Axial de-scanning using remote focusing in the detection arm of light-sheet microscopy.

The ability to image at high speeds is necessary for biological imaging to capture fast-moving or transient events or to efficiently image large samples. However, due to the lack of rigidity of biological specimens, carrying out fast, high-resolution volumetric imaging without moving and agitating the sample has been a challenging problem. Pupil-matched remote focusing has been promising for high NA imaging systems with their low aberrations and wavelength independence, making it suitable for multicolor imaging. However, owing to the incoherent and unpolarized nature of the fluorescence signal, manipulating this emission light through remote focusing is challenging. Therefore, remote focusing has been primarily limited to the illumination arm, using polarized laser light to facilitate coupling in and out of the remote focusing optics. Here, we introduce a novel optical design that can de-scan the axial focus movement in the detection arm of a microscope. Our method splits the fluorescence signal into S and P-polarized light, lets them pass through the remote focusing module separately, and combines them with the camera. This allows us to use only one focusing element to perform aberration-free, multi-color, volumetric imaging without (a) compromising the fluorescent signal and (b) needing to perform sample/detection-objective translation. We demonstrate the capabilities of this scheme by acquiring fast dual-color 4D (3D space + time) image stacks with an axial range of 70 µm and camera-limited acquisition speed. Owing to its general nature, we believe this technique will find its application in many other microscopy techniques that currently use an adjustable Z-stage to carry out volumetric imaging, such as confocal, 2-photon, and light sheet variants.

Socioeconomic disparities in Papanicolaou test utilization in Western Iran.

BACKGROUND: Cervical cancer remains the fourth most frequently diagnosed cancer among women, and its impact is particularly significant in women residing in less developed countries. This study aims to assess socioeconomic inequality in using Papanicolaou tests, commonly known as Pap tests, which are crucial for detecting cervical cancer. The research also seeks to decompose this inequality, identifying its contributing factors. This investigation is conducted within a sizable population-based study focused on the Kurdish population, with an additional examination of potential variations between urban and rural areas. METHOD: The study utilized baseline data from the Ravansar Non-Communicable Disease Cohort Study (RaNCD), involving 3,074 ever-married women aged 35-65. Asset data was employed to determine socioeconomic status (SES), and Principal Component Analysis was applied. The uptake of Papanicolaou tests was assessed for inequality using the Concentration Index (Cn). Additionally, decomposition analysis was conducted to identify and understand the factors contributing to socioeconomic inequality. RESULTS: The study found that overall, 86% of women reported having undergone cervical cancer screening at least once in their lifetime. The Concentration Index (Cn) for the total population was 0.21 (p < 0.0001), indicating a higher concentration of Papanicolaou test uptake among wealthier groups. In urban areas, the Cn was 0.34 (p < 0.0001), reflecting a significant concentration among the rich. However, in rural areas, the Cn was -0.10 (p = 0.3006), suggesting no significant socioeconomic inequality. Factors such as socioeconomic status (SES), education, and age contributed to reducing inequality, explaining 62.7%, 36.0%, and 1.7% of the observed inequality, respectively. Interestingly, place of residence had a negative influence on inequality. CONCLUSION: The uptake of Papanicolaou tests varies across different socioeconomic status levels, with a higher concentration among wealthier groups. The results enable health policymakers and researchers to tailor health intervention toward increasing public awareness, especially among women with lower levels of education women in economically deprived groups.

Axial de-scanning using remote focusing in the detection arm of light-sheet microscopy.

