Factors Affecting Social Health from Young Adults' Perspective: A Qualitative Study.

BACKGROUND: Factors affecting social health, especially in young adults, are among the most important research priorities. Knowledge of social factors affecting young adults' health will lead to understand them in the social context. The present study is aimed to explain the perspective of young adults on social factors affecting health. METHODS: In the present qualitative content analysis study, semi-structured open interviews were conducted through targeted sampling of young volunteers aged 18-30 who were selected from Tehran Province. Interviews were recorded, transcribed, and analyzed. The inclusion criteria for participants were willingness to participate in the study and ability to express their personal experiences. Twenty-one data were collected through collection was done with individual in-depth interviews. RESULTS: Using this qualitative approach, the present study was conducted to identify factors affecting social health from the perspective of young adults. The analysis led to the extraction of three main categories, each with two or three subcategories: expectations regarding the community, expectations regarding the family, and expectations regarding infrastructures. CONCLUSIONS: Our findings shown that social support considered as effective elements in providing social health of young adults. The evidence on controlling factors should be considered in promoting the social health of specific target groups. The results of the present study could be used for better planning of interventions in youth social health domains.

Prevalence of medication adherence in patients with hypertension in Iran: A systematic review and meta-analysis of studies published in 2000-2018.

BACKGROUND: Medication adherence (MA) has a crucial role in controlling of hypertension (HTN). A difference was observed in the prevalence of anti-hypertensive MA reported in different studies in Iran, so we aimed to determine the overall prevalence of MA. METHODS: Using the English and Persian keywords extracted from Mesh, the databases of MagIran, Barakat Knowledge Network System, Scientific Information Database (SID), Web of Sciences, PubMed, Science Direct, and Google Scholar were reviewed from 2000 to 2018. The overall prevalence of MA was estimated using Random effect mode. The I2 and Egger's tests were used to assess heterogeneity and publication bias, respectively. Meta-regression and subgroup analysis were conducted based on variables such as age, marital status, regions, and tools. RESULTS: The overall prevalence of MA was 33%. Moreover, the prevalence of MA based on the 8-Item Morisky Medication Adherence Scale (MMAS-8), Hill-Bone Medication Adherence (HBMA) scale, researcher-made tools, and self-care tools, were 13%, 34%, 48%, and 47%, respectively. A higher MA prevalence (38%) was observed among older adults compared to other age groups, and married patients (32%) compared to single (23%) individuals. The highest MA prevalence (50%) was related to region 5 of the country. Meta-regression results showed a significant relationship between the used tools and MA prevalence. CONCLUSION: The overall prevalence of MA is low in Iran. Furthermore, MA was measured using different questionnaires, such as standard international scales and researcher-made tools. It is proposed that a standard international questionnaire should be used in future studies.

Prevalence of HTN in Iran: Meta-analysis of Published Studies in 2004-2018.

INTRODUCTION: Prevalence of hypertension (HTN) is increasing in the developing countries like Iran. Various studies have reported different rates of HTN in Iran. The purpose of this study was to estimate an overall prevalence of HTN in Iran. METHODOLOGY: Using the English and Persian key derived from Mesh, the databases including MagIran, Iran Medex, SID, Web of Sciences, PubMed, Science Direct and Google Scholar as a searching engine were reviewed: from 2004 to 2018. The overall prevalence of MA was estimated using Random effect model. The I2 test was used to assess the heterogeneity of the studies. Additionally, the quality of studies was evaluated using a standard tool. Publication bias was conducted with the Egger test. Meta-regression and analysis of subgroups were analyzed based on variables such as age, marital status, region and tools. Data were analyzed using STATA 12 software. RESULTS: Analysis of 58 primary articles with a sample size of 902580 showed that the prevalence of HTN in Iran was 25% (with 95% CI of 22-28). The highest prevalence of HTN was related to elderly (42%). The prevalence of HTN was 25% (95% CI: 19-31) in women and 24% (95% CI: 20-28) in men with no significant difference (p = 0.758). The results also indicated that the prevalence of HTN was not related to the year of studies (p = 0.708) or sample size (p = 769). CONCLUSION: Despite the advancements in science and technology, along with health and prevention of diseases, the overall prevalence of HTN raised in Iran. Since HTN is a silent disease with significant health consequences and economic burden, programs designed to better HTN control seem vital to enhance community health.

