Aims: Landfill leachate contains many pollutants including chemical oxygen demand (COD), biological oxygen demand, ammonia nitrogen, organic matter, minerals, and toxins. Given the importance of COD removal from landfill leachate, this study was conducted to evaluate and compare different methods used for the removal of COD from leachate. Materials and Methods: This study was conducted as a narrative review using keywords of leachate, COD, landfill in related journals issued in scientific databases such as Web of Science, PubMed, SID, and Google Scholar. We reviewed different aspects of COD removal from leachate to find better options in this respect. Results: The highest rate of COD removal was observed for batch reactor methods of anaerobic and aerobic granular activated carbon and electro Fenton by 98.4% COD removal, and the lowest one was 22.7% for the electro-Fenton method. The most commonly used methods for removing COD from solidwaste leachate have been physical and chemical methods. Conclusion: This study showed that a wide range method has been used to remove COD from leachate. It seems that combined methods are more effective to reduce the content of leachate COD. Besides, methods such as Fenton and absorption are more preferable because of simple application and low energy consumption.

Aims: Latex sensitivity has been a concern for health-care workers in recent years. Due to the excessive exposure to latex products in the operating room, the personnel of this department are exposed to high sensitivity to these products. Therefore, the present study was conducted to investigate the prevalence of latex sensitivity among operating room personnel. Materials and Methods: This systematic review and meta-analysis conducted based on a Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist. The present study researchers explored four international databases, namely Medline/PubMed, ProQuest, Scopus, and Embase in February 2020. The selected keywords for international databases were classified into three categories (a) operating room personnel, (b) latex sensitivity, and (c) prevalence. The collected data were entered into the EndNote X8 software and analytical analysis was performed by STATA statistical software version 12. Results: Seventy-five articles were found by searching for databases. After several screening steps, 12 articles entered the final analysis. The results show that the prevalence of latex sensitivity in total is 14.76 (confidence interval 95%: 9.27–20.25). Meta-regression results showed that the relationship between the years of study and the prevalence of latex sensitivity is not statistically significant (P = 0.222). Conclusion: The results of the present study showed that sensitivity to latex is significantly prevalent among operating room staff. Due to the importance of sterility and sensitive working conditions in the operating room, as well as frequent contact with latex products, it is important to pay attention to the side effects caused by latex powder.

Aims: According to the World Health Organization, migraine is the twentieth rank among all disability-causing disorders. The present study aimed to evaluate the effectiveness of acceptance and commitment therapy (ACT) on perfectionism and resilience in migraine patients. Materials and Methods: The research method was semi-experimental with a pretest–posttest design and a control group. The statistical population of the study included all patients with migraine who presented to neurologists in Tehran in the fall of 2018, from which thirty patients were selected using convenience sampling method and randomly assigned to experimental and control groups. The data were collected by the Connor-Davidson Resilience Scale and Ahvaz Perfectionism Scale (APS). The experimental group received ACT in eight weekly sessions, while the control group was on the waiting list. The data were analyzed using the multivariate analysis of covariance. Results: Findings showed that there was a difference between the control and experimental groups in perfectionism and resilience means at the posttest level. Regarding the means of the variables after the intervention, results showed that those patients who received the intervention had more resilience and lower perfectionism than those who were in the waitlist control group. Therefore, the ACT was effective on perfectionism (P < 0.001) and resilience (P < 0.001) of migraine patients. Conclusion: Given the effectiveness of ACT, it is recommended to use the ACT as a supplementary therapy with medical treatments for migraine patients. Theoretical and practical implications are discussed in the discussion section.