The ability to image at high speeds is necessary in biological imaging to capture fast-moving or transient events or to efficiently image large samples. However, due to the lack of rigidity of biological specimens, carrying out fast, high-resolution volumetric imaging without moving and agitating the sample has been a challenging problem. Pupil-matched remote focusing has been promising for high NA imaging systems with their low aberrations and wavelength independence, making it suitable for multicolor imaging. However, owing to the incoherent and unpolarized nature of the fluorescence signal, manipulating this emission light through remote focusing is challenging. Therefore, remote focusing has been primarily limited to the illumination arm, using polarized laser light for facilitating coupling in and out of the remote focusing optics. Here we introduce a novel optical design that can de-scan the axial focus movement in the detection arm of a microscope. Our method splits the fluorescence signal into S and P-polarized light and lets them pass through the remote focusing module separately and combines them with the camera. This allows us to use only one focusing element to perform aberration-free, multi-color, volumetric imaging without (a) compromising the fluorescent signal and (b) needing to perform sample/detection-objective translation. We demonstrate the capabilities of this scheme by acquiring fast dual-color 4D (3D space + time) image stacks, with an axial range of 70 µm and camera limited acquisition speed. Owing to its general nature, we believe this technique will find its application to many other microscopy techniques that currently use an adjustable Z-stage to carry out volumetric imaging such as confocal, 2-photon, and light sheet variants.

The COVID-19 pandemic and healthcare utilization in Iran: evidence from an interrupted time series analysis

Objectives@#This study aimed to examine the effect of the coronavirus disease 2019 (COVID-19) outbreak on the hospitalization rate, emergency department (ED) visits, and outpatient clinic visits in western Iran. @*Methods@#We collected data on the monthly hospitalization rate, rate of patients referred to the ED, and rate of patients referred to outpatient clinics for a period of 40 months (23 months before and 17 months after the COVID-19 outbreak in Iran) from all 7 public hospitals in the city of Kermanshah. An interrupted time series analysis was conducted to examine the impact of COVID-19 on the outcome variables in this study. @*Results@#A statistically significant decrease of 38.11 hospitalizations per 10,000 population (95% confidence interval [CI], 24.93–51.29) was observed in the first month of the COVID-19 outbreak. The corresponding reductions in ED visits and outpatient visits per 10,000 population were 191.65 (95% CI, 166.63–216.66) and 168.57 (95% CI, 126.41–210.73), respectively. After the initial reduction, significant monthly increases in the hospitalization rate (an increase of 1.81 per 10,000 population), ED visits (an increase of 2.16 per 10,000 population), and outpatient clinic visits (an increase of 5.77 per 10,000 population) were observed during the COVID-19 pandemic. @*Conclusion@#Our study showed that the utilization of outpatient and inpatient services in hospitals and clinics significantly declined after the COVID-19 outbreak, and use of these services did not return to pre-outbreak levels as of June 2021.

Sexual health concerns in women with intellectual disabilities: a systematic review in qualitative studies.

BACKGROUND: Studies indicate that women with intellectual disabilities (ID) face various personal and socio-environmental barriers in their sexual lives. This study aimed to identify the concerns and sexual health needs experienced by women with ID. METHOD: A systematic review of relevant qualitative articles was conducted in PubMed, Web of Science Scopus and PsycINFO databases from June 2018 to August 2018. We designed our search strategy according to two main foci: (1) sexuality; and (2) women with ID. In the study, searches were limited to articles published from January 2000 to December 2017. In this review, studies on women ages 16 and over were included. RESULTS: Within the four databases, the search found 274 unique articles. After three steps of screening (title, abstract and full text), 22 studies were included in the final review. The articles mentioned difficulties with lack of sexual experience, negative experiences with sexuality, negative attitudes towards sexuality by nondisabled individuals, limited cognitive capacities to understand sexual identity, difficulty with finding the right partner, lack of access to sexual health information, lack of school-based sexuality education, violence and sexual abuse, lack of support from families and caregivers about sexuality, fear of sexual acts and unwanted pregnancy, shyness in expressing sexual desires, and limited knowledge of sexual behaviors. CONCLUSION: Our findings indicate that women with ID need to be provided with school-based sexuality education tailored to the level of understanding needed to attain the requisite knowledge to form relationships, understand sexual and romantic relationships, and practice safe sex when they choose this option. Families along with education and healthcare systems should provide opportunities for women with ID to talk about their sexual needs and make their own choices.