Conceptual Model of Medication Adherence in Older Adults with High Blood Pressure-An Integrative Review of the Literature.

BACKGROUND: Medication adherence (MA) is the most important controlling factor of high blood pressure (HBP). There are a few MA models, but they have not been successful in predicting MA completely. Thus, this study aimed to expand a conceptual model of MA based on an ecological approach. METHODS: An integrative review of the literature based on theoretical and empirical studies was completed. Data source comprised: Medline (including PubMed and Ovid), ISI, Embase, Google scholar, and internal databases such as Magiran, Google, SID, and internal magazines. Primary English and Persian language studies were collected from 1940 to 2018. The steps of study included: (a) problem identification, (b) literature review and extracting studies, (c) appraising study quality, (d) gathering data, (e) data analysis using the directed content analysis, (f) concluding. RESULTS: Thirty-six articles were finally included and analyzed. After analysis, predictors of MA in older adults with hypertension were categorized into personal, interpersonal, organizational, and social factors. Although the personal factors have the most predictors in sub-categories of behavioral, biological, psychological, knowledge, disease, and medication agents, social, organizational and interpersonal factors can have indirect and important effects on elderly MA. CONCLUSION: There are many factors influencing MA of elderly with HBP. The personal factor has the most predictors. The designed model of MA because of covering all predictor factors, can be considered as a comprehensive MA model. It is suggested that future studies should select factors for study from all levels of the model.

An explanatory model for the concept of mental health in Iranian youth.

Background: Mental health is considered as an integral and essential component of overall health. Its determinants and related factors are one of the most important research priorities, especially in adolescents and young people. Using a qualitative approach, the present study aimed to identify factors affecting the mental health of youth in Iran. Methods: In 2017, following content analysis principles, and using semi-structured in-depth interviews, we conducted a qualitative study exploring the opinions of young people about mental health. A targeted sampling method was used, and participants were young volunteers aged 18 to 30 who were selected from Tehran province, Iran. Inclusion criteria for participants was willingness to participate in the study, and ability to express their experiences. Data collection was done with individual in-depth interviews. According to the explanatory model, the interviews were directed toward the concept of mental health and path of causality and auxiliary behaviors. Results: 21 young adults participated, who met the study inclusion criteria, of whom 12 participants were male. Their mean age was 24.4 ± 0.41 years and their education varied from primary school to Master's degree. Mental health was considered as mental well-being and a sense of satisfaction and efficacy, not only the presence of a disease or mental disorder. Based on the opinions of the interviewees, three factors of personal characteristics, family and society are involved in mental health. Individual factors were associated with behavioral and physical problems. One of the most important issues was revealed as tensions in societal and family conflicts. Economic problems and unemployment of young people were also extracted from the social factor. Conclusion: In Iran, social factors such as jobs for the unemployed and job security are considered as important determinants in the mental health of young people.

Effects of Spiritual Group Therapy on Caregiver Strain in Home Caregivers of the Elderly with Alzheimer's Disease.

INTRODUCTION: Care of patients with Alzheimer's disease is one of the most difficult types of care that exposes the caregiver to a high level of care strain. The present research aimed at determining the effect of spiritual care on caregiver strain of the elderly with Alzheimer's disease. METHODS: An experimental study was carried out on 100 caregivers who were selected by convenience sampling and randomly divided into intervention, control one and control two groups. Group spiritual therapy was performed on the intervention group for five weeks, Control one participate in the group sessions without any particular interventions, and control two received no interventions. Data was collected through a demographic questionnaire and Robinson's (1983) Caregiver Strain Index, and analyzed using the Chi-square, Fisher's Exact test, one-way analysis of variance and paired t-test. Statistical significance level was considered as 0.05. RESULTS: In the intervention group mean of the posttest care strain score 32.43±2.73 was significantly lower than pretest 37.16±1.26 (P<0.001). The mean posttest score of care strain was significantly lower in the intervention group compared to the two other groups (P<0.001). CONCLUSION: Spiritual care can reduce care strain in home caregivers of the elderly with Alzheimer's disease.

Exploring the youth experience about sense of social security: a qualitative study.

