or habit), the distinction that set the stage for Gilbert Ryle’s philosophical project against intellectualism from the 1940s onward. Ramsey thus influenced Ryle’s account of knowledge through the channel of MacDonald.

The study aimed to evaluate the effectiveness of Gabapentin in controlling postoperative pain in New Zealand white rabbits after ovariohysterectomy. Twenty sexually mature and healthy female rabbits were divided into four groups: a negative control, Meloxicam treatment, Gabapentin treatment, and Meloxicam plus Gabapentin treatment. After the surgery, the rabbits" pain levels were assessed using the Grimace Scale at various time points. The Gabapentin group consistently had the lowest Grimace Scale scores. Statistical analysis showed significant differences between the Meloxicam group and the negative control, the Gabapentin plus Meloxicam group and the negative control, the Gabapentin group and the negative control, and the Gabapentin group and the Gabapentin plus Meloxicam group. Postoperative analgesia was significantly better in the Meloxicam, Gabapentin, or combined treatment groups compared to the negative control. Gabapentin was found to be equally effective as Meloxicam in controlling pain. However, the combination of Meloxicam and Gabapentin was not as effective as Gabapentin alone. In conclusion, Gabapentin showed preventive efficacy in controlling postoperative pain after ovariohysterectomy in New Zealand white rabbits. These findings suggest that Gabapentin could be a valuable analgesic option for surgeons to provide adequate pain control in this surgical context. Further research is needed to explore optimal dosing and potential synergistic effects when combining Gabapentin with other analgesics.

Cerebral gliomatosis (GC) is a rare diffuse infiltrative growth pattern of glioma with nonspecific clinical manifestations like visual impairment that may involve bilateral temporal lobes. Herpes simplex encephalitis (HSE) and limbic encephalitis (LE) can also lead to temporal lobe involvement. Differentiating these entities is necessary for patients with misleading presentations and imaging findings. To the best of our knowledge, this is the third case of GC presenting with blindness. The patient was a 35 years-old male in a drug rehabilitation center for heroin addiction. He presented with a headache, a single episode of seizure, and a 2-month history of bilateral decrease in visual acuity, which had acutely worsened. Magnetic resonance imaging (MRI) and computed tomography (CT) showed bilateral temporal lobe involvement. Ophthalmological studies showed bilateral papilledema, absence of visual evoked potential, and thickening of the retinal nerve fiber layer. Due to this clinical presentation, normal laboratory data, and suspicious MRI findings, further investigation with magnetic resonance spectroscopy (MRS) was performed. Results showed a greatly increased ratio of choline to creatinine(Cr) or N-acetyl aspartate (NAA), suggesting a neoplastic nature of the disease. Subsequently, the patient was referred for a brain tissue biopsy with a suspicion of malignancy. The pathology results revealed adult-type diffuse glioma with isocitrate dehydrogenase (IDH) mutation. Bilateral blindness, as well as bilateral temporal lobe involvement, each has many different causes. However, as demonstrated in this study, adult-type diffuse glioma must be considered a rare cause of concomitant bilateral temporal lobe involvement and blindness.

Introduction: Urinary extracellular vesicles (uEVs) can be considered biomarkers of kidney diseases. EVs derived from podocytes may reflect podocyte damage in different glomerular diseases. IgA nephropathy (IgAN) is one of the most common forms of glomerulonephritis (GN) characterized by proteinuria and hematuria. This study aimed to analyze the uEVs of IgAN patients to understand the pathophysiological processes of the disease at the protein level. Methods: Patients with GN [biopsy-proven IgAN (n = 16) and membranous glomerulonephritis (MGN, n = 16)], and healthy controls (n = 16) were included in this study. The uEVs were extracted, characterized, and analyzed to evaluate the protein levels of candidate markers of IgAN, including vasorin precursor, aminopeptidase N, and ceruloplasmin by western-blot analysis. Results: Higher levels of both podocytes and EVs-related proteins were observed in the pooled urine samples of GN patients compared to the healthy controls. In IgAN patients, uEV-protein levels of vasorin were statistically lower while levels of ceruloplasmin were significantly higher compared to MGN (P = 0.002, P = 0.06) and healthy controls, respectively (P = 0.020, P= 0.001). Conclusion: Different levels of the studied proteins in uEVs may indicate podocyte injury and represent a direct association with the pathology of IgAN and MGN.

