Chloroplast DNA Diversity of Tunisian Barley Landraces as Revealed by cpSSRs Molecular Markers and Implication for Conservation Strategies.

In Tunisia, barley local landraces are still cropped for human and animal consumption in some subsistence farming systems under marginal and stressed conditions. These high-value genetic resources present a potential source of resistance genes to biotic and abiotic stresses useful for both national and international breeders. Actually, they are represented by threatened small populations, which face a high risk of genetic erosion and progressive substitution by modern varieties. In this study, the genetic diversity of 60 Tunisian barley landraces was assessed using six chloroplast microsatellites. All loci were found polymorphic, with 2 or 3 alleles per locus. Thirteen alleles were detected across the studied sample, which were combined into 8 haplotypes, giving a haplotype diversity (Hd) of 0.847. High punctual and haplotype genetic diversity was observed for Tunisian barley landraces when compared to other germplasms from other regions of the world. The genetic structure analysis revealed two major clusters of Tunisian barley landraces, which confirms their multiorigin. This result was corroborated by the median-joining network showing the genetic relationships among the eight detected haplotypes. The AMOVA analysis revealed that 83% of the genetic variation is between populations, which requires the in situ and ex situ conservation of plant material for all Tunisian populations of barley landraces. Information on genetic variation within the chloroplast genome is of great interest to ensure an efficient conservation strategy that takes into account the preservation of the various maternal lineages of Tunisian barley.

Design and Rationale of the National Tunisian Registry of Heart Failure (NATURE-HF): Protocol for a Multicenter Registry Study.

BACKGROUND: The frequency of heart failure (HF) in Tunisia is on the rise and has now become a public health concern. This is mainly due to an aging Tunisian population (Tunisia has one of the oldest populations in Africa as well as the highest life expectancy in the continent) and an increase in coronary artery disease and hypertension. However, no extensive data are available on demographic characteristics, prognosis, and quality of care of patients with HF in Tunisia (nor in North Africa). OBJECTIVE: The aim of this study was to analyze, follow, and evaluate patients with HF in a large nation-wide multicenter trial. METHODS: A total of 1700 patients with HF diagnosed by the investigator will be included in the National Tunisian Registry of Heart Failure study (NATURE-HF). Patients must visit the cardiology clinic 1, 3, and 12 months after study inclusion. This follow-up is provided by the investigator. All data are collected via the DACIMA Clinical Suite web interface. RESULTS: At the end of the study, we will note the occurrence of cardiovascular death (sudden death, coronary artery disease, refractory HF, stroke), death from any cause (cardiovascular and noncardiovascular), and the occurrence of a rehospitalization episode for an HF relapse during the follow-up period. Based on these data, we will evaluate the demographic characteristics of the study patients, the characteristics of pathological antecedents, and symptomatic and clinical features of HF. In addition, we will report the paraclinical examination findings such as the laboratory standard parameters and brain natriuretic peptides, electrocardiogram or 24-hour Holter monitoring, echocardiography, and coronarography. We will also provide a description of the therapeutic environment and therapeutic changes that occur during the 1-year follow-up of patients, adverse events following medical treatment and intervention during the 3- and 12-month follow-up, the evaluation of left ventricular ejection fraction during the 3- and 12-month follow-up, the overall rate of rehospitalization over the 1-year follow-up for an HF relapse, and the rate of rehospitalization during the first 3 months after inclusion into the study. CONCLUSIONS: The NATURE-HF study will fill a significant gap in the dynamic landscape of HF care and research. It will provide unique and necessary data on the management and outcomes of patients with HF. This study will yield the largest contemporary longitudinal cohort of patients with HF in Tunisia. TRIAL REGISTRATION: ClinicalTrials.gov NCT03262675; https://clinicaltrials.gov/ct2/show/NCT03262675. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/12262.

Strategies for improvement of blood consumption management in the operating rooms: experts´ suggestions.