BACKGROUND: Undoubtedly, one of the vital needs of man is security. Determinants and related factors to sense of social security is one of the most important research priorities, especially in adolescents and young people. OBJECTIVE: To identify the factors affecting the social security of the youth. METHODS: In 2017, using conventional content analysis, and benefiting from semi-structured in-depth interviews, we conducted a qualitative study exploring the opinions of young people about their feelings regarding social security. First, a targeted sampling method was determined to collect the data. Participants were young volunteers aged 18 to 30 who were selected from Tehran, the capital of Iran. Inclusion criteria for participants were willingness to participate in the study and ability to express their experiences. Data was extracted from 21 participants. RESULTS: The participants consisted of 21 young people who met the study inclusion criteria, of whom 12 participants were male. Their mean age was 24.4±0.41 years and their education varied from primary school to master's degree. Under two main categories of the need for economic and financial security and the need for a safe society, we extracted 11 subcategories following 32 codes. According to the findings, most participants agreed on the important role that sense of social security has in their lives and their health. CONCLUSION: The important role of sense of social security in participant's lives and health was the main important point of our findings, emphasized by most of participants. Based on the results; the assessment of the specific needs of different target groups, the design, development and implementation of health programs led to more effective interventions.

Skills Required for Nursing Career Advancement: A Qualitative Study.

BACKGROUND: Nurses require certain skills for progression in their field. Identifying these skills can provide the context for nursing career advancement. OBJECTIVES: This study aimed to identify the skills needed for nurses' career advancement. MATERIALS AND METHODS: A qualitative approach using content analysis was adopted to study a purposive sample of eighteen nurses working in teaching hospitals affiliated with the Qazvin, Shahid Beheshti, and Iran Universities of Medical Sciences. The data were collected through semi-structured interviews, and analyzed using conventional content analysis. RESULTS: The three themes extracted from the data included interpersonal capabilities, competency for career success, and personal capacities. The results showed that acquiring a variety of skills is essential for career advancement. CONCLUSIONS: The findings showed that personal, interpersonal, and functional skills can facilitate nurses' career advancement. The effects of these skills on career advancement depend on a variety of conditions that require further studies.

Health Impact Assessment of Urban Development Project.

BACKGROUND: Health impact assessment (HIA) has emerged to identify those activities and policies likely to have major impacts on the health of a population. METHOD: In this research, qualitative method was applied to identifying health determinants that urban man made lake affect on them, formatting and weighing the hierarchy of the factors, calculating AHP, and Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method for decide and ranking alternatives. RESULTS: According to the results of the study, from the structural determinants point of view, the most positive effect of man-made lake was on Recreational services by 89.5% and the most negative one was on housing. According to intermediary determinants and general average, the most positive effect of lake was on physical activity and quality of air by 88.9% and the most negative one was on noise pollution by 46.7%. Ultimately, considering the positive and negative effects of lake between constructing and not constructing the lake option, the construction option was selected. CONCLUSION: There is substantial potential to improve public health by bringing decision makers' attention to the health consequences of their actions; city councilpersons, zoning commissioners, and other decision makers typically have little background in health.

Keeping up with the caravan of life: Successful aging strategies for Iranian women.

BACKGROUND: Because of improving life expectancy in the world in recent times, the focus has shifted to the issue of the quality and nature of life and how to assist successful aging (SA) rather than increasing physical survival and lifespan. SA is a multidimensional, relative, and context-dependent concept with different paths and outcomes. The purpose of this qualitative study was to explore older women's strategies for SA in a specific context. METHODS: Following a grounded theory design approach, we conducted semi-structured individual interviews with 21 women between the ages of 28 and 96 years. We analyzed the data from interviews, written narratives, and field notes using the grounded theory approach. RESULTS: We identified four categories: prevention of threats, internal self-control against threats, coping with threats, and optimizing the passage of time according to opportunity. These described the strategies for SA when encountering with age-related changes. Utilizing these strategies, the women accompanied the caravan of life in the context of threats and opportunities. CONCLUSIONS: The findings suggest that SA is a continuous process in confronting changes related to age. The identified strategies can help to promote SA by familiarizing older women with the threats and opportunities of life and training them in how to use these strategies.

Factors Influencing the Successful Aging of Iranian Old Adult Women.