Health-care determinants of mortality and recovered cases from COVID-19: Do heath systems respond COVID-19 similarly?

BACKGROUND: The COVID-19 pandemic has spread rapidly across the world and has currently impacted most countries and territories globally. This study aimed to identify health-care determinants of mortality and recovery rates of COVID-19 and compare the efficiency of health systems in response to this pandemic. MATERIALS AND METHODS: A cross-sectional study was conducted using data obtained from the World Bank database, that provides free and open access to a comprehensive set of health- and socioeconomic-related data, by September 12, 2020. An adjusted linear regression model was applied to determine predictors of mortality (per 1 million population [MP]) and recovery rates (per 1 MP) in the included countries. One-way analysis of variance was applied to assess health systems' efficiency in response to COVID-19 pandemic using mortality and recovery rate (output variables) and current health expenditure (CHE) per capita (input variable). RESULTS: Globally, San Marino and Qatar had the highest mortality rate (1237/1 MP) and confirmed case rate (43,280/1 MP) until September 12, 2020, respectively. Iran had a higher mortality rate (273/1 MP vs. 214.5/1 MP) and lower recovery rate (4091.5/1 MP vs. 6477.2/1 MP) compared to countries with high CHE per capita. CHE per capita (standardized coefficient [SC] = 0.605, P < 0.001) and population aged 65 years and over as a percentage of total population (SC = -0.79, P < 0.001) significantly predicted recovered cases from COVID-19 in the included countries. CONCLUSION: This study revealed that countries with higher CHE per capita and higher proportion of older adults were more likely to have a higher recovery rate than those with lower ones. Furthermore, our study indicated that health systems with higher CHE per capita statistically had a greater efficiency in response to COVID-19 compared to those with lower CHE per capita. More attention to preventive strategies, early detection, and early intervention is suggested to improve the health system efficiency in controlling COVID-19 and its related mortalities worldwide.

In Silico Comparison of Separate or Combinatorial Effects of Potential Inhibitors of the SARS-CoV-2 Binding Site of ACE2.

BACKGROUND: The COVID-19 is a pandemic viral infection with a high morbidity rate, leading to many worldwide deaths since the end of 2019. The RBD (Receptor Binding Domain) of SARS-CoV-2 through its spike utilizes several host molecules to enter host cells. One of the most important ones is the angiotensin-converting enzyme 2 (ACE2), an enzyme normally engaged in renin angiotensin pathway and is responsible for hypertension regulation. As different articles have analyzed separate compounds which can bind ACE2 as the potential virus entry blockers, and each one with a different molecular docking algorithm, in this study we compared all candidate compounds individually as well as their combinations using a unique validated software to introduce most promising ones. METHODS: We collected and prepared a list of all available compounds which potentially can inhibit RBD binding site of the ACE2 from different studies and then reanalyzed and compared them using the Patchdock (ver. 1.3) as a suitable molecular docking algorithm for analysis of separate compounds or their combinations. RESULTS: Saikosaponin A (e.g. in Bupleurum chinense), Baicalin (e.g. in several species in the genus Scutellaria), Glycyrrhizin (Glycyrrhiza glabra), MLN-4760 and Umifenovir better occupied ACE2 to inhibit viral RBD binding and are suggested as the top five inhibitors of the SARS-CoV-2 binding site of ACE2. Their combinatory effects were also inspiring concurrent ACE2 blockade. CONCLUSION: The results propose greatest compounds and their combinatory anti-SARS-CoV-2 effects in order to decrease the time and expenses required for further experimental designs.

Barriers in access to healthcare for women with disabilities: a systematic review in qualitative studies.

