Rise In Iran Research Articles

Delamanid and bedaquiline resistance patterns in Mycobacterium tuberculosis in Iran: A cross-sectional analysis

IntroductionThe surge of multidrug-resistant TB (MDR-TB) in Iran poses a significant challenge to global healthcare. The introduction of delamanid (DLM) and bedaquiline (BDQ), two potent antimycobacterial drugs, marks a crucial advance. Nevertheless, as resistance in Mycobacterium tuberculosis is on the rise in Iran and resistance to these newer medications is emerging, investigations in this field are of utmost importance. MethodsIn this cross-sectional study, 38 MDR-TB strains were collected from five distinct regional TB laboratories in Iran. The clinical isolates were confirmed as M. tuberculosis using the phenotypic tests and IS6110-based PCR assay. Drug susceptibility testing (DST) for isoniazid, rifampicin, ethambutol, DLM, and BDQ was performed using WHO-approved methods. Sequencing was used to investigate genetic mutations in DLM (ddn, fgd1) and BDQ (Rv0678, atpE, pepQ) genes associated with resistance. ResultsAmong the 38 collected MDR-TB isolates, 7 (18.5 %) exhibited resistance to DLM, while all remained susceptible to BDQ. Analysis of the sequencing data revealed that the ddn gene exhibited the highest number of mutations in DLM-resistant isolates, including 18 nonsynonymous mutations and 1 indel leading to frameshift mutations. A common mutation, Gly81Ser, was present in 4 of the DLM-resistant isolates (4/7; 57.1 %). A synonymous mutation, T960C, in the fgd1 gene was uniformly found in DLM-resistant samples. Notably, no significant mutations were observed in the atpE, Rv0678, or pepQ genes in any of the BDQ-susceptible isolates. ConclusionsOur study underscores the emergence of DLM resistance in a subset of MDR-TB isolates in Iran, primarily associated with mutations in the ddn gene. This emphasizes the ongoing necessity for TB drug resistance surveillance and research. While BDQ remains efficacious, the emergence of DLM resistance is a concerning development, warranting further exploration into resistance mechanisms and the formulation of effective TB control strategies.

Evaluation of diagnostic value of Doppler ultrasound in the diagnosis of malignant breast masses.

Breast cancer is the leading cause of cancer mortality in women, and it is on the rise in Iran. Therefore, an early-stage diagnosis of breast cancer is of critical importance. Because ultrasound is one of the available, inexpensive, and minimally invasive techniques for distinguishing malignant from benign masses, a comparison of conventional ultrasound, color Doppler, and spectral Doppler findings can be useful. The purpose of this study was to determine the diagnostic value of sonographic indices, specifically Doppler parameters, in identifying the nature of breast masses. This is a cross-sectional study, with diagnostic value analysis. Before undergoing a biopsy, 80 patients with breast masses underwent B-mode and Doppler breast ultrasound. The ultrasound findings were then compared to pathologic results to determine which groups were malignant or benign. The resulting data were analyzed using statistical tests and diagnostic values with SPSS 22 software. B-mode grey-scale ultrasound indices such as mass shape, mass margin, mass orientation, and posterior features, as well as Doppler indices such as vascularity, RI (Resistive Index), PI (Pulsatility Index), and PSV (Peak Systolic Velocity), were found to be statistically significant with pathological findings. Color Doppler revealed vascularity in 65% of benign and 84% of malignant masses. The diagnostic value results revealed that mass shape, mass margin, mass orientation, and posterior features all play a significant role in predicting lesion malignancy, with a sensitivity of 92%, 58%, 64%, 56%, and specificity of 59%, 66%, 82%, and 84%, respectively. The RI, PI, and PSV indices were significantly higher in malignant masses, and all of them had remarkable diagnostic values in predicting malignancy, with a (Area Under The Curve) AUC of 0.863, 0.882, 0.702, a sensitivity of 84% and 84%, 68%, and a specificity of 83%, 86%, and 62%, respectively, at the optimal cut-off points (0.65, 1.32, 12.40) obtained from the Receiver Operating Characteristics (ROC) curves.

