Association Between Plant-based Diet and Kidney Function in Adults

OBJECTIVE

A plant-based diet has both antioxidant and anti-inflammatory properties. Therefore, it is hypothesized that adherence to a plant-based diet may have a positive effect on kidney function. The study aimed to determine the association between the plant-based diet index (PDI) and chronic kidney disease (CKD).

METHODS

This cross-sectional analysis used information from the Ravansar noncommunicable diseases cohort study, which included 9,746 participants between the ages of 35 and 65. By measuring the estimation glomerular filtration rate (eGFR) with the modification of diet in the renal disease equation, CKD was determined. Using a food frequency questionnaire, the PDI was computed based on food intake. To determine odds ratios (ORs), multivariable logistic regression models were utilized.

RESULTS

1,058 (10.86%) participants had CKD (eGFR<60 mL/min/1.73 m2), and the mean PDI was 54.22 ± 6.68. The mean eGFR in the group with a high PDI score was significantly higher than the group with a low PDI score (fourth quartile: 79.20 ± 0.36 vs. first quartile: 72.95 ± 0.31, P < .001). Adherence to a plant-based diet was more prevalent in those with a higher socioeconomic status (P < .001). After adjusting for potential confounders, the odds of CKD in the third and fourth quartiles of PDI were 25% (OR: 0.75; 95% confidence interval: 0.62-0.91) and 39% (OR: 0.61; 95% confidence interval: 0.48-0.78, P trend<.001) lower than the first quartile, respectively.

CONCLUSIONS

The findings of this study suggest that having a plant-based diet may prevent the prevalent CDK. However, further studies with a cohort design are recommended.

Genome-wide study of linkage disequilibrium, population structure, and inbreeding in Iranian indigenous sheep breeds

Knowledge of linkage disequilibrium (LD), genetic structure and genetic diversity are some key parameters to study the breeding history of indigenous small ruminants. In this study, the OvineSNP50 Bead Chip array was used to estimate and compare LD, genetic diversity, effective population size (Ne) and genomic inbreeding in 186 individuals, from three Iranian indigenous sheep breeds consisting of Baluchi (n = 96), Lori-Bakhtiari (n = 47) and Zel (n = 47). The results of principal component analysis (PCA) revealed that all animals were allocated to the groups that they sampled and the admixture analysis revealed that the structure within the populations is best explained when separated into three groups (K  =  3). The average r2 values estimated between adjacent single nucleotide polymorphisms (SNPs) at distances up to 10Kb, were 0.388±0.324, 0.353±0.311, and 0.333±0.309 for Baluchi, Lori-Bakhtiari and Zel, respectively. Estimation of genetic diversity and effective population size (Ne) showed that the Zel breed had the highest heterozygosity and Ne, whereas the lowest value was found in Baluchi breed. Estimation of genomic inbreeding using FROH (based on the long stretches of consecutive homozygous genotypes) showed the highest inbreeding coefficient in Baluchi and the lowest in Zel breed that could be due to higher pressure of artificial selection on Baluchi breed. The results of genomic inbreeding and Ne showed an increase in sharing haplotypes in Baluchi, leading to the enlargement of LD and the consequences of linkage disequilibrium and haplotype blocks confirmed this point. Also, the persistence of the LD phase between Zel and Lori-Bakhtiari was highest indicating that these two breeds would be combined in a multi-breed training population in genomic selection studies.

The effects of coenzyme Q10 supplementation on metabolic profiles and parameters of mental health in women with polycystic ovary syndrome

OBJECTIVE

Evaluating the impact of coenzyme Q10 (CoQ10) supplementation on hormonal indices, mental health, and biomarkers of inflammatory responses and oxidative stress among female patients suffering from polycystic ovary syndrome (PCOS).

METHODS

The present double-blinded, placebo-controlled randomized clinical trial consisted of 55 PCOS women (aged 18-40 years old), who were randomized into groups receiving 100 mg/day of CoQ10 (28 cases) or placebo (27 cases) for 12 weeks.

