Hybrid powdered activated carbon-activated sludge biofilm formation to mitigate biofouling in dynamic membrane bioreactor for wastewater treatment.

Membrane costs and biofouling limit applications of membrane bioreactors (MBRs) for wastewater treatment. Here, powdered activated carbon (PAC) utilization in the formation and performance of a self-forming dynamic membrane consisting of activated sludge and PAC during hybrid wastewater treatment process was studied. Short-term agitation helped (non)biological particles to quickly uniformly settle on mesh filter, forming more uniform PAC-containing dynamic membranes (PAC-DMs). PAC adsorbed adhesive materials, resulting in an increase in average floc size and DM permeability while decreasing biofouling. The most efficient PAC concentration was 4 g L-1 considering techno-economics, i.e. the highest effluent quality (turbidity of 19.89 NTU) and the lowest biofouling (transmembrane pressure rise of 2.89 mbar). Short-term performance of hybrid PAC-DM bioreactor (PAC-DMBR) showed stability in effluent quality improvement including 92%, 95%, 83%, 84% and 98% reductions in turbidity, chemical oxygen demand, total dissolved solids, total nitrogen, and total phosphorous, respectively. Accordingly, adopting hybrid PAC-DMBR has potential to alleviate biofouling and capital cost.

Exome sequencing utility in defining the genetic landscape of hearing loss and novel-gene discovery in Iran.

Hearing loss (HL) is one of the most common sensory defects affecting more than 466 million individuals worldwide. It is clinically and genetically heterogeneous with over 120 genes causing non-syndromic HL identified to date. Here, we performed exome sequencing (ES) on a cohort of Iranian families with no disease-causing variants in known deafness-associated genes after screening with a targeted gene panel. We identified likely causal variants in 20 out of 71 families screened. Fifteen families segregated variants in known deafness-associated genes. Eight families segregated variants in novel candidate genes for HL: DBH, TOP3A, COX18, USP31, TCF19, SCP2, TENM1, and CARMIL1. In the three of these families, intrafamilial locus heterogeneity was observed with variants in both known and novel candidate genes. In aggregate, we were able to identify the underlying genetic cause of HL in nearly 30% of our study cohort using ES. This study corroborates the observation that high-throughput DNA sequencing in populations with high rates of consanguineous marriages represents a more appropriate strategy to elucidate the genetic etiology of heterogeneous conditions such as HL.

Health and Art (HEART): Integrating Science and Art to Fight COVID-19.

Netting individuals separated from each other by vast distances; the present condition of COVID-19 needs art and its extraordinary capacity to connect human beings and integrate scientific disciplines. We can predict that the COVID-19 pandemic would leave the mind lonely and vulnerable to diseases, for, on the one hand, the COVID-19 pandemic and related problems, in particular social isolation, are itself stressor. On the other hand, studies confirm the potential of COVID-19 to involve the central nervous system by affecting the immune system, either directly or indirectly. The COVID-19 condition, thus, calls for a necessary compensation of loneliness to reduce the psychological impact of the pandemic. Not only art can fulfill this purpose by meeting social affiliation needs, but also its related creativity is a definite achievement of the performer while acting as a motivation facilitator of creation for the observer. Besides, artworks that illustrate effective hygiene behaviors and physical distancing in an easy-to-understand manner could help health information systems to control the spread of COVID-19. The integration of art with biomedical science applied for simulation of the infected population, lung imaging data, and the viral surface has been useful for prediction of the spread of disease and earlier diagnosis of COVID-19 by imaging techniques and might be a contributor to drug discovery for COVID-19. Also, arts admirably influence the immunoemotional regulatory system so that not only would it enable humanity to tolerate quarantine but also enhance antiviral immunity. More interestingly, the effects of dance have been observed in children, elderly, healthcare workers, and pregnant women, which have been of special attention during the COVID-19 pandemic. In summary, arts provide us powerful tools for tolerating the quarantine time and enhancing the immune system, educating behavioral tips for hygiene practices and physical distancing and in psychosocial care of vulnerable populations during the pandemic.

Sexual Dynamics of Married Women with Interpersonal Dependency: A Qualitative Study on Iranian Women.