BACKGROUND: Studies show that different socio-economic and structural factors can limit access to healthcare for women with disabilities. The aim of the current study was to review barriers in access to healthcare services for women with disabilities (WWD) internationally. METHODS: We conducted a systematic review of relevant qualitative articles in PubMed, Web of Science and Scopus databases from January 2009 to December 2017. The search strategy was based on two main topics: (1) access to healthcare; and (2) disability. In this review, women (older than 18) with different kinds of disabilities (physical, sensory and intellectual disabilities) were included. Studies were excluded if they were not peer-reviewed, and had a focus on men with disabilities. RESULTS: Twenty four articles met the inclusion criteria for the final review. In each study, participants noted various barriers to accessing healthcare. Findings revealed that WWD faced different sociocultural (erroneous assumptions, negative attitudes, being ignored, being judged, violence, abuse, insult, impoliteness, and low health literacy), financial (poverty, unemployment, high transportation costs) and structural (lack of insurance coverage, inaccessible equipment and transportation facilities, lack of knowledge, lack of information, lack of transparency, and communicative problems) factors which impacted their access healthcare. CONCLUSIONS: Healthcare systems need to train the healthcare workforce to respect WWD, pay attention to their preferences and choices, provide non-discriminatory and respectful treatment, and address stigmatizing attitudinal towards WWD. In addition, families and communities need to participate in advocacy efforts to promote WWD's access to health care.

Prognostic factors of chest CT findings for ICU admission and mortality in patients with COVID-19 pneumonia

BackgroundStudies have shown that CT could be valuable for prognostic issues in COVID-19 Objectiveto investigate the prognostic factors of early chest CT findings in COVID-19 patients. Materials and MethodsThis retrospective study included 91 patients (34 women, and 57 men) of RT-PCR positive COVID-19 from 3 hospitals in Iran between February 25, 2020, to march 15, 2020. Patients were divided into two groups as good prognosis, discharged from the hospital and alive without symptoms (48 patients), and poor prognosis, died or needed ICU care (43 patients). The first CT images of both groups that were obtained during the first 8 days of the disease presentation were evaluated considering the pattern, distribution, and underlying disease. The total CT-score was calculated for each patient. Univariate and multivariate analysis with IBM SPSS Statistics v.26 was used to find the prognostic factors. ResultsThere was a significant correlation between poor prognosis and older ages, dyspnea, presence of comorbidities, especially cardiovascular and pulmonary. Considering CT features, peripheral and diffuse distribution, anterior and paracardiac involvement, crazy paving pattern, and pleural effusion were correlated with poor prognosis. There was a correlation between total CT-score and prognosis and an 11.5 score was suggested as a cut-off with 67.4% sensitivity and 68.7% specificity in differentiation of poor prognosis patients (patients who needed ICU admission or died. Multivariate analysis revealed that a model consisting of age, male gender, underlying comorbidity, diffused lesions, total CT-score, and dyspnea would predict the prognosis better. ConclusionTotal chest CT-score and chest CT features can be used as prognostic factors in COVID-19 patients. A multidisciplinary approach would be more accurate in predicting the prognosis.

Factors Related to Relapse in Patients with Substance-related Disorders under Methadone Maintenance Therapy: Decision Tree Analysis.

OBJECTIVES: We sought to determine the main factors related to relapse in patients with substance-related disorders (SRDs) who received methadone maintenance therapy (MMT) using decision tree (DT) analysis. METHODS: We conducted a cross-sectional study of 4175 patients referred to the 45 MMT centers in Kermanshah province, west of Iran. We included all patients who were under MMT for at least one year. All information was collected through an interview by a psychologist. Descriptive statistics and univariate and multiple regression models were used in statistical analysis. The Gini index was calculated to determine the cut-off point of nodes. We used the Classification and Regression Trees algorithm to create the DT. RESULTS: The relapse rate was 76.6% for all participants, with no significant gender differences. The DT resulted in a five-level model of significant factors affecting substance abuse relapse. These included lower cost for buying substances, lower age at first substance use, history of quitting substances without medication, frequency of substances utilization per month, and frequency of methadone therapy. CONCLUSIONS: Knowing the main factors associated with substance abuse relapse could be important for health care providers to make better decisions for improving the treatment outcomes of SRDs.

Experimental and mathematical survey of sound absorption performance of date palm fibers.