RESULTS

The supplementation of CoQ10 decreased significantly the scores of Beck Depression Inventory (BDI) (p = .03) and Beck Anxiety Inventory (BAI) (p = .01) and high-sensitivity C-reactive protein (hs-CRP) level (p = .005) when comparing with the placebo group. Moreover, CoQ10 group exhibited a significant drop in total testosterone (p = .004), dehydroepiandrosterone sulfate (DHEAS) (p < .001), hirsutism (p = .002) and malondialdehyde (MDA) (p = .001) levels in the serum, and a significant rise in sex hormone-binding globulin (SHBG) (p < .001) and total antioxidant capacity (TAC) (p < .001) levels in the serum than the placebo group.

CONCLUSIONS

12-week supplementation of CoQ10 to PCOS women showed beneficial impact on BDI, BAI, hs-CRP, total testosterone, DHEAS, hirsutism, SHBG, TAC and MDA levels.

Components of contributing conditions to strengthen health system management and leadership capacity building: a systematic review and decision making framework

PURPOSE

The purpose of this study is to identify components of contributing conditions to strengthen leadership and management capacity in the health system.

DESIGN/METHODOLOGY/APPROACH

A systematic search was undertaken in databases including PubMed, Scopus, Web of Science and local resources of Scientific Information Database and Magiran in January 2020. Two independent researchers checked the research process, screening of articles and quality assessment. The quality of the studies was assessed by JBI critical appraisal tools for qualitative studies. The components of the dimensions of health system management and leadership capacity were categorized according to the WHO conceptual framework using a content analysis approach.

FINDINGS

A total of 17 articles were included in this study. In total, 16 categories of components include human resource information system (n = 5); criteria, plans and procedures for selection and appointment (n = 5); development of education system (n = 11); skills (n = 39); knowledge (n = 8); attitudes (n = 6); behaviors (n = 10); resource and critical management system (n = 7); performance and processes management (n = 3); operational planning for critical systems (n = 4); establish control systems (n = 2); inputs and outputs of organizations (n = 2); accountability and responsibility to customers and stakeholders (n = 4); legal authority and requirements to play the role of managers (n = 9); external and internal environment management (n = 7); establish a system of appreciation and encouragement (n = 6). Each of these categories also contains subcategories.

ORIGINALITY/VALUE

Identifying prerequisite conditions are necessary for building leadership and management capacity in health systems. Therefore, extracted components provide a simple but coherent framework that can be adapted or modified for use in local situations. The components have a variety of uses, including mapping current activities, needs assessment, planning leadership and management development strategies and monitoring and evaluation.

Exploring the challenges and features of implementing performance-based payment plan in hospitals: a protocol for a systematic review

BACKGROUND

Implementing performance-based payment (PBP) plan has led to developing a number of significant potentialities such as performance improvement and effectiveness, quality improvement of provided services, and decline in health system expenditure in hospitals. Despite the fact that PBP plan has a variety of potential advantages, its implementation still may face some challenges. Hence, it seems crucial to identify these barriers and challenges in order to devise some strategies and interventions to pave the way for better implementation of PBP in hospitals. The aim of this proposed protocol is to identify, summarize, and synthesize the existing evidence by undertaking a systematic review to explore the challenges, barriers, and features of implementing PBP in hospitals.

METHODS AND ANALYSIS

An inclusive search of the literature will be conducted in seven international and national databases including PubMed/MEDLINE, Scopus, Cochrane Library and Web of Science, Magiran, Scientific Information Database (SID), and Barakat knowledge network system (BKNS). The search will be limited to the studies published in English or Persian language. Database search will be supplemented by hand-search of citation, reference lists, and grey literature sources. Based on the pre-established criteria in all steps of the review, two researchers will independently screen all of the retrieved studies. Any discrepancies will be resolved through a discussion between two researchers. In cases where consensus is not reached, it will be referred to a third researcher. The methodological quality of all the included studies will be appraised using the Mixed Methods Appraisal Tool (MMAT). The data will be extracted by means of using a data extraction form, which will be developed and piloted by the research team. The findings will be synthesized through directed content analysis method.

DISCUSSION

With the growth and development of payment systems all over the world, it is expected that recognizing the challenges of implementing a PBP plan in hospitals will be useful in developing and designing strategies to better implement this plan.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number CRD42020152569.

Nurses' perception of teamwork and its relationship with the occurrence and reporting of adverse events: A questionnaire survey in teaching hospitals

AIMS

To identify the levels of teamwork and its relationship with the occurrence and reporting of adverse events among Iranian nurses.