Background: In operating rooms, blood product wastage occurs with various reasons especially over-demand ordering during elective surgeries. Consequently, it imposes a heavy financial burden on health system. Therefore, managing blood consumption in the operating rooms is of special importance. Surgeons and anesthesiologists play a key role in blood transfusion practice in operating rooms. Objective: To investigate surgeons´ and anesthesiologists´ perspectives in regard to the effective strategies for better management of blood transfusion practice in operating rooms. Method: In this qualitative cross-sectional study, from January to March 2020, 60 surgeons and anesthesiologists were participated. All of them were working in surgical departments of the general hospitals affiliated with Shiraz University of Medical Sciences, in Shiraz, Southern Iran. Their viewpoints regarding the improvement of blood consumption management in operating rooms were recorded through interviews and several focus group sessions. Results: After content analysis, the most important recommendations with the highest scores were regular training programs for surgical team (23.3%), collaboration of surgeons, anesthesiologists, and managers of the surgical departments by arrangement of monthly meetings to estimate the number of required blood bags more accurately (23.3%), establishing a well-organized electronic requesting and registration system (13.3%), promoting the ordering process by a comprehensive preoperative evaluation (11.6%), and updating transfusion protocols based on the standards and monitoring the adherence to these standards (10%). Conclusion: Implementing the proposed policies, which are based on the invaluable experiences of related experts would be effective in improving blood consumption management in operating rooms.

Adapted fairness benchmarks for the evaluation of Iran health system reform.

INTRODUCTION: This study has been designed to localize fairness benchmarks for the evaluation of health system reform with an ethical approach. METHODS: A descriptive-analytic study was applied in which a questionnaire with selected indicators and based on main fairness benchmarks was validated. Besides, the final indicators were chosen for surveys of 255 health equity experts from 31 provinces of Iran to localize fairness benchmarks using the exploratory factor analysis through the SPSS software. RESULTS: Seven fairness benchmarks were adopted: (1) Efficacy, Efficiency, and Quality of Health Care; (2) Impact of Information Infrastructure on Health Reform; (3) Responsiveness; (4) Equitable Access, and Universal Health Coverage; (5) Equitable Financing; (6) Social Determinant of Health; and (7) Financial Barriers to Equitable Access. CONCLUSION: The priorities of fairness benchmarking through localization included focusing on the quantity and quality of primary health care, allocating resources based on the need; for equitable efficiency, and paying attention to community-based information infrastructure, and social determinants for fair reform. Moreover, respecting patient rights as a part of democratic accountability was more close to equity. Elimination of financial and nonfinancial barriers for health access and coverage based on vulnerability, through fair financing, was also confirmed.

New insights into the intraspecific cytoplasmic DNA diversity, maternal lineages classification and conservation issues of Tunisian pearl millet landraces.

Tunisian pearl millet (Pennisetum glaucum L.) landraces are still growing in contrasting agro-ecological environments and are considered potentially useful for national and international breeders. Despite its genetic potential, the cropping areas of this species are still limited and scattered which increases the risk of genetic erosion. The chloroplast DNA polymorphism and maternal lineages classification of forty nine pearl millet landraces representing seven populations covering the main distribution area of this crop in Tunisia were undertaken based on informative cpSSR molecular markers. A total of 21 alleles combining to 9 haplotypes were detected with a mean value of 3.5 alleles per locus and a haplotype genetic diversity (Hd) of 0.82. The number of chloroplast haplotypes per population ranged from 1 to 4 with an average of 1.28. The haplotypes median-joining network and UPGMA analyses revealed two probable ancestral maternal lineages with a differential pearl millet seed-exchange rate between the investigated areas. Northern and Central populations presented unique genetic backgrounds while historical farmers' practices in the South-East area resulted in the isolation of their own local landraces. The genetic evidences strongly support at least two introduction origins of pearl millet in Tunisia, one in the North and the other in the South followed by distinct local dispersal histories. Complementary in-situ and ex-situ conservation strategies taking into account the conservation of the maternal lineage cytoplasmic diversity are required. The investigated chloroplast SSRs provide useful molecular markers which could be used in further genetic studies and breeding surveys of pearl millet genetic resources.