Aim: This study aimed to compare family planning (FP) services in urban and rural health facilities in Nigeria. Materials and Methods: The study is a cross-sectional study conducted in 204 rural and 198 urban health facilities comprising 182 primary and 216 secondary facilities in Nigeria. A FP client was randomly selected from each of the facilities, and structure questionnaires were used to collect information from them. Data collected include the various types of contraception available, waiting time, and satisfaction with services. Data were analyzed with IBM-SPSS Statistics Version 25.0. Results: The most requested contraceptives methods were injectables (48.2%) and oral contraceptives (22.6%). Most clients in both the rural (76.0%) and urban (76.3%) waited <30 min to see health providers. However, 20.1% of clients in urban health facilities waited for 30–60 min compared to 15.2% in rural areas (P < 0.05). The overall quality of service was 90.0% in rural and 92.9% in urban areas (P < 0.05). Over 90% of both rural and urban clients were satisfied with how providers received them, cleanliness of the facilities, and time spent with care providers but less than half (<50%) were satisfied with the services they received. Significantly higher quality of services was reported by clients in the northern parts of Nigeria (6.74/7) (P < 0.001), whereas client's satisfaction was slightly higher in the South (6.56/7) (P > 0.05). Conclusion: There is a need for an improvement in waiting time and quality of services offered in health facilities. Policymakers should to carry out regular supervision of health facilities and ensure availability of contraceptives in the health facilities at affordable prices in order to improve FP uptake in Nigeria.

Aims: Fruit juices, especially lemon juice, are the most targeted food goods for adulteration and fraud in Iran. The aim of this study was to investigate the profile and concentration of free primary amino acids as a marker for adulteration in lemon juice. Materials and Methods: Amino acids were determined with high-performance liquid chromatography fluorescence. The limit of detection and limit of quantification were in the range of 0.008–0.01 ng/ml and 0.03 ng/ml, respectively. Results: The method is suitable for distinguishing authentic juices from drinking products that may contain little or no fruit juice. In our study, total amino acid concentration in natural lemon was 13.15 mmol/l and in other brands was in the range of 1.81–14.84 mmol/l. Further, the concentration of aspartic acid, glutamic acid, asparagine, and serine was more than other amino acids. The findings showed that only brands 1 and 2 were considered similar to natural lemon juice. Conclusion: The present study demonstrated that the concentration of the first four amino acids can use as a marker to determine lemon juice adulteration.

Aims: The aim of this study was to determine the relationship between academic procrastination and depression in students of Kashan University of Medical Sciences. Materials and Methods: In this cross-sectional descriptive-analytic study, 400 students of Kashan University of Medical Sciences were selected by stratified random sampling in 2020. Data collection tools included three sections of demographic information, the Procrastination Assessment Scale, and the Beck Depression Inventory II. Data were analyzed using SPSS version 16 software and independent t-test, ANOVA, and multivariate regression. Results: The results of demographic data showed that the number of females was more than the males (61.3% vs. 38.7%). The student's academic procrastination's score was 65.22 ± 14.92, indicating a moderate level of procrastination (58.4%). The variables of performing religious duties, students' depression have a significant relationship with academic procrastination (P < 0.001). There is a significant positive correlation between academic procrastination and student depression (P < 0.001, r = 0.325). Conclusion: Based on the research findings, academic procrastination among students was moderate to high. Considering the important role of academic procrastination in various aspects of education and future careers of students and future of community health, it is essential for professors and academic advisors to pay a special attention to this subject and it is suggested to investigate the causes and to propose appropriate strategies for reducing this behavior.

Introduction: Occupational burnout is one of the complications of work and a psychological syndrome including emotional exhaustion, depersonalization, and feeling of inadequacy. Furthermore, personality traits such as openness, conscientiousness, extroversion, agreeableness, and neuroticism can affect the degree of occupational burnout. This study is to investigate the relationship between these two factors. Materials and Methods: This descriptive study was performed on 87 nurses from Kashan Beheshti Hospital. We used Neo and Maslach questionnaires to investigate the personality traits and occupational burnout. Sampling was performed by a simple random sampling method, and the data were collected by Neo and Maslach questionnaires. Statistical analysis was performed using Chi-square, Fisher exact test, independent t-test, and Pearson correlation coefficient. Results: In general, there is a significant relationship between different aspects of occupational burnout with personality traits. There was no significant relationship between occupational burnout and age (P < 0.262), while there was a relationship between occupational desirability and age. There was no significant relationship between the frequency and severity of occupational burnout in the various aspects of age, sex, and marital status of nurses. There is also no relationship between personality traits and these three factors. Conclusion: The study showed that the personality traits of nurses are effective in their occupational burnout. Furthermore, compare to depersonalization, emotional exhaustion, and feeling of inadequacy in nurses is more related to personality traits and the modification of work environment and reduction of work stress are recommended for these employees.