BACKGROUND: Aging is an irreversible natural process characterized by a decline in both the physical and mental status of individuals. Because of multiple factors, this process and its consequences vary greatly between individuals. A successful aging (SA) is the target of current health policies and well-being of individuals. Knowing the factors that contribute to SA and its barriers would translate in measurements that increase the quality of life of elderly and reduce health costs. OBJECTIVES: The aim of this study was to explore barriers and facilitators to Iranian elderly women's SA. PATIENTS AND METHODS: A purposive sample of 16 elderly women, aged 61 - 96 years, was recruited for this qualitative content analysis study. Study data were collected during 2012 -.2013 by conducting 16 face-to-face semi-structured in-depth interviews. We continued the data collection until reaching saturation. Study data were analyzed concurrently with data collection, by using the conventional qualitative content analysis approach. RESULTS: Barriers and facilitators to Iranian elderly women's SA fell into five main categories, including availability of support systems, state of health, personal capabilities, personality characteristics, and lifestyle. CONCLUSIONS: Availability of support systems, state of health, personal capabilities, personality characteristics, and lifestyle were the main interrelated factors affecting Iranian elderly women's SA. Accordingly, providing elderly women with strong educational, emotional, financial, cultural, and social supports can help facilitate their SA.

Nurse Leaders' Experiences of Implementing Career Advancement Programs for Nurses in Iran.

BACKGROUND & PURPOSE: Career advancement programs are currently implemented in many countries. In Iran, the first career advancement program was Nurses' Career Advancement Pathway. The purpose of this study was to explore nurse leaders' experiences about implementing the Nurses' Career Advancement Pathway program in Iran. METHODS: This exploratory qualitative study was conducted in 2013. Sixteen nurse managers were recruited from the teaching hospitals affiliated to Shahid Behesthi, Qazvin, and Iran Universities of Medical Sciences in Iran. Participants were recruited using purposive sampling method. Study data were collected through in-depth semi-structured interviews. The conventional content analysis approach was used for data analysis. RESULTS: participants' experiences about implementing the Nurses' Career Advancement Pathway fell into three main categories including: a) the shortcomings of performance evaluation, b) greater emphasis on point accumulation, c) the advancement-latitude mismatch. CONCLUSION: The Nurses' Career Advancement pathway has several shortcomings regarding both its content and its implementation. Therefore, it is recommended to revise the program.

Ranking the effects of urban development projects on social determinants of health: health impact assessment.

BACKGROUND & OBJECTIVE: Health impact assessment (HIA) offer a very logical and interesting approach for those aiming to integrate health issues into planning processes. With a lot of works and plans waiting to be done (e.g., developing and updating plans, counseling planning commissions, cooperation with other organizations), planners find it difficult to prioritize health among a variety of possible issues and solutions they confront. METHODS: In the present article, first, the list of social determinants of health associated with Chitgar man-made lake was extracted out using a qualitative method and with content analysis approach, and then they were prioritized using analytic hierarchy process. RESULTS: 28 social determinants of health including "intermediary" and "structural" determinants were extracted out. Regarding positive effects of lake on these determinants, "recreational services" and "traffic" received the highest and the lowest weights with 0.895 and 0.638 respectively among structural determinants and with consideration to "construction" option. Furthermore, among intermediary determinants for "construction" option, sub-criteria of both "physical activity" and "air quality" received the final highest weight (0.889) and "pathogenesis" indicated the lowest weight with 0.617. Moreover, lake demonstrated the highest negative effects on "housing" among "structural" determinants which it takes the highest weight (0.476) in "non-construction" option. Additionally, lake had the highest negative effects on "noise pollution" among "intermediary determinants" and it takes the highest weight (0.467) in "non-construction" option. CONCLUSION: It has been shown that urban development projects such as green spaces, man-made lakes … have a huge range of effects on community's health, and having not considered these effects by urban planners and mangers is going to confront urban health with many challenges.

Seeking comfort: women mental health process in I. R. Iran: a grounded theory study.

BACKGROUND: Psychosocial factor is considered as intermediate social determinant of health, because it has powerful effects on health especially in women. Hence deeper understanding of the mental-health process needed for its promotion. The aim of this study was to explore women's experience of the mental-health problem and related action-interactions activities to design the appropriate interventions. METHODS: In-depth interviews with women 18-65 years were analyzed according to the grounded theory method. The selection of Participants was based on purposeful and theoretical sampling. RESULTS: In this study, a substantive theory was generated; explaining how female with the mental-health problem handled their main concern, which was identified as their effort to achieve comfort (core variable). The other six categories are elements in this process. Daily stress as a trigger, satisfaction is the end point, marriage is the key point and action - interaction activities in this process are strengthening human essence, Developing life skills and help seeking. CONCLUSIONS: Better understanding the mental-health process might be useful to design the interventional program among women with mental-health problems.