The present study examines the acoustic behavior sample composites made of date palm natural fibers and polyvinyl alcohol. It also provides the comparison between the sound absorption coefficients obtained from the experimental tests and the ones predicted by the mathematical models. An impedance tube system was used to measure the normal sound absorption coefficient of the samples. Using the differential equation algorithm, the predicted sound absorption coefficient for the Johnson-Champoux-Allard model was also calculated. The sound absorption properties of samples increased significantly by increasing the frequency, and increasing the thickness of materials with constant density. Comparison of the data from the experimental tests and mathematical model showed that increasing the thickness of samples will make the predicted and tested values of acoustic absorption coefficient significantly comparable. Date palm fibers have a good potential for dissipating the energy of sound waves particularly when an air gap is introduced behind the sample and can be used as a new source for the fabrication of natural fiber reinforced composites.

Life and health satisfaction and their association toward health-related quality of life, body mass index and chronic diseases in Iran.

BACKGROUND: The study aimed to investigate the associations between life and health satisfaction with health-related quality of life (HRQoL), body mass index (BMI) and chronic disease among people who are covered by health insurance schemes in Tehran city, Iran. METHODS: A cross-sectional study was conducted in Tehran city, Iran, from May to June 2016. A total of 600 people were included in the study using a cluster sampling technique. The questionnaire that used for data collection included demographic and socioeconomic variables, questions about health variables such as chronic disease, weight, height, smoking status, and EQ-5D-3L questionnaire. Two univariate and multivariate regression models performed to examine affecting factors on life and health satisfaction. RESULTS: The univariate regression showed that on average female have 0.22 and 0.69 score lower than males with their life and health satisfaction, respectively. Explanatory variables of gender, age, level of education, and employment status were not significantly associated with life and health satisfaction in multiple regression models. However, marital status was correlated with life satisfaction. Furthermore, HRQoL, BMI and chronic disease and smoking were associated with dependent variables (P < 0.001). CONCLUSIONS: The result showed that there was a strong association between BMI, HRQoL, chronic disease, and life and health satisfaction among participants. Therefore, the Iranian policymakers need to consider these factors on life and health satisfaction of adults and design health-promoting programs to improve health outcomes of them. Further studies should assess the associations between BMI, HRQoL, chronic conditions, and life and health satisfaction among Iranian adults.

Targeted subsidy plan and Kakwani index in Iran health system.

INTRODUCTION: Health care is considered as a human right, and fair financial contribution to health care plays an important role in providing effective services for all members of society. This study aimed at investigating the effects of targeted subsidy plan (since 2010) on equality in health-care financing in Iran from 2004 to 2014. MATERIALS AND METHODS: This was a descriptive-analysis, cross-sectional study that was conducted using data obtained from households' expenditure-income survey that is performed every year by the Statistical Center of Iran. The Lorenz curve, Gini coefficient, and Theil index were applied to measure inequality in healthcare expenditures (HEs). Furthermore, the Kakwani index was used to examine inequality in health-care finance during the study period. The analysis was performed using Stata version 13. RESULTS: Kakwani index was negative for all the studied years, except 2007. The value of this index was equal to -0.032, -0.045, and -0.046 in 2004, 2008, and 2014 for rural areas and was equal to -0.041, -0.029, and -0.0001 for urban areas, respectively. Despite the Kakwani index has been negative for most of the years, which reflects regressive financing in health care, there is no significant change in the trend of this indicator after the implementation of the subsidies. In addition, this indicator is moving toward being positive (progressive) in urban areas in 2014, which represents increased share of the poor in health payments. CONCLUSIONS: According to the results, the targeted subsidy plan could not reach to its purpose in health-care system for supporting the poor from HEs. It is recommended for policy-makers to design a specific plan for health-care financing and to allocate some defined resources such as taxes or subsidies to health-care sector.

Iranian hospital efficiency: a systematic review and meta-analysis.