Aims: In any organization, there is a set of safety hazards that, if ignored, can lead to accidents. Universities can be considered a small example of organizations with all kinds of risks. The aim of this study was to investigate the level of safety noncompliance of Kashan University of Medical Sciences with the safety audit method. Materials and Methods: The present study is a descriptive cross-sectional study in which the safety status of faculties of Kashan University of Medical Sciences was assessed by audit. Audit checklists were prepared in accordance with national safety standards and regulations as well as the expert opinion of safety experts, including electrical safety, fire safety, general safety, safety requirements, beam safety, emergency response program, safety the pressure system, the safety of the elevators, and the general specifications of the faculties. Results: Based on this study, it was observed that in the areas of public safety, the highest noncompliance was reported in the areas of emergency, safety requirements, and pressure system with 88 cases (88.23%) and no noncompliance in the areas of public safety and elevators 0 (0%). According to the year of construction, the highest noncompliance was reported in the areas of emergency and safety requirements (100%) in 17 cases and the lowest noncompliance was in the field of public safety, which had no noncompliance 0 (0%). Conclusion: The safety situation of the classes of the studied faculties, especially in the subjects of safety requirements, emergency response program, and safety system under pressure, was at an unfavorable level. The most important reason for this was the lack of clear responsibilities and the lack of organizational structure in the field of safety issues, which in order to improve it, universities need to establish a safety management system.

Aims: Environmental conditions affect workers health and performance. The present study aimed to investigate the simultaneous effect of ambient temperature and light intensity on human error. Materials and Methods: This cross-sectional study was conducted on 50 students from Shiraz University of Medical Sciences. Each participant performed 9 tests in 5 min at 3 different temperatures (20°C, 25°C, and 30°C) and 3 lighting conditions (50, 500, and 1000 lux). The participants were asked to select a text randomly. Participants asked to read the text in just 6 min and identify the mistakes. In each step, the number of remaining lines, number of spelling mistakes found, and task completion time were estimated. Results: There was no significant relationship between the temperature and the number of remaining lines, the number of spelling mistakes, and the task completion time (P > 0.05). However, the relationship between different light intensity and the number of remaining lines and number of spelling mistakes was statically significant (P < 0.05). At a lighting of 500, 1000 lux, and a temperature of 25°C, male subjects performed better. Unlike men, women's performance was not affected that much by the light intensity and only declined slightly in the 1000 lux and at 20°C. Conclusions: The results showed that light intensity could be important to create a suitable environment for reducing human error. If the temperature could not increase in an environment due to the nature of a job or economic issues, reducing human errors could achieve by increasing light intensity.

Aims: According to the global burden of disease study 2019, low back pain (LBP) is among the top ten high-burden diseases and injuries. As a common complication of spinal anesthesia, this study aimed to consider the incidence of LBP and related factors in operating patients under spinal anesthesia in Kashan University of Medical Sciences' (KAUMS) hospitals in 2019. Materials and Methods: During a cross-sectional study, patients who underwent surgical procedures under spinal anesthesia at the teaching hospitals of KAUMS in 2019 were evaluated. Needed information about surgery and anesthesia was retrieved from the medical records. In addition, information about LBP was extracted from patients' records as well as telephone calls. Using SPSS for statistical analysis, P < 0.05 was considered statistically significant. Results: During the study period, the total number of 460 surgical patients were considered. Among them, 290 were men (63.0%) and the mean age of participants was 38.6 ± 6.2. The incidence of LBP among study participants was 47.6%. Regarding sex, women were 2.8 times more likely to develop a backache than men (odds ratio = 2.8, 95% confidence interval: 1.8–4.8, P < 0.001) after spinal anesthesia. The highest frequency of pain was seen in gynecologic surgeries, lateral position, and ages 26–44 years. Conclusion: The incidence of LBP after spinal anesthesia was 47.6% and it was significantly associated with age (mostly in 26–44 y), gender (higher in women), type of surgery (higher in gynecologic procedures), and surgical position (higher in lateral position).