Epidemiology of heart failure and long-term follow-up outcomes in a north-African population: Results from the NAtional TUnisian REgistry of Heart Failure (NATURE-HF).

The NATURE-HF registry was aimed to describe clinical epidemiology and 1-year outcomes of outpatients and inpatients with heart failure (HF). This is a prospective, multicenter, observational survey conducted in Tunisian Cardiology centers. A total of 2040 patients were included in the study. Of these, 1632 (80%) were outpatients with chronic HF (CHF). The mean hospital stay was 8.7 ± 8.2 days. The mortality rate during the initial hospitalization event for AHF was 7.4%. The all-cause 1-year mortality rate was 22.8% among AHF patients and 10.6% among CHF patients. Among CHF patients, the older age, diabetes, anemia, reduced EF, ischemic etiology, residual congestion and the absence of ACEI/ ARBs treatment were independent predictors of 1-year cumulative rates of rehospitalization and mortality. The female sex and the functional status were independent predictors of 1-year all-cause mortality and rehospitalization in AHF patients. This study confirmed that acute HF is still associated with a poor prognosis, while the mid-term outcomes in patients with chronic HF seems to be improved. Some differences across countries may be due to different clinical characteristics and differences in healthcare systems.

Developing a Shared Decision-Making Model for Diabetic Patients: A Qualitative Study.

Background: Patient participation in healthcare leads to increased satisfaction and trust, reduction of anxiety, and a better understanding of patients' needs. The components of shared decision-making (SDM) are well documented in the literature. The purpose of this study was to design an SDM model for diabetic patients. Materials and Methods: This qualitative content analysis study was performed in three steps. First, a descriptive comparative study was conducted using the widely-used George Brady method. Next, the perceptions of participants (both physicians and patients) were collected via interview and in focus group discussions (FGDs). Content analysis was used to categorize the comments made by participants. In the final step, the model of SDM for diabetic patients was designed based on expert panel discussions. Results: Twelve components were extracted from the comparative study. Two themes and six sub-themes were extracted from data resulting from physicians' interviews, and two themes and ten sub-themes were extracted from data resulting from the FGDs involving patients. The model of SDM for diabetic patients was designed in light of three concepts; practitioners' behavior, participatory decision-making process, and patients' autonomy. Conclusion: This model was valuable because it recognizes the process of SDM in the context of Iran. The model's main purpose was to help choose optimum strategies for the care of diabetic patients within the health sector.

Interspecific variability of 1,8-cineole content, phenolics and bioactivity among nine Eucalyptus taxa growing under the sub-humid bioclimate stage.

Background Eucalyptus essential oils and extracts are used since the ancient times in alternative medicine. The 1,8-cineole is the most significant constituent of Eucalyptus essential oil, while phenolic contents define the value of eucalyptus extracts. Based on the last considerations, interspecific variability of 1,8-cineole content, phenolics and antioxidant potentials among nine Eucalyptus taxa growing under the sub-humid bioclimate stage of Tunisia was investigated. Methods Essential oil profiling was assessed based on gas chromatography-mass spectrometry analysis. Total phenolic and flavonoid contents were assessed using Folin-Ciocalteau and aluminium chloride colorimetric methods, respectively. The antioxidant ability of Eucalyptus volatile metabolites and extracts was achieved based on two test systems namely DPPH and FRAP assays. Results Qualitative and quantitative variations in the composition of essential oils according to the studied taxon were shown. The total phenolic and flavonoid contents varied also significantly among the investigated samples. Based on the obtained results, the species Eucalyptus sideroxylon exhibits the highest 1,8-cineole content (76.24 ± 0.86), total phenolics and flavonoids contents (38.5 ± 1.4 mg GAE /g DW and 18.6 ± 0.3 mg RE /g DW, respectively). Moreover this species highlighted the highest free radical-scavenging ability and ferric reducing power for both essential oil and methanolic extracts. Chemometric multivariate analysis showed the classification of the nine studied taxa to three clusters. Conclusions The pattern of 1,8-cineole concentration, phenolic and flavonoid contents for the studied nine Eucalyptus species and hybrid showed E. sideroxylon species as the potential candidate for further improvement strategies regarding the production of eucalyptus essential oils and phenolics with high quality for pharmaceutical industry.