BACKGROUND

Strengthening teamwork is emphasized worldwide for enhancing quality care and patient safety.

METHODS

This study applied a cross-sectional survey design. A total of 327 Iranian nurses from eight teaching hospitals participated in a self-administered survey using simple random sampling. The Teamwork Perceptions Questionnaire was used to measure the teamwork. The frequency of occurrence and reporting of adverse events were measured with two questions. Data were analysed using descriptive analyses, independent t tests and logistic regression analysis.

RESULTS

The mean teamwork score was 3.81 out of 5. Among the nurses, 48.0% had experienced adverse events in the past 6 months and 79.8% reported having an appropriate performance in adverse events reporting. Teamwork was significantly associated with lower occurrences of adverse events and better adverse events reporting. Specifically, nurses with higher situation monitoring (odds ratio (OR) = 0.47), mutual support (OR = 3.18) and team leadership (OR = 2.09) scores were more likely to report adverse events. Nurses with higher situation monitoring scores were less likely to experience the occurrence of adverse events (OR = 0.38).

CONCLUSIONS

Nurses' perception of teamwork was moderate to high. Teamwork was associated with the occurrence and reporting of adverse events. Further study is needed to identify the effects of teamwork training on the learning outcomes, including teamwork, occurrence and the reporting of adverse events among nurses.

IMPLICATIOS FOR NURSING MANAGEMENT

Nursing managers should consider multiple educational strategies including structured teamwork training to improve staff nurses' teamwork competency. Administrative initiatives and quality improvement projects are needed to increase nurses' performance in the reporting of adverse events through an accreditation process.

Developing competent public hospital managers: a qualitative study from Iran

Purpose

Hospitals need highly trained and competent managers to be responsible for the strategic development, overall operation and service provision. The identification and confirmation of core management competency requirements is a fundamental first step towards developing the competent management workforce for sustainable hospital service provision. This paper reports on the finding of a recent study focusing on identifying managerial competencies required by middle and senior-level managers in the public hospitals in Iran.

Design/methodology/approach

The qualitative research design included position description analysis and focus group discussions with middle and senior-level public hospital managers in Iran. When analysing the identified knowledge, skills and attitudes, the validated MCAP framework was used to guide the grouping of them into associating management competencies.

Findings

The study identified 11 to 13 key tasks required by middle and senior-level managers and confirmed that the position descriptions used by current Iranian hospitals might not truly reflect the actual core responsibilities of the management positions. The study also confirmed seven core managerial competencies required to perform these tasks effectively. These core competencies included evidence-informed decision-making; operations, administration and resource management; knowledge of healthcare environment and the organisation; interpersonal, communication qualities and relationship management; leading people and organisation; enabling and managing change and professionalism.

Research limitations/implications

Competencies were identified based on managers' perceptions. Views and experiences of other stakeholders were not captured.

Practical implications

The seven core management competency identified in the current study provides a clear direction of competency development among senior and middle-level managers working at the Iranian public hospitals. The study also confirms that position descriptions do not reflect the actual responsibilities of current hospital managers, which are in need to urgent review.

Originality/value

This is the first study that has identified the core managerial competencies required by middle and senior-level hospital managers in Iran.

Impact of the Iranian Health Sector Evolution Plan on Rehospitalization: An Analysis of 158000 Hospitalizations

Background:

In May 2014, Iran launched the most far-reaching reform for the health sector, so-called Health Sector Evolution Plan (HSEP), since introduction of the primary health care network, with a systematic plan to bring about Universal Health Coverage. We aimed to analyze the time to first all-caused rehospitalization and all-caused 30-day readmission rate in the biggest referral hospital of Northwest of Iran before and after the reform.

Methods:

We retrospectively analyzed discharge data for all hospitalization occurred in the six-year period of 2011–2017. The primary endpoints were readmission-free survival, and overall 30-day readmission rate. Using multivariate cox proportional hazards regression and logistic regression, we assessed between-period differences for readmission-free survival time and overall 30-day rehospitalization, respectively.