Aim: The aim of this study was to develop combination approach for the treatment of Escherichia coli-producing extended-spectrum β-lactamases (ESBLs) isolated from intensive care unit (ICU)-acquired urinary tract infections (UTIs). Materials and Methods: The observational study was conducted between January 5, 2018- June 5, 2019 to isolate and detect E. coli from UTI patients admitted to ICUs in Shahid Rajaee hospital, Gachsaran, Iran. Morphological, biochemical and molecular methods were conducted to identify E. coli isolates. Phenotypic confirmation of E. coli producing ESBL was performed using ESBL disc diffusion test according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. The combination index assay set-up was based on CLSI guidelines to investigate antibacterial susceptibilities to vancomycin alone and in combination with trimethoprim and interpreted with the fractional inhibitory concentration (FIC) index. Eventually, the expression levels of bla_CTX-M-33 gene were determined by real-time quantitative reverse transcription–polymerase chain reaction. Results: A total of 90 ICU-acquired UTIs occurred among 255 patients. The combination index assay results showed that vancomycin/trimethoprim combination would be reduced its minimal inhibitory concentration₉₀ value. The vancomycin/trimethoprim combination revealed partial synergistic and indifferent effects (FIC = 0.52–1.50) in the isolates of E. coli-producing ESBL. The results of gene expression analysis indicated that vancomycin/trimethoprim combination caused downregulation of bla_CTX-M-33 gene at negligible levels by 55.56–58.82-fold and stopped drug resistant. Conclusion: Vancomycin/trimethoprim combination may diminish resistance in the E. coli-producing ESBL isolated from ICU-acquired UTI patients.

Aims: The purpose of this study was to investigate the extent of technology use at home by older adults and to identify factors related to technology use. Materials and Methods: This cross-sectional study was performed using 400 older adults that were referred to Urban Comprehensive Health Service Centers in Kashan, Iran, from July 2017 to March 2019. The multistage cluster sampling method was used to select the health centers, and simple random sampling was used to recruit older adults that were referred to the centers. Data were collected using a demographic questionnaire and the Older Adults' Technology Use at Home (OATUH) scale. The independent t-test, Chi-square test, and Pearson's correlation were used to analyze data. Results: The mean score of OATUH was 17.25 ± 8.6 in the range of 0–36. Technology use at home was significantly associated with gender, education, income, and chronic conditions. Participants without chronic conditions were more likely to use technology, especially out-of-kitchen technology. Age had a negative correlation with OATUH (r = −0.3), out-of-kitchen technology use (r = 0.21), and in-kitchen technology use (r = 0.28). Conclusions: The use of technology was associated with participants' demographics and health characteristics. The results can be integrated with the knowledge base for improving older adults' technology use to enhance their quality of life.

Aims: With advances in computer technology, the recent decade has witnessed a growth in resources and an increase in the availability of devices for language learning and teaching. This study aimed at investigating the effect of Adobe Connect virtual classrooms on technical vocabulary learning of students of medicine as well as to explore their attitudes toward Adobe Connect virtual classrooms. Materials and Methods: This quasi-experimental study was performed on 60 EFL students of medicine studying at Kashan University of Medical Sciences, Kashan, Iran. To ensure the participants' homogeneity in terms of language proficiency, the Oxford Quick Placement Test was used. The participants were randomly divided into two groups (n = 30): conventional teacher-centered and Adobe Connect virtual groups. Data were collected using pre- and post-tests of technical medical vocabularies to evaluate vocabulary knowledge and a five-point Likert scale to evaluate the students' attitudes toward Adobe Connect virtual classrooms. Data were analyzed using an independent t-test and a paired t-test by SPSS version 22. Results: The results revealed no significant difference in the mean scores of the vocabulary test between the conventional teacher-centered and Adobe Connect virtual groups before training (P = 0.757); however, the mean vocabulary scores after training in the Adobe Connect virtual group was significantly higher than the conventional group (P < 0.001). Conclusion: The findings of the present study show the effectiveness of the Adobe Connect virtual classrooms and students' satisfaction with such a virtual environment in terms of technical medical vocabulary learning.

