Shahid Sadoughi University of Medical Sciences Journal of Environmental Health and Sustainable Development 2476-6267 2476-7433 7 3 2022 9 1 Proposing an Intelligent Monitoring System for Early Prediction of Need for Intubation among COVID-19 Hospitalized Patients 1698 1707 EN Mohammad Reza Afrash Department of Medical Informatics, Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran. mmdrza.lp19@gmail.com N 0000-0001-9571-2112 Hadi Kazemi-Arpanahi Department of Health Information Technology, Abadan University of Medical Sciences, Abadan, Iran. hadi.kazemi67@yahoo.com N 0000-0002-8882-5765 Raoof Nopour Department of Health Information Management, Student Research Committee, School of Health Management and Information Sciences Branch, Iran University of Medical Sciences, Tehran, Iran. raoof.n1370@gmail.com N 0000-0003-3770-2375 Elmira Sadat Tabatabaei Department of Genetics, Islamic Azad University, Tehran Medical Branch, Tehran, Iran. elmirarozetaba@yahoo.com N 0000-0003-1355-9930 Mostafa Shanbehzadeh Department of Health Information Technology, School of Paramedical, Ilam University of Medical Sciences, Ilam, Iran. mostafa.shanbehzadeh@gmail.com Y 0000-0002-3419-1947 10.18502/jehsd.v7i3.10719 Introduction: Predicting acute respiratory insufficiency due to coronavirus disease 2019 (COVID-19) can diminish the severe complications and mortality associated with the disease. This study aimed to develop an intelligent system based on machine learning (ML) models for frontline clinicians to effectively triage high-risk patients and prioritize who needs mechanical intubation (MI). Materials and Methods: In this retrospective-design study, the data regarding 482 COVID-19 hospitalized patients from February 9, 2020, to July 20, 2021, was analyzed by six ML classifiers. The most critical clinical variables were identified by a minimal-redundancy-maximal-relevance (mRMR) feature selection technique. In the next step, the models' performance was assessed using confusion matrix criteria and, finally, the best model was adopted. Results: Proposed models were implemented using 23 confirmed variables. Results of comparing six selected ML algorithms indicated the extreme gradient boosting (XGBoost) classifier with 84.7% accuracy, 76.5 % specificity, 90.7% sensitivity, 85.1% f-measure, 87.4% Kappa statistic, and 85.3% for receiver operating characteristic (ROC) had the best performance in the intubation prediction. Conclusion: It is found that ML enables a satisfactory accuracy level in calculating intubation risk in COVID-19 patients. Therefore, using the ML-based intelligent models, notably the XGBoost algorithm, actually enables recognizing high-risk cases and advising correct therapeutic and supportive care by the clinicians. COVID-19, Coronavirus, Artificial Intelligence, Machine Learning, Intubation, Prognosis. http://jehsd.ssu.ac.ir/article-1-451-en.html http://jehsd.ssu.ac.ir/article-1-451-en.pdf

Shahid Sadoughi University of Medical Sciences Journal of Environmental Health and Sustainable Development 2476-6267 2476-7433 7 3 2022 9 1 Investigating the Relation between Meteorological Parameters and the Number of Patients and Clinical Symptoms of Outpatients with COVID-19: A Case Study in Abarkouh, Iran 1708 1718 EN Reza Ali Fallahzadeh Genetic and Environmental Adventures Research Center, School of Abarkouh Paramedicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. fallahzadeh4@yahoo.com N 0000-0003-1107-4366 Fariborz Omidi Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran. omidifariborz@yahoo.com N 0000-0002-2506-2801 Davoud Ghadirian Genetic and Environmental Adventures Research Center, School of Abarkouh Paramedicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. davood.ghadirian@gmail.com N 0000-0001-8786-1572 Marzieh Shukohifar Genetic and Environmental Adventures Research Center, School of Abarkouh Paramedicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. amar.zisti2014@gmail.com N 0000-0003-1246-231x Mohammad Sadegh Eshaghpanah Genetic and Environmental Adventures Research Center, School of Abarkouh Paramedicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. sfallah.eshagh@yahoo.com Y 0000-0003-1917-1304 Najmeh Soltani Gerdefaramarzi Genetic and Environmental Adventures Research Center, School of Abarkouh Paramedicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. najmehsoltani001@gmail.com N 0000-0002-7739-6379 Omolbanin Nateghi Genetic and Environmental Adventures Research