Develop the World Health Organization Assessment Instrument for Mental Health System (WHO-AIMS) In IRAN / Desarrollar el instrumento de evaluación de la Organización Mundial de la Salud para el sistema de salud mental (WHO-AIMS) en IRÁN

Introduction: The tool for assessing the Mental Health System of the World Health Organization has been used in different countries in different countries,by which examining the mental health system and identifying their problems along with finding out the instrumental problems are done simoltaneously. Objetive: this study was conducted in order to develop the means of evaluating the mental health system organization of the world health organization in iran. Method: This research is based on the implementation, analytical, and in terms of variables, combination (qualitative and quantitative), and purposeful, exploratory, and from the perspective of the result, an application that was carried out in six phases. Phase I: Review of texts that have been used to recognize the status of countries Different and Iran. Phase II: The status of mental health system in Khuzestan province was investigated and the problems of mental health system and instrumental problems were determined. Phase III: weaknesses and strengths of the mental health system evaluation tool were surveyed in Khuzestan province, Phase IV: To identify the key components of the WHO Mental Health Routing Program and the 2013-2015 operational plan for development of tools, in the fifth phase: The proposed components were embedded in each main field of the tool, and the content of the content validity and content validity index were evaluated by the experts. Result: Finally, 11 main components were identified and 95 questions were designed for them, which in the sixth phase these questions Mental Health Managers were given an exploratory and confirmatory factor analysis and identified their main factors and their impact on the development of the Mental Health Assessment System of the World Health Organization. Using PLS software from 11 components and 95 suggested questions, 6 factors influencing The development of tools has been identified whose impact coefficients include: Leadership and Governance (0.972), mental health and e-service use (0.929), Policy and Legislative Framework (0.697), status analysis (0.613), mental health services pattern for common disorders (0.413), mental health promotion services (0.259). Conclusion: The development of the Mental Health Assessment Tool of the World Health Organization in Iran will help identify the mental health gap and, with regard to the problems, will be the best pattern for providing mental health services

Introducción: La herramienta para evaluar el Sistema de Salud Mental de la Organización Mundial de la Salud se ha utilizado en diferentes países en diferentes países, mediante el cual el examen del sistema de salud mental y la identificación de sus problemas junto con el descubrimiento de los problemas instrumentales se realizan de forma simultánea. Objetive: este estudio se realizó con el fin de desarrollar los medios para evaluar la organización del sistema de salud mental de la organización mundial de la salud en Irán. Método: Esta investigación se basa en la implementación, analítica y en términos de variables, combinación (cualitativa y cuantitativa), y con una finalidad, exploratoria y, desde la perspectiva del resultado, una aplicación que se realizó en seis fases. Fase I: Revisión de textos que se han utilizado parareconocer el estado de países diferentes e Irán. Fase II: Se investigó el estado del sistema de salud mental en la provincia de Khuzestan y se determinaron los problemas del sistema de salud mental y los problemas instrumentales. Fase III: se examinaron las debilidades y fortalezas de la herramienta de evaluación del sistema de salud mental en la provincia de Khuzestan, Fase IV: para identificar los componentes clave del Programa de Enrutamiento de Salud Mental de la OMS y el plan operativo 2013-2015 para el desarrollo de herramientas, en la quinta fase : Los componentes propuestos se integraron en cada campo principal de la herramienta, y los expertos evaluaron el contenido de la validez de contenido y el índice de validez de contenido. Resultado: Finalmente, se identificaron 11 componentes principales y se diseñaron 95 preguntas para ellos, que en la sexta fase a estas Gerentes de Salud Mental se les realizó un análisis factorial exploratorio y confirmatorio e identificaron sus factores principales y su impacto en el desarrollo de la Salud Mental Sistema de evaluación de la Organización Mundial de la Salud. Utilizando el software PLS de 11 componentes y 95 preguntas sugeridas, se han identificado 6 factores que influyen El desarrollo de herramientas cuyos coeficientes de impacto incluyen: Liderazgo y Gobernanza (0,972), salud mental y uso de servicios electrónicos (0,929), Marco Político y Legislativo (0.697), análisis de estado (0.613), patrón de servicios de salud mental para trastornos comunes (0,413), servicios de promoción de salud mental (0,259). Conclusión: El desarrollo de la Herramienta de evaluación de salud mental de la Organización Mundial de la Salud en Irán ayudará a identificar la brecha de salud mental y, con respecto a los problemas, será el mejor patrón para proporcionar servicios de salud mental.

