مریم باقری

Multiple sclerosis is one of the most important diseases of the nervous system, the prevalence of which is two to three times higher in women than in men. The main cause of this disease is not known and there is no definitive treatment for it. The purpose of this study was to compare the effectiveness of commitment-based therapy and group reality therapy on the general health of women with multiple sclerosis.

The research method was semi-experimental with a pre-test-post-test design and follow-up with a control group. The research population consisted of all married women with multiple sclerosis in Hamadan city in 2023. From this number, 3 groups of 15 people were selected by available sampling method and randomly divided into experimental and control groups and answered the Goldberg General Health Questionnaire (1979) in three pre-test, post-test and follow-up sessions. The subjects of the experimental group were treated with the approach of treatment based on acceptance and commitment and reality therapy, during 8 sessions, 1 session of 60 minutes per week, but no training was given to the control group. The data were statistically analyzed with SPSS version 26 software and using the mixed variance analysis test and a significant level of p < 0.05.

The results showed that there is a significant difference between the general health scores in the pre-test, post-test and follow-up stages, and the difference between the post-test and follow-up scores is significant. The comparison of the adjusted means showed that the general health scores in the pre-test stage (M=52.4) are higher than the post-test stage (M=46.8) and the follow-up stage (M=46.6). Also, there is a significant difference between the effect of the first and second experimental groups and the control group. The comparison of the averages shows that the general health scores in the first experimental group are based on acceptance and commitment (M=44.5, Eta=0.335), and the group Experimental reality therapy (M=47.3, Eta=0.227) is more than the control group (M=54.1). Also, in relation to the interaction between the stages and group factors, the F value calculated for the effect of the stages (pre-test, post-test and follow-up) between the three test and control groups is significant at the 0.01 level (Eta=0.245, <0.01). P=F 6.818), as a result, there is a significant difference between the average scores of the pre-test, post-test and general health follow-up in the three groups.

According to the results of this research, it can be said that treatment based on acceptance and commitment and treatment based on reality therapy led to general health in women.

Coronavirus disease 2019 (COVID-19) can affect the peripheral and central nervous system. Headache, cerebrovascular disease, anosmia, taste and vision disorders, and neuropathic pain have been observed in patients with COVID-19. In this study, the effect of predisposing factors, such as blood sugar level and age, on the occurrence of changes in the function of some cranial nerves has been investigated.

In this study, 1138 men and women with COVID-19 (18-89 years old) hospitalized in Shahid Mostafa Hospital in Ilam City without a history of diabetes were studied. Fasting blood sugar levels, taste disorders, smell disorders, sore throat, and various blood factors were studied in these individuals.

The rate of dysfunction of the 1st, sensory part of the 7th, and the 9th cranial nerves in non-diabetic patients with COVID-19 showed an inverse correlation with blood sugar level. Furthermore, the incidence of smell and taste disorders in patients with COVID-19 without a history of diabetes showed an inverse correlation with increasing age.

Coronavirus can cause partial or complete dysfunction in the activity of some cranial nerves.  The incidence of impaired sense of smell and taste in patients with COVID-19 decreases with increasing fasting blood sugar levels as well as with increasing age.

Patient satisfaction is considered as one of the most important elements of the evaluation of healthcare centers. In this research, the level of satisfaction of infertile patients was evaluated.

This study is a cross-sectional descriptive study. The research population is infertile patients who referred to the infertility clinic (at least 4 visits) and hospitalized in four hospitals affiliated with the Tehran University of Medical Sciences. The satisfaction questionnaire was valid researcher-made which included 56 questions in 9 areas, and were collected from May 2021 to September 2022. In order to comply with the ethical principles in research, hospitals were named 1-4.The results were analyzed using the chi-square test or Fisher's exact test for qualitative variables and analysis of variance for quantitative variables in SPSS software, version 24 (SPSS Inc., Chicago, IL, US).

Results:

 Three hundred–four infertile women in four hospitals were studied. The mean age of the participants was 33.8 years, with a standard deviation of 5.8 years. The average satisfaction with admission and discharge services, medical services, nutrition, accounting, and insurance services in the number-1 Hospital had the highest score, and the average satisfaction with nursing or midwifery services, diagnostic and therapeutic services (radiology/laboratory), hospital services, charter patient rights, management services, paid expenses in Hospital 4 received the most points. The mean score of satisfaction was the highest among those who visited the infertility clinic of Hospital 3 (161.54±21.41). Average satisfaction with admission and discharge services, medical services, nutrition, accounting, and insurance services in Hospital No. 1 had the highest score, and average satisfaction with nursing or midwifery services, medical diagnostic services (radiology/laboratory), hospital services, respecting the patient's rights, management services, paid expenses in hospital number 4 got the most points. The average of nursing or midwifery services, respecting the patient's rights, and hotelling in all hospitals received the highest score, respectively, and nutrition services and paid expenses received the lowest points (most dissatisfaction) (P<0.05).