Center, School of Abarkouh Paramedicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Omnateghi1998@gmail.com N 0000-0002-9485-7536 Farnaz Istadeh Genetic and Environmental Adventures Research Center, School of Abarkouh Paramedicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Farnaz.is99@gmail.com N 0000-0002-9715-4350 10.18502/jehsd.v7i3.10720 Introduction: SARS CoV-2 pandemic has caused illness and death in millions of people worldwide. Extensive studies are being conducted on the effect of meteorological parameters on the number of patients and clinical symptoms of COVID-19. Materials and Methods: This cross-sectional descriptive study was conducted in Abarkouh city with a population of 51199 people during 215 days (from April 20, 2020 to November 20, 2020).  The present study aimed to investigate the effect of meteorological parameters, such as temperature, humidity, sunshine hours, evaporation, and maximum wind speed on the number of cases with definite diagnosis of COVID-19. Moreover, symptoms in the infected patients were assessed using Pearson correlation coefficient and regression coefficient. Results: During the 215 days of the study, a total of 2526 symptoms were diagnosed in 1298 outpatients. Among which, fever and body aches were the most common symptoms in the subjects. The results of examining the relationship between meteorological parameters and the prevalence of symptoms showed that there was a negative correlation between the minimum and maximum temperature, sunshine hours, evaporation, and wind speed with the number of cases and the prevalence of symptoms. The results of regression coefficient also showed that among the meteorological parameters, the minimum temperature variable had the most negative effect on the prevalence of symptoms as well as the number of cases. Conclusion: The results showed that changing the meteorological parameters in cold weather can increase both the number of patients and clinical symptoms of outpatients with COVID-19. Communicable Disease, COVID- 19, Environment, Abarkouh City. http://jehsd.ssu.ac.ir/article-1-455-en.html http://jehsd.ssu.ac.ir/article-1-455-en.pdf

Shahid Sadoughi University of Medical Sciences Journal of Environmental Health and Sustainable Development 2476-6267 2476-7433 7 3 2022 9 1 Ecological Risks Attributed to the Heavy Metals Pollution of Dust Settled on the Surface of Coastal Roads along the Persian Gulf 1719 1726 EN Tooba Darijani Department of Environmental Health Engineering, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. toobada86@gmail.com N 0000000159397848 Vali alipour Department of Environmental Health Engineering, Faculty of Health, Hormozgan University of Medical Sciences, Bandar Abbas, Iran. v_alip@yahoo.com N 0000-0001-8928-3649 Mohsen Heidari Department of Environmental Health Engineering, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran. moheidari@modares.ac.ir Y 0000-0001-5034-3472 10.18502/jehsd.v7i3.10721 Introduction: Heavy metals (HMs) accumulated in the road dust may be transferred to the surrounding land and water bodies and pose ecological risks. Hence, such pollution should be considered, especially in coastal roads. This study focuses on the HMs pollution of dust settled on the surface of coastal roads along the Persian Gulf in Bandar Abbas city. Materials and Methods: In this study, road dust samples were collected from 13 points in coastal roads and analyzed by ICP-OES for the measurement of As, Cd, Co, Cr, Cu, Mn, Ni, and Pb. Based on the HMs contents of dust, pollution, and ecological risk indices, including contamination factor (CF), modified pollution index (MPI), and modified ecological risk index (MRI) were calculated. Results: Among the studied HMs, Cu (4.73) showed the highest CF value. The levels of MPI showed that the road dust was strongly polluted by HMs (4.02), but it was mainly contributed by a low toxic metal (Cu). Therefore, the mean value of MRI was 132.3, indicating the low ecological risk of such pollution. Note that the MRI value was > 150 in some sampling points, indicating moderate ecological risk. Conclusion: This study showed that the road dust along the Persian Gulf coastline is polluted to different levels of the studied HMs and may pose various levels of ecological risks. The current level of HMs pollution in the study area was not significantly high. However, high pollution levels in the west roads should not be overlooked. Environmental Monitoring, Metals, Heavy, Persian Gulf, Ecological Risk, Persian Gulf, Risk Assessment. http://jehsd.ssu.ac.ir/article-1-452-en.html http://jehsd.ssu.ac.ir/article-1-452-en.pdf