Results:

Overall, 157969 admissions were included. After adjusting for available confounders including age; sex; ward of admission; length of stay; and admission in first/second half of year, the risk of being readmitted within 30 days after the reform was significantly higher (worse) compared to pre-reform hospitalization (odd ratio 1.22, P<0.001, 95% CI, 1.15–1.30). Adjusting for the same covariates, after-reform period also was slightly significantly associated with decreased (deteriorated) readmission-free time compared with pre-HSEP period (HR 1.06, P=0.005, 95% CI 1.01–1.11).

Conclusion:

HSEP seems insufficient to improve neither readmission rate, nor readmission-free time. It is advisable some complementary strategies to be incorporated in the HSEP, such as continuity of care promotion, self-care enhancement, effective information flow, and post-discharge follow up programs.

Preparedness of non-hospital health centers to manage patients with life-threatening emergency conditions: findings from a qualitative study

BACKGROUND

Management of Life-threatening Emergency (LTE) patients in urban and rural areas is an important challenge, which can affect pre-hospital mortality rate. Therefore, Non-hospital Health Center (NHHC) must be prepared to manage such emergency cases that may occur in the geographic area where these centers act. The aim of this study was to explore domains related to the preparedness of NHHCs to manage LTE patients through resorting to healthcare providers' and experts' perspectives.

METHODS

A qualitative exploratory study was applied using Semi-Structured Interviews (SSIs) and Focus Group Discussions (FGDs). Prior to beginning data collection, the study and its objectives were explained to the participants and their informed consents were obtained. Then, SSIs and FGDs were conducted by two trained researchers using an interview guide, which was developed through literature review and consulting experts. In total, 12 SSIs were done with the providers at different NHHCs in Tabriz. In addition, 2 FGDs were conducted with the specialists in Emergency Medicine (EM) and Primary Health Care (PHC), and the executives of health centers, with over 5 years of work experience, and Emergency Medical Services (EMS) experts. Purposive sampling method was used in this study. All SSIs and FGDs were audio recorded and subsequently transcribed. Framework Analysis was employed to manually analyze the interview transcripts from all the SSIs and FGDs.

RESULTS

The interview transcripts analysis resulted in the emergence of 3 themes and 11 sub-themes, categorized according to Donabedian's triple model. 5 sub-themes were related to input, including medical equipment and supplies, environmental infrastructures of the centers, emergency medicines, human resource, and protocols, guidelines and policies. 4 sub-themes were related to process, including providing clinical services, medicine storage capacity, maintenance of equipment, and management process. Finally, 2 sub-themes were related to outcome, which were patients' satisfaction with the quality of care and improved survival of LTE patients.

CONCLUSIONS

The results of this study can provide a new perspective for health managers and policy makers on how to evaluate the preparedness of NHHCs in managing LTE patients. In addition, it will be used to develop instruments to measure the preparedness of these centers.

Psychometric properties of the Iranian version of self-care ability scale for the elderly

BACKGROUND

Measuring self-care ability in elderly people needs specific instruments. The Self-care Ability Scale for Elderly (SASE) is one of the common instruments used for assessing self-care ability. The aim of this study was to assess the psychometric properties of the SASE among Iranian elderly population.

METHODS

This cross-cultural adaptation study was carried out at Shahid Chamran and Shadpour Health Complex in Tabriz, Iran. The forward-backward procedure was applied to translate the SASE from English into Persian. Then, it was completed to 220 elderly people. A systematic random sampling method was used for sampling. Content validity was calculated through modified Kappa coefficient (modified CVI) based on clarity and relevance criteria. Reliability was measured by internal consistency and test-retest analysis. The construct validity also was assessed using Exploratory Factor Analysis (EFA). All the statistical analyses were performed using SPSS 21 statistical software package.

RESULTS

The mean of self-care ability was 61.14 ± 21.08. The CVI and modified kappa were 0.91 and 0.92 for relevance and clarity, respectively. The Cronbach's alpha coefficient was 0.73 and Intra-class correlation coefficient was 0.97. The results of EFA revealed a three-factor solution ('ability to take care of personal responsibility', 'ability to take care for the goals', and 'ability to take care of the health') that jointly explained for 64.61% of the total variance.

CONCLUSION

Results of the study showed that the Iranian version of the SASE has good psychometric properties and can be used in assessing the self-care ability of elderly people.