Hezb-e Tudeh-ye Iran and Its Struggle Against the Challenges Posed Against It by the British, 1942–1946: An Analysis Based on Soviet Documents

Abstract Archival documents from Russia, which are becoming more accessible, help to provide a more accurate accounts of Iran's political past. Based on Soviet documents from the Russian State Archive of Socio-Political History, as well additional primary and secondary sources in various languages, the focus of this article is on the challenges and obstacles which the Tudeh Party faced from the British and their proxies in Iran during the Allied occupation of Iran in Second World War (thus creating Tudeh's ‘British Problem’). The article delves not only on describing and analyzing those challenges and obstacles, but also on the way the Tudeh was able to overcome them, and its political breakthrough and success in the Fourteenth Majlis elections and later in introducing three of its members into Qavam's coalition government. Faced with such successes of the Tudeh, and worried about the future of their own interests in Iran, and especially the oil installations of the AIOC, the British sought American assistance. According to the Soviet view, it was only through an Anglo-American cooperation that Tudeh's political rise in Iran was checked.

Prevalence of overweight and obesity among Iranian population: a systematic review and meta-analysis.

Obesity is a major risk factor for chronic diseases. Politicians and practitioners should be aware of the dramatic increase in obesity and its subsequent complications to prevent associated health risks. This systematic review aimed to provide better insight into the prevalence of overweight and obesity in the Iranian population. An evaluation was conducted on all published observational studies from both national (SID, Irandoc, Iranmedex) and international (Web of Knowledge, PubMed, Scopus) sources, which reported the prevalence of overweight/obesity among normal population samples, between January 2012 and December 2021. A total of 152 eligible studies were included in this meta-analysis. Of the 152 selected studies, 74 reported the prevalence of overweight/obesity in patients aged ≤ 18years, and 61 studies in adults. In the rest of the articles (17 studies), the results were reported for a combination of these age groups. The prevalence of overweight and obesity in Iran was estimated at 20.1 (95% CI 17.92-22.30) and 13.44 (95% CI 11.76-15.22), respectively. This percentage (95% CI) was 11.71 (10.98-12.46) for overweight and 8.08 (7.02-9.22) for obesity in those aged ≤ 18years, and 35.26 (32.61-37.99) for overweight and 21.38 (19.61-23.20) for obesity in those aged > 18years. The overall prevalence of overweight and obesity in the entire population was 35.09% (95% CI 31.31-38.98). As obesity is on the rise in Iran, we should seek both weight loss strategies and ways to control comorbidities associated with high BMI.

The Quantitative Basis, Geopolitical Motivation and Influence of the Qualitative Change in the Relationship between the United Arab Emirates and Israel

The United Arab Emirates and Israel have reached a peace deal, and the relations between the two countries have undergone a qualitative change. This kind of qualitative change has a relatively sufficient basis of quantitative change: The signing of the peace deal between Egypt and Israel, the conclusion of the Oslo Accords, the obvious warming of relations between Saudi Arabia and Israel after the “Arab Spring”, and the gradual warming of relations between the United Arab Emirates and Israel. The peace deal between the United Arab Emirates and Israel has a lot to do with the geopolitical changes in the Middle East in recent years. This is mainly manifested in two aspects: First, the geopolitical changes brought about by the rise of Iran’s power; second, Turkey’s Pan-Islamism diplomacy guided by the “new Ottoman” vision has promoted the geopolitical changes in the Middle East. These geopolitical changes have become important driving forces behind the peace deal between the United Arab Emirates and Israel. The peace deal between the United Arab Emirates and Israel has a certain impact on Palestine, the Trump administration and the Middle East, but the nature of the impact is different: It has a greater negative impact on Palestine; it has a certain positive impact on the Trump administration; it has both positive and negative effects on peace in the Middle East as a whole, but the overall impact is limited, and the negative impact is greater than the positive impact. It can produce a certain demonstration effect for Arab countries, but the demonstration effect for small Arab countries is greater than that for Saudi Arabia.

Providing a Population Based Registry Model of Drug Poisoning in Iran.

The prevalence of drug poisoning is on the rise in Iran due to the increased public access to drugs. A national drug poisoning registry system is a suitable tool for better management, control, and prevention of drug poisoning. This study aimed to propose a national drug poisoning registry model for Iran. This was an applied research conducted in two major phases. In the first phase, all sources pertaining to drug poisoning registries were reviewed, and a national drug poisoning registry model was proposed. In the second phase, this model was validated and finalized using a researcher-made questionnaire and through a two-stage Delphi technique. The focus of national drug poisoning activities and registry management reached the 100% consensus of experts at the Drug and Poison Information Center of the Food and Drug Organization (Ministry of Health and Medical Education). Goals, data sources, registry system structure, data set, standards, data exchange, registry features, and processes of the proposed model also achieved unanimous expert consensus. Given the importance of a national drug poisoning registry in gathering, storing, analyzing, and reporting the data of patients, it is essential to provide a framework for evaluating and controlling drug poisoning and for generating valuable data for decision-making. The model proposed herein can offer the information infrastructure for designing and implementing such a system.