How Iranian women conceptualize mental health: an explanatory model.

BACKGROUND: In Iran, more than 25% of women suffer from mental disorders. Mental disorders and subclinical problems are associated with socioeconomic problem. At the community level, mental health promotion can reduce social damage. The aim of this study as a part of community based mental health promotion intervention was to explore how mental health in Iranian women is viewed. METHODS: According to a qualitative method in 2012, participants were selected by purposeful sampling from married women 18 to 65 years who are residents in Tehran. Fifteen in depth individual interviews were conducted with regard to the concept of mental health, causal pathway and help-seeking behavior according to explanatory model. RESULTS: Mental health was perceived as the same of emotional well-being. It conceptualized not only lack of mental disorder but also sense of satisfaction and healthy functioning. According to participant's view, the causal pathway of mental health problems were classified to individual, familial and social factors. Physical and behavioral problems were related to individual factor, Lack of marital adjustment was one of the most important issues in familial item and in social factor, cultural context and socio-economic problems were extracted. In help seeking process, all of the participants believed that the religion has important effect in mental health. CONCLUSION: Marital adjustment is an important stage in process of mental health in women.

Position of social determinants of health in urban man-made lakes plans.

BACKGROUND AND OBJECTIVE: A social determinants approach proposes that enhancing living conditions in areas such as income, housing, transportation, employment, education, social support, and health services is central to improving the health of urban populations. Urban development projects can be costly but have health impacts. The benefit derived from the creation of man-made lakes in developing countries is usually associated with great risks; however, the evidence for physical and non-physical health benefits of urban man-made lake is unclear. The aim of this paper is to formulate a conceptual framework of associations between urban man-made lakes and social determinants of health. METHOD: This study was a qualitative study carried out using one focus group discussion and 16 individual interviews. Data were analyzed based on deductive-inductive content analysis approach. RESULTS: Participants' points of view were analyzed within 261 codes. Data analysis matrix was the conceptual framework of social determinants of health commission and its sub-groups, thus, two structural and mediating determinants categories as well as their sub-sets were created accordingly. In addition, some extra sub-sets including environment, air quality, weather changes, noise pollution, pathogenesis, quality of life, shortage of available resources, region popularity, ethnicity, tourism, social and physical development of children, unintentional injuries, aesthetic, and spirituality were extracted beyond the matrix factors, which were placed in each of above categories based on their thematic content. CONCLUSION: This paper has illustrated that the quality and type of man-made lake provided within communities can have a significant and sustained impact on community's health and wellbeing. Therefore, in order to strengthen positive effects and reduce negative effects of any developmental projects within community, their impacts on public health should be taken into consideration.

The effect of sleep restriction treatment on quality of sleep, sleep medication intake, and daytime function among the elderly who were members of Shiraz Jahandidegan canter in 2010.

BACKGROUND: Studies showed that poor quality of sleep is a common problem among the elderly. Because of drug complications and side effects such as drug dependency and resistance and decrease of sleep depth in long-term intake of sleep medication, cognitive-behavior therapy including sleep restriction therapy which does not cause these problems is more considered. MATERIALS AND METHODS: This is a quasi-experimental study on 38 elderly who were members of jahandidegan canter in Shiraz. The subjects were selected according to the inclusion criteria and were divided into experimental and control groups. The Pittsburgh Sleep Quality Index (PSQI) was used for evaluation of sleep quality. A 4 week sleep restriction therapy was implemented for experimental group and finally both groups were compared. The data were analyzed by Kolmogorov-Smirnov test, independent and dependent t-tests in significance level of 0.05. RESULTS: Mean sleep quality decreased from 14.21 to 11.26 after the intervention in the experimental group while it was 13 before intervention and decreased to 12.78 after the intervention in the control group. Independent t-test showed a significant difference after the intervention (P = 0.038). Mean of sleep medication intake and daytime dysfunction after intervention were 0.947, 1.94 in experimental group and 0.894, 1.63 in control group respectively, which showed no significant difference (P = 0.903, P = 0.272). CONCLUSIONS: This study indicated that sleep restriction therapy can improve quality of sleep, but the amount of sleep medication intake and daytime dysfunction did not show a significant difference after intervention.