Shahid Sadoughi University of Medical Sciences Journal of Environmental Health and Sustainable Development 2476-6267 2476-7433 7 3 2022 9 1 Experimental Protocol for Detecting SARS-CoV-2 in Screenings and Grit Samples of Wastewater Treatment Plants 1727 1732 EN Ali Abdolahnejad Department of Environmental Health Engineering, Maragheh University of Medical Sciences, Maragheh, Iran. N 0000-0003-0193-7690 Mojtaba Pourakbar Department of Environmental Health Engineering, Maragheh University of Medical Sciences, Maragheh, Iran. N 0000-0002-8211-9640 Saber Raeghi Department of Laboratory Sciences, Maragheh University of Medical Sciences, Maragheh, Iran. saber_raeghi@mrgums.ac.ir N 0000-0002-8283-6447 Amir Mohammadi Department of Environmental Health Engineering, Maragheh University of Medical Sciences, Maragheh, Iran. mohammadiurm@gmail.com N 0000-0003-3932-0688 Behzad Ranjbar Office of Waste Management Organization, Maragheh Municipality, Maragheh, Iran. Behzad.ranjbar@gmail.com N 0000-0002-6612-7325 Ali Behnami Department of Environmental Health Engineering, Maragheh University of Medical Sciences, Maragheh, Iran. ali.behnami64@gmail.com Y 0000-0001-9113-2102 10.18502/jehsd.v7i3.10722 Introduction: Although various liquid, solid, and gaseous streams of wastewater treatment plants (WWTPs) have been analyzed in many studies for the presence of SARS-CoV-2 RNA, no study was found to sample and detect SARS-CoV-2 RNA in screenings and grit samples separated from primary treatment units of WWTP. Hence, this study aims to provide an experimental protocol for sampling and extracting SARS-CoV-2 RNA from screenings and grits separated from WWTPs. Materials and Methods: First, sampling was conducted to extract SARS-CoV-2 RNA from screenings and grit samples. After sample processing and viral RNA extraction, SARS-CoV-2 RNA detection was performed by one-step reverse transcription quantitative polymerase chain reaction (RT-qPCR). Results: Based on the results, SARS-CoV-2 RNA was successfully extracted from screenings and grit samples of the studied WWTP with concentrations of (1.54 –3.9 × 104) and (0.8 – 2.3 × 104) genomic copies/L, respectively. Conclusion: Considering the successfully isolation and detection of SARS-CoV-2 viral RNA in solid phase samples of WWTP,  this method can be applied for extracting SARS-CoV-2 RNA and maybe other viruses from the screenings and grit samples of WWTPs in related studies. SARS-CoV-2, Waste Water, Mass Screening. http://jehsd.ssu.ac.ir/article-1-456-en.html http://jehsd.ssu.ac.ir/article-1-456-en.pdf

Shahid Sadoughi University of Medical Sciences Journal of Environmental Health and Sustainable Development 2476-6267 2476-7433 7 3 2022 9 1 Analyzing the Quality of Dialysis Machines Input Water in Hospitals of Kashan City, in 2019 1733 1743 EN Samaneh Mehraban Navaz Kohan Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran. samanehmehraban1362@yahoo.com N 0000-0003-2984-4971 Gholam Reza Mostafaii Department of Biostatistics and Public Health, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran. mostafai_gr@kaums.ac.ir N 0000-0002-7087-0133 Hosein Akbari Department of Biostatistics and Public Health, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran. akbari_h@kaums.ac.ir N 0000-0001-7486-8580 Mohammad Bagher Miranzadeh Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran. miranzadehm@ymail.com Y 0000-0001-6731-6956 10.18502/jehsd.v7i3.10724 Introduction: According to high volumes of water used in hemodialysis, quality of water entering the dialysis machine is very important. The current study aims to analyze microbial and chemical quality of water used for hemodialysis in hospitals of Kashan city in 2019. Materials and Methods: This descriptive cross-sectional study was performed on 54 water samples used in dialysis machines in hospitals of Kashan city during 3 months of the fall season in 2019. Microbial tests of the samples were done, and also heavy metals were assessed using inductively coupled plasma optical emission spectrometry. Statistical tests, sample t-test, and ANOVA were used to compare the mean results with standards. Results: Based on the results, the mean concentrations of magnesium (Mg) (2.7 ± 2.22 mg/L), sulfate (13.09 ± 21.06 mg/L), sodium (Na) (17.27 ± 24.47 mg/L), and potassium (K) (0.09 ± 0.17 mg/L) in