The level of satisfaction of women referring to the infertility clinic in 35.9% of cases was considered to be at an appropriate and exceptional level, in 49.3% of cases it was at a partially appropriate level, and in 14.8% at an inappropriate level.

This research aimed to compare the effectiveness of short-term psychodynamic psychotherapy and emotion-focused couple therapy on couples with alexithymia, marital satisfaction, and difficulty in emotion regulation. The method of the present study is quasi-experimental including pretest- posttest with a control group and with 3 month follow-up pattern. The statistical population of this study is based on online invitations for volunteered couples living in strict 1,2,3 in Tehran, for which 60 teams among them were selected according to inclusion criteria. The instruments used included the Farsi version of The Toronto Alexithymia Scale-20 (FTAS-20), the Afrooz and Erich Marital Satisfaction Scale, and the Difficulties in Emotion Regulation Scale. The experimental groups got two different types of therapy once a week. Data were analyzed by multivariate analysis of the Covariance and Bonferroni tests. Results showed that both therapies were significant for research variables and they were consistent in 3-month follow-up. So both methods can help reduce symptoms of Alexithymia, marital dissatisfaction, and difficulties in emotion regulation.

The SARS-CoV-2 can increase blood levels of D-dimer by causing thrombosis and affecting the homeostasis system. This study aimed at investigating the blood levels of D-Dimer and its relationship with the incidence of headache in patients with type 2 diabetes infected with COVID-19 who were admitted to Ilam Shahid Mostafa Hospital, Iran.

We studied the patients hospitalized in Ilam Shahid Mostafa Hospital. with COVID-19 (n=988) in two groups of with and without diabetes. Blood levels of D-dimer, and glucose, and also the incidence of headache were evaluated in all patients.

Fasting blood sugar levels, blood levels of D-dimer, white blood cell count, and ESR significantly increased in diabetic patients with COVID-19 compared with the non-diabetic patients (P<0.001). The incidence of headache was found to be significantly lower in diabetic patients than non-diabetic patients (n= 91, P= 0.0009).

According to present research, there is an inverse relationship between the blood levels of D-dimer and incidence of headache in diabetic people with COVID-19, as by increase in blood levels of D-dimer the incidence of headache decreased.

The quality of permeability is a physical indicator that is significant in the formation of a successful place, especially in the field of public spaces. On the other hand, given that this research considers the issue of attendance of a traditional bazaar, the quality of permeability at the edges, especially the entrances and the rows leading to them, can play a significant role here. The entrance of a space is the first place where many of its features are discovered. Accordingly, the issue of quality of permeability is considered in this research as an independent variable, and its role in people’s presence in the space of a traditional bazaar is examined as a dependent variable. This concept of permeability has been proposed in the existing literature in three forms: neighborhood quality, spatial continuity, and accessibility. 
Theoretical framework
According to the existing literature, the factors affecting permeability, especially in connection with urban contexts, can be examined in three areas, as follows.
- The quality of neighborhoods. The quality of neighborhoods in a spatial configuration means the functional compatibility of the uses that form that space so that the performance of one does not disturb or hinder that of another.
- Spatial continuity. Spatial continuity means the formal and functional connection of spaces with each other so that the environment is perceived by an external observer in a unified manner. This concept can be analyzed in an urban environment using indicators such as integration and connectivity.
- Accessibility. In the literature on architecture, the issue of accessibility can be examined in two areas: visual accessibility and physical accessibility. Visual accessibility means the ability to view a space from neighboring spaces. Physical access pertains to people’s ability to move within the space.

The current research adopts a combination of the qualitative and quantitative methods in data analysis. In the data collection section, the methods of documentary study, direct field observation, and interview with businesses and bazaar users were used, and in the data analysis section, the content analysis method and the space syntax software were used.
  In regard to the edges (independent variable), the three indicators of access quality (including physical access and visual access), spatial continuity, and the quality of neighborhoods were measured separately for each of the entrances. In the analysis of the quality of visual access, indicators were used such as the visibility of the entrances, the variety of uses in the bazaar that can be viewed from the entrance areas, and the amount of details on the space that can be viewed from the entrances. In the measurement of physical access, the degrees of enclosure and isolation of entrances in the bazaar were analyzed. In relation to the quality of neighborhoods, indicators such as the diversity and density of neighborhoods and the degree of their compatibility and interdependence were examined.