BACKGROUND: Considering the lack of documented research on the sexuality of dependent persons, this qualitative study examined sexual dynamics among Iranian married women with excessive interpersonal dependency. METHODS: Interviews with 18 married women with high interpersonal dependency were coded using thematic analysis. RESULTS: Three major areas emerged from the data under which the themes clustered. These were (1) intrapersonal level which included confused sexual cognitions, intrusive thoughts during sex, preoccupation by sexual thoughts, low tolerance for reduction or interruption of sexual activity, and emotional distress during sex, (2) interactional dynamics including imposing pressure on the husband to have sex and assuming a submissive and receptive role during sex, and (3) contextual processes including social stigma and the effects of social phenomena. CONCLUSIONS: These findings presented a relatively clear understanding of the impacts of interpersonal dependency on the sexuality of Iranian women. The majority of the women reported maladaptive sexual strategies, attitudes, and emotions. Moreover, there were several similarities between the sexual dynamics of the women and those of individuals with anxious attachment style. These findings suffer from some limitations in terms of generalization due to the small size of the sample and clinical and cultural considerations. The implications of these findings for practitioners are also considered.

Late recognition of cardiac implantable electronic device misplacement in left ventricle: a case report.

Background: Cardiac electronic device implantation may be associated with complications. Case Summary: This is a report of inadvertent implantation of implantable cardioverter-defibrillator lead through an unrecognized sinus venosus atrial septal defect into the left ventricle that was not diagnosed early after implantation. Six months later chest x-ray showed an abnormal lead course that was confirmed with echocardiography as to be in the left ventricle. Surgical removal of the implantable cardioverter-defibrillator lead, repair of atrial septal defect, and correction of abnormal pulmonary venous connections were performed. Meanwhile, follow-up of the patient receiving a new dual chamber permanent pacemaker from the contralateral side and discussion of the aforementioned complication are addressed. Conclusion: Early diagnosis of device implantation complication is of paramount importance and prevents potential catastrophic complications.

This is a report of a middle-aged woman who received a heart battery (pacemaker) without proper initial indication and faced unnecessary consequences/complications. The wire was supposed to be implanted in the right side of the heart, but due to the congenital heart disease of the patient (that was not diagnosed), the wire was erroneously passed through the congenital defect to the left side of the heart. After the diagnosis of the problem, we referred her to a heart surgeon to correct the congenital heart defect and also pull the wire out. After open surgery, a new pacemaker (with two wires) was implanted in the patient without any additional complications.

Spiritual well-being and quality of life in Iranian women with breast cancer undergoing radiation therapy.

PURPOSE: Psychological distress and morbidity are common consequences of diagnosis and treatment of breast cancer and associated with poor quality of life (QOL). Spiritual well-being is an important aspect of QOL, but little is known about the spiritual well-being and its relationship with QOL in patients of different cultures such as Iranian Muslim patients. The aim of this study was to investigate the association of QOL and spirituality among patients with breast cancer undergoing radiation therapy. METHODS: This was a cross-sectional study which was conducted in the Breast Cancer Research Center of St. S. Al-Shohada Hospital, Isfahan, Iran. Spiritual well-being was measured using the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp12). The European Organisation for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) and its supplementary breast cancer questionnaire (QLQ-BR23) were used to assess the quality of life of patients. Descriptive analysis, Pearson's correlation, and multiple regression analysis were performed for statistical assessment. RESULTS: In all, 68 patients fulfilled the study's inclusion criteria and were interviewed. The mean global QOL was 41.42 (SD = 18.02), and the mean spiritual well-being was 28.41 (SD = 6.95). There was a significant positive correlation between general QOL and total spiritual well-being scores. Also, spiritual well-being, social functioning, pain, and arm symptoms were significant predictors of global QOL. DISCUSSION: The results of this study provide evidence that breast cancer survivors in Iran experience a poor quality of life across a broad spectrum of health domains, particularly social, emotional, and spiritual, indicating that psychosocial-spiritual support should be considered in caring for patients with breast cancer.

Association of children's obesity with the quality of parental-child attachment and psychological variables.

AIM: This study aimed to investigate the association of children's obesity with parental attachment and psychological variables as impulsivity, self-control and efficiency of eating control. METHODS: This cross-sectional study was conducted among 202 obese students aged 9-13 years selected by multistage cluster sampling from different areas of Isfahan, Iran. Three questionnaires were considered to be answered by the students and one for their parents. The students completed the following questionnaires: (i) Inventory of Parent and Peer Attachment-Revised version for Children (IPPA-R); (ii) Impulsivity Scale (IS); (iii) Efficiency of Eating Control; and (iv) Self-control Rating Scale (SCRS). RESULTS: The quality of children's attachment had direct effects on self-efficacy of eating management and on obesity by mediating of self-efficacy of eating. Moreover, attachment had direct effect on self-control and impulsivity, and in turn through these psychological variables, it had indirect effects on self-efficacy of eating management. CONCLUSION: The findings of this study underscore the importance of parent-child attachment quality. It can be suggested that childhood obesity can be prevented and managed with creating a secure attachment bond between children and parents and increasing perceived self-efficacy eating management in children.