all samples were based on the standard levels. However, the mean concentrations of nitrate (3.22 ± 1.21 mg/L), aluminum (Al) (0.26 ± 0.16 mg/L), silver (Ag) (0.52 ± 0.85 mg/L), lead (Pb) (0.08 ± 0.13 mg/L), and zinc (Zn) (0.91 ± 0.71 mg/L) were above standard levels in all the samples. Thallium (Tl) ion was reported to be zero. Moreover, heterotrophic bacteria were not observed in any of the samples. Conclusion: Given the high concentration of chemicals and heavy metals in dialysis machines water input, it is necessary to plan for periodic monitoring of water treatment systems and heavy metals and regular replacement of reverse osmosis filters. Hemodialysis, Kashan City, Water Quality, Hospital. http://jehsd.ssu.ac.ir/article-1-444-en.html http://jehsd.ssu.ac.ir/article-1-444-en.pdf

Shahid Sadoughi University of Medical Sciences Journal of Environmental Health and Sustainable Development 2476-6267 2476-7433 7 3 2022 9 1 Evaluation of Safety Culture and the Effect of Lean Safety Approach on the Improvement of Safety Culture (Case Study: Sarv Combined Cycle Power Plant [Chadormelo] of MAPNA Operation and Repair Company) 1744 1754 EN Reza Jafari Nodoushan Department of Health, Safety and Environment Management (HSE), School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. jafarinodoushan@gmail.com N 0000-0002-9383-0534 Ali Reza Hajihosseini Department of Industrial Engineering, Science and Arts University, Yazd, Iran. vidaanoosheh1370@gmail.com N 0000-0002-7478-2813 Roozbeh Ahmadzadeh Department of Industrial Safety Engineering Science and Arts University, Yazd, Iran. vidaanoosheh1370@gmail.com N 0000-0002-9612-1063 Vida Sadat Anoosheh Department of Occupational Health and Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran. anooshehvida@gmail.com Y 0000-0001-8568-7355 10.18502/jehsd.v7i3.10725 Introduction: Accidents in the workplace hurt people and sometimes cause death. One of the ways to prevent occupational accidents is to change the behavior and attitude of people towards safety. The present study was conducted to investigate the effect of the lean approach on the promotion of safety culture in Sarv combined cycle power plant of MAPNA exploitation. Materials and Methods: In this study, to evaluate the safety culture before performing the lean approach interventions, a safety culture questionnaire was distributed among 110 people who were randomly selected from 294 employees of the company. The results were analyzed as pre-intervention data. Then, with the introduction of lean tools that can be implemented in the power plant and their selection by a group of managers who came together for this purpose, the necessary measures were defined and performed in line with the lean approach. After six months from the beginning of the intervention, the questionnaire was distributed and collected among the selected individuals in the second stage. Results: Based on the findings, safety culture had no significant relationship with the demographic data of the sample. The results of paired t-tests showed that the safety culture score increased in all dimensions after the intervention. As a result, the total safety culture score showed a significant increase compared to the safety culture score before the intervention. Conclusion: The findings indicated that the pure approach has a great impact on safety culture and it is important to pay attention to it. Safety Management, Organizational Culture, Lean Safety Approach, Chadormelo. http://jehsd.ssu.ac.ir/article-1-417-en.html http://jehsd.ssu.ac.ir/article-1-417-en.pdf

Shahid Sadoughi University of Medical Sciences Journal of Environmental Health and Sustainable Development 2476-6267 2476-7433 7 3 2022 9 1 Effect of Dietary Clove (Syzygium Aromaticum) Essential Oil on Growth Performance, Oxidative Indices, Lipid Profile, and Cadmium Accumulation in Cd-exposed Quails 1755 1766 EN Elahe Askari Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran. dr.Askari2011@gmail N 0000-0003-4735-4095 Aziz A. Fallah Department of Food Hygiene and Quality Control, Faculty of Veterinary Medicine, Shahre-kord University, Shahre-kord, Iran. Fallah.aziz55@yahoo.com N 0000-0003-3292-7647 Saeid Habibian Dehkordi Department of Basic Sciences, Faculty of Veterinary Medicine, Shahre-kord University, Shahre-kord, Iran. Habibian@vet.sku.ac.ir N 0000-0003-3545-4566 Shahab Bahadoran Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahre-kord University, Shahre-kord, Iran. bahadoran-s@sku.ac.ir