No research has been conducted on the issue of attendance of the bazaar and the effect of the quality of permeability thereon, hence the attempt to answer the research questions about how the quality of permeability affects people’s attendance of the bazaar.
 
- How does visual access affect attendance in the bazaar?
The more visible the details from inside the bazaar to the user through its inputs, the more widely people choose those inputs to penetrate the bazaar and, therefore, the greater the attendance of the bazaar. The results of this research demonstrated that the difference in level between the passage and the space inside the market and the increase in the visible surface due to the presence of linear geometries along the lines leading to the entrances raises the range of visibility before entry into the bazaar space.
 
- How does physical access affect attendance in the bazaar?
The first feature for people to identify about the entrances is their visibility from the surrounding roads. If people can see inside the space before entering it, they can choose whether they want to enter the space or not.
The second factor effective on physical access to the bazaar is the users’ willingness to use different entrances. In some cases, this increases the attendance of the bazaar, and in others, it decreases people’s desire attend it.
 
- How does the quality of the neighborhood affect attendance in the bazaar?
The existence of diverse uses and their density in those respects provides the possibility of meeting a greater range of client needs, which ultimately increases their attendance. Moreover, because they complement each other, users increase related nearby users’ attendance. However, the necessary conditions concerning the quality of neighbors are compatible with one another. This means that when incompatible users are placed together, they prevent people from attending the space due to the nuisance that they cause, besides their negative effects on each other’s functions.
         
- How does spatial continuity at the entrances of the bazaar cause attendance thereof?
The degree of spatial continuity at the bazaar entrances can be evaluated using the two indices of integration and connectivity. The values of these two indicators are directly related to the geometric and spatial qualities of the inputs and the lines leading to them.

The most important results of the current research can be presented as follows.
- The quality of access to bazaar inputs is considered as the most important factor affecting permeability, thereby increasing bazaar attendance. This quality can be examined in the form of the two concepts of visual access and physical access.
- The quality of neighborhoods can increase attendance in the bazaar in the form of the compatibility of and dependence between the uses of different bazaar lines and their density and diversity.
- Spatial continuity at the entrances and the rows leading to them in the form of their geometric and spatial features (increasing the widths of the entrance and the rows leading thereto, connecting the entrance with public open spaces and main passages, using linear geometry, reducing the depths of the rows, and integrating and connecting the lines leading to the entrance with other spaces) can increase bazaar permeability and therefore its attendance.

During the outbreak of Corona, the anxiety due to Corona led to psychological distress and challenged distress tolerance.

The present study aimed to investigate the structural relationships between Corona anxiety and experiential avoidance with the mediating role of distress tolerance in the period of the outbreak of Covid-19.

The method of this study was based on the fundamental objective and the descriptive method of the correlation type based on the structural equation method. The statistical population included all students of Kharazmi University in 2018-2019, who were students during the outbreak of Corona and virtual education. Based on this, 350 students were selected by multi-stage cluster random sampling. The participants responded to Alipour et al.'s Corona Anxiety Scale (2018), Simons and Gaher's Distress Tolerance Scale (2005), and Bond et al.'s (2011) Experiential Avoidance Questionnaire in a Google form. Finally, the data were analyzed via SPSS-24 and AMOS-14.

The results showed; the structural model between Corona anxiety and experiential avoidance with the mediating role of distress tolerance had the goodness of fitness. The direct effect of experiential avoidance on the anxiety of Corona disease was positively significant, therefore, the direct effect of experimental avoidance on distress tolerance and distress tolerance on Corona anxiety was negatively significant (P<0.01).

Experiential avoidance can predict the level of Corona anxiety with the mediating role of distress tolerance. Based on the findings, it is suggested; researchers should pay attention to the psychological findings obtained from this study in future studies in the field of disease anxiety, especially diseases that are highly contagious such as covid-19 in humans.

 There is inconsistent data regarding COVID-19 prognosis in patients with background hypothyroid disorder. The present study aimed to evaluate the severity of symptoms and blood parameters in COVID-19 patients with hypothyroidism.

 This study investigated 100 COVID-19 patients (50 individuals with a history of hypothyroidism and 50 patients without thyroid disorder [euthyroid]). Demographic and clinical characteristics were collected from the COVID-19 registry database in Shahid Mustafa Khomeini Hospital. All patients were admitted and treated between March and December 2020. Hospitalization duration, the ICU admissions rate, and blood laboratory tests were evaluated in this study.

 Hospitalization period was significantly longer in the hypothyroid group, compared to the euthyroid group (P=0.009). The number of red blood cells (RBCs), hemoglobin level, and hematocrit percentage were lower in the hypothyroid group (P=0.001, P=0.003, and P=0.003, respectively). Nevertheless, the number of white blood cells (WBCs) and inflammatory indicators, including erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were the same in both groups.