Neural interfacing devices interact with the central nervous system to alleviate functional deficits arising from disease or injury. This often entails the use of invasive microelectrode implants that elicit inflammatory responses from glial cells and leads to loss of device function. Previous work focused on improving implant biocompatibility by modifying electrode composition; here, we investigated the direct effects of electrical stimulation on glial cells at the electrode interface. A high-throughput in vitro system that assesses primary glial cell response to biphasic stimulation waveforms at 0 mA, 0.15 mA, and 1.5 mA was developed and optimized. Primary mixed glial cell cultures were generated from heterozygous CX3CR-1+/EGFP mice, electrically stimulated for 4 h/day over 3 days using 75 μm platinum-iridium microelectrodes, and biomarker immunofluorescence was measured. Electrodes were then imaged on a scanning electron microscope to assess sustained electrode damage. Fluorescence and electron microscopy analyses suggest varying degrees of localized responses for each biomarker assayed (Hoescht, EGFP, GFAP, and IL-1β), a result that expands on comparable in vivo models. This system allows for the comparison of a breadth of electrical stimulation parameters, and opens another avenue through which neural interfacing device developers can improve biocompatibility and longevity of electrodes in tissue.

The Anzali Wetland, located in the Guilan Province of Iran, is a vital ecosystem with significant ecological value. However, it faces numerous environmental challenges due to pollution, habitat degradation, and unsustainable resource use. This paper aims to assess the awareness and perceptions of local communities regarding the Anzali Wetland, Iran, and its management and how these factors might influence the implementation of the CEPA program. A quantitative survey based on a structured questionnaire was designed and administered to local communities within the wetland’s watershed. The data were analyzed using descriptive statistics. The results indicate that local communities have limited knowledge about the wetland, often associating it solely with Anzali Lagoon. Despite this lack of awareness, most participants recognize the wetland’s importance in conserving wildlife. Further, participants identified domestic and industrial wastewater pollution as the most significant threat to the wetland. Additionally, education at the school level, the Internet, and virtual networks were perceived as effective means of raising awareness among the local population. The study highlights the importance of increasing public participation and interaction among different social groups to enhance awareness of the wetland’s value and environmental issues. It also emphasizes the need for coordinated efforts among stakeholders in wetland management and policy-making, including government agencies and civil organizations. By examining the significance of public awareness in the Iranian context, the study provides unique insights into wetland conservation efforts in a specific geographical and ecological setting. Furthermore, by considering the perceptions and opinions of these stakeholders, the study offers a holistic understanding of the diverse perspectives and interests related to wetland conservation, which adds depth and richness to the analysis.

Background To examine the association of blood pressure (BP) levels with coronary artery calcium and carotid intima‐media thickness (CIMT) in people with maintained BP below the hypertension range based on current definitions. Methods and Results In this post hoc analysis of the CARDIA (Coronary Artery Risk Development in Young Adults) prospective observational cohort study conducted in 4 US cities, we examined 1233 study participants (mean [SD] age at year 20 examination was 45.3 [3.5] years; 65.4% women). Participants with BP assessments across 20 years and untreated BP of 1.01 mm was ≈50% higher per 1‐SD increase in systolic BP (OR, 1.50 [95% CI, 1.19–1.88]) and pulse pressure (OR, 1.46 [95% CI, 1.19–1.79]). Similar findings for CIMT were observed among individuals with a coronary artery calcium score of 0 as well as those with maintained BP of

Machine learning has exhibited high efficiency in designing concrete. However, collecting the dataset for training machine learning models is challenging. To address this challenge, this paper develops an approach to collect concrete design data automatically based on information extraction techniques. The approach enables machine learning models to automatically track, extract, and learn knowledge embedded in data from relevant publications. The approach has been incorporated into AI-assisted design of low-carbon cost-effective ultra-high-performance concrete (UHPC) via integrating the capabilities of automatically collecting and processing data, predicting UHPC properties, and optimizing UHPC properties regarding the material cost, carbon footprint, and compressive strength. A self-updating mechanism is imparted to continuously learn available data. Such a mechanism enables the self-updatable automatic discovery of low-carbon cost-effective UHPC. The results showed increasing prediction accuracy and optimization performance of the proposed approach over time when more knowledge was learned from new data, therefore accelerating the design of UHPC.