A genome-wide association study revealed five SNPs affecting 8-month weight in sheep

Lamb weight at 8 months of age is an important trait in the sheep industry in terms of the onset of puberty around this age; however, knowledge of its effective genetic factors is limited. Therefore, a GWAS using the 50K SNP-Chip was performed on 96 Baluchi sheep to identify the genomic regions associated with 8-month weight. The results of the present study revealed five SNPs on chromosomes 4, 14 and 16 at 5% chromosome-wide significance level, jointly accounting for 0.95% of total genetic variance. Four genes - MTPN, HYDIN, LRGUK and ZFP90 - were found in 50 kb intervals around the significant SNPs, of which MTPN is involved in regulation of skeletal muscle growth. Our results may provide a new vision to identify the genomic regions affecting growth traits in sheep.

Leadership and Management Competencies for Hospital Managers: A Systematic Review and Best-Fit Framework Synthesis

OBJECTIVE

Competent managers are vital to the productivity and service quality of healthcare organizations and the sustainability of the healthcare system. To improve their management competence, understanding of management competency requirements is important. The purpose of this study was to synthesize the evidence related to the leadership and management competencies in healthcare organizations through the best-fit method.

METHODS

A systematic review of literature published between 2000 and 2020 was performed to identify studies focusing on confirming and/or identifying the competency requirements of hospital managers. The best-fit framework synthesis method was used to map the identified competencies and associated behavioral items against the validated management competency assessment program (MCAP) management competency framework.

RESULTS

Twelve studies were identified for inclusion in the review. The mapping of the identified competencies and behavioral items generated a competency model for hospital managers that can apply for different healthcare context. The new competency model includes the following seven core leadership and management competencies: evidence-informed decision-making, operations, administration and resource management, knowledge of healthcare environment and the organization, interpersonal, communication qualities and relationship management, leading people and organisation, enabling and managing change, and professionalism.

CONCLUSION

This review and the mapping of the competencies identified in previous studies against the validated MCAP framework has resulted in the recommendation for an extended leadership and management competency framework for health service managers. It provides guidance for the formulation of training and development directions for the health service management workforce in a different healthcare context.

Country-level interventions for the prevention and management of hypertension through the modification of social determinants of health: a systematic review protocol

BACKGROUND

Hypertension is one of the public health challenges. Various risk factors are associated with hypertension, including social demographics, geographical location, health behaviours, and social stress. Interventions in the social determinants of health can improve hypertension and health promotion. Accordingly, different sectors such as agriculture, housing, education, and transportation should cooperate. This systematic review examines policies as a set of activities and actions/interventions aimed at the modification of the social determinants of health to prevent hypertension.

METHODS

A systematic search will be conducted in Medline (via Ovid), PubMed, EMBASE, Cochrane Library, ProQuest Dissertations & Theses, and scientific Persian databases including SID and Magiran. There will be no time restriction. The quality of selected studies will be assessed using an appropriate Joanna Briggs Institute (JBI) Critical Appraisal Checklists according to the type of studies. Two independent researchers will carry out screening and quality assessment. Disagreement between two researchers will be resolved by a third party.

DISCUSSION

Recommendations will be made for policymakers in order to make better evidence-based decisions about the prevention and management of hypertension with regard to the social determinants of health.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42020152298.

Methodological issues on "challenges and opportunities towards the road of universal health coverage (UHC) in Nepal: a systematic review"

Systematic reviews adhere to the principle that science is cumulative and attempt to identify all empirical evidence in accordance with pre-determined eligibility criteria to answer a specific research question. Therefore, in order to achieve reliable findings, these studies must use an explicit method, as they are increasingly used to guide political decision and the direction of future research. We would like to thank the authors Chhabi Lal Ranabhat et al., for the article "Challenges and opportunities towards the road of universal health coverage (UHC) in Nepal: a systematic review". Although the authors have stated that they reported th according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, some items have not been well reported. We critically appraised it using the PRISMA guidelines. Results of the study were significantly valuable, but some important points that hamper the utility of the study need to be considered by the audors. The purpose of this letter is to improve the quality of study and present methodological issues about the search strategy, quality assessment of included studies, and data analysis and synthesis.