 Although background hypothyroidism had no significant effect on inflammation severity caused by COVID-19; however; it extended hospital stay in these patients. Anemia, a common problem in hypothyroidism, may explain longer hospitalization in hypothyroid COVID-19 patients.

This research investigates the relationship between attribution styles and psychological capital through the flow with academic engagement. The type of research was descriptive and correlational. The statistical population of the research is male and female students of Yazd University in the academic year 1398-1399 (14470), in which 384 students were selected by convenience sampling. The research instruments included standard questionnaires of attributional styles by Patterson and Seligman (1984), flow by Jackson and Auckland (2002), psychological capital by Luthans, Avolio, Avey, & Norman (2007) academic engagement by Fredericks, Blumenfeld & Paris (2004). Data analysis was performed using SmartPLS2 and software. The results of structural equation modeling showed that psychological capital plays a role in predicting academic engagement. Positive attribution style plays a role in predicting academic engagement. Negative attribution style plays a role in predicting academic engagement. Psychological capital plays a role in predicting academic engagement by mediating the flow. Positive attribution style plays a role in predicting academic engagement by mediating the flow (p<0/05). Negative attritional style plays a role in predicting academic engagement through the mediating role of the flow (p<0/05).Finally, considering the role of document styles and psychological capital in predicting academic enthusiasm, it seems necessary to establish educational workshops to improve psychological capital and improve students' document styles.

Evidence shows that most diseases, including heart disease, cancer, pneumonia, and health inequalities, are all strongly influenced by social characteristics. Therefore, this study was conducted to determine the relationship between social participation and general health of the elderly in Mashhad

The present study was a cross-sectional descriptive analysis for which 350 elderly retirees (employees) and retirees of the Social Security Organization (workers), based on a multi-stage method ((class, systematic random access and available) based The proportions were proportionally selected.The data were collected using the elderly demographic information questionnaire, GHQ general health questionnaire and social participation questionnaire.The data obtained using SPSS-v24 software and using correlation tests, independent t-test, one-way analysis of variance And multiple linear regression was analyzed.

The mean and standard deviation of age of the research units was 68.91 7 7.62 years. The mean scores of general health and social participation were 15.19 and 31.71, respectively. The variables of social participation along with age, marriage, gender, employment, source of income, income satisfaction, illness and life companions as independent variables predicted 15% of general health (P <0.05).

In this study, no significant results were observed between the relationship between social participation and public health in retired elderly. Further research focusing on more individual factors such as age, marital status, gender, employment, source of income, income satisfaction, illness, and life companions can be useful for planning and implementing comprehensive and effective strategies.

Nurses face many ethical challenges in providing care to patients. Scenario-based  learning along  with the use of  reflection can be an interactive, dynamic, and expansive learning strategy in ethics education that enhances students' decision-making skills and self-learning abilities. The aim of this study was to investigate the effect of reflective learning based on clinical scenarios on students' moral sensitivity in the course of professional communication and nursing ethics.

This study was a semi-experimental pre-test-post-test single group study that was performed on nursing students of Fasa University of Medical Sciences during the academic year of 2018-2019 in three stages of design, implementation and evaluation to assess students' moral sensitivity. In this study, all second semester nursing students including 48 people participated in the study. To collect data, the Persian version of the Lutzen Ethical Sensitivity Questionnaire (2006) was used. Data were analyzed in SPSS software version 21 at the level of descriptive and analytical statistics (paired t).

In this study, there was no significant difference between the mean of the total score of moral sensitivity before and after the intervention (p value> 0.05). Also, the results of paired t-test did not show a significant difference before and after the educational intervention in the subscales of moral sensitivity (Sense Of Moral Burden,  Moral Strength, Moral Responsibility) (p value> 0.05).

The present study, considering the non-significant difference between students 'moral sensitivity scores before and after the intervention, suggests that despite the place of reflective activities in the development of students' learning, especially in Western studies, and also applying such new approaches, especially by considering different cultural pedagogies, can take on more complex dimensions in order to be effective. Therefore, further studies on the effectiveness and dimensions of using reflection activities in ethics education are recommended to undergraduate nursing students in Iran.

Fatigue is one of the most common side effects which is known as one of the most important stressors and is expressed as a debilitating complaint. Despite advances in pharmaceutical and non-pharmaceutical fields, this problem still exists, so the present study was conducted to determine the effect of lowering the temperature of dialysis solutions on fatigue in these patients. This two-group randomized clinical trial was performed on 60 patients undergoing hemodialysis in Mashhad hospitals in 2017. The temperature of the dialysis solution was set at 35°C in the intervention group and 37°C in the control group. fatigue of patients in both groups was measured by the Piper scale before and after the intervention. Data were analyzed using SPSS 18 statistical software and t-test, Mann-Whitney and paired t-test. The results showed that fatigue in patients undergoing cold hemodialysis was significantly reduced in the postoperative phase (P <0.05). Cold hemodialysis solution (35°C) can help reduce fatigue in hemodialysis patients. Therefore, it is recommended that care providers use this method to reduce the complications of hemodialysis in these patients.

