Healthcare constitutes one of the largest shares in economy. Ageing population, shortage of resources, and increasing costs of medical services cause many changes in healthcare systems. Healthcare facilities are one of the most important components of these systems. Due to these increasing changes, the facility network should be designed to use the resources optimally and serve the needs of population. In other words, managers try to design the network in the best way in order to signiFicantly reduce the costs and improve the patient satisfaction. In this paper, a multi-service hospital network is presented for designing and capacity planning of healthcare facilities problem. In this model, some strategies are considered such as: 1) establishing new facilities on favorable sites, 2) opening new services in facilities, 3) determining the optimal capacity for existing and new facilities, and 4) allocating of demand points to facilities. Facilities provide various services that are different in type, size, and quality. In some of them, it may not be allowable to open some services. In addition, it is possible to service each demand point by several hospitals and getting service from one hospital by several demand points. A bi-objective mixed integer linear mathematical programming model is presented. This bi-objective model minimizes the total network designing costs while maximizing equity throughout hospital network. Therefore, the equity is defined as the ratio of quality of providing services to distances from demand points to facilities, because the quality of services and access to care are two vital factors that directly affect the entire patient's satisfaction. We solve the model by a new version of "-constraint method (i. e., the augmented "-constraint). Also, real data from healthcare facility network in the Isfahan province of Iran is applied for validation purposes. The sensitivity analysis is done on the main parameters. Results show that the proposed model can be used to decide on designing and capacity planning of healthcare facilities.

In classic covering location models, each demand point can be covered by only one facility.In cooperative covering problems, each demand point can be covered by one or more facilities. As an application of cooperative models, each facility sends signals out so that signal intensity decreases by an increase in distance.In the hierarchical maximal covering location problem (HMCLP), a fixed number of facilities with different servicing levels is located in order to maximize covered demands.In this paper, the cooperative covering concept is developed by the HMCLP with referral (HMCLP (R)) in a discrete space. It is assumed that there are two level facilities and the model is nested, so, high-level facilities provide both types of service. Each demand point is covered if its high-level demands are provided by high-level facilities directly or with referral from low-level facilities. The proposed model is presented in two forms: CHMCLP (R) for physical signals and CHMCLAP (R) for non-physical signals, while the second one considers the allocation structure as well.The proposed models are analyzed using numerical examples.The analysis shows that the covering radii have important roles to play in the performance of the developed models. For instance, with very small referral covering radius, each low level facility is located around and near a high-level facility. So, low level facilities are covered in a non-cooperative manner by the high-level facilities, and, moreover, they cover less demand points.Therefore, covering radii should be determined carefully by considering the problem, facility specifications and other determinant factors. A simulated annealing (SA) algorithm was developed and tuned for solving the proposed models in larges caled instances. The developed algorithm was implemented using randomly generated problems with different sizes. Comparisons between results of the solution algorithm and an exact solution approach show the efficiency of the proposed solution algorithm.

A new multi-objective intermodal hub-location-allocation problem is modeled in this paper in which both the origin and the destination hub facilities are modeled as an M/M/m queuing system. The problem is being formulated as a constrained bi-objective optimization model to minimize the total costs as well as minimizing the total system time. A small-size problem is solved on the GAMS software to validate the accuracy of the proposed model. As the problem becomes strictly NP-hard, an MOIWO algorithm with an efficient chromosome structure and a fuzzy dominance method is proposed to solve large-scale problems. Since there is no benchmark available in the literature, an NSGA-II and an NRGA are developed to validate the results obtained. The parameters of all algorithms are tuned using the Taguchi method and their performances are statistically compared in terms of some multi-objective metrics. Finally, the entropy-TOPSIS method is applied to show that MOIWO is the best in terms of simultaneous use of all the metrics.