Design of a Model for Management of Referral System in the Iranian Urban Family Physician Program.

BACKGROUND: The purpose of this research was to identify the main dimensions of management of referral systems in family physician program and then introduce them to policymakers of the country primary health care. METHODS: This descriptive-correlation study was designed in Mazandaran Province, northern Iran (2017). The participants were employees of health centers of Mazandaran and Fars Provinces, Iran. The dimensions influencing on the referral system were identified systematically in the selected countries by using researcher-made questionnaire according to a statistical method called Factor Analysis. The data sufficiency was evaluated by the Bartlett's and Kaiser-Meyer-Olkin's tests. Reliability of test was calculated and confirmed according to Cronbach's Alpha and Combined Reliability tests. Validity of the test was calculated and confirmed based on the average variance extracted (AVE). RESULTS: In confirmatory factor analysis, coefficient of effect of Electronic Health Record on referral system (as the most important dimension), coefficient of Family Physician, coefficient of structure of insurance, coefficient of policymaking in health care system, coefficient of proper stewardship of health system, and basic health care services, were 0.887, 0.877, 0.860, 0.804, 0.568, and 0.522, respectively. CONCLUSION: Six effective dimensions including Electronic Health Record (as the most important dimension), family physician, structure of insurance, policymaking in health care system, proper stewardship of health system, and basic health care services were identified. According to six effective dimensions on management model of the referral system in the Iranian urban family physician program, the health system authorities pay serious attention to the six identified dimensions of the current study to improve the health of the urban community.

A Singular Manifestation of Contrast-induced Encephalopathy Following Coronary Angiography.

Contrast-induced encephalopathy is an uncommon complication of coronary angiography. The clinical presentation may be very puzzling, leading to an unnecessary and hazardous therapy. The prognosis is believed to be benign, with spontaneous resolution. We report a 71-year-old woman with a past medical history of hypertension, type two diabetes and no history of renal disease. She was admitted to our cardiology department with symptoms of recurrent angina. She had a history of unstable angina two years ago and had undergone a percutaneous coronary intervention without incident. Three hours after un-elective coronary angiography, she experienced a sudden, transitory deterioration in her consciousness's level with neurovegetative symptoms (high blood pressure, high temperature). The cerebral Computer Tomography scan ruled out any acute hemorrhagic or ischemic stroke. In less than 24 hours, she recovered spontaneously with a complete resolution of the neurological symptoms.

Conservation priorities for endangered coastal North African Pennisetum glaucum L. landrace populations as inferred from phylogenetic considerations and population structure analysis.