Scenario-based learning provides students with the opportunity to interact with each other and engage in the situation through applying active learning strategies. The present study intended to compare scenario-based learning with two methods of group discussion and question and answer on the learning achievement of nursing students.

This interventional-comparative study was conducted during the first semester of the academic year 2018-2019, with 94 nursing students in the 6th semester who were randomly assigned to two groups. In the control group, case scenarios were taught through question and answer method while in the test group, the scenario cases were taught through group discussion method. The final test score of Nursing Care at Home course was compared as a marker of learning achievement between the two groups. To analyze the data, independent t-test was applied to compare the scores of the two groups, covariance analysis test was performed to adjust the variables and to investigate the relationship between demographic traits (age and average score) with learning achievements Pearson Correlation Coefficient was implemented using SPSS 18.

Analysis of covariance by adjusting the variables in the two groups detected that the obtained scores from the final exam as a marker of learning achievement had a significant relationship with the teaching method (P-value< 0.05) therefore the average score of the group with discussion method was higher than that of the group with question and answer method in scenario-based learning.

Scenario - based learning with group discussion methods can facilitate and promote students' learning.

The mother's vital signs change in the face of stressful phenomena Acupressure improves vital function by secreting enkephalins. The aim of this study was to determine the effect of acupressure, LV3 point on maternal physiological parameters and non-stress testing of the fetus.

A clinical trial study was performed on 84 primiparous mothers. The study tool was a questionnaire in three sections: demographics, maternal vital signs and interpretation of non-stress fetal test. After measuring the mother's vital signs, non-stress testing of the fetus was done. After 5 minutes, in the intervention group, the researcher applied a pressure of 3 kg to the LV3 point for 1 minute, rested for 30 seconds and performed 2.5 minutes for each leg. In the control group, the researcher touched a point near LV3 (the tip of the big toe). Five minutes after the non-stress test, the vital signs of the mothers were re-measured and the NST print was interpreted by a specialist and an uninformed person. The collected information was entered into SPSS software, analyzed.

In the intervention group, the difference between the mean variables of fetal heart rate and fetal movements was statistically significant, in the second 10 minutes after the intervention was more than the first 10 minutes (p <0.05). The difference between the means in increasing the basal rate of fetal heart rate and the number of fetal movements in the first and second stages in the intervention group was more than the control group and was statistically significant (p <0.05). But the pressure on LV3 point on pulse and blood pressure of pregnant mothers in the study group was not statistically significant.

Acupressure can be used to reduce the false non-reactive test results of non-stress fetal test.

The cut-off point in a test is the score that divides test takers into different classes (such as rejection-acceptance). The process of determining the cut-off point is frequently used in educational tests. The cut-off point should be based on a generally accepted methodology and reflect the judgment of competent and qualified individuals. The aim of this study was to determine the basics of determining the cut of point in academic achievement tests.

 The present study is a review study in which all articles related to the purpose, using keywords of standardization of the test and determination of the cutting point in reputable Persian and English scientific sites were searched..

 In the search, it was found that there was no reliable Persian scientific source in determining the cutting point. However, English articles and books in this field were carefully studied.

Despite the importance of determining the correct cut point, especially in academic achievement tests, but Persian texts contain few resources in the field of principles and foundations for doing this and probably the lack of these resources makes researchers less familiar with the correct process of determining the point. Their inclination and tendency to use unscientific methods to do it in their studies. This article can be a useful tool as a guide to the basic principles of determining the cut-off point in academic achievement tests, which puts more emphasis on using the cut-off point for important decisions.

Connexon is a membrane structural protein in the gap junctions. These cellular connections are responsible for transporting ions and messenger molecules to the oocyte. This study aimed to investigate the role of beta-2-adrenoceptors in the process of follicle growth based on the expression of the two connexins 37/43 in the gap junctions that have a primary role in the mitotic resumption and oocyte maturation.

This case-control study was conducted from April 2019 to November 2020 at the Reproductive Health Research Center of Tehran Imam Khomeini Hospital was performed on women with the poor ovarian response (POR) and control (women donate eggs) groups. Both groups had entry criteria with a body mass index under 28 m2/kg and 20-45 years old. Exit criteria were including no drug use except ovarian stimulants and no illness. The diagnosis was made agreeing to the Bologna model criterion. Ovulation stimulation cycle was performed, and then after the puncture, cumulus cells were isolated by enzyme and were freezing in -80 centigrade until the time of inserting into the cell culture medium. Isoproterenol (agonist) and propranolol (antagonist) at a concentration of 100 nM were added to the culture medium as the beta-2 adrenoceptors selective drugs. After culture, RNA extraction was performed and the concentration was read by Nanodrop, and then cDNA was synthesized. Gene expression was determined by real-time PCR.

The findings of connexin expression in the three study groups: without the drug (P<0.001), propranolol (P<0.001), and isoproterenol (P<0.001) were significant compared to the control group. Isoproterenol decreased expression but propranolol increased it (P<0.001).

These findings confirm the important role of connexins 37 and 43 in cumulus cleft junctions that propranolol was able to increase its expression. Therefore, we suggest firstly these two connexins can be an effective target for oocyte growth and maturation. Secondly, propranolol could be a new treatment for women with POR and be effective in assisted reproductive technology (ART).

The increasing pace of change in the early decade of the 21st century has led to the emergence of an age of uncertainty and an environment full of opportunities and threats to today's complex systems. In this volatile and rapidly changing environment, traditional planning tools such as outsourcing, forecasting, and foresight alone will not work for the medium to long term. In fact, it should be said that the current problems of human society due to the lack of accurate knowledge of the future in the past on the one hand and astonishing developments in technology along with the accelerating process of globalization on the other hand, recognizing future developments and striving for architecture is necessary and avoided. Zanjan province has experienced rapid growth in the number of urban population, number of urban settlements and economic activities in the last 4 decades. Due to the challenges of the natural and environmental structure of the province, including the province in semi-arid and arid conditions, exploitation of mines and economic, development activities and the spread of pollution, reduction of some animal species, destruction of biological resources, severe soil erosion, harvest unprincipled sources of water resources and destruction of riverbeds, etc. make it necessary to conduct research on the environmental status of the province in the next few years based on the current situation and future forecasts based on scientific methods. Therefore, this study aims to identify the main and influential factors on the environment of Zanjan province and finally select the most appropriate scenario and help reduce environmental problems in the future by evaluating the available information and documents in the field of environment and based on land management. Has been.

Method of the present study is combination of library, documentary and survey methods and in terms of nature is based on futures research methods. Gathering information about the environmental status of the province is based on land management studies and analysis of the environmental status of the province and preparing maps related to ArcGIS software using the layers in the province. In this study, influential factors were determined according to the opinion of experts and specialists and using a questionnaire in the form of Delphi method (Delphi technique) and to analyze the research information, the method of interaction analysis was selected. MICMAC software was also used to analyze the effect of factors on each other and also Scenario Wizard software was used to perform scripting calculations. In this study, using the Delphi method, a questionnaire was prepared in two stages. In the first stage, the questionnaire was designed as an open-ended question and was provided to experts (25 experts) and they were asked to identify the effective factors in the environment of Zanjan province in the central issues, taking into account various and comprehensive areas, including economic. , Introduce social, cultural, political and environmental. The result was the extraction of 53 possible factors affecting the environment of Zanjan province. In the second stage, after identifying the effective factors, the variables were entered into the interaction analysis matrix, and then the standard interaction analysis questionnaire was provided to the experts. The calculated indirects were analyzed and after identifying the effective factors and uncertainties, finally the final key factors identified as the main underlying factors in the scenario were used. As a result, by preparing favorable and credible scenarios, strategies for the environmental situation of Zanjan province have been stated.

In order to analyze the future of environmental research in Zanjan province, first through Delphi method and focus groups and based on the discussions in the theoretical and methodological frameworks and environmental challenges of the province, the opinions of experts in the field of environment through an open questionnaire, 53 effective factors in the environment. Biology of Zanjan province was extracted. Then, by placing these factors in a matrix of 53 by 53, the effect of each of these factors on each other was determined in the form of a questionnaire. The results show that the environment is more dependent on the human factor and legal structure than anything else. As laws and regulations and environmental management have an important role in the future environment of the province, in the next stage, economic and investment structures are effective. On the other hand, the natural environment and natural areas have the most direct impact in the future, in the second stage, all types of environmental pollution are affected. Then the fields of agriculture and natural resources are the most affected. In general, it can be inferred that human factors are the most influential and natural factors and natural resources are the most influential. Based on the results, it was determined that one of the most important factors in the future of Zanjan province's environment with a landscaping approach is Zanjan province's environmental management and the economic situation of the province and the country, which as two driving forces can affect the future of Zanjan province's environment. Give. These two forces were identified as the axes of the scenario, based on which three scenarios with the titles of the first scenario (marigold) - economic stability - integrated environmental management of the province, the second scenario (in search of spring) - economic stability - lack of integrated environmental management Biology of the province and the third scenario (spring death) - economic instability - lack of integrated management of the province's environment were developed.According to the the lack of selected certainties and the main axes of the scenario, three scenarios for the future environment of Zanjan province were conceived. In the most favorable scenario, we will face economic stability and integrated environmental management of the province. In this scenario, the situation of environmental indicators will increase and the province will develop in all environmental areas. Public participation and capacity building will also increase in this scenario. In fact, this scenario shows the optimal environmental situation of Zanjan province. In the second scenario, when economic stability and lack of integrated environmental management prevail in the province, the scenario of parts of the environment, including the protection of natural areas and endangered species due to lack of management costs and human resources are most affected. In general, in this scenario, the environmental situation of the province will be degraded in some sectors and will be protected in some sectors. In the latest scenario, which is faced with economic instability and lack of integrated environmental management, all sectors of the environment, including the protection of natural and endangered species, polluting industries and urban and rural waste management, are most affected. In general, in this scenario, the environmental situation of the province will be destroyed in all sectors.

The present study was conducted with the aim of presenting a conceptual model of transformational leadership of primary school principals in Tehran. The research method was developmental in terms of purpose, and in terms of data type, it was part of a series of exploratory mixed research conducted using grounded theory. As with the method of the study, it was a descriptive survey. The statistical population in the qualitative phase included a number of experts, while the quantitative phase involved all male and female principals of public elementary schools in Tehran, including 907 principals who were employed in the academic year 2019- 2020. In the qualitative phase, 12 experts were selected using snowball method, and in the quantitative phase, 270 principals were selected by cluster random sampling according to Krejcie and Morgan table. The research tool was a researcher-made questionnaire. According to the results, 6 main factors and 18 components were identified in the developed model. These included: school identity factor (school dynamics, school synergy, school organizational structure including lack of transparency in the formulation of administrative rules and regulations, education inflexibility, organizational motivation factor in education (meeting the material and spiritual needs of teachers, dissemination of value behaviors, dissemination of moral behaviors, the factor of organizational communication in education, including managers having leadership qualities, support for education, having mental and educational abilities, having innovative decisions, the cultural factor governing organization in education (emphasis on behavioral skills, emphasis on humanism, emphasis on scientific orientation, the education development factor including the creation of strategic thinking in education, reformability of education, ethical promotion of education, and functional growth of education.

Critical thinking development in healthcare professions is a necessity for making effective decisions in high-risk situations. The present study aimed to evaluate the effect of reflective writing with Gibb’s cycle on students’ critical thinking disposition.

This was an interventional research with a pretest-posttest design and a control group. The anesthesia students in the clinical education course were selected, and those entered into the control group received conventional education such as clinical conferences, performing actions and giving performance reports under the supervision of a clinical instructor. On the other hand, a structured reflective writing activity was implemented in the intervention group. Moreover, a critical thinking disposition questionnaire was applied to evaluate the difference in the level of critical thinking disposition and its subscales before and after the intervention.

In the present study, the total mean score of critical thinking disposition and the innovativeness subscale were significantly higher in the test group after the intervention, compared to the control group (P<0.05).

Findings suggested the positive effects of reflective writing as a part of students’ learning activities on the development of critical thinking disposition during a clinical education course. It is recommended that reflective writing be used as a part of students’ assignments when planning clinical education courses.

Today student-centered teaching has been emphasized by educational experts. Learning through feedback and jigsaw are two student-centered teaching methods of interactive - reflective approaches in which students are active in the classroom. This study compared studentschr('39') satisfaction with two methods of teaching feedback and jigsaw.

This experimental study was performed on 65 nursing and anesthesiology students of Mashhad University of Medical Sciences. Six Common theoretical sessions related fundamental of nursing care were selected to perform the intervention. Studentschr('39') satisfaction was assessed through a researcher- made survey form included three domains and 24 items. For analyzing data, SPSS and Descriptive statistics, Mann-Whitney statistical test  were used.

A comparison of the satisfaction score between Jigsaw teaching method and feedback showed a statistically significant difference(p=0.001) and it was found that the satisfaction with the Jigsaw method in all three areas studied included: time, skills development and interest in motivation, significantly more than feedback method (p=0.002)

The results of this study showed that the dynamic and passive teaching method of jigsaw and the involvement of more students in the teaching-learning process, makes students more interested in relevant topics and the use of these teaching methods, while familiarizing students. With new educational methods, it can lead students to self-learning

Due to multiple roles of albumin in the body, injection of its medicinal product as one of the therapeutic or management strategies under conditions such as severe bleeding, burns, liver failure, and neonatal hemolytic diseases is on the physicians' agenda. Considering that albumin is the most abundant plasma protein, designing an appropriate method to purify it is highly important. There are several methods such as human plasma fractionation, chromatographic, or Salting-out methods for the isolation and purification of the human albumin. The present study investigates a direct and combined ion-exchange chromatography approach for purification of albumin from human plasma and compares the quality of the final products obtained by both ion-exchange chromatographic methods.

This study was carried out from January 2019 to October 2019 at the Blood Transfusion Research Center, High institute for research and education in transfusion medicine, affiliated with the Iranian Blood Transfusion Organization. For this study, 10 human plasma bags were randomly collected. After thawing, all 10 human plasma bags were pooled, and in order to separate cryo paste, it was centrifuged at 4000 g for 10 minutes at the temperature of 1 Centigrade degree. Then the obtained cryo poor plasma was used to purify the albumin protein by direct and combined methods of ionexchange chromatography. The purity of the final products was compared by cellulose acetate electrophoresis and SDS-PAGE tests. The sample obtained by the combined approach was pasteurized and HPLC analysis was performed to investigate any polymer aggregates.

In contrast to the direct method, the final product obtained by combined ionexchange chromatography had a good purity by the average of about 95% and the amount of polymer was estimated to be less than 5% by HPLC analysis (P<0.05).

By diluting the plasma and subsequently reducing the ionic strength, albumin can be separated from human plasma with a high degree of purity only by two steps of ion-exchange chromatography

The purpose of this study was to investigate the factors affecting university brand loyalty among graduate students in Shiraz. This research was applied in terms of purpose and in terms of nature and method of correlation. The statistical population of the study consisted of 9300 graduated students from Shiraz University who were randomly selected using random cluster sampling method, 191 people were selected. The sample was surveyed through brand image questionnaire, fascination with the brand, commitment to brand, brand loyalty, trust the brand, brand satisfaction and brand performance. . The validity of these questionnaires was confirmed by experts and the reliability was calculated through Cronbachchr('39')s alpha coefficient, respectively (0.92), (0.80), (0.80), (0.93), (0.81), (0.85) and (0.93). The collected data were analyzed by path analysis method using LISREL 8.8 and SPSS 16 software. At the level of descriptive statistics, mean and standard deviation, and inferential statistics, correlation coefficient and path analysis were used. The results indicate that the brand image of brand loyalty through indirect brand enthusiasm and commitment to the brand have indirect effect. Brand trust has an indirect effect on brand loyalty through the mediation of brand enthusiasm and brand commitment. Brand satisfaction has a direct impact on brand loyalty through the intermediation of brand enthusiasm and commitment to the brand. The brandchr('39')s fascination for brand loyalty through indirect commitment to the brand has an indirect effect.

The pandemic of Covid-19 is spreading around the world. Extensive research is needed to focus on identifying the underlying causes of the disease. This study aimed to investigate the clinical and etiological symptoms of the Covid-19.

This descriptive-analytical study, conducted on 510 infected patients in the infectious disease clinic of Imam Khomeini Hospital in Tehran from March 2019 to June 2020 for A period of Four months during the first wave of Covid-19 pandemic. The method of selecting patients was continuous and was divided into two groups of 179 inpatients and 331 outpatients based on lung scan and clinical symptoms. Demographic information, clinical signs, and risk factors were collected through a questionnaire and the data were statistically analyzed.

Symptoms such as fever, chills and cough were reported in the majority of patients in both groups, to such an extent that they were present in 176 (52%) of outpatients and in 101 (59%) of inpatients. The mean hemoglobin measured in hospitalized patients was lower, P=0.001). Vitamin D3 supplementation was reported in 30% of outpatients and in 16.5% of hospitalized patients (P=0.001). This means that vitamin D3 consumption is higher in the outpatient group.The results showed that Chronic diseases such as hypertension was 4.9 times more likely (OR=4.9, 95% CI2. 433-10.25, P=0.0001) and anemia with 22 times more likely (OR=22.905, 95% CI9. 355-56.083, P=0.000) to be effective in the severity of the disease. It seems Vitamin D3 intake has a supportive effect on reducing the severity of the disease and decreases the risk of the disease getting worse.

Fever, chills and cough were important symptoms in identifying infected patients with Covid-19. According to the results of the present study and the findings of other studies, the supportive effect of vitamin D3 in reducing the severity of infectious diseases should be considered. Clinical trials with appropriate sample size are recommended to investigate the functional role of this vitamin in Reducing the severity of viral diseases of the respiratory tract.