AbstractBackground and aims We aimed to assess the potential socio-demographic, clinical, and lifestyle-related risk factors for kidney function decline (KFD), defined as ≥30% estimated glomerular filtration rate (eGFR) decline, in an Iranian cohort study.Methods 7190 participants (4049 women) aged 20–90 years with 2–5 eGFR data from examinations (2001–2005 to 2015–2018) were included. Cox proportional hazard models were used to examine the association between potential risk factors and eGFR decline.Results During 11.5 years of follow-up, 1471 (889 women) participants had incident KFD with a crude incidence rate of 192.1 (182.6–202.2) per 10,000 person-year. Among the total population, older age, female gender, prehypertension, hypertension, diabetes, widowed/divorced states, higher triglycerides (TG), prevalent cardiovascular diseases (CVD), and higher baseline eGFR were significantly associated with higher, while moderate physical activity and a positive family history of diabetes were associated with lower risk of KFD (all p values

Abstract Background Glycemic variability (GV) is developing as a marker of glycemic control, which can be utilized as a promising predictor of complications. To determine whether long-term GV is associated with incident eGFR decline in two cohorts of Tehran Lipid and Glucose Study (TLGS) and Multi-Ethnic Study of Atherosclerosis (MESA) during a median follow-up of 12.2 years. Methods Study participants included 4422 Iranian adults (including 528 patients with T2D) aged ≥ 20 years from TLGS and 4290 American adults (including 521 patients with T2D) aged ≥ 45 years from MESA. The Multivariate Cox proportional hazard models were used to assess the risk of incident eGFR decline for each of the fasting plasma glucose (FPG) variability measures including standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and variability independent of the mean (VIM) both as continuous and categorical variables. The time of start for eGFR decline and FPG variability assessment was the same, but the event cases were excluded during the exposure period. Results In TLGS participants without T2D, for each unit change in FPG variability measures, the hazards (HRs) and 95% confidence intervals (CI) for eGFR decline ≥ 40% of SD, CV, and VIM were 1.07(1.01–1.13), 1.06(1.01–1.11), and 1.07(1.01–1.13), respectively. Moreover, the third tertile of FPG-SD and FPG-VIM parameters was significantly associated with a 60 and 69% higher risk for eGFR decline ≥ 40%, respectively. In MESA participants with T2D, each unit change in FPG variability measures was significantly associated with a higher risk for eGFR decline ≥ 40%.Regarding eGFR decline ≥ 30% as the outcome, in the TLGS, regardless of diabetes status, no association was shown between FPG variability measures and risk of eGFR decline in any of the models; however, in the MESA the results were in line with those of GFR decline ≥ 40%.Using pooled data from the two cohorts we found that generally FPG variability were associated with higher risk of eGFR decline ≥ 40% only among non-T2D individuals. Conclusions Higher FPG variability was associated with an increased risk of eGFR decline in the diabetic American population; however, this unfavorable impact was found only among the non-diabetic Iranian population.

Background and Aims In previous studies, different results have been reported regarding the effect of corrective exercises on improving scapular dyskinesis and its related symptoms. The present study aims to investigate the effect of eight weeks of selected corrective exercises on strength and range of motion (ROM) of shoulder rotation in male boxers with scapular dyskinesis.Methods This is a quasi-experimental study that was conducted on 30 male boxers in Guilan province of Iran including 15 in the control group (age: 24.05±3.80 years; weight: 73.54±5.52 kg; height: 177.18±5.08 cm) and 15 in the exercise group (age: 25.01±4.05 years; weight: 74.14±6.31 kg; height: 176.69±5.14 cm). The boxers in the exercise group performed selected corrective exercises for 8 weeks (strengthening the serratus anterior and middle retractors and stretching the pectoralis minor). Diagnosis and severity of scapular dyskinesis was measured by the lateral scapular slide test. The ROM of shoulder rotation was measured using a manual goniometer, and the shoulder rotation strength was assessed using a manual dynamometer. All tests were performed in pre-test and post-test phases. Statistical analyses were performed using paired t-test and analysis of covariance. The significance level was set at 0.05.Results The selected corrective exercises had a significant effect on improving scapular dyskinesia and the external rotation strength of the shoulder in the exercise group compared to the control group (P≤0.05), but had no significant effect on improving the internal rotation strength of the shoulder and the ROM of shoulder rotation (P>0.05)Conclusion The selected corrective exercises can improve scapular dyskinesis and increasing the external rotation strength of the shoulder in male boxers with scapular dyskinesis. Therefore, trainers, athletes and therapists can use these exercises to reduce the symptoms related to this disorder and improve performance of boxers with scapular dyskinesis.