What is missed in self-immolated patients' care? A grounded theory study.

AIMS AND OBJECTIVES: To explore rehabilitation care process in patients who commit self-immolation. BACKGROUND: Self-immolation is not only a type of burn injury, but it is also a suicidal method. It is placed in burn injury category that requires long-term rehabilitation and treatment measures. As a suicidal method, among all forms of suicidal attempts, it is the most dramatic, violent and often difficult one to understand. Unfortunately, there are few reported studies investigating experiences and perceptions of nurses about burn care and with qualitative study about the patients' experiences and perceptions. DESIGN: On the basis of the research question, the grounded theory method was used. METHODS: Considering ethical codes of Belmont and Helsinki statements, purposive sampling was used to select the participants. The patients were deliberately selected, based on the research needs. They were self-immolated patients being referred to Talaghani hospital of Ilam (western Iran) or discharged previously (time of interview and observation ranged from immediately later the burn till 5 years after), in Ilam, where self-immolation rate is very high. The main methods for data collection were deep, open ended, semi-structured interviews, dairies and observations. The interviews were audio taped in Persian, and verbatim transcriptions were made. By doing so, semantic meaning is preserved, and misinterpretation of data due to translation into English is minimised. Data analysis was conducted using the Strauss and Corbin method. RESULTS: Five main categories were emerged: situation of crisis unprofessional care, prolongation and formidability of the journey, self-immolation as paralyse, and attempt for self-management. Finally, by constant, comparison of collected data and emerged categories, central variable entitled unintegrated care emerged as the main problem of self-immolated patients' care. CONCLUSION: The study comes to the conclusion that we need to focus on specific considerations to provide integrated care for the burned patients as it is a decisive component of care that is missed. RELEVANCE TO CLINICAL PRACTICE: Although self-immolation requires long-term treatment and social, emotional rehabilitation, such a rehabilitation care process is not clear.

Synthesis and evaluation of antitumor activity of novel N-acyllavendamycin analogues and quinoline-5,8-diones.

A series of 7-N-acyllavendamycins with zero, one or two substituents at the C-2', C-3', and C-11' were synthesized through short and efficient methods. Pictet-Spengler condensation of 7-N-acylamino-2-formylquinoline-5,8-diones with tryptamine or tryptophans produced the desired lavendamycins. Screening data on a panel of three ras oncogene-transformed cell lines and the non-transformed parent cell line showed that a significant number of these analogues are potent antitumor agents and appear to be particularly active against K-ras transformed cells. Compared with the corresponding quinolinediones, these novel lavendamycins are much more inhibitory toward the transformed cells indicating that the beta-carboline moiety of the lavendamycin analogues plays an important role in its potency and selective toxicity.

Novel lavendamycin analogues as antitumor agents: synthesis, in vitro cytotoxicity, structure-metabolism, and computational molecular modeling studies with NAD(P)H:quinone oxidoreductase 1.

Novel lavendamycin analogues with various substituents were synthesized and evaluated as potential NAD(P)H:quinone oxidoreductase (NQO1)-directed antitumor agents. Pictet-Spengler condensation of quinoline- or quninoline-5,8-dione aldehydes with tryptamine or tryptophans yielded the lavendamycins. Metabolism studies with recombinant human NQO1 revealed that addition of NH2 and CH2OH groups at the quinolinedione-7-position and indolopyridine-2'-position had the greatest positive impact on substrate specificity. The best and poorest substrates were 37 (2'-CH2OH-7-NH2 derivative) and 31 (2'-CONH2-7-NHCOC3H7-n derivative) with reduction rates of 263 +/- 30 and 0.1 +/- 0.1 micromol/min/mg NQO1, respectively. Cytotoxicity toward human colon adenocarcinoma cells was determined for the lavendamycins. The best substrates for NQO1 were also the most selectively toxic to the NQO1-rich BE-NQ cells compared to NQO1-deficient BE-WT cells with 37 as the most selective. Molecular docking supported a model in which the best substrates were capable of efficient hydrogen-bonding interactions with key residues of the active site along with hydride ion reception.