ABSTRACT The attention of contemporary planners to environmental factors and increasing awareness and communication of man with his surrounding environment has increased the layers and defining factors of design and planning concepts. In such a way, a common problem with the issue of environmental capabilities to respond was put in front of the planners. The collection of ideas presented in this era was in the form of responsive planning, focusing on the maximum use of environmental capabilities. The necessity of the emergence of a comprehensive discourse to overcome the plurality of factors, definitions and design methods in the environmental fields has been given less attention. Based on this, the current research aims to organize the leading theories in this field in a targeted manner and seeks to improve them based on their synergy. The structural question of this research is the meanings, examples and meaningful contexts of flexibility in various aspects and scales of urban planning. The research method used is qualitative thematic analysis with the help of artificial intelligence in MAXQDA software in a 6-step processing process. The important application of this research is to structure the minds of the planners of this field to reduce the scattered and interdisciplinary problems of the resources. The results of this research revealed dimensions such as identification and recognizability, diversity and changeability, adaptability and expandability, distribution, separation and continuity, organization and compatibility in the field of flexibility and related to the corresponding parts in urban planning   Extended Abstract Introduction Responsiveness-based design and planning emphasizing the maximum use of environmental capacities to meet users' needs implicitly cause a targeted improvement of environmental quality. As the environmental awareness of contemporary man has expanded and the platforms have become more diverse, many challenges are raised in the field of environment-oriented in the field of infrastructure quality and service provision. Urban developments and new developments in cities should be interpreted with integrated conceptualization. The conceptualization of interpretive flexibility in the planning and designing of public spaces in the city is used as an interdisciplinary perspective in urban space design to open and discuss its connection and potential as an approach to strengthening social cohesion and inclusion. The general definition of flexibility is that it can create places with new forms of meaning and be used for different groups to strengthen its coherence and multidisciplinary inclusion in terms of design and planning of space and body. On this basis, the concept of flexibility is proposed as a principle in the context of design and planning due to its wide range of effects on background phenomena. The history of such a role can be seen in the diversity of users' needs. In such a way, it is impossible to express the specific time and area of the need to pay attention to this concept. This is in line with Oldenburg's theory of "social public spaces," in which being in public space, communicating with people and the environment through observing the streets, sidewalks, squares, and parks of the city is a necessary step for people as a part of their social life. The meaningfulness of the design of the artificial environment was considered. In any case, in the contemporary era, on the one hand, at the same time as the quantitative and qualitative increase of human environmental awareness, there is no longer any phenomenon in the eyes of contemporary man arising from a unique aspect and range of factors. On the other hand, his life needs in the individual and collective dimensions have seen a high diversity, which has led to the formation of multiple semantic domains of past flexibility. The meaning of flexibility in such an interdisciplinary platform and basic design refers to the concept of understanding and responding quickly and efficiently to environmental changes. Such a holistic definition for this broad field of environmental design means the implicit acceptance of the role of scale in the meaningful domain of these concepts. On a macro scale, it means making design options to increase the presence, participation, and power of choices of users of the environment in participatory urban planning and design methods, and on a small scale, it means making design options to increase spatial quality and, as a result, the quality of activities. The daily activities of environmental users are through selection against the "dominant space." Flexibility at different scales is crucial for dimensional optimization, shaping, and structuring spatial features, leading to improved performance of space components and spaces. The development of the concept of "flexibility" from various studies in metropolitan to micro scales, such as interior architecture, allows it to pass the discourse of responsiveness to provide a broad approach to environmental design in which different values, interests, and priorities are prioritized. As a result, the issue of flexibility in environmental design has been raised as a multi-dimensional field in the design and planning of the basic environment. The breadth and complexity of this concept have made the researchers of this field deal with it in one or more ways, and it has been avoided to provide a comprehensive framework about the nature and structuring processes. The current research presents a structured view of flexibility in architecture and urban planning with an environmental approach.   Methodology The methodology to achieve this goal is to use the macro research method and achieve a comprehensive framework by combining categorized interpretations. In such a way that by sorting and categorizing these concepts and bases in a new way, he has found a new level of theoretical findings, which will be a suitable answer for the gaps in scientific knowledge and scientific methods created in this field. In this context, the research method "thematic analysis" has been used with a qualitative approach and the use of library resources. Also, to overcome the breadth and complexity of these concepts and the multi-layer networking of concepts in this research method, artificial intelligence has been used in MAXQDA research assistance software.   Results and discussion In the meantime, attention should also be paid to the fields of influence and application of the results of this research because designers refer to flexibility as the creator of environmental qualities, including dynamism. Also, since flexibility, along with the principles of readability and adaptability, affect the lifestyle and behavioral patterns of the audience of environmental design in architecture and urban planning, it will also be effective in dealing with the challenge of complexity in environmental design factors. One of the key questions for achieving research goals on this issue is how flexibility in environmental design impacts the relationship between flexibility and scale.   Conclusion The most important finding of this research suggests that first, it requires a focus on the conditions under which the processes of perceiving human abilities and discovering the needs of the human audience can manifest. The theoretical framework arises from a comparative approach between design disciplines. These conditions are independent of the final state of the design product, and strengthening the environmental capacities will lead to a direction and an area that includes environmental flexibility. By responding to new situations, the construction of the space and the body within a space building can be adapted to various configurations. Even though the environment may remain constant, the designed place will continue functioning as a strong living system over time.  It also seems that the nature of issues related to flexibility has complexity. Considering that the quality of flexibility in urban planning and architecture is significant in multilevel and multifaceted scales from micro to macro, it is important to pay attention to the scale of different variables. In order to reduce this problem, the consistency and adjustment of the scale of the variables measured in a specific analysis should be considered in the first step.   Funding There is no funding support.   Authors’ Contribution All of the authors approved the content of the manuscript and agreed on all aspects of the work.   Conflict of Interest Authors declared no conflict of interest.   Acknowledgments We are grateful to all the scientific.