Objective: To evaluate the spiral chest computed tomography (CT) scan findings in patients with multipletrauma during the COVID-19 pandemic.Methods: This retrospective study was performed on multiple trauma patients admitted to a tertiary hospital inthe north of Iran in 2020. All patients with multiple trauma who had undergone a chest spiral CT were includedin this study. Furthermore, the data analysis was performed through descriptive and analytical statistics usingSPSS software.Results: A total of 600 patients were included over the study period. The mean age of patients was 48.2±20.3years. Of the total, 496 (65.3%) patients had blunt chest injuries, and 104 (34.7%) had penetrating chest injuries.Falling was the most common mechanical cause of chest trauma in 270 patients (45%). Surgical interventionswere performed in 110 (18.3%) patients. A total of 276 (46%) patients had chest injuries identified by CTscans. Many patients (15.6%) had ground-glass lung opacity in the CT scan reports. Lung consolidation,pneumothorax, lung contusion, hemothorax, and rib fractures were the most common.Conclusion: Due to the high frequency of typical findings in spiral CT scan examinations, obtaining a reliablehistory of trauma severity, injury mechanism, and a detailed physical examination is recommended beforeprescribing a CT scan for patients.

Abstract High-performance fiber-reinforced cementitious composites (HPFRCC) exhibit benefits in improving infrastructure resilience but often compromise sustainability due to the higher upfront cost and carbon footprint compared with conventional concrete. This paper presents a framework to improve bridge resilience and sustainability through optimizing HPFRCC. This research considers ultra-high-performance concrete and strain-hardening cementitious composite, both featuring high mechanical strengths, ductility, and damage tolerance. This paper establishes links between bridge resilience, bridge sustainability, mechanical properties of HPFRCC, and mixture design. The investigated mechanical properties include the first crack stress, the ultimate tensile strength, and the ultimate tensile strain. With the established links, sustainability is maximized while resilience is retained by optimizing HPFRCC mixtures. The framework is implemented into a case study of a bridge that collapsed during construction. Results show that use of HPFRCC enhances resilience, and HPFRCC mixtures can be engineered to minimize the material cost and carbon footprint while retaining high resilience.

Abstract Background The COVID-19 pandemic and consequent public health response may have undermined key responses to the protracted drug poisoning crisis, including reduced access to opioid agonist therapy (OAT) among people with opioid use disorder. Our study objectives were to estimate the prevalence of and identify factors associated with inability to contact OAT prescribers when in need among people on OAT in a Canadian setting during the dual public health crises. Methods Survey data were collected from three prospective cohort studies of community-recruited people who use drugs between July and November 2020, in Vancouver, Canada. A multivariable logistic regression analysis was used to identify potential factors associated with inability to contact OAT prescribers among patients who accessed OAT in the past 6 months. Results Among 448 respondents who reported accessing OAT in the past 6 months, including 231 (54.9%) men, 85 (19.0%) reported having been unable to contact OAT prescribers when needed, whereas 268 (59.8%) reported being able to talk to their prescriber when needed, and 95 (21.2%) reported that they did not want to talk to their medication prescriber in the previous 6 months. Among those who reported inability to contact prescribers, 45 (53.6%) reported that their overall ability to contact prescribers decreased since the start of the pandemic. In multivariable analyses, factors independently associated with inability to talk to OAT prescribers included: chronic pain (Adjusted Odds Ratio [AOR] = 1.82; 95% Confidence Interval [CI] 1.02, 3.27), moderate to severe symptoms of depression or anxiety (AOR = 4.74; 95% CI 2.30, 9.76), inability to access health/social services (AOR = 2.66; 95% CI 1.41, 5.02), and inability to self-isolate or socially distance most or all of the time (AOR = 2.13; 95% CI 1.10, 4.14). Conclusions Overall, approximately one fifth of the sample reported inability to contact their OAT prescribers when needed, and those people were more likely to have co-occurring vulnerabilities (i.e., co-morbidities, inability to access health/social services) and higher vulnerability to COVID-19. Interventions are needed to ensure optimal access to OAT and mitigate the deepening health inequities resulting from the COVID-19 pandemic and the escalating drug poisoning crisis.