The burden of nonrheumatic valvular heart diseases in Iran between 1990 and 2017: Results from the global burden of disease study 2017.

BackgroundNonrheumatic valvular heart diseases (NRVDs) are some of the common and treatable cardiovascular diseases. The objective of this study was to describe the burden of NRVDs in Iran from 1990 to 2017 and to compare the findings with those from the world and in particular, the North Africa and Middle East (NAME) region.MethodsUsing publicly available estimates from the Global Burden of Disease 2017 Study (the GBD 2017 Study) for Iran and the NAME region, we reported the years of life lost (YLLs), years lived with disability (YLDs), disability-adjusted life years (DALYs), and the prevalence for NRVDs by age group and sex between 1990 and 2017.ResultsThere were an estimated 174,071 cases and 957 deaths from NRVDs in Iran in 2017. In addition, 1844 YLDs, 21,661 YLLs, and 23,506 DALYs were caused by NRVDs in Iran in 2017. Between 1990 and 2017, the age-standardized prevalence rate increased in Ian by 15%, the death rate by 15.3%, and DALYs by 2%. Nevertheless, in the world and the NAME region, the age-standardized rates for DALYs and deaths decreased and the age-standardized prevalence rate increased till 2017.ConclusionsThe burden of NRVDs is on the rise in Iran. A reduction in the burden of NRVDs in Iran requires the development of appropriate plans to meet the health needs of patients, the decrease of the modifiable risk factors, the allocation of adequate resources for the early diagnosis and management of the diseases, and an improvement in access to treatment technologies.

Data Infrastructure for a Poisoning Registry with Designing Data Elements and a Minimum Data Set

Background: The prevalence of poisoning is on the rise in Iran. A poisoning registry is a key source of information about poisoning patterns used for decision-making and healthcare provision, and a minimum dataset (MDS) is a prerequisite for developing a registry. Objectives: This study aimed to design a MDS for a poisoning registry. Methods: This applied study was conducted in 2021. A poisoning MDS was developed with a four-stage process: (1) conducting a systematic review of the Web of Science, Scopus, PubMed, and EMBASE, (2) examining poisoning-related websites and online forms, (3) classification of data elements in separate meetings with three toxicology specialists, and (4) validating data elements using the two-stage Delphi technique. A researcher-made checklist was employed for this purpose. The content validity of the checklist was examined based on the opinions of five health information management and medical informatics experts with respect to the topic of the study. Its test-retest reliability was also confirmed with the recruitment of 25 experts (r = 0.8). Results: Overall, 368 data elements were identified from the articles and forms, of which 358 were confirmed via the two-stage Delphi technique and classified into administrative (n = 88) and clinical data elements (n = 270). Conclusions: The creation of a poisoning registry requires identifying the information needs of healthcare centers, and an integrated and comprehensive framework should be developed to meet these needs. To this end, a MDS contains the essential data elements that form a framework for integrated and standard data collection.

Epidemiological study of brain cancer in Iran: A systematic review

Introduction: In recent decades, the incidence and mortality rate of brain tumours, especially in adults, has increased. In order to better plan to reduce the burden of this cancer, knowledge of the epidemiological aspects of this disease is essential. Therefore, due to the lack of a comprehensive study on brain cancer in Iran, this study aimed to investigate the epidemiological aspects of this cancer in Iran. Methods: In June 2020, keywords of 'brain tumour', 'nervous system tumours', 'nervous system neoplasm', 'nervous system cancer', 'central nervous system (CNS)' and 'Iran' were searched on Medline/PubMed and Web of Science databases Scopus, Embase, SID, IranMedex, and Google Scholar. The search results were entered Endnotes Version 8; finally, 35 full papers were reviewed and included in the study. Results: The incidence of brain cancer and CNS tumour is lower in children in central Iran. The incidence of CNS cancer was relatively high among children in Golestan province. Furthermore, the standardised incidence of primary CNS tumours in Iran is 5.69 per 100,000, which is lower than in other countries. Nervous system malignancies were more common in men than in women (age-standardized rate 3 versus 2.2 per 100,000 in men and women, respectively). Tehran had the highest incidence of CNS tumours. Meningiomas were the only most common tumour in women. Gliomas were the most common primary brain tumour, and most of the lesions in this subgroup were in low-grade astrocytoma and ependymomas. Brain cancer mortality was higher in men than in women. Age is a potential risk factor, and the incidence of CNS tumours increases with increasing age after 30 years. Conclusion: Nervous system cancers are on the rise in Iran due to lifestyle changes and increased risk factors. Planning to reduce risk factors and early detection of the disease can be helpful in reducing cases and reducing mortality.