The effect of spiritual therapy for improving the quality of life of women with breast cancer: a randomized controlled trial.

Diagnosis of breast cancer is a devastating psychological experience for a woman. Also, treatments such as radiation therapy may cause psychosocial distress in these patients and threaten their quality of life (QOL). Among several approaches, spirituality has been shown to be significantly associated with improving the QOL. The aim of this study was to assess the role of spiritual therapy intervention in improving the QOL of patients with breast cancer undergoing radiation therapy. This was a randomized controlled trial study undertaken in a radiotherapy clinic, Isfahan, Iran. Between October 2010 and February 2011, 68 patients under radiation therapy were randomized to either spiritual therapy intervention group or control group who received routine management and educational programs. Before and after six weeks of spiritual therapy sessions, the QOL was evaluated using Cancer quality-of-life questionnaire (QLQ)-C30 and breast cancer-specific questionnaire (BR-23). Multivariate, repeated-measures ANOVA, t-test, and Paired t-test were used for analysis using Predictive Analytic Soft Ware (PASW, version 18) for windows. In all, 65 patients actually completed the six-week intervention and were evaluated for the outcome. The mean Global health status score/QOL reached from 44.37 (SD = 13.03) to 68.63 (SD = 10.86), (p = 0.00). There was a statistically significant difference in all functional scales of QLQ-C30 after intervention (p < 0.05). The results of this trial showed that the spiritual therapy program can improve the overall QOL of women with breast cancer; therefore, it could be adopted in comprehensive care programs for women with breast cancer.

Evaluating and prioritizing the healthcare waste disposal center locations using a hybrid multi-criteria decision-making method.

Healthcare waste disposal center location (HCWDCL) impacts the environment and the health of living beings. Different and sometimes contradictory criteria in determining the appropriate site location for disposing of healthcare waste (HCW) complicate the decision-making process. This research presents a hybrid multi-criteria decision-making (MCDM) method, named PROMSIS, to determine the appropriate HCWDCL in a real case. The PROMSIS is the combination of two well-known MCDM methods, namely TOPSIS and PROMETHEE. Moreover, fuzzy theory is used to describe the uncertainties of the problem parameters. To provide a reliable decision on selecting the best HCWDCL, a comprehensive list of criteria is identified through a literature review and experts' opinions obtained from the case study. In total, 40 criteria are identified and classified into five major criteria, namely economic, environmental, social, technical, and geological. The weight of the considered criteria is determined by the Analytical Hierarchy Process (AHP) method. Then, the score of the alternative HCWDCLs in each considered criterion is obtained. Finally, the candidate locations for disposing of HCWs are ranked by the proposed fuzzy PROMSIS method. The results show that the most important criteria in ranking the alternatives in the studied case are economic, environmental, and social, respectively. Moreover, the sub-criteria of operating cost, transportation cost, and pollution are identified as the most important sub-criteria, respectively.

Contribution of Iran in Elucidating the Genetic Causes of Autosomal Recessive Intellectual Disability.

Many genes with different inheritance modes contribute to the pathogenicity of intellectual disability (ID) making it the most known genetically heterogeneous disorder. Advanced next-generation sequencing (NGS) technologies have helped researchers identify genes underlying ID at an exponential pace. As a consanguineous country, Iran is a hotspot for discovering novel autosomal recessive intellectual disability (ARID) genes. Here, we aimed to review and compare reported ARID gene discovery both in Iran and globally, and pinpoint the research areas that need to be developed in future. We studied published articles and reviews on all known ID genes. In parallel, the gene-discovery research carried out on the Iranian population were also reviewed to determine the contribution of Iran to identifying novel ID genes. Also we tried to find supporting evidence on the causative role of novel genes identified in Iran including confirmatory functional studies and existence of more affected families. We also briefly reviewed the current therapeutic approaches under development for a subset of eligible ID cases. In total, 8% of all ID and 11.5% of all ARID genes described so far have been identified via studies on Iranian population. Functional studies have been performed on 29% of the genes identified in Iran. More than one affected family has been reported for many of these genes, supporting their causative role in ID pathogenesis. Despite the notable contribution of Iran in gene-discovery research, further functional studies on the identified genes are required.

Coping strategies, quality of life and pain in women with breast cancer.