Abstract Background We aimed to assess the gender-specific impact of 3-year changes in fasting plasma glucose (FPG) status on the risk of all-cause, cardiovascular (CV), and cancer mortality in individuals without type 2 diabetes (T2DM) during an 18-year follow-up. Methods The study population included 14,378 participants aged 30–60 years (8272 women) from three population-based cohort studies, including Atherosclerosis Risk in Communities, Multi-Ethnic Study of Atherosclerosis, and Tehran Lipid and Glucose Study. Subjects were classified into six categories based on the approximately three-year changes in FPG status: (1) normal FPG (NFG) to NFG (reference category); (2) NFG to impaired fasting glucose (IFG) (i.e., 126 > FPG ≥ 100 mg/dl); (3) NFG to T2DM; (4) IFG to NFG; (5) IFG to IFG; (6) IFG to T2DM. Multivariable stratified Cox regression, adjusting for age, body mass index (BMI), BMI-Change, smoking status, hypertension, and hypercholesterolemia was used to estimate hazard ratios (HRs (95% CI)) for all-cause and cause-specific mortality events. Women-to-men ratios of HRs (RHRs) for each category were also estimated. Results During follow-up, 2,362 all-cause mortality events were recorded. Among women, all categories of FPG change, excluding IFG-NFG (HR, 95%CI 1.24 (0.98–1.57), p = 0.07), were associated with a higher risk of all-cause mortality compared to the NFG-NFG category. Moreover, women in IFG-T2DM group were at increased risk for CV mortality (2.21 (1.42–3.44)). We also found that women in NFG-IFG (1.52 (1.20–1.91)), NFG-T2DM (2.90 (1.52–5.51)), and IFG-IFG (1.30 (1.02–1.66)) categories had a higher risk for cancer mortality. However, among men, a higher risk of all-cause mortality was found for only two groups of NFG-T2DM (1.78 (1.15–2.74)) and IFG-T2DM (1.34 (1.04–1.72)). Women with IFG-IFG had a 24% higher risk for all-cause mortality events than their men counterparts (RHR; 1.24 (1.01–1.54)). After further adjustment for physical activity, results were in line with the main findings, excluding T2DM up to six years after the measurement period and early mortality events. Conclusion In women, the IFG status, whether as incident, persistent, or converted to T2DM, had a higher risk for mortality events; however, among men, only conversion to T2DM conferred an excess risk of all-cause mortality.

Abstract Background To evaluate the impact of different definitions of metabolic syndrome (MetS) and their components on the risk of sudden cardiac death (SCD) among the Iranian population according to the World Health Organization (WHO), International Diabetes Federation (IDF), Adult Treatment Panel III (ATP III), and Joint Interim Statement (JIS) criteria. Methods The study population included a total of 5,079 participants (2,785 women) aged ≥ 40 years, free of cardiovascular disease (CVD) at baseline. Participants were followed for incident SCD annually up to 20 March 2018. Multivariable Cox proportional hazards regression models were applied to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of MetS and its components for incident SCD. Results The prevalence of MetS ranged from 27.16% to 50.81%, depending on the criteria used. Over a median of 17.9 years of follow-up, 182 SCD events occurred. The WHO, IDF, and JIS definitions were strong predictors of SCD with multivariable-adjusted HRs (95% CI) of 1.68 (1.20–2.35), 1.51 (1.12–2.03), and 1.47 (1.08–1.98), respectively; these associations significantly attenuated after further adjustment for MetS components. MetS by the ATP III definition was not associated with the risk of SCD after controlling for antihypertensive, glucose-lowering, and lipid-lowering medication use. Among the components of MetS, high blood pressure (WHO definition), high waist circumference (using the national cutoff of ≥ 95 cm), and high glucose component by the JIS/IDF definitions remained independent predictors of SCD with HRs of 1.79 (1.29–2.48), 1.46 (1.07–2.00), and 1.52 (1.12–2.05), respectively. Conclusions The constellation of MetS, except for when defined with ATP III definition, is a marker for identifying individuals at higher risk for SCD; however, not independent of its components. Among MetS components, abdominal obesity using the population-specific cutoff point, high glucose component (JIS/IDF definitions), and high blood pressure (WHO definition) were independent predictors of SCD.