The increasing anthropologic pressure and the modernization of agriculture have led to a forsaking of pearl millet traditional cultivars, inducing a progressive loss of the genetic variability encompassed in this locally adapted germplasm. Imperatively, national efforts based on robust data gleaned from genetic surveys have to be undertaken in order to set up suitable conservation priorities. In this study, in addition to the assessment of the genetic diversity and population structure among and within a set of seven pearl millet landrace populations from coastal North Africa, demographic and phylogenetic data, conservation priority scores were calculated according to Vane-Wright et al. (1991). To date, genetic diversity of pearl millet in North Africa is still poorly documented. The present survey reports for the first time the use of highly informative nSSR markers (PIC = 0.74) on Pennisetum glaucum landraces representative of the Mediterranean coastline of North Africa. A high level of genetic diversity was obtained within the investigated landraces (He = 0.80) at the population level. FST, AFC-3D, and Bayesian clustering underlined significant differentiation and an apparent genetic structure, according to geographical origin. Phylogenetic considerations integrated with demographic and genetic information enabled conclusive inferences of highly prioritized populations for conservation. Populations Haouaria, Hammem Laghzez, Mahdia, and Medenine, representatives of the main pearl millet growing areas in Tunisia and cultivated in the North African littoral, should be strongly recommended for an ex situ conservation program. Dynamic on-farm conservation method is also required as it allows the local landraces to evolve in different environments, while maintaining their adaptation potentials.

Metabolomic fingerprint of Mentha rotundifolia L. Leaf tissues promotes this species as a potential candidate for sustainable production of biologically active molecules.

Background The Mentha rotundifolia L. (Lamiaceae family), is a medicinal herb used since the ancient times as an antiseptic, analgesic and anti-inflammatory agent. In the present work, metabolomic profiling of two Mentha rotundifolia L. ecotypes leaf tissues spontaneously growing in the North of Tunisia was achieved. Methods Phenolic contents (TPC, TFC and TTC) were assessed using colorimetric methods. Metabolomic profiling of leaf tissues extracts was assessed based on Gas Chromatography-Mass Spectrometry (GC/MS) analysis. The antioxidant ability of M. rotundifolia extracts was achieved based on two test systems namely DPPH and FRAP assays. Antimicrobial activity against a set of Gram negative and Gram positive bacteria was estimated by measuring ID, MIC and MBC values. Results Fifty metabolites were identified as belonging mainly to phenolics, fatty acids, terpenes, steroids and aldehydes classes with qualitative and quantitative variability. Most of the identified compounds are reputed bioactive with potent antioxidant, antimicrobial and anti-inflammatory among others effects. To confirm these findings common in vitro biological activities were achieved. The investigated extracts showed significant antioxidant abilities based on both 1,1-diphenyl-2-picrylhydrazyl (DPPH) and Ferric reducing antioxidant potential (FRAP) assays. Furthermore, the extracts revealed promising antimicrobial ability against tested Gram+ and Gram- bacterial strains (ID: 12.5-14.5 mm, MIC: 3.125-25 (µg/mL), MBC: 6.25-100 (µg/mL)). Conclusions Based on our findings Mentha rotundifolia L. leaves extracts present a potential source of natural antioxidants and diverse bioactive compounds which could be used in green pharmacy, food preservation, alternative medicine and natural therapies.

Fingerprinting and genetic purity assessment of F1 barley hybrids and their salt-tolerant parental lines using nSSR molecular markers.