BACKGROUND: Breast cancer is the most common malignancy among Iranian women and is a significant stressor in women's life that may affect their coping strategies and quality of life. This study aimed to investigate coping strategies, quality of life and pain of women with breast cancer. MATERIALS AND METHODS: This was a cross-sectional study which held in Seyed-AL shohada hospital and two private offices in Isfahan, Iran. Target population was women with confirmed diagnosis of breast cancer in a recent year and between 18 and 60 years old. Data were collected via3 questionnaires (Brief cope, EORTC QLQ-C30 and Brief pain Inventory). The reliability and validity of these questionnaires were confirmed in different studies. Sixty-two patients completed the questionnaires. Analysis included descriptive statistics and Pearson correlation coefficient and t-test where necessary. All analysis were conducted using the SPSS version 16.0 and P-value of less than 0.05 considered as statistically significant. RESULTS: Sixty-two women with breast cancer completed questionnaires. The mean age of respondents was 45/81±6/78 years; most married (93/5%), high school-educated (41/97%), house wife (82/3%) and stage II (46/8%). The most common coping strategies were religion, acceptance, self-distraction, planning, active coping, positive reframing and denial. Mean score for the worst pain during the past 24 hours was 6/24 ± 2/55 and for the least pain was 3/19 ± 2/17. The global health scale was 60.34 ± 21.10. Emotion-focused coping strategies were positively and significantly related to symptom aspect of quality of life (r = 0/43 P ≤ 0/01) and affective interference of pain (r = 0/36 P = 0/004) and also was inversely correlated to functional health status (r = -0/38 P = 0/002). There was no significant correlation between problem-focused coping strategies and dimensions of quality of life and also different aspects of pain. CONCLUSIONS: The findings of this study indicated that the care of breast cancer should address physical, psychological and social wellbeing and the findings point to the importance of taking individual coping strategies into account when evaluating the impact of breast cancer on psychosocial wellbeing. Description of coping strategies might be useful for identifying patients in need to particular counseling and support.

Spiritual therapy to improve the spiritual well-being of Iranian women with breast cancer: a randomized controlled trial.

Purpose. The aim of this study was to investigate the role of spiritual therapy intervention in improving the spiritual well-being and quality of life (QOL) of Iranian women with breast cancer. Methods. This randomized controlled clinical trial (RCT) recruited 65 women with breast cancer, randomly assigned to a 6-week spirituality-based intervention (n = 34) or control group (n = 31). Before and after six-week spiritual therapy intervention, spiritual well-being and quality of life (QOL) were assessed using Functional Assessment of Chronic Illness Therapy Spiritual Well-being scale (FACIT-Sp12) and cancer quality-of-life questionnaire (QLQ-C30), respectively. t-test, Paired t-test, pearson's correlation, and hierarchical regression analyses were used for analysis using Predictive Analytic software (PASW, version 18) for Windows. Results. After six spiritual therapy sessions, the mean spiritual well-being score from 29.76 (SD = 6.63) to 37.24 (SD = 3.52) in the intervention group (P < 0.001). There was a significant difference between arms of study (F = 22.91, P < 0.001). A significant positive correlation was detected between meaning and peace with all subscales of functional subscales on European Organization for Research and Treatment of Cancer quality of Life (EORTC QLQ-C30) (P < 0.05). Hierarchical regression analyses of participants indicated that the study arm, pain, and financial impact were significant predictors of spiritual well-being and overall QOL. Social functioning was another significant predictor of spiritual well-being. Conclusion. The results of this randomized controlled trial study suggest that participation in spiritual therapy program is associated with improvements in spiritual well-being and QOL. Targeted interventions to acknowledge and incorporate spiritual needs into conventional treatment should be considered in caring of Iranian patients with breast cancer.

A Preliminary Study on the Effects of Attachment-based Intervention on Pediatric Obsessive-Compulsive Disorder.

BACKGROUND: Research on attachment has shed new light on understanding one of the underlying mechanisms of psychopathology in children. The aim of this study was to investigate the therapeutic efficacy of attachment-based intervention in a pediatric sample with obsessive-compulsive disorder (OCD). METHODS: Twelve participants, 10-12 years of age, were treated across an eight-week period. They had not been treated with either pharmacotherapy or psychotherapy previously and remained medication-free during the attachment-based therapy. This study comprised two groups of children: The experimental group, who received attachment-based intervention, and the control group, who did not receive treatment. All participants were assessed in terms of severity of OCD symptoms by administrating the Children's Yale-Brown Obsessive-Compulsive Scale before and after the experimental group had received the therapeutic sessions. The children were assessed again one month later. The level of children's depression, and attachment insecurity, as well as their mothers' depression, OCD symptoms, and attachment insecurity, were statistically controlled in this study. RESULTS: Multivariate analysis of covariance (MANCOVA) indicated that the OCD symptoms in children decreased significantly over the course of the therapy, and this gain was maintained at follow-up. The results of this study demonstrated that the attachment-based intervention was efficacious in alleviating the OCD symptoms. CONCLUSION: It is suggested that parental instruction in attachment-based relationships may help prevent young children from developing OCD symptoms in middle-childhood and adulthood.