Abstract One of the main challenges in designing a supersonic forebody is thermal protection. The application of the mechanical spike mounted at the nose considerably decreases the heat load on the main body. In this investigation, the hybrid technique of mechanical spike and coolant injection are examined to reduce the thermal load on the nose cone in the supersonic air stream. A three-dimensional model of a double aerodisked spike with different cooling systems is provided to find the efficient cooling injection system for reducing the heat load on the nose cone. Computational studies have been done on investigating a cooling mechanism in the proposed injection systems. This study has tried to present valuable information on flow features and shock interaction nearby the nose. The influence of different coolant gas on the thermal performance of the proposed configurations is comprehensively explained. Our results indicate that the cooling performance of single carbon dioxide is 85% more than helium jet in lateral injection. According to our findings, the cooling performance of lateral multi-jets is 90% more than opposing ones.

Precise modelling of the interaction of ions with materials is important for many applications including material characterization, ion implantation in devices, thermonuclear fusion, hadron therapy, secondary particle production (e.g. neutron), etc. In this study, a new approach using the Geant4 toolkit in combination with the Bayesian regularization (BR) learning algorithm of the feed-forward neural network (FFNN) is developed to estimate the range of ions in materials accurately and quickly. The different incident ions at different energies are interacted with the target materials. The Geant4 is utilized to model the interactions and to calculate the range of the ions. Afterward, the appropriate architecture of the FFNN-BR with the relevant input features is utilized to learn the modelled ranges and to estimate the new ranges for the new cases. The notable achievements of the proposed approach are: 1- The range of ions in different materials is given as quickly as possible and the time required for estimating the ranges can be neglected (i.e. less than 0.01 s by a typical personal computer). 2- The proposed approach can generalize its ability for estimating the new untrained cases. 3- There is no need for a pre-made lookup table for the estimation of the range values.

Abstract Background Compared to the healthy population, the psychological impact of rheumatoid arthritis(RA) on patients' lives could dramatically lower their oral health-related quality of life (OHRQoL). Our goal is to analyze OHRQoL in RA patients and look into the role of disease activity, dental health index, and Temporomandibular disorders score in maintaining their oral health. Methods In a cross-sectional comparative study, we compared a sample of 40 RA patients with 40 age- and gender-matched healthy controls in terms of oral health and OHRQoL. Temporomandibular disorders (TMD), number of decayed, filled, or missing teeth (DMFT), and Oral Health Impact Profile (OHIP) were among the oral health factors studied (OHIP-14). This study also looked at the link between the RA disease activity score (DAS28) and oral health factors. Results RA patients had a significantly higher mean (poorer OHRQol) than healthy controls in total oral function, total psychosocial impact, OHIP-14 sum score, OHIP-14 extent score, TMD score and the number of missed teeth (Mann–Whitney U test, P-value

Abstract Aims/Introduction To evaluate the association between ideal cardiovascular health metrics (ICVHM) and incident type 2 diabetes mellitus among Iranian men and women. Materials and Methods The study population included 7,488 Iranian adults aged ≥20 years (4,236 women) free from diabetes at baseline. The ICVHM was defined according to the American Heart Association's 2020 impact goals. The multivariable Cox proportional hazards regression analysis was used to calculate the hazard ratios (HRs) for ICVHM both as continuous and categorical variables. Results Over the median of 9.1 years of follow‐up, we identified 922 new cases of type 2 diabetes mellitus (526 women). Body mass index

Abstract The importance of the cooling system for the design of the forebody of high-speed vehicles is significant due to severe aerodynamic heating at hypersonic flight. In the present study, injection of multi and single-coolant jets on the thermal performance of forebody design of nose cone with the cut spike is thoroughly investigated at hypersonic flow. A three-dimensional model of the blunt cone is presented for computational investigations of proposed jet and spike configurations. Injection of two coolant gasses (Helium and carbon dioxide) into the cooling system of the nose cone with a blunt spike is investigated. Three locations for both opposing and lateral jets are compared to find the efficient jet location. Our results indicate that a single lateral jet injected from the tip of the spike is more efficient for heat reduction. A comparison of the multiple injection system also shows that the heat reduction of the helium gas is about 15% more than CO2 jets.