BACKGROUND AND OBJECTIVE: In recent years, using of local antibiotic as an adjunctive treatment in periodontitis has been considered. The aim of this study was to survey the local effects of doxycycline with scaling/ root planning in treatment of adult periodontitis. METHODS: This experimental study was accomplished on five patients with adult periodontitis. The patients were chosen with at least three pockets with depth of approximately ≥4 mm and bleeding in each quadrant. After initial preparation and scaling, the jaws were divided into 3 parts; upper right: receiving doxycycline gel (case group), upper left: receiving base gel (control group) and lower right: do not received any gel (Sham group). One, three and six months after beginning the study, all the indices were measured again; and finally all data were analyzed by statistical tests. FINDINGS: In this study after 6 months, reduction of pocket depth and clinical attachment level (CAL) in case, control and sham groups were difference. Mean of pocket depth in case group was reduced from 2.3±0.5 mm to 1.5±0.6 mm after three months, and 1.9±0.6 mm after six months, and in control group from 2.2±0.8 mm to 1.6±0.6 mm after three months, and 1.8±0.7 mm after six months, these differences for clinical attachment level in buccal side of the teeth in three groups were significant (p<0.05). Also, there were differences in bleeding index in three groups. As for mobility and plaque index there was not any significant difference between the groups. CONCLUSION: Totally, the outcome of doxcycline gel and SPR treatment group was satisfied than the other groups during 6 months, although the effects were not too long.

Background: The benefits of breastfeeding for both the infant and the mother are indisputable and the necessity of contraception during breast feeding is one of the most important issues in this regard. This study was conducted to evaluate the usage of minipill (progesterone only pills), its related problems, reasons for give it up and other factors.Materials and Methods: In this cross-sectional study, the contraception method, duration of minipill consumption, side effects and reasons for discontinuation were evaluated.Results: The mean age of participants was 24.8±5.3 years old and mean number of their children was 2.2±0.8. 47% used the minipill and 41.8% gave it up during an 18-month follow up. Side effects of minipill were as follow: 71.4% bleeding disturbances, 52.3% menstrual retard, 38% vaginal discharge, 28.5% spotting, 23.8% headache and palpitation, 4.76% dwindling flow of excreted milk and mastalgia.Conclusion: The usage of minipill is lower than what we expect which is of great concern. Moreover, the side effects and other related problems, are important issues that should be rigorously investigated.

Achieving rural development goals in Iran as depends on adopting suitable social, ‎economic and physical approaches, it involves the use of a compatible and effective ‎approach to rural development planning process (preparation and implementation of ‎development plans).‎ Up to now, rationalism and communicative approaches to frame and process of ‎development planning were under consideration, but in Iran planning system, ‎rationalism approach has been preferred to communicative approach which has been ‎taken in to consideration at world planning literature since last years of twentieth ‎century‏. ‏‎‎ What are the deficiencies and weaknesses of prevalent approach in development ‎planning process of Iran? Which choice is a suitable one for Iran rural development ‎planning process? Answers to these questions are the goal of this article that is ‎presented in analytic and descriptive method‏. ‏‎‎ According to results of searches, "pivotal specialty" and "non-participatory ‎characteristic" have caused rationalism approach to face some weakness and many ‎failures, so with attention to conditions, the choice of communicative approach is of ‎essential necessities for rural development planning process in Iran‏.‏