Preventing worry and rumination by induced positive emotion.

BACKGROUND: Thus study aimed to test the hypothesis that positive emotion can quell or undo the lingering worry and rumination following induced negative emotion. METHODS: 32 female students in grade 1 of high school were randomly recruited and assigned in two experimental and control groups. They completed questionnaires in a pretest that are listed herewith: (1) Rumination questionnaire; (2) Two scales of the big five factorial questionnaire (extraversion - introversion; (3) MMPI(2); (4) Penn-state worry questionnaire. Then for the first group a sad movie, for the second group a cheerful movie, and for the third group a neutral movie was played, and the fourth group remained without intervention. Next day, all the group members completed the worry and rumination questionnaire again. Research findings were analyzed using covariance analysis and multivariate analysis of variance (MANOVA). RESULTS: Those participants whose attention was turned toward the cheerful movie recovered from negative emotions (rumination and worry) more than those who saw either a neutral or sad movie or remained without intervention. CONCLUSIONS: Positive emotion is effective on negative emotion like worry and rumination. This effect is called the undoing effect of positive emotions.

Metacognitive therapy for body dysmorphic disorder patients in Iran: acceptability and proof of concept.

The purpose of the present study was to determine the effect of metacognitive therapy (MCT) on symptoms of body dysmorphic disorder (BDD) and on symptoms of thought-fusion, by means of a wait-list controlled clinical trial. Participants were referred from dermatology and cosmetic surgery clinics in the city of Isfahan, Iran, and 20 patients were selected on the basis of DSM-IV-TR diagnostic criteria for BDD. They were randomly assigned to either the experimental or the wait-list control group. The Yale-Brown Obsessive Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) and the Thought-Fusion Inventory (TFI) were used as the outcome measures. The experimental group received 8 weekly metacognitive intervention sessions. The control group was in the waiting-list until the end of the follow-up. Measures were taken at pre-test, post-test (after 2 months) and follow-up (after 6-months). The results of analysis of variance showed that MCT significantly reduced the symptoms of BDD and of thought-fusion, compared to the wait-list. Effects on both outcome measures were maintained at 6-months follow-up.

Factor Structure and Reliability of the Revised Dyadic Adjustment Scale (RDAS) in Iranian Population.

OBJECTIVE: To determine the reliability and validity of the Revised Dyadic Adjustment Scale (RDAS) with 14 items (short form) in Iranian population. METHODS: The English version of the RDAS was translated into Persian. Then, Persian version was retranslated to English. To study factor structure 338 questionnaires were filled out by parents of elementary students. Other measurement tools were The Marital Happiness Scale (MHS), Enrich Marital Satisfaction Questionnaire (ENRICH).Both English and Persian forms were completed by 35 married undergraduate English students. The Cronbach's alpha coefficients of the RDAS, MHS, and ENRICH were 0.79, 0.87. and 0.76-0.91, respectively. RESULTS: The content validity of the backward translation of the original version was confirmed.The findings confirmed the factor structure.Also, the validity was confirmed by retest and internal consistency. There was relationship between RDAS with marital happiness and satisfaction in anticipated direct, between husband and wifeadjustment scores. CONCLUSION: The reliability and validity of the RDAS with 3-factor structure in Iranian population was confirmed with an appropriate validity and reliability.

Females are more anxious than males: a metacognitive perspective.

OBJECTIVE: Previous studies have suggested that anxiety disorders are more prevalent among women than men. The purpose of this study was to compare the metacognitive perspective of Generalized Anxiety Disorder (GAD) in females with males. METHODS: A cross sectional study was conducted on the high school girls and boys who have been affected by GAD. The sample consisted of 100 high school students (50 boys and 50 girls) selected by Generalized Anxiety Disorder Scale (GADS) and semi-structured interview. They filled the Metacognitive Thought Control Questionnaire (TCQ), and Anxiety Thoughts Inventory (AnTI). RESULTS: Significant differences were observed between girls and boys in anxiety thoughts (health anxiety, social anxiety, and meta-worry). Anxiety thoughts affect girls more than boys; they have more metacognitive beliefs about uncontrollability of worry and believe that worry must be avoided. On the other hand, positive beliefs in worry are more common in girls and punishment and meta-worry are being implemented as control strategies in girls more than boys. CONCLUSION: Metacognitive beliefs in uncontrollability, advantages and avoidance of worry may contribute to the higher prevalence of anxiety in females than males.