The crescent of Influence: The rise of Iran as a regional power in the middle east

The crescent of Influence: The rise of Iran as a regional power in the middle east

Prevalence and Antimicrobial Resistance of Campylobacter coli and Campylobacter jejuni in the Animals, Food Products, and Human Clinical Specimens in Iran During 2004 - 2017: A Review Study

Context: Several studies reported that the prevalence and antibiotic-resistant of Campylobacter coli (C. coli) and Campylobacter jejuni (C. jejuni) are on the rise in Iran. To explain the prevalence and antibiotic-resistant of Campylobacter coli and Campylobacter jejuni, we reviewed related studies published from 2004 to 2017 in Iran. Methods: We systematically searched biomedical databases (PubMed, Scopus, Google Scholar, and Web of sciences) to identify relevant studies from 2004 to 2017, either in English or in Persian. Out of 65 identified articles, 47 were published during 2004 - 2017. Results: We found an increase in the prevalence of C. coli and C. jejuni in the animals (34.71%, 68.73%), food products (42.18%, 72%), and different clinical human samples (7.77%, 25.84%), respectively. This comprehensive review showed that C. jejuni is the foremost species in Iran. Accordingly, antimicrobial resistance studies performed during 2004 - 2017 reported a high rate of resistance to several antibiotics like ciprofloxacin, nalidixic acid, and tetracycline, with the exception of gentamicin, neomycin, and chloramphenicol that had a low resistance rate. Conclusions: According to the results, novel prevention and treatment strategies against C. coli and C. jejuni infections are recommended, and these data may help in revising treatment guidelines in aviculture, stockyard and decreasing the antimicrobial resistance in human society.

Diagnosis of Acanthamoeba keratitis in Mashhad, Northeastern Iran: A Gene-Based PCR Assay.

Background:The genus Acanthamoeba is a free-living opportunistic protozoan parasite, which widely distributed in soil and fresh water. Acanthamoeba keratitis, which causes a sight-threating infection of the cornea, is going to rise in Iran and worldwide. The aim of this study was to compare direct microscopy, culture and PCR for detection of Acanthamoeba spp. in clinical samples and to determine the genotypes of Acanthamoeba spp. by sequencing 18SrRNA gene.Methods:Among patients clinically suspected to AK referred to a tertiary ophthalmology center at Mashhad, northeastern Iran. During 2017-18, twenty corneal scrapes specimens obtained. The samples were divided into three parts, subjected to direct microscopic examination, culture onto non-nutrient agar and PCR technique. Sensitivity, specificity, accuracy and likelihood ratio were evaluated.Results:Among 20 persons clinically suspected to amoebic keratitis, 13(69.2%) patients definitely diagnosed as Acanthamoeba keratitis. Wearing contact lens, eye trauma due to foreign particle and swimming in fresh water were the main predisposing factors. Most of patients suffered from pain and photophobia. Corneal ring infiltration and epithelial defect were common clinical sings. Direct examination had the lowest sensitivity and sensitivity of both Nelson-PCR and JDP-PCR methods were equal and highest. In addition, the results of sequencing identified that all strains belonged to T4 genotype.Conclusion:Amoebic keratitis is a sporadic parasitic keratitis, which is mainly seen in contact lens user in Mashhad. PCR based on 18S ribosomal DNA with JDP primers is a reliable and highly sensitive method for diagnosis of Acanthamoeba keratitis in clinically suspected cases.

Designing a Structural Equation Model for Creative Leadership in the Relief Supply Chain in Isfahan Hospitals

INTRODUCTION: Despite the fact that natural disasters are on the rise in Iran, no study has yet explained the performance indicators in the relief supply chain in crisis situations. Creative leadership in the relief supply chain can be of great help to the enhancement of internal strengths, provision of creative solutions to potential threats, and maintenance and promotion of public health. The present study aimed to provide a Structural equation model of creative hospital leadership. METHODS: The present exploratory research was conducted on 215 cases that were selected as the sample size using Cochranchr('39')s formula. The data collection tool was a standard questionnaire which was completed by managers, supervisors, and experts of hospitals in Isfahan province. The reliability coefficient of the questionnaire was assessed using SPSS software based on Cronbachchr('39')s alpha test, which indicated the high reliability of the research tool. FINDINGS: A hierarchical structure was established using DEMATEL software, which is a variety of decision-making methods based on pairwise comparisons, and benefiting from expert opinion in extracting the factors of a system and their systematical structuring based on the principles of graph theory. CONCLUSION: Finally, the effectiveness and affectability of the components were expressed as the output of DEMATEL software in a way that their interaction effect was denoted as numerical values. Thereafter, the data were analyzed in linear structural relations (LISREL) software using structural equation modeling, and the creative leadership model was designed.

The Rise of Iran as a Regional Power

Emerging as a destabilising factor for the Arab world and the Western powers in 1979, the Islamic Republic of Iran has over time established itself as a strong regional power. Standing tall in the face of isolationism, threats, sanctions and wars, it has cleverly embedded itself across the region. Taking advantage of the opportunity presented by the Arab Spring, it has solidified its base of loyalists in countries such as Iraq, Syria, Lebanon, Yemen and Palestine. Despite the economic instability and upheaval, it has continued to expand its power in the region.

Effects of media, interpersonal communication and religious attitudes on HIV-related stigma in Tehran, Iran

Abstract Human immunodeficiency virus (HIV) prevalence owing to sexual contact has been on the rise in Iran since 2006, with those afflicted liable to social stigmatization. Focusing on the role of the media, this quantitative study investigates factors associated with HIV-related stigma in Iran by using a structural equation model (PLS-SEM). A questionnaire was administered to 315 respondents drawn through 2-stage cluster sampling carried out in Iran's capital city, Tehran. The results indicate that media exposure augments HIV-related knowledge and thus, diminishes the HIV-related stigma; this effect is, however, diminished by the underdeveloped role of the Iranian media in HIV-oriented discussions. Moreover, adherence to Islamic teachings on sexual relationships boosts HIV-related knowledge. Furthermore, obtaining information through interpersonal communications influences knowledge and stigma regarding HIV; this effect is more powerful than that of the media in Tehran. In a backdrop of a pervasive stigma surrounding HIV in Iran, interpersonal communications appear to play a more prominent role in obtaining HIV-related information than do the media, which calls for the further development of the media's capacity and communication power.

Data Scientists’ Skills in Detecting Archetypes in Iran

The use of data-driven decision making and data scientists is on the rise in Iran as companies have rapidly been focusing on gathering data and analyzing it to guide corporate decisions. In order to facilitate the process and understand the nature and characteristics of this transformation, the current study intends to learn about data scientists’ skills and archetypes in Iran. Detecting skills archetypes has been done via analyzing the skills of data scientists which were self-expressed through an online survey. The results revealed that there are three archetypes of data scientists including high level data scientists, low level data scientists and software developers. The archetypal patterns are based on levels of data scientists’ skills rather than the type of dominant skills they possess which was the most frequent pattern in previous studies.

Distribution of Class D Carbapenemase and Extended-Spectrum β-Lactamase Genes among Acinetobacter Baumannii Isolated from Burn Wound and Ventilator Associated Pneumonia Infections.

Resistance to Acinetobacter baumannii is dramatically on the rise in Iran. Therefore, it is important to study resistance pattern among Acinetobacter isolates which is a common cause of nosocomial infections. To investigate antibiotic resistance patterns and the role of resistant genes and biofilm formation in the induction of resistance among Acinetobacter baumannii isolated from burn wound and ventilator associated pneumonia infections. Total 103 isolates such as 33 burn samples from Rasool Akram Hospital and 70 isolates from ventilated patients in Shahid Motahhari Hospital were identified with A. baumannii using biochemical method, and then identified to species level with PCR of gyrB and blaOXA-51 gene. Antibiotic sensitivity pattern for β-lactam and carbapenem antibiotics was assessed using Agar disc diffusion test and E-test. The presence of different carbapenemase and metalo-β-lactamase (blaOXA-51-like, gyrB, blaOXA-23-like, blaOXA-24-like, blaOXA-58, blaVEB, blaPER, blaGIM, blaSIM, blaIMP, blaVIM), extended-spectrum β-lactamases (blaTEM, blaSHV) and two insertion sequences genes (ISaba1, IS1113) was assessed. Biofilm formation of all isolates was then assessed. Chi-square analysis or Fisher's-exact tests were used for statistical analysis. A p-value <0.05 was considered statistically significant. Colistin was the most effective antimicrobial agents, although 10.7% (11/103) of the isolates were resistant. The high rate of resistance to meropenem (93.2%) and imipenem (90.3%) was determined. Also, with exception of ampicillin-sulbactam, surprisingly the resistant rate was 28.2%, the resistance to β-lactam antibiotic was dramatically increased. Co-existence of two and three blaOXA genes was also determined. The blaOXA-58 was detected in only one isolate. The blaTEM and blaOXA-23 was the most prevalent Extended-Spectrum β-Lactamases (ESBL) gene. All isolates were biofilm producers. Antibiotic resistance is increasing among A. baumannii isolates which is due to excessive use of antibiotics and also acquired resistant genes and biofilm production. Resistance to nearly all antimicrobial agents especially colistin as end choice for treatment of multiple drug resistance A. baumannii is a big concern.

The Myth of Saudi Power

In the past few years, especially after the outbreak of the Arab Spring in late 2010, Saudi Arabia has attempted to assert its military dominance in the Middle East region to realize two objectives: first, to maintain the status quo in the Gulf neighborhood through direct military interventions and the use of force; and secondly, to contain the rise of Iran, which Riyadh views as a destabilizing power in the whole Middle East region. Under the new King Salman bin Abdulaziz Al-Saud, who ascended to the throne in January 2015, the military assertiveness has taken a new dimension, in terms of launching an air assault on Yemen in late March last year to downsize Houthi power and increasing support for the Syrian rebel group – the Islamic Army to topple the Bashar Al-Assad government, Iran’s only Arab ally. This piece probes Saudi Arabia’s potential and limitations to rise as the Middle East’s dominant power and concludes that Riyadh’s bid to emerge as the region’s preeminent military power and control regional affairs may come up short.

Demographic Profile and Substance Abuse Patterns in Women Stationed at Detoxification and Rehabilitation Centres in Tehran

Objective: Throughout recent years, wide spread substance abuse in both genders, especially in women, has been increasingly on the rise in Iran. This is a serious matter. There are no solid and accurate statistics on female drug abusers yet. According to the World Drug Report (2014), the highest amount of methamphetamine consumption has been observed in Mexico, the USA, China, Thailand, and Iran. Despite global concerns in the matter, it is difficult to estimate the exact number of amphetamine consumers. Method: This descriptive cross-sectional study aimed to examine the socio-demographic profile and substance abuse patterns in woman stationed at three Detox and Rehab Centres in Tehran. The statistical society at this centre includes 112 female patients. In this study, a questionnaire designed by the team of SOS-Enterprise.

Peace on the Fence? Israel's Security Culture and the Separation Fence to the West Bank

This article examines the role of the separation fence as a metaphorical reflection within Israeli society. Two points of view examined are the construction of the separation fence and the historical idea of separation. Since the founding of Israel, the goal of the political maxim has been to construct internationally approved borderlines. Starting from a historical perspective and continuing to modern day, the development and establishment of various differentiation concepts, the latest in the form of a separation fence, are represented within Israeli society. The search for a boundary and security is questioned as a possible psychological and social bonding component of Israel. Different approaches to the design of the state border are subjected to the sociology of space, as understood in a short analysis by George Simmel. The construction of the separation fence is the political implementation of the Delimitation Theories. Questions regarding recognized borders, security in the country, and the determination of the Palestinian population's identity are fundamental for Israeli society. The separation fence is the physical expression of these perceptions. Fear, as a collective theme, plays an important role in this debate, and the prospect of a future boundary is a step closer to positively influencing social sense. The need for Israeli security is linked to the search for identity and cohesion. Separation is also linked to Israeli identity, an identity that functions as a basic cohesion of Israeli society. The separation fence can serve as a solution to the historic, territorial conflict between the Israelis and the Palestinians. However, the separation fence provides no possible solutions for global changes in the Middle East. Against the background of the American withdrawal from Iraq and Afghanistan as well as the regional rise of Iran the purpose and function of the separation fence is, and remains, determined solely by Israeli society.