Hybridity and the genuineness of hybrids are prominent characteristics for quality control of seeds and thereby for varietal improvement. In the current study, the cross between two local barley genotypes (Ardhaoui: female; Testour: male) previously identified as susceptible/tolerant to salt stress in Tunisia was achieved. The hybrid genetic purity of the generated F1 putative hybrids and the fingerprinting of the parents along with their offspring were assessed using a set of 17 nuclear SSR markers. Among the analyzed loci, 11 nSSR were shown polymorphic among the parents and their offspring. Based on the applied 11 polymorphic SSR loci, a total of 28 alleles were detected with an average of 2.54 alleles per locus. The locus HVM33 presented the highest number of alleles. The highest polymorphism information content value was detected for the locus HVM33 (0.6713) whereas the lowest PIC value (0.368) was revealed by the loci BMAC0156, EBMAC0970 and BMAG0013 with a mean value of 0.4619. The probabilities of identical genotypes PI for the 11 microsatellite markers were 8.63 × 10-7. Banding patterns among parents and hybrids showed polymorphic fragments. The 11 SSR loci had produced unique fingerprints for each analyzed genotype and segregate between the two parental lines and their four hybrids. Parentage analysis confirms the hybrid purity of the four analyzed genotypes. Six Tunisian barley accessions were used as an outgroup in the multivariate analysis to confirm the efficiency of the employed 11 nSSR markers in genetic differentiation among various barley germplasms. Thus, neighbor joining and factorial analysis revealed clearly the discrimination among the parental lines, the four hybrids and the outgroup accessions. Out of the detected polymorphic 11 nuclear SSR markers, a set of five markers (HVM33, WMC1E8, BMAC0154, BMAC0040 and BMAG0007) were shown to be sufficient and informative enough to discriminate among the six genotypes representing the two parental lines and the four hybrids from each others. These five nSSR markers presented the highest number of alleles per locus (An), expected heterozygosity (He), PIC values and the lowest probabilities of identity (PI). These nSSR loci may be used as referral SSR markers for unambiguous discrimination and genetic purity assessment in barley breeding programs.

Patterns of genetic structure and evidence of gene flow among Tunisian Citrus species based on informative nSSR markers.

This study investigates the extent of genetic diversity, phylogenetic relationships and the amount of gene flow among Tunisian Citrus species based on a set of 15 informative nuclear SSR molecular markers. Genotyping data highlighted an allelic richness among Tunisian Citrus species and has allowed the detection of 168 alleles among them 104.19 were effective. The partition of the total genetic diversity (HT=0.832) showed that the highest amount of variation within the Citrus species is HS=0.550, while the relative amount of the between-species genetic diversity GST does not exceed 0.338. This pattern of genetic structure was supported by low-to-moderate FST pairwise values and the presence of a gene flow (Nm) among the eight Citrus species. The lowest genetic differentiation was revealed between the species C. sinensis and C. insitorum (FST=0.111, Nm=1.99), while the highest genetic differentiation was recorded between the species C. aurantifolia and C. paradisi (FST=0.367, Nm=0.43). The established Neighbor Joining analysis showed that all genotypes were widely discriminated and clearly pooled according to their species of origin, with minor exceptions.

The Relationship Between the Customer Relationship Management and Patients' Loyalty to Hospitals.

BACKGROUND & AIM: Customer Relationship Management (CRM) with its various components has been considered as a tool causing customers' loyalty. The present study aims to investigate the relationship between the various components of customer relationship management and patients' loyalty to the place of their treatment. METHODS: This cross sectional and descriptive-analytical study was conducted among nurses and hospitalized patients in inpatient wards in selected hospitals in 2014. Using the stratified random sampling method, 224 valid and reliable researcher-drafted questionnaires were completed for CRM by nurses and 359 questionnaires were completed by patients for patients' loyalty in the studied wards. Data were analyzed using the SPSS(20) software. RESULTS: There was no statistically significant relationship between the level of patients' loyalty and organizational indicators, information technology and knowledge management (P Value>0.05). However, there was a statistically significant relationship between loyalty and the dimensions of the service process (P Value=0.04), human resources (P Value=0.002) and CRM (P Value=0.038). The strength of these relationships were 34, 40 and 36 percent, respectively all of which were positive. CONCLUSION: Customer Relationship Management is a tool for improving influencing factors on patients' satisfaction and loyalty. Therefore, attempts to implement customer relationship management as a process for improving hospitals performance and improving communication between service providers in hospitals and customers leading to enhance patients' loyalty should be taken into account by managers and policy makers in the health sectors.

Effectiveness of Five-Level Emergency Severity Index Triage System Compared With Three-Level Spot Check: An Iranian Experience.