N 0000-0002-5897-8509 Abdonnaser Mohebbi Department of Clinical Sciences, Faculty of Veterinary Medicine, Shahre-kord University, Shahre-kord, Iran. mohebi-ab@sku.ac.ir N 0000-0002-2645-4233 sara mohamadi Department of Food Hygiene and Quality Control, Faculty of Veterinary Medicine, Shahre-kord University, Shahre-kord, Iran. saramohamadi12@yahoo.com Y 0000-0002-7703-9195 10.18502/jehsd.v7i3.10726 Introduction: Natural products can alleviate oxidative stress induced by toxic metals. This study evaluated antioxidant properties of clove essential oil (CEO), compared to oxidative deterioration of Cd. It was carried out by measuring growth performance parameters (BW, FI, and FCR), oxidative indices (TBARS, CP, CAT, SOD, and GPx), lipid profile (TG, TC, LDL-C, and HDL-C), and Cd bioaccumulation in quails. Materials and Methods: In this study, 480 Japanese quails were fed with diets for 35 days. The diets included basal diet, basal diet + VC (500 mg/kg), basal diet + CEO (450 mg/kg), basal diet + CEO (100 mg/kg), basal diet + VC (500 mg/kg) + Cd (40 mg/l), basal diet + CEO (450 mg/kg) + Cd (40 mg/l), basal diet + CEO (100 mg/kg) + Cd (40 mg/l), and basal diet + Cd (40 mg/l). Oxidative indices and Cd bioaccumulation (ICP-OES) were measured. Results: The major ingredients of CEO included Eugenol (77.63%) and β-Caryophyllene (9.55%).  Quails exposed to Cd and treated with CEO had a reduced amount of oxidative stress as evidenced by lower concentrations of TBARS and CP, higher activities of SOD, GPx, and CAT, an improved lipid profile, and lower accumulation of Cd compared to the positive control. However, FI and FCR did not change. Conclusion: Antioxidant properties of CEO were dose-dependent. CEO (450 mg/kg) was potentially as effective as, or even more potent than VC (500 mg/kg) in reducing the adverse effects of Cd. However, further studies are required to determine the minimum concentration of COE. Cadmium Chloride, Oxidative Damage, Oxidative Stress, Quail. http://jehsd.ssu.ac.ir/article-1-461-en.html http://jehsd.ssu.ac.ir/article-1-461-en.pdf

Shahid Sadoughi University of Medical Sciences Journal of Environmental Health and Sustainable Development 2476-6267 2476-7433 7 3 2022 9 1 The Association between Dietary Nitrate Intake and Alanine Transaminase in Adolescent Girls 1767 1772 EN Zahra Darabi Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. z.darabi91@yahoo.com N 0000-0002-3034-7182 Gordon A Ferns Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex, UK. N 0000-0002-0957-8349 Majid Ghayour-Mobarhan Metabolic syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. N 0000-0002-1081-6754 Sayyed Saeid Khayyatzadeh Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Y 0000-0002-9133-7340 10.18502/jehsd.v7i3.10727 Introduction: The effects of dietary nitrate on health are controversial. The current study aims to investigate the relationship between dietary intake of nitrate and liver enzymes among Iranian adolescent girls. Materials and Methods: This cross sectional study was conducted on 733 adolescent girls. They were recruited from several schools in different areas in the cities of Mashhad and Sabzevar, northeast region of Iran, by random cluster sampling method. The dietary intake of nitrate was assessed using a validated food-frequency questionnaire (FFQ). Levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and gamma-glutamyl transferase (GGT) were measured by auto-analyzer. Linear regression was applied to investigate the correlation between nitrate intake and liver enzymes in crude and adjusted models. Results: There was a direct association between dietary intake of nitrate and serum levels of ALT in crude [β = 0.117; 95% CI (0.003-0.016); P < 0.01] and adjusted models for energy intake, age, BMI percentile, physical activity, menstruation, father's education, and mother's education [β = 0.128; 95% CI (0.003-0.016); P < 0.01]. No significant associations were found between dietary intake of nitrate and levels of ALP, AST, and GGT in crude or adjusted models. Conclusion: There was a direct relationship between dietary intake of nitrate and serum concentration of ALT. Longitudinal studies are required to examine the association between dietary nitrate intake and liver functional tests. Nitrates, Alanine Aminotransferase, Aspartate Aminotransferases, Alkaline Phosphatase, Gamma-Glutamyl Transferase. http://jehsd.ssu.ac.ir/article-1-415-en.html http://jehsd.ssu.ac.ir/article-1-415-en.pdf