Assessing preparedness of non-hospital health centers to provide primary emergency care: a systematic literature review

Background:

Methods:

Results:

Conclusions:

Keywords:

Preparedness of non-hospital health centers to deal with life-threatening emergencies: a ‎qualitative study of healthcare providers’ and experts’ perspectives

Background:

The life-threatening emergency (LTE) in urban and rural areas is an important challenge, which ‎can affect pre-hospital mortality rates. Therefore, non-hospital centers must be prepared to deal ‎with such emergency cases that may occur in the geographic area of activity of these centers. ‎The aim of this study was to identify prevalent domains related to the preparedness of non-‎hospital centers to deal with the LTE using of healthcare providers’ and experts’ perspectives. ‎

Methods:

A qualitative exploratory study was applied using Semi-Structured Interviews (SSIs) and Focus ‎Group Discussions (FGDs). Prior to beginning on data collection, the study and its aims were ‎explained to participants and their informed consents were obtained. Then SSIs and FGDs were ‎conducted by two trained researchers using an interview guide, which was developed through ‎literature review and consulting experts. In total, 12 SSIs were carried out with 4 clinical ‎officers, 2 nurses and 6 physicians at different non-hospital centers in Tabriz. In addition, 2 ‎FGDs were conducted with specialists in emergency medicine, primary health care, and ‎executives of health centers, with over 5 years of work experience. Purposive sampling method ‎was used as tool to select participants who have sufficient knowledge in our research scope. All ‎SSIs and FGDs were transcribed and immediately recorded word by word. Framework Analysis ‎was employed to manually analyze the interview transcripts from all the SSIs and FGDs. ‎

Results:

The interview transcripts analysis resulted in the emergence of 3 domains and 11 sub-domains, ‎categorized according to Donabedian’s triple model. 3 sub-domains were related to inputs, ‎including fundamental infrastructures, support facilities, and human resources. 6 sub-domains ‎were related to processes, including clinical interventions, maintenance of equipment, medicine ‎storage capability, educating and training, infection control, and quality control. Finally, 1 sub-‎domain was related to outcome, which was also patient’s satisfaction. ‎

Conclusions:

Existence of an efficient and effective assessment system can play a pivotal role in identifying ‎the capabilities of non-hospital centers. Therefore, the results of this study can assist health ‎managers to assess the preparedness of these centers.‎

Keywords:

Non-hospital Health centers, Preparedness, Assess, Life-threatening emergency

Developing and validating an instrument to assess non-hospital health centers’ preparedness to provide initial emergency care: a sequential exploratory mixed-method study

Background:

Methods:

Results:

Conclusions:

Keywords:

Developing and validating an instrument to assess non-hospital health centers' preparedness to provide initial emergency care: a study protocol

INTRODUCTION

Basic emergency management in urban and rural areas is a critical challenge. This paper presents the protocol for developing, validating and piloting an instrument to assess the preparedness of non-hospital health centres which deliver initial emergency care.

METHODS AND ANALYSIS

This study will be designed based on a sequential exploratory mixed method in two phases, in each of which there are three steps. In the first step of phase I, an extensive systematic review will be conducted. In the second step, through focus group discussions (FGDs), the experts' views on the definition of domains and items of the instrument will be compiled. In addition, semistructured interviews with the target group will be performed. Then, qualitative framework analysis will be performed. In the last step of phase I, the results of both steps will be triangulated by a panel of experts to define the domains and items to be included in the instrument. Phase II will include content validity, feasibility and reliability of the instrument. Content validity of the instrument will be assessed using modified Kappa coefficient based on clarity and relevance criteria. Feasibility of the instrument will be assessed through its implementation in 10 non-hospital health centres in Tabriz, which will be selected randomly. Reliability will be assessed in a pilot on 30 non-hospital health centres through using stratified random sampling method. Reliability of the instrument will be assessed through measuring internal consistency, test-retest reliability and inter-rater agreement. The main statistical methods for assessing reliability will include Cronbach's alpha, intraclass correlation coefficient and Kendall's tau-b. All the statistical analyses will be performed using Stata V.14.

ETHICS AND DISSEMINATION

This study is approved by Tabriz University of Medical Sciences Research Ethics Committee (IR.TBZMED.REC.1397.145). The results of the study will be presented at national scientific conferences and published in peer-reviewed journals.