Aims: In vitro cultivation of digenea would help the development of effective treatments and studies of the biology of the parasites. The goal of the present study was to optimize culture conditions for the maintenance liver fluke, Dicrocoelium dendriticum. Materials and Methods: Forty fresh D. dendriticum were collected from the sheep liver and washed three times with warm Roswell Park Memorial Institute (RPMI) 1640 Medium. The collected worms were transferred to 24-well Nunc-Immuno plates containing RPMI media supplemented with 50% of fetal bovine serum (FBS), 2% of sheep red blood cells (RBCs), 50 IU/ml of penicillin, and 50 mg/ml streptomycin. The mobility of the live/dead worms was observed by inverted microscope. The mean and median survival time was calculated by Kaplan–Meier model, and survival and hazard function graphs were also analyzed. Results: D. dendriticum was lived in vitro only for long periods of about 25 dyes. The 1^st day of maintaining in culture media, one worm was dead and the number of dead worms was raised to 40 after 25 days of incubation. On the one hand, the mean survival time was 392 h with a confidence interval (CI) of 95% (384.8–400.03). On the other hand, the median survival time was 420 h with a CI of 95% (406.9–433.09). D. dendriticum was able to be alive in RPMI 1640 media for at least 25 days. Conclusion: RPMI 1640 supplemented with FBS, and RBCs can be used as short-term maintenance for the in vitro culture of D. dendriticum. The outcomes of the current study could be useful for many aspects of parasitological analysis.

Aims: The current study determined the faunistic composition, sex ratio, seasonal abundance, and physiological status of sandflies as vectors of leishmaniasis in Abadan County, Khuzestan Province, Iran, during 2015–2016. Materials and Methods: Sandflies were captured using sticky paper traps installed at sunset and collected after sunrise at indoor and outdoor locations. Sandflies were mounted on slides in Puri's medium and identified using diagnostic keys. Results: Overall, 13 species (2 species of Phlebotomus Rondani and Bert 1840 and 11 species of Sergentomyia Franca and Parrot 1920) were identified among the 6173 sandflies collected including Phlebotomus papatasi, Scopoli, 1786 (45.64%); Phlebotomus alexandri, Sinton, 1928 (31.31%); and Sergentomyia sintoni, Pringle, 1953 (15.9%). Four species, including Sergentomyia tiberiadis, Adler, Theodor, and Lourie, 1930; Sergentomyia clydei, Sinton, 1928; Sergentomyia antennata, Newstead, 1912; and Sergentomyia christophersi, Sinton, 1927, are reported for the first time in Abadan. The sex ratios of the sandflies of genus Phlebotomus and Sergentomyia were 362.4 and 92.2 males per 100 females, respectively. The analysis of physiological status of sandflies in outdoors and indoors revealed 61.2% and 71.1% unfed, 2.9% and 4.8% blood-fed, 26.7% and 17.7% semi-gravid, and 9.2% and 6.4% gravid, respectively. Conclusion: P. papatasi and P. alexandri may play important as vectors of cutaneous leishmaniasis (CL) in Khuzestan Province, due to their high abundance and monthly prevalence in regions affected with CL.

Aims: In this study, we aim to describe the impact of COVID-19 pandemic on the burden and pattern of hospitalization from the COVID-19-unrelated illnesses among children in Barbados. Materials and Methods: This is a population-based prospective clinical audit. It included children (Age <16 years) admitted for COVID-19-unrelated illnesses to the only tertiary care hospital in this country during the ongoing COVID-19 pandemic. This audit covers the period extending from April to July 2020. The audit data for the corresponding period in 2019 and and 2018, which were also collected prospectively, was used as historical control. Results: There were a total of 178 pediatric medical admissions (PMAs) in this country from April to July 2020. This was a decline of 47.2% (95% confidence interval [CI] = 41.6%, 52.5%) compared to the 336 PMA during the corresponding period in 2019 and 2018. The decline in the number of admissions from asthma phenotypes, respiratory infections, and gastrointestinal infections accounted for 88.0% (95% CI – 78.6%, 94.8%) of the total decline in PMA during the pandemic-related lockdown period when compared with the corresponding period in 2019. The difference in the proportion of children who required transfer to the pediatric intensive care unit during the pandemic and the corresponding period in 2019 and 2018 was statistically not significant (P = 0.8234). Conclusions: A sharp decline in the admissions from asthma phenotypes and those from the respiratory tract and gastrointestinal tract infections resulted in a close to 50% decline in hospitalizations from COVID-19-unrelated illnesses among children in this population.