BACKGROUND: Triage for patients' prioritization in the emergency department is a suitable solution to decrease overcrowding. Different methods are used for prioritization that needs effectiveness evaluation. OBJECTIVES: The aim of this study was to assess the effectiveness of the emergency severity index (ESI) 5-level triage system in contrast with spot check triage. PATIENTS AND METHODS: Data for this quasi-experimental study were extracted using a form to review 770 records of patients referred to emergency department of Imam Khomeini hospital (in Sari, north of Iran) during two separated periods each for four months; the first from 20th March to 19th July 2010 and the other from 21 March to 20 July 2011. The method used in the first time was spot check triage and the second one ESI triage. Data were processed with descriptive statistics and analyzed using independent samples t-test (CI = 95%). RESULTS: Increase from 6.46 to 8.92 minutes in the average time from patient arrival to being visited by a physician (P < 0.001) and increase in average time from physician visit to receive the first nursing care from 7.68 to 15.89 minutes were significant (P < 0.001). The average waiting time for laboratory services was significantly decreased from 112.3 to 84.1 (P = 0.033). Increase in the average waiting time for radiology, decrease in average waiting time for sonography, average length of stay in the emergency department, and number of patients per emergency bed were not significant. CONCLUSIONS: Between the two systems of triage, ESI was more effective than the spot check and in the spatial and temporal domain of research, was a successful method in improving some indicators of emergency and improving the performance indices. Hospital managers by implementation of ESI system can take a step toward new health policies and improve the processes as key tools of continuous quality improvement system.

Genetic diversity of wild and cultivated grapevine accessions from southeast Turkey.

Wild grapevine genetic diversity in southeast Turkey has not been documented to date. In the present work, in order to clarify the relationships between wild and cultivated grape accessions from southeastern Turkey, 22 nuclear and three chloroplast microsatellite loci were used on 21 wild grapevine Vitis vinifera L. ssp. sylvestris (Gmelin) and 13 cultivated grapevine Vitis vinifera ssp. sativa accessions. The number of alleles per SSR locus ranged from 4 (VVIn16) to 20 (VVIv67) and the mean allele number per locus was 10.09. Expected locus heterozygosity ranged from 0.586 (locus VVIb01) to 0.898 (locus (VVIv67)). The three cpSSR molecular markers presented variation in size both in cultivars and in wild Turkish accessions. Two size variants were detected for cpSSR3 (106 and 107 bp) for cpSSR5 (104 and 105 bp), and for cpSSR10 (115 and 116 bp). The six alleles in wild grapevines fell into three haplotypes B, C and D. A genetic structure according to accessions taxonomic status (wild or cultivated) was revealed by UPGMA analysis. This highlighted a clear separation between domesticated and wild accessions in Turkish germplasm. The results pointed out the need to further collect and characterize this wild and cultivated grapevine germplasm.

Ethylene response factor Sl-ERF.B.3 is responsive to abiotic stresses and mediates salt and cold stress response regulation in tomato.

Sl-ERF.B.3 (Solanum lycopersicum ethylene response factor B.3) gene encodes for a tomato transcription factor of the ERF (ethylene responsive factor) family. Our results of real-time RT-PCR showed that Sl-ERF.B.3 is an abiotic stress responsive gene, which is induced by cold, heat, and flooding, but downregulated by salinity and drought. To get more insight into the role of Sl-ERF.B.3 in plant response to separate salinity and cold, a comparative study between wild type and two Sl-ERF.B.3 antisense transgenic tomato lines was achieved. Compared with wild type, Sl-ERF.B.3 antisense transgenic plants exhibited a salt stress dependent growth inhibition. This inhibition was significantly enhanced in shoots but reduced in roots, leading to an increased root to shoot ratio. Furthermore, the cold stress essay clearly revealed that introducing antisense Sl-ERF.B.3 in transgenic tomato plants reduces their cell injury and enhances their tolerance against 14 d of cold stress. All these results suggest that Sl-ERF.B.3 gene is involved in plant response to abiotic stresses and may play a role in the layout of stress symptoms under cold stress and in growth regulation under salinity.