Detecting selection signatures in three Iranian sheep breeds

The objective of genome mapping is to achieve valuable insight into the connection between gene variants (genotype) and observed traits (phenotype). Part of that objective is to understand the selective forces that have operated on a population. Finding links between genotype-phenotype changes makes it possible to identify selective sweeps by patterns of genetic variation and linkage disequilibrium. Based on Illumina 50KSNP chip data, two approaches, XP-EHH (cross-population extend haplotype homozygosity) and F_ST (fixation index), were carried out in this research to identify selective sweeps in the genome of three Iranian local sheep breeds: Baluchi (n = 86), Lori-Bakhtiari (n = 45) and Zel (n = 45). Using both methods, 93 candidate genomic regions were identified as harboring putative selective sweeps. Bioinformatics analysis of the genomic regions showed that signatures of selection related to multiple candidate genes, such as HOXB9, HOXB13, ACAN, NPR2, TRIL, AOX1, CSF2, GHR, TNS2, SPAG8, HINT2, ALS2, AAAS, RARG, SYCP2, CAV1, PPP1R3D, PLA2G7, TTLL7 and C20orf10, that play a role in skeletal system and tail, sugar and energy metabolisms, growth, reproduction, immune and nervous system traits. Our findings indicated diverse genomic selection during the domestication of Iranian sheep breeds.

Assessing Preparedness of Non-Hospital Health Centers to Provide Primary Emergency Care; A Systematic Review

Objectives

To identify prevalent domains related to the concept of assessing preparedness of non-hospital centers to provide primary emergency care in order to develop a comprehensive framework.

Methods

Five databases including PubMed, Scopus, Web of science, Barakat Knowledge Network Systems (BKNS) and Scientific Information Database (SID) were searched in English and/or Persian languages with no time limit until March, 2018. Manual search and grey literature were also done. According to the eligibility criteria, all the studies were independently tracked by two researchers. Studies were appraised using the Mixed Methods Appraisal Tool (MMAT). The findings were synthesized through directed content analysis method.

Results

Out of 3014 studies, 15 studies were included for data synthesis. The synthesis of literature resulted in the emergence of 13 domains and 25 sub-domains. Then, they were categorized based on Donabedian's triple model and a conceptual framework was developed. In this framework, 6 domains were put in input, 6 in processes, and 1 domain in outcome. Of the 15 included studies, 1 study considered 10 domains and 14 other studies considered 4 to 8 domains out of 13 synthesized domains. The most prevalent synthesized domains were "medical supplies and equipment" and "human resources", which were considered in 15 studies.

Conclusion

In this study, a conceptual framework was constructed that identifies elements that significantly affect the preparedness of these centers. This framework may assist managers to take a comprehensive approach to assess these centers.

A mechanistic insight into the effect of piperidine as an organocatalyst on the [3 + 2] cycloaddition reaction of benzalacetone with phenyl azide from a computational study

Several transition structures (TSs) for catalyst-free [3 + 2] cycloaddition and two plausible mechanistic pathways for the organocatalyzed [3 + 2] cycloaddition (32CA) between benzalacetone and phenyl azide were located by quantum chemistry methods. Calculations were carried out with B3LYP, MPWB1K and M06-2X functionals using 6-31G(d) and 6-311G(d,p) basis sets in gas and solvent phases. The calculated activation barriers imply that the lowest barrier pathway is the catalyzed process producing 3-regioisomers through the iminium intermediate and not through the dienamine route. Electronic displacements along the reaction path have been examined using a topological analysis of the electron-localization function (ELF). ELF topological analyses along the intrinsic reaction coordinates (IRC) of both catalyzed and uncatalyzed 32CA reactions indicated that while the first C1-N1 single bond is formed as a dative bond, the formation of the second C2-N3 bond takes place via a C-to-N coupling between the interacting centers of the reagents. Moreover, the ELF analyses imply that the reaction mechanism is a two-stage one-step process in the presence of a piperidine organocatalyst, while bond formation in an uncatalyzed process is almost synchronous.

The origin of regio- and stereoselectivity in the 1,3-dipolar cycloaddition of nitrile oxides with C1-substituted 7-oxabenzonorbornadienes, a DFT study

The origin ofexo/antiselectivity in the 1,3-dipolar cycloaddition of nitrile oxides with C₁-substituted 7-oxabenzonorbornadienes has been investigated theoretically.