PURPOSE: The purpose of this paper (systematic review and meta-analysis) is to synthesize and analyze studies that assessed Iranian hospital efficiency. DESIGN/METHODOLOGY/APPROACH: A systematic literature search was conducted using both international (the Institute for Scientific Information, Scopus and PubMed) and Iranian scientific (Magiran, IranMedex and Scientific Information Database) databases. The review included original studies that used the Pabon Lasso Model to examine Iranian hospital performance, published in Persian or English. A self-administered checklist was used to collect data. In total, 12 questions were used for quality assessment. FINDINGS: In total, 34 studies met our inclusion criteria. The fixed-effects meta-analysis indicated that 19.2 percent (95% confidence interval (CI): 15.6-23.2 percent) of hospitals were in Zone 1 (poor performance: low bed turnover rate (BTR) and bed occupancy rate (BOR) and high average hospital stay (ALoS)), 23.7 percent (95% CI: 20.1-27.8 percent) were in Zone 2, 31.7 percent (95% CI: 27.7-36 percent) in Zone 3 (good performance: high BTR and BOR and low ALoS) and 25.4 percent (95% CI: 21.7-29.5 percent) in Zone 4. PRACTICAL IMPLICATIONS: Results help Iranian health policymakers to understand hospital performance, which, in turn, may lead to promoting greater awareness and policy attention to improve Iranian hospital efficiency. ORIGINALITY/VALUE: This study indicated that most Iranian hospitals had sub-optimal performance. Further studies are required to understand factors that explain the country's hospital inefficiency.

Functional biological pacemaker generation by T-Box18 protein expression via stem cell and viral delivery approaches in a murine model of complete heart block.

Despite recent advances in the treatment of cardiac arrhythmia, the available options are still limited and associated with some complications. Induction of biological pacemakers via Tbx18 gene insertion in the heart tissue has been suggested as a promising therapeutic strategy for cardiac arrhythmia. Following a previous in vitro study reporting the production of Tbx18-expressing human induced pluripotent stem cell-derived cardiomyocytes (hiPS-CMs), we aimed to investigate the efficacy of these engineered cells to generate pacemaker rhythms in a murine model of complete heart block. We also attempted to generate a functional pacemaker by Tbx18 overexpression in native cardiac cells of rat heart. The hiPSC-derived pacemaker cells were produced by lentiviral delivery of Tbx18 gene to stem cells during a small molecule-based differentiation process. In the present study, 16 male albino Wistar rats were randomly assigned to Tbx18-lentivirus (n = 4) and Tbx18-pacemaker cells (n = 4) administered via injection into the left ventricular anterolateral wall. The control rats received GFP-lentiviruses (n = 4) and GFP-pacemaker cells (n = 4). Fourteen days after the injection, the rats were sacrificed and analyzed by electrocardiography (ECG) recording using a Langendorff-perfused heart model following complete heart block induced by hypokalemia and crashing. Immunofluorescence staining was used to investigate the expression of Tbx18, HCN4 and connexin 43 (Cx43) proteins in Tbx18-delivered cells of heart tissues. The heart rate was significantly reduced after complete heart block in all of the experimental rats (P < 0.05). Heart beating in the Tbx18-transduced hearts was slower compared with rats receiving Tbx18-pacemaker cells (P = 0.04). The duration of ventricular fibrillation (VF) was higher in the lentiviral Tbx18 group compared with the GFP-injected controls (P = 0.02) and the Tbx18-pacemaker cell group (P = 0.02). The ECG recording data showed spontaneous pacemaker rhythms in both intervention groups with signal propagation in Tbx18-transduced ventricles. Immunostaining results confirmed the overexpression of HCN4 and downregulation of Cx43 as a result of the expression of the Tbx18 gene and spontaneously contracting myocyte formation. We confirmed the formation of a functional pacemaker after introduction of Tbx18 via cell and gene therapy strategies. Although the pacemaker activity was better in gene-received hearts since there were longer VF duration and signal propagation from the injection site, more data should be gathered from the long-term activity